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RELACTATION AND

INDUCED LACTATION

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Relactation &
Induced Lactation

Jane Bradshaw
RN, BSN, IBCLC, RLC

Jane Bradshaw/Lactation Education Resources 2012

Objectives
Define induced lactation and relactation
Describe historical and cultural examples of cross-
nursing, relactation and wet nursing
Describe indications for induced lactation and
relactation
Describe the physiological and hormonal
requirements for lactation without a pregnancy
(nonpuerperal)
Discuss 2 different methods to induce lactation
List at least 3 herbal, 2 nutritional and 2 prescription
galactogogues
Describe methods to encourage a baby to nurture or
feed at the breast when the mother does not have a
full milk supply

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The Dream

The natural progression


Conception
Pregnancy
Birth
Breastfeeding

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Breastfeeding is important for infant survival
and is extremely flexible

An example of the flexibility of lactation is that


mothers can re-establish a milk supply after
weaning (relactate) or initiate a milk supply for
an adopted baby.
Australian Breastfeeding Association booklet

Louis XIV and his nurse Wet nursing

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Wet-nurses from Spreewald
(region in East Germany)

Picture of Heinrich Zille (1911)

Maternal instinct crosses the


species line

http://www.youtube.com/watch?v=k
TkZ6RhL6i8

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Australian
Breastfeeding
Association

Products: www.mothersdirect.com.au

Resources
Relactation: Review of
experience and recommendations
for practice
Authors: World Health Organization
Number of pages: 38
Publication date: 1998
Languages: English, French,
Spanish
ISBN: WHO/CHS/CAH/98.14

Go to WHO website:
http://www.who.int/en/
Search: relactation

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June 29, 2012 storm power outage

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Breastfeeding an Adopted Baby
and Relactation
by Elizabeth Hormann
Full price$10.95 Online price$9.95
Your Price/Member price$8.95
Soft cover Book/Single Item
Description
Did you know that induced lactation
and relactation are possible? Author
Elizabeth Hormann explains how in this
book. Some of the topics discussed
include: preparation for adoptive
breastfeeding; substances that
stimulate milk production; beginning
breastfeeding with an adopted baby;
and sources of support for adoptive
parents. Ideal for mothers who wish to
breastfeed an adopted baby or
relactate, as well as for the health
professionals who assist them.

http://store.llli.org/public/search?utf8
=%E2%9C%93&q=Relactation&commi
t=Go

Definitions (vary with authors)

Relactation restimulation of lactation


after cessation following birth or untimely
weaning at any age. Some include
breastfeeding a non-biological child years
later.
Induced lactation stimulation of the
breasts to lactate in order for an infant to
be breastfed when pregnancy has been
absent or some define it as when a
woman has never been pregnant.

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Why relactate?
Convinced of the benefits of breastfeeding,
dont want baby to miss out
Infant may be doing poorly on formula
Mother intended to breastfeed but
circumstances hindered it
Desire to experience all the aspects of
mothering

Survey of 366 women who


relactated
Most concerned about their relationship
with the baby
75% felt a positive experience
More than half established a full milk
supply in a month
Many found the length of time to relactate
fully is about equal to how long it was since
BF discontinued
Midwifery today 1999

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Survey of 366 women who
relactated
Some went to the breast easily
39% baby nursed well on 1st attempt!
32% babies were ambivalent about BF
28% baby refused the breast
BUT within 1 week 54% had taken the
breast well
By 10 days 74% taking the breast well
Time, patience and persistence important
Midwifery Today E-News (Vol 1 Issue 8, Feb. 19, 1999)

Why breastfeed an adopted infant?


Wants the same advantages as a birth
mother
Wants everything that goes with being a
mother for herself, even if she could not
experience pregnancy
Concerns for the babys situation
Sometimes baby has been in poor health or
compromised physically or emotionally
Another separation has taken place
BF can help reduce stresses
Promote bonding

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The Five Protective Factors
http://www.childwelfare.gov/preventing/preventionmo
nth/factors.cfm
Nurturing and attachment
Knowledge of child development
Parental resilience
Social connections
Concrete support for parents

Protective factors
Protective factors are conditions in families and
communities that, when present, increase the health
and well-being of children and families. They are
attributes that serve as buffers, helping parents who
might otherwise be at risk of abusing their children
to find resources, supports, or coping strategies that
allow them to parent effectively, even under stress.
Research has shown that these protective factors
are linked to a lower incidence of child abuse and
neglect.

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Nurturing and attachment
Infant care and strategies that promote
bonding and attachment (e.g.,
breastfeeding, rocking, using a baby
carrier, responding to crying, talking
lovingly, consistency within and across
caregivers, and stability of primary
caregivers)

Myths
Many women cannot produce enough milk
It is common for the milk to dry up at any
point in breastfeeding and there is no
reason or remedy
It is natural for a baby under 6 to 9
months, even before solids are begun, to
wean himself

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Myths
A mother is selfish for wanting to induce
lactation or reestablish breastfeeding
There is no benefit or reason to restart
breastfeeding baby got all the benefits in
the first few weeks
It is too stressful and not worth it to
relactate

Relactation issues - Do a history


What was original reason for weaning or
not breastfeeding?
Was there a milk supply?
Was she breastfeeding fully at any time?
Is there still any milk?
Were there breastfeeding problems that
were not resolved?
What is health status of mother and baby?

