Dear Kathleen- Leakies ask an IBCLC

Daily, we receive hundreds of emails and messages from Leakies looking for help and information in their breastfeeding journey.  As so many seek support from us, we are so honored to have the support of Kathleen Huggins, IBCLC and author of The Nursing Mothers’ Companion.  Kathleen is jumping on board with The Leaky Boob to have a regular article answering Leaky questions every month.  The questions will be selected from the huge pool we get in every day to try and help cover the wide range of topics about which Leakies are asking.  These questions are from real moms and represent hundreds of requests for more information in the past two weeks.  Please understand that this is simply the professional opinion of one International Board Certified Lactation Consultant in an informal setting and is not intended to replace the care of a health care provider.  Kathleen is offering support and information, not diagnosing or prescribing treatment.  For your health and safety, please seek the care of a qualified physician and/or IBCLC.  Kathleen does have limited availability for phone or online consultations, see her website for more information.

Dear Kathleen,

After pumping, is it ok to feed the baby that milk and then if baby doesn’t finish to save the rest by putting it in the fridge?

Thanks!

Bewildered in pumping land

 

 

Hi Bewildered!

Pretty hard to work to express milk for your baby and then have to toss it out!  Some health care providers say to dump partially drank bottles, or give it at the next feeding.  I think that placing back an unfinished bottle of breast milk back into the refrigerator is just fine. I would suggest removing the nipple and screwing on a clean lid to keep the bacteria from the baby’s mouth to a minimum.  By using a fresh nipple for the next feed you will keep more germs from mixing in with that bottle of milk. I would recommend using the milk within the next 24 hours.  One very small study of just a few moms found that milk could be placed in the refrigerator for up to 36 hours at 4-6 degree Centigrade.  Storing milk in the back of the refrigerator is recommended. If you use the milk a second time, and there is still leftover milk, it is probably best to dump it out.  When milk has gone bad, it does have a rancid smell.

When pumping or feeding your baby a bottle, be sure to always start by washing your hands well.  Also, make sure that all of the pump parts are washed thoroughly in warm soapy water or in a dishwasher and if wet, left to dry on a clean paper towel. Also, try and store just small amount of milk for your baby; maybe just 2-3 ounces per bag or bottle. In that way, there will be less leftover milk to deal with.Hi Bewildered!  Pretty hard to work to express milk for your baby and then have to toss it out!  Some health care providers say to dump partially drank bottles, or give it at the next feeding, but I think that placing back an unfinished bottle of breast milk back into the refrigerator is just fine. I would suggest removing the nipple and screwing on a clean lid to keep the bacteria from the baby’s mouth to a minimum.  By using a fresh nipple for the next feed you will keep more germs from mixing in with that bottle of milk. I would recommend using the milk within the next 24 hours.  One very small study of just a few moms found that milk could be placed in the refrigerator for up to 36 hours at 4-6 degree Centigrade.  Storing milk in the back of the refrigerator is recommended. If you use the milk a second time, and there is still leftover milk, it is probably best to dump it out.  When milk has gone bad, it does have a rancid smell.

Happy pumping,

Kathleen

 

TLB meme breastmilk storage

 

Dear Kathleen,

As a first time mommy (I have a two week old girl), I’m really struggling to seek out why things to happen and don’t happen… maybe you can help? 

To make a long story short, I wanted to nurse my little one since day one she was born. However, I have flat nipples so not only was it extremely painful when she would latch on, but it was also challenging, frustrating and depressing because I refused to even give her a bit of formula. The pain was so strong when she would latch that I would cry every single time and I knew she could feel my frustration because she would stop and look at me. I even dreaded watching the clock because I knew that in a few minutes it was going to be time to nurse again. As the days passed, my baby lost almost 3 pounds under her birth weight because I thought she was getting enough milk from me but it turns out I was barely making any. That made me so sad; I felt like a HORRIBLE mother so because I wanted her to get better, my husband and I decided we give her formula. After she gained a few pounds (almost back to her birth weight), I tried nursing her AND giving her formula but she would no longer latch on to me. She obviously likes the bottle nipple better because she can actually latch on without struggling. I tried everything I could. I’ve tried pumping and nothing comes out. Maybe one drop– if not, two. I’m honestly broken yet content she’s healthy once again. I’ve humbly given up on nursing because my husband and I feel it’s the healthiest decision for her and I. She won’t get frustrated and I won’t dread seeing her precious innocent face. We’re just bottle feeding her now but a lot of questions are going through my mind such as will be baby still be healthy with formula?

