What is the procedure for relactation (re-establishing lactation)?

Procedure for Relactation

Relactation is possible in most mothers with proper techniques, motivation, and support, without requiring lactagogues or medications. 1

Definition and Overview

• Relactation is the resumption of breast milk production and breastfeeding after a period of cessation or significant decrease in milk supply 2
• It may be appropriate following untimely weaning, hospitalization with mother-infant separation, or for mothers who initially chose not to breastfeed 2

Key Components for Successful Relactation

Preparation Phase

• Assess maternal motivation and breast condition before beginning the relactation process 3
• Begin breast and nipple stimulation through manual expression or pumping to initiate milk production 3
• Nipple toughening exercises may help prepare for increased suckling 3

Core Techniques

• Frequent, short breastfeeding sessions are the most effective technique to increase milk supply 4
• Implement supplemental nursing support systems that allow the baby to receive formula/milk while stimulating the breast 4
• Ensure repeated suckling at the breast, which is crucial for stimulation of milk production 1
• Breast pumping between feeding sessions provides additional stimulation 4

Managing Supplementation

• Initially supplement with formula or donor milk while the milk supply is being established 4
• Gradually reduce supplementation as milk production increases 1
• Use a supplemental nursing system device to provide supplementation while the baby suckles at the breast 4
• The "drop and drip method" can help overcome nipple confusion and baby's frustration during initial attempts 1

Common Challenges and Solutions

• For small or retracted nipples (affecting 8% of relactation attempts), use proper positioning and lact-aid support 1
• For sore or fissured nipples (affecting 4% of attempts), ensure proper latch and positioning 1
• If the baby refuses the breast, temporary use of an artificial nipple for 2-3 days may help overcome breast strike 4
• Nipple confusion may occur but can be managed with proper techniques and persistence 1

Timeline and Expectations

• First breast milk secretion (colostrum) may appear within days of starting relactation 4
• Complete relactation can be achieved within approximately one month from beginning the process 4
• Success rates are high, with studies showing 98% of mothers achieving some level of relactation and 92% achieving complete relactation 1
• The time to reach maximum milk production varies widely, ranging from 8 to 58 days 5

Factors Affecting Success

• Shorter postpartum interval correlates with likelihood of successful relactation and faster onset of lactation 5
• Less postpartum breast involution is associated with better relactation outcomes 5
• Infant age affects willingness to suckle, with babies younger than 3 months generally being more responsive 2
• Maternal factors such as nutrition, parity, and previous feeding practices do not significantly impact outcomes if proper techniques are used 1

Professional Support

• Support from an International Board Certified Lactation Consultant is highly beneficial 4
• Strong professional support from skilled health workers helps overcome initial problems during relactation 1
• Family support contributes to successful relactation outcomes 4

Medication Options

• While not necessary for most women, medications may be considered in some cases 1
• Domperidone may be used to support relactation, with a relative infant dose of 0.01-0.35% (well below the 10% safety threshold) 6
• Metoclopramide has been studied for relactation but shows no significant advantage over non-pharmacological approaches alone 1

By following these steps consistently and with proper support, most mothers can successfully reestablish lactation, even weeks or months after cessation of breastfeeding 4, 1.