Guidelines for Relactation in Hospital Settings
Hospitals should implement comprehensive relactation support protocols that include skilled lactation staff, appropriate environment, and evidence-based techniques to ensure successful relactation for mothers who wish to resume breastfeeding.
Key Components of Hospital-Based Relactation Support
Environmental and Logistical Support
- Provide a suitable environment for breastfeeding, including a private room where family members can accompany the mother 1
- Minimize separation between mother and infant to support the relactation process 1
- Make breast pumps available to mothers who need to express milk, especially during periods of separation 1
- Develop specific hospital policies that facilitate ongoing breastfeeding and relactation efforts 1
Skilled Staff Support
- Ensure access to trained staff with expertise in breastfeeding support and relactation techniques 1
- Train staff to provide motivation, support, and guidance on proper positioning and latch techniques 2, 3
- Implement telephone triage protocols for staff to address breastfeeding and relactation concerns 1
- Collaborate with local breastfeeding community resources to provide comprehensive support 1
Clinical Techniques for Relactation
- Encourage frequent, short breastfeeding sessions to stimulate milk production 2, 4
- Implement proper positioning and latch techniques to overcome common barriers like nipple confusion 2, 3
- Consider supplemental nursing systems when appropriate to maintain infant at breast while supplementing 4
- Address common challenges such as small/retracted nipples or sore/fissured nipples with appropriate interventions 2
Pharmacological Considerations
Galactagogues
- Metoclopramide may be considered as a galactagogue to increase milk supply, though evidence shows successful relactation is possible without pharmacological support 2
- Domperidone can also be used as a galactagogue and may increase milk supply 1
- Note that strong professional support and frequent suckling are more important determinants of successful relactation than medication use 2, 3
Medication Considerations During Relactation
- Most medications are compatible with breastfeeding and relactation efforts 1
- Use resources like LactMed to provide guidance on medication safety during breastfeeding/relactation 1
- For mothers requiring surgery or anesthesia during relactation, most anesthetic agents are safe and compatible with continued breastfeeding 1
Factors Affecting Relactation Success
Maternal Factors
- Younger maternal age (<25 years) is associated with higher rates of complete relactation 3
- Strong maternal motivation is a key factor in successful relactation 4
- Maternal nutrition, parity, and previous feeding practices generally do not significantly impact relactation outcomes 2
Infant Factors
- Younger infant age (<6 weeks) is associated with higher success rates for complete relactation 3
- Infants older than 3 months may be less willing to return to the breast 5
- Duration of artificial feeding affects relactation success; longer periods of bottle feeding may reduce chances of complete relactation 3
Common Pitfalls and Solutions
- Misconception of insufficient milk is a common cause of lactation failure; proper education and support can address this 3
- Nipple confusion and infant frustration can be overcome with techniques like the drop and drip method or supplemental nursing systems 2, 4
- Bottle feeding may reduce chances of complete relactation; cup feeding may be preferable when supplementation is needed 3
- Infant breast refusal may occur during relactation; temporary use of an artificial nipple during breast strike may help overcome this 4
Monitoring and Follow-up
- Monitor infant weight gain during the relactation process 2, 4
- Adjust supplementation based on infant growth and maternal milk supply 4
- Provide ongoing support until complete relactation is achieved or stable partial relactation is established 3
- Continue support beyond initial relactation to ensure sustained breastfeeding success 4