Relactating | The Leaky B@@b

Stopped breastfeeding and want to start again? Here’s our guide to relactation.

What is relactation?

Relactation is re-establishing breastfeeding after stopping breastfeeding, or after a period of very little breastfeeding.

Why would I want to relactate?

Mothers decide to relactate for many reasons, but most want either to resume the breastfeeding relationship, or provide more breastmilk, or both.

What are my odds of successfully relactating?

There is little research on relactation, but the available studies strongly suggest that, with proper support, most mothers can partially or fully relactate. Below are some studies that offer some encouraging findings about the success of relactation. It’s important to bear in mind that in most of these studies mothers received help in relactating from trained breastfeeding support people.

One study of 139 Indian mothers who had stopped breastfeeding for at least ten days found that 84% were capable of either full or partial relactation:

61% fully relactated
23% partially relactated (formula supplements reduced by half)
16% were unable to relactate

A recent survey of 84 relactating mothers of infants (on average, 2 months old) in Korea found:

75% of mothers fully relactated (defined as 90% or more breastmilk feedings)
25% of mothers either partially relactated or did not relactate

An older survey of 366 U.S. mothers, mothers reported that:

More than 50% established full production within one month
25% required more than one month to establish full production
The remaining mothers breastfed with supplements until their babies weaned

A study of 50 mothers of hospitalized infants under four months old, found:

92% of mothers fully relactated
6% partially relactated

What factors will influence my success in relactating?

The research on relactation confirms what you might already suspect. The following factors are associated with more success at relactating:

A younger baby
A shorter gap between weaning and relactating (sometimes called a “lactation gap”)
The willingness of the baby to take the breast
Having assistance from trained breastfeeding support people

These factors may influence your chance at meeting your goals, but each mother/baby pair is different, and relactation may still be possible even you don’t meet the most favorable criteria.

How long will it take?

Based on the research above, Nancy Mohrbacher, IBCLC, in Breastfeeding Answers Made Simple, recommends that mothers plan for relactation to take one month.

How should I measure success? What goals should I set?

You may want to spend some time reflecting on your motivation for relactating. Is it important to you to provide as much breastmilk as you can? To have the feeling of closeness you have with breastfeeding?

You might set a goal of full breastfeeding, or you might set a goal of partial or any breastfeeding. Some moms, who don’t think that their babies will return to the breast, set a goal of pumping and providing as much breastmilk as they can by bottle (exclusive pumping). Some mothers want the breastfeeding relationship back, and aren’t concerned with how much milk they provide.

Interestingly, one survey of relactating mothers found that “Milk production was less often a goal and, when so specified, it was likely to influence the mother to evaluate her experience negatively and to result in difficulty in achieving a total milk supply.”

There is no right or wrong way to set goals for relactation. And you may not want to set any goals at all.

How do I relactate?

There are two, related parts to relactation: bringing back a milk supply, and bringing the baby back to the breast. These are interrelated projects, as the best thing for your milk supply is to have a baby nursing frequently, and a baby is more likely to return to the breast if there is plenty of milk there.

But the first, and probably the most important thing, is to seek some support.

Get support.

We strongly recommend seeking out sources of support for this process. As we note above, the mothers in the studies cited above were typically receiving skilled help with relactation, and this may have influenced their success rates.

You may want to consult with a lactation consultant (IBCLC), La Leche League leader, a breastfeeding-friendly pediatrician, or other trained breastfeeding support person (see links at the end of this guide for sources of support). A well-trained support person can help you uncover reasons why breastfeeding stopped, troubleshoot as you work on relactating, and connect you with good resources to help you meet your goals.

Trained help is important, but don’t underestimate the power of support from other moms, family, and friends. Having more people on your team can make a big difference in breastfeeding success. You may find attending a La Leche League or other support group meeting helpful. WIC breastfeeding peer counselors are another good source of mom-to-mom support. You may also want to discuss your goals and motivation with some friends or family members (especially your partner), and ask for their support and encouragement. Relactation requires time and effort, and having support is key.

Explore what happened.

It helps to explore why breastfeeding stopped. If it was a problem with basic breastfeeding management (poor advice, infrequent feeding, etc.), relactation may be a simple project of restarting what you were doing before. If breastfeeding ended because, in spite of “doing everything right,” you didn’t produce enough milk, and your baby became unwilling to breastfeed, there are more issues to explore. If you stopped because of pain, learning more about latch, and exploring the possibility of issues like tongue tie, are worthwhile topics to consider.