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Relactation issues
Emotions
Will baby take the breast?
Time since termination of
breastfeeding
Support system
Should not be approached as
an all or nothing activity,
although exclusive
breastfeeding is certainly
possible and optimal

Relactation issues
Mother needs
Factual, accurate information
She may have myths and misinformation about
breastfeeding that may have caused her to stop
Education about relactation
Mother needs
Validation and praise for
Her mothering & choices she has made
Her efforts and any amount of breastfeeding

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Relactation issues
Mother needs
Support throughout the process
Weight checks for baby
To assures baby gains well throughout the
process
Dictates the safety of reducing supplements

Milk Benefits Non-milk Benefits


Baby receives the Bonding
health benefits of More skin to skin contact
breastmilk! Easier to meet babys
We must value even needsMother feels
more competent
small amounts of
Mouth-jaw development
breastmilk
Eye/hand coordination,
The benefits are development
dose related Baby & diapers smell
better
Night feeds easier
May put some of
mothers hormonal
problems into a resting
state

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Goals
To establish/reestablish the breastfeeding
relationship and to create a milk supply so
baby receives his mothers breastmilk
AAP & WHO goals
AAP: Breastfeed at least 1 year
WHO: Breastfeed at least 2 years
US Breastfeeding Committee
Increase duration of breastfeeding
50% at 6 months
25% still breastfeeding at 1 year

Three clinical issues


Creating/reestablishing a milk supply
Feeding the baby & managing supplements
Getting the baby to the breast

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Induced lactation issues
Primary goal is to nurture the baby at the
breast
Any amount of breastmilk is a bonus

Induced lactation issues


Emotions of adoption
Legal/travel concerns
Social & family concerns
Bonding of mother and baby
Milk production

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Creating a milk supply

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Physiology of induced lactation

Not well understood


Mammary stimulation causes
proliferation of secretory tissue

Necessary Unnecessary
Breasts

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Breast preparation
With a normal pregnancy
Prepares the breast
Estrogen and progesterone, and Human placental
lactogen cause proliferation of the ductal and
alveolar system
Without a pregnancy
Breast stimulation alone increases the hormones
from the anterior pituitary and causes mammary
growth
Women have used hand expression or a
breastpump before the baby arrives to start the
process

Milk removal continues the process

Helps maintain and increase production


Infant suckling
Expressing/pumping
Increases prolactin levels
Also stimulates oxytocin to encourage the Milk
Ejection Reflex (MER)

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Pre-baby breast preparation, or not
Depends on timing of arrival of baby and
mothers preference
Some mothers choose to pump, weeks or
months in advance
May begin gradually with 5 min three times a
day, then 10 minutes and increase to every four
hours
Drops may appear in about a month
May begin galactogogues
OR upon receiving baby, mother may just
put him to breast with tube device with no
breast prep

Creating a milk supply


with hormones and medication

Hormonal preparation may be


considered if 1 month or more
advance time

(Newman/Goldfarb protocols)

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Newman & Goldfarb protocols

Regular Protocolif the woman has 6


mo or more before babys arrival
Accelerated Protocolif less than 6
mo
Menopause Protocol for women who
have had surgical removal of their
reproductive organs or natural
occurring menopause

www.asklenore.info

Newman & Goldfarb protocols

All include 3 steps


An active oral contraceptive pill with 1 to 2
mg of progesterone and no more than
0.035mg estrogen (active pills only-no
sugar pills) + prescribed medicine
(domperidone)simulates pregnancy
Pill is stopped (timing varies with protocol)
Herbs and pumping are begun

www.asklenore.info

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Newman & Goldfarb protocols
Regular Protocolmothers have produced
enough milk for 60% to 100% of babys
needs
Accelerated Protocol25% to 50% of
babys needs

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Creating a milk supply

Relactation
Milk may increase rapidly or slowly
depending on circumstances and length
of time since weaning
Induced lactation
No colostral phase
Typically begins 1 to 4 weeks after
initiating breast stimulationmuch
sooner with hormonal preparation

Galactogogues:
Prescription medications
Metoclopramide (Reglan)
AAP: Listed as drug of concern
Caution due to side effects--depression
Taper slowly to reduce rapid drop in milk supply
Domperidone
Does not cross blood-brain barrier
AAP: Listed usually compatible for BF
In US may be available thru a compounding
pharmacistmuch political controversy
Sulpride
Thyrotropin-releasing hormone
Chlorpromazine
Human growth hormone
Theophylline
Oxytocin: Can be compounded as a nasal spray to
enhance MER

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Galactogogues: Nonprescription herbs,
foods & others

Herbals and Therapies Foods


Fenugreek Oatmeal
Blessed Thistle Brewers yeast
Fennel Beer
Nettle Garlic

Goats Rue Anise

Acupuncture
Hypnosis--
visualization

Lactation cookies

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Composition of induced lactation breast
milk

Milk in other species (bovine and rat)


show milk composition similar to
normal pregnancy-induced lactation
Research on induced lactational
breast milk is limited
Composition analysis indicated there
is no colostral phase

Relactation Boot Camp

http://www.fourfriends.com/abrw/Boot%20Camp/bc1.htm

Relactation Boot Camp concentrates on


improving general diet, regulating liquid
intake, boosting self confidence, education
and support!