I did everything I could and I STILL am. Even though my milk is drying, I’m striving to keep it going by taking some pills that will help my milk come down. I’m doing this with the hope that once my milk comes down FULLY, I’ll be able to pump and mix it with her formula. 

I welcome your advice and encouragement. 

Love,

Disappointed but hopeful

 

 

Hello Disappointed,

I am sorry that you didn’t get the help you needed and suffered so much both physically and emotionally.  Unfortunately at this point, with your milk nearly gone, you need to make a final decision.

I do have questions for you, but in this Q&A format, I can only wonder.  Did your breasts grew during pregnancy?  Is less than an inch of space between them?  If the answers to these questions is no, then you may have insufficient glandular tissue which limits the amount of milk that can be produced.  That could explain the initial weight loss.

Yes, you can relactate but that takes a lot of time and effort and, in my opinion, you need to make a commitment to either go full steam ahead or let it go.  If you decide to relactate, you will need a rental grade pump and pump at least 8 times every 24 hours including during the night, using a double pump kit for about 15-20 minutes.   While some people may suggest teas, cookies and other herbs such as fenugreek, I think you need bigger guns!  You should consider taking the medication Motilium (Domperidone) that is available through compounding pharmacies with a prescription from your OB or midwife. If you are going to get some, I would suggest getting a month’s worth to start.  The typical starting dose is 30 mgms three times a day but can be increased to 40 mgms four times a day.  You can read more about taking Motilium on Dr. Jack Newman’s website.  Understand that pills, or herbs alone will not restart your production.  Your breasts must be stimulated and drained at least eight times each 24 hours.

If you start the Motilium and want to get more, it may be less expensive ordering it on-line through a New Zealand pharmacy.  There is a less expensive version, Domperon (a generic) that is $.12 per pill.  Under the care of your health care provider and with a prescription you can order Domperon online and delivery takes about 10-14 days to get a shipment.

Being only 2 weeks into this, unless you have insufficient glandular tissue, I think you could bring back your supply with the medication and pumping.  If you decide to move forward and your milk supply is equal to what your baby requires, about 3-4 ounces per feeding, I would urge you to consider an appointment with an experienced lactation consultant. Who knows, your baby may be able to nurse completely or with a formula supplement!

While breastmilk is the biological norm for human infants, your baby needs food and formula will provide her with the nutrition she needs.  What are missing are the live cells that protect her from illness and certain other factors in breast milk that protect against other conditions. As you are finding out, formula is also quite expensive.

While nursing is a loving and bonding experience, you can capture some of this with bottle-feeding. Please be sure to always hold your baby for feedings.  It isn’t long before babies can hold their own bottles and so many bottle-feeding parents take advantage of this.  Bottle-feeding requires both hands and I believe a majority of mothers hand over the bottle to the baby as soon as the baby can hold his own bottle. I think this allows the baby to bond with the bottle instead of their parents.  This may also be the reason that so many bottle-fed babies become overfed and overweight.  Parents simply fill the bottles to the top and the baby just sucks it down.  Consider trying baby-led bottle feeding if you need to continue with bottles and here’s some information about bottle feeding the breastfed baby.

So now the decision is up to you.  I know you will decide what is right for you and your baby, no matter which way you go.

All the best,

Kathleen

 

 

Kathleen-Higgins Kathleen Huggins RN IBCLC, has a Master’s Degree in Perinatal Nursing from U.C. San  Francisco, founded the Breastfeeding Warmline, opened one of the first breastfeeding clinics in  the United States, and has been helping breastfeeding mothers professionally for 33 years.  Kathleen  authored The Nursing Mother’s Companion in 1986 followed by The Nursing Mother’s Guide to Weaning.  Kathleen has also co-authored Nursing Mother, Working Mother with Gale Pryor, Twenty Five Things Every Breastfeeding Mother Should Know and The Nursing Mothers’ Breastfeeding Diary with best-friend, Jan Ellen Brown.  The Nursing Mothers’ Companion has also been translated into Spanish.  Mother of two now grown children, Kathleen retired from hospital work in 2004 and after beating breast cancer opened and currently runs Simply MaMa, her own maternity and breastfeeding boutique.  She continues to support breastfeeding mothers through her store’s “breastaurant,” online at The Leaky Boob, and in private consultations.  