You may find it helpful, particularly in cases of unexplained milk supply problems or behavior in your baby, to explore these issues with a lactation consultant (IBCLC). You’ll find a link to find one at the bottom of this guide.

Bring back your milk supply.

Empty your breasts frequently. If your baby is willing to nurse, feeding frequently is the single most effective thing you can do. Aim for at least 10-12 feedings every 24 hours. Feed on both sides, and feed long enough to drain each breast well.

If your baby isn’t taking the breast, or is doing so infrequently, use a pump to stimulate your milk supply. Ideally you should pump at least every three hours (though many mother find it more manageable to take a break at night). Double pumping provides more stimulation than pumping one side at a time.

Ensure effective feedings. If your baby is nursing, make sure that he or she is taking the breast deeply into the mouth, and that you feel comfortable when nursing. A shallow latch and/or pain can mean that your baby isn’t feeding as effectively as possible. Get help correcting this from a trained breastfeeding support person.

Pump after feedings. If your baby is nursing, try pumping after feedings with a hospital grade breastpump. Since milk supply seems to be calibrated based on how empty your breasts get, pumping after feedings can be an effective way to increase milk supply.

Use breast compression. When nursing and/or pumping, use breast compression to fully empty your breasts and keep your baby engaged while nursing. This is a particularly effective way to get good feedings with a baby who is sleepy at the breast.

Consider a supplemental nursing system (SNS). Using an SNS allows a baby to receive formula supplements at the breast while stimulating your milk production by nursing. There is also some evidence that substituting feeding methods other than bottles – such as cup, spoon, SNS – increases the chances of relactation success.

Use the power of skin. Holding your baby skin-to-skin (your baby in just a diaper on your bare chest) boosts your milk making hormones. And it feels great!

Take a galactagogue. There are both herbal supplements and prescription medications which increase milk supply. Some herbs are particularly helpful with glandular and hormonal causes of low milk supply. Consult with a lactation consultant and/or your health care provider about which may best suit your needs.

Bring your baby back to the breast.

Get skin-to-skin. Skin-to-skin contact is immensely powerful in establishing breastfeeding, and it can significantly aid the process of relactation. Hold your baby (wearing only a diaper) on your bare chest as often as you can. You may find that he or she begins to self attach (see next point).

Use Baby-led Breastfeeding, Laid Back Breastfeeding positions, and co-bathing. Research is increasingly pointing toward the importance of baby’s innate feeding instincts in the establishment and re-establishment of breastfeeding. Babies are able to crawl, scoot, and wiggle their way to the breast all on their own from birth, and new research is showing that babies retain this instinct long after the newborn period. Baby-Led Breastfeeding involves positioning babies in a way that allows them to crawl to the breast. Biological Nurturing, or Laid-Back Breastfeeding, involves reclining to breastfeed. See more about the Laid Back Breastfeeding position and its ability to take advantage of babies feeding reflexes. Some lactation consultants have also found that taking baths with your baby (called remedial co-bathing) can help in re-establishing breastfeeding.

Ensure a good latch. As mentioned above, a deep latch will allow your baby to receive the most milk, and will keep you comfortable. Seek help from a trained support person if getting a good latch poses a challenge.

Breast compression. Keep your baby engaged at the breast by squeezing your breast when your baby is nursing. This is particularly effective if your baby is sleepy at the breast.

Consider a nipple shield. Some babies who have had many bottle feedings will nurse if the mother uses a nipple shield, as it makes the breast feel more like a bottle. For some babies, it can be hard to wean from nipple shields. Seek help from breastfeeding support person for assistance in using and weaning from a nipple shield.

Use a supplemental nursing system. SNS can persuade babies to return to the breast because they get a greater flow when they nurse. And as noted above, they can help increase milk supply by keeping all sucking at the breast. Seek help from breastfeeding support person for assistance in using one.

Focus nursing around strategic times. Try nursing when supply is higher, such as nighttime and morning. Offer the breast for comfort when you know that your baby is already full, or when your baby is sleepy.

Consider pre-feedings. Some babies will nurse if the “edge” has been taken off their hunger. Try giving your baby an ounce of formula just before attempting a feeding at the breast.

Ensure that your baby continues to thrive.

If you are reducing formula supplements while relactating, we’d suggest:

Reducing formula supplements gradually. Kelly Bonyata, IBCLC, of kellymom.com recommends initially reducing formula supplements by one ounce per day (not per feeding).
Doing frequent weight checks to ensure that your baby continues to grow normally. Checking for swallowing and monitoring diaper output can also provide some information about your baby’s intake.

What are some good resources for more information and support?