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Hindrances to a milk supply
Some medications
Hormonal birth control
Low thyroid (hypothyroidism)
Anemia
Smoking
Rapid weight loss
Hx hormonal problems, breast surgery or injury
Retained placenta
Insufficient glandular tissue
Breastfeeding management issues

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What may hinder milk supply?
Herbs & foods
Sage
Thyme
Mint

What may hinder milk supply?


Management issues
Infrequent breast stimulation
Attitude that breastfeeding can be turned on and
off at will
Embarrassment to take time to pump or
breastfeed when around others
Pacifier overuse
Baby training methods to eliminate all night
feeds at an early age
Early introduction of solids or juices
Nipple shield use without pumping/expressing
Maternal/infant separation

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Signs of breastmilk production/intake

Breast signs; fuller before feeds, soften


with feed
Audible swallows when on the breast alone
Babys stool changes; more like a breastfed
stool, watery, yellow, seedy, much less
odor
Baby may take less supplement

Feeding the baby

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Supplementation
1st choice:
Feeding at breast
Tube devices: SNS, and
Lact-Aid
Syringes (periodontal),
droppers
2nd choice:
Cups, spoons
3rd choice:
Bottles: socially acceptable
& easy

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Supplementation
Offer ample amounts to produce
appropriate weight gain of baby
Can estimate amount of breastmilk baby is
receiving by calculating:
Babys weight X 2.5 to 3 = 24 hr total of ounces
baby consumes
Subtract amount of formula consumed in 24 hrs
= approximate amount breastmilk baby is
receiving

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Decreasing supplements--relactation
Weight checks are essential to prevent
stressing baby by underfeeding
May initially weigh every 2 -- 4 days
Can decrease supplementation gradually as
long as baby is gaining
Add amounts back if baby stops gaining
Let the baby decrease the supplements on
his own
Breastfeed twice before giving a
supplement
Divide supplement into more smaller feeds

Supplements

NEVER stress baby with hunger!


May reach a plateau
Find a level of supplementation that
achieves happy baby and mother

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Getting the baby to breastfeed

Getting baby to the breast


If newborn: Same techniques as working
with any reluctant breastfeeder
Lots of skin to skin
Offer milk at the breast
Coaxing techniques
Dont take no for an answer
If older baby
Feed the baby adequate amounts
Offer the breast when baby is NOT hungry
Lots of skin to skin contact with breast available
Alternative feeding methods
Nipple shield may help
Patience, patience, patience

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Mother/Baby time

Nipple shield

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Tube devices

Lact-Aid Medela SNS

Using the SNS

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Using the Lact-Aid

Used with permission Pat Gima

Used with permission Pat Gima

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Pitfalls
Magic milk syndrome
Exaggerated expectations
Socially unacceptable
Expectation to turn
lactation on and off, due
to embarrassment or
social situations
Burnout

Breastfeeding a foster child or


an older adopted child

It is possible to breastfeed children adopted


at older ages
Significance
May help heal the pain of the past
Institutionalization
Abuse / trauma
Separation from primary caregiver
Fosters attachment of mother and child
No evidence BF causes trauma to foster child

Gribble: J Hum Lact 21(1), 2005

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Case study
3 month old infant
Mother had difficult birth, sore nipples and
gave up breastfeeding within 3 weeks after
the birth
Regretted missing out on breastfeeding
Began skin to skin
Pumped every 2 to 3 hours

Case study
Began coaxing baby to breast using a
nipple shield with a tube device
Within 3 days receiving most of his
feedings at mothers breasts
Weight checks every 3 to 4 days to assure
appropriate gain
After 2 weeks baby was taking less and less
formula
By 1 month baby was completely breastfed
without formula or nipple shield

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The breast is an amazing organ!
Breast stimulation alone can produce
hormonal changes to cause growth and
proliferation of the milk glands, and milk
production.
Hormonal protocols are available & can
prepare the breasts, like pregnancy and
women have been able to produce more
milk: Up to full a milk supply in some
circumstances.

In summary
Women can resume breastfeeding after
stopping and should be helped and
supported to do so
Women who birth through adoption or
surrogacy can also look forward to enjoying
mothering their babies by breastfeeding
They can produce milk, varying on the
preparation time and circumstances

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In summary
The non-milk benefits of breastfeeding are
extremely valuable and deserve as much
attention, praise and support as the milk
benefits
A partial milk supply and any amount of
breastfeeding should be celebrated

In summary

Mothers should be fully supported to


nurture their babies and young children
at their breast

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