 

 

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Your Guide to Relactation

 

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?

  • Lowmilksupply.org.  Comprehensive online source of information on increasing milk supply
  • KellyMom.com:  Relactation and Adoptive Breastfeeding:  The Basics

 

 

 Tanya Lieberman is a lactation consultant (IBCLC) who has helped nursing moms  in hospital and pediatric settings.  She writes and produces podcasts for several  breastfeeding websites, including MotherwearMotherlove Herbal Company, and  the Best for Babes Foundation.  Tanya recently authored Spanish for Breastfeeding Support, a guide to help lactation consultants support Spanish-  speaking moms.  Prior to becoming a lactation consultant she was senior  education policy staff to the California legislature and Governor, and served as a  UN civilian peacekeeper.  Tanya is passionate about supporting nursing moms, and especially to eliminating the barriers so many moms face in meeting their breastfeeding goals. She lives in Massachusetts with her husband, her 8 year old son and her 1 year old daughter.

This resource page was made possible by Motherlove Herbal Company.

 

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Breast Nurting: A Re-lactation Story

For our WBW blog carnival on “Perspectives: Breastfeeding From Every Angle” we are pleased to host guest posts from various contributors. Today we hear the perspective on breastfeeding from Rachel, a mom that re-lactated after medical reasons led her to wean very early. Rachel has a re-lactating blog chronicling her journey.


When my son was almost 4 weeks old, I began my relactation journey. I stocked up on medication, supplements, information and support. You see, he was formula fed at one week old. I was hospitalised overnight with severe anxiety attacks and extreme insomnia when he was 6 days old and was not in a state to breastfeed so he was given formula feeds.

I then allowed my milk to dry up as I focused on getting better mentally. After finding out that I had lost my first pregnancy early in the second trimester, I understandably was anxious during my second pregnancy and beyond. As a result, I had postnatal depression & anxiety all surrounding the fear of losing my son and not being a ‘good enough’ Mumma to him.

I so desperately missed breastfeeding – not only for all of the health benefits to him and myself but because I loved it.

I started being very conscious of eating well, drinking loads of fluids, resting, and nursing him as often as possible. He would latch on but got increasingly frustrated because I was producing next-to-no milk. I was taking several galactologues and started pumping regularly. I stayed in contact with a lactation consultant and ordered a Supplementary Nursing System. Some beautiful, generous Mummas are donated expressed breastmilk to us as well.

To say I was determined is an understatement.

I was so blessed to have a cooperative baby and an extremely supportive husband. I went from expressing literally a couple of mLs from both breasts at a time to producing more than enough breastmilk (750 mL in a 24 hour period) in just seventeen days!


Getting my supply back was only half the battle. It was then a matter of getting him back to the breast. 11 days later, after much frustration and a few meltdowns (from both him and I) my baby boy had his first of many feeds from the breast… and we haven’t looked back. That was over 5 months ago and my ‘boobah’ loving baby boy is so happy.

It was trying, don’t get me wrong. I had to hand express at first and expressing so regularly and constantly was draining both physically and emotionally. I had all the normal duties of a first time Mum to contend with alongside postnatal anxiety, an exhaustive pumping schedule, painful nipples (hello nipple thrush, meet hospital grade double breast pump), the financial cost and it was so time consuming. But it was beyond worth it.

I spent most of my free time (hah! Free time with a tiny baby?) researching relactation on the internet. I searched for success stories, blogs, articles, anything that would tell me that it was not only possible but that it was worth it. At one point I remember saying I just want someone to come to me from the future and tell me that this will all be worth it. Well, it is. It really really is.


I didn’t just want to breast-feed. I wanted to breast-nurture. I am a relactation success story. I just want to be a voice for relactation to say that it is achievable and gaining back our breastfeeding relationship has been so very rewarding.

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