Milk Supply Issues

Whether real or perceived, low milk supply is one of the main reasons given for mothers to supplement or wean their baby.  There are a number of things that can cause milk supply issues; these are known as antigalactogogues.  The Top 10 most common antigalactogogues in our western culture are listed below:

  • alcohol, tobacco, other recreational drugs
  • caffeine
  • decongestants & antihistamines
  • contraceptives with estrogen
  • chasteberry (fruit/leaf)
  • greek oregano
  • parsley
  • peppermint
  • rosemary
  • sage

While not every mom reacts to these, if you are at all concerned about your milk supply it would be wise to steer clear.  But it is important to remember that these antigalactogogues are dose-dependent – the more you have the greater the negative impact on milk supply issues. For example, an occasional glass of wine or daily cup of coffee is usually fine for most breastfeeding mothers.  But daily alcohol intake or multiple sources of caffeine throughout the day can definitely cause milk supply issues.  And while most drugs are completely compatible with breastfeeding, decongestants and antihistamines should be taken with extreme caution.  Not only do they dry up the sinuses but they can dry up a mother’s milk supply quite fast.

Perhaps the most often overlooked antigalactagogue is STRESS.  If you are facing milk supply issues, seek out qualified help and support and try not to spend time worrying about making milk.  Also, try to eliminate other sources of stress you may be dealing with.

Two herbal galactagogues that can increase your milk supply are Fenugreek (3 capsules, 3 x per day) and Blessed Thistle (3 capsules, 3x). It usually takes at least 24 hours to begin to see any effect.

In Egypt, home to the fenugreek research for increasing women’s milk supply, the common wisdom is to cook fenugreek (it looks similar to wheat) like you would oatmeal and then serve with milk and honey. All new moms drink this regularly after giving birth.

For any mothers with supply issues, please let me know if you’ve found any of these to be true and what has worked for you!

Additional information about reasons for low milk supply and increasing your milk supply can be found here.


4 Goals Of A Healthy Breastfeeding Diet

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Fruits and vegetables in season are always a good option for healthy meals.

A healthy breastfeeding diet doesn’t look a whole lot different from a healthy pregnancy diet except for the volume of food that you eat. Once your baby is born, your nutritional needs as a mother increase even beyond when you were pregnant. Your baby is growing bigger and still relying on you as their sole source of sustenance.

While you are breastfeeding is not the time to focus on a super-restrictive diet (perhaps in the hope of losing weight faster). Dieting and breastfeeding need to be handled with great care and wisdom. The caloric demands on your body grow, not diminish, once you have your baby. But it’s the type of calories that you intake that will make all the difference for you and your growing baby.

“If you come up short on your calories or nutrients, your breast milk is usually still sufficient for supporting your baby’s proper growth and development. Unless you are severely malnourished, your breast milk will provide what the infant requires. However, this will be at the expense of your own nutrient reserves.” ~ Kimberly A. Tessmer, R.D., L.D. 1

A healthy balanced diet is key to providing for all the nutrients both your baby and your own body needs during this time. The goal is to eat a nutrition-packed diet.

Here are four guidelines for a healthy breastfeeding diet. Use these to see how your current eating habits might be tweaked.

1. Fill half your plate with fruits and vegetables at every meal.

The fresher the produce, the better. That’s always a good rule of thumb. This could be a mixed green salad, a fresh fruit salad, 1/2 a grapefruit with your sandwich, some steamed vegetables, etc. Use lots of variety and have fun with it! Eating with the seasons can be helpful in giving your body lots of variety, and it’s easier on your pocketbook as well.

2. Keep prepackaged snack foods to a minimum…perhaps only once/week.

Prepackaged snacks are typically high in ingredients that your body does not need and lower in nutrients (a higher percentage of “empty calories”). Instead, if you feel “snacky”, choose a nutrient-dense snack. This could be a favorite nut mix, an apple with some peanut butter, some low-fat cottage cheese with fruit, or some fresh popcorn popped over the stove. The absolute best way to insure that you don’t get snacky on nutrient-deficient foods is to not even bring them home.

3. Don’t eat past bedtime.

Make your healthy evening meal or a small evening snack the last food of the day. Avoid snacking during midnight feedings. If you have been in the habit of eating late into the night, your body will fight against the change…but not forever. You can retrain your brain and your stomach to not expect this anymore. And these extra nighttime calories are not really needed at all as long as you are getting adequate calorie intake throughout the day.

4. Reduce sugary beverages to 1/day.

Ok, this is a big one for some folks. Sugary drinks like sodas, sweetened lattes, and fruit juice are the largest contributors of added sugar in today’s American Diet.2 Your body (and your baby) get almost zero nutritional benefit from these liquid calories. You are both better off when you just drink water when you are thirsty.

These nutritional habits are great not just for breastfeeding, but for a lifetime of excellent health. Use your lactation season to become consciously aware of what a healthy breastfeeding diet looks like. Then, when your breastfeeding time is done, you will have some healthy dieting habits that will serve you long into the future!

Note: As always, if you are on a special diet that has been recommended by your doctor for specific health reasons, then be careful not to change things without his/her approval.

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Bonnie Hershey is a family health coach, practical nutrition advisor, and mother of three breastfed children. At Proven Nutrition For Kids, Bonnie shares research-based information and experience to help moms find targeted nutritional solutions to common health problems. You can also connect with Bonnie on Twitter {@bonniehershey}, GooglePlus {google.com/+BonnieHershey} and on Facebook {fb.com/ProvenNutritionForKids}.


Breastfeeding

Breastfeeding Gave Me Confidence

Krista Elliott HeadshotKim is an American living abroad in China with her husband and 2 very active boys. She enjoys cooking, cross-cultural living, and experiencing life through the eyes of her children.

When I got pregnant with my first son, Nate, I knew I wanted to breastfeed. My mom had breastfed my sister and me and talked often of the benefits. I remember as a child hearing her talk about how she wanted to “give us the best start in life possible” and not really understanding at that time what she meant. Now, after having children of my own, I understand.

Thinking through what it meant to be a mother and how God was entrusting this tiny human to my care, I was determined to breastfeed. I believed it made a lot of practical sense. Breast milk is free, convenient and healthy. I was also looking forward to the extra cuddle time and close knit bonding that breastfeeding provides.

During my pregnancy with Nate, I read lots of books about pregnancy, nursing, and newborn care. I watched other moms nurse, met with a Lactation Consultant and felt like I had a good handle on what to do. I often daydreamed of a perfectly latched baby who smiled lovingly up at me as he enjoyed the nourishing milk, flawlessly suited to his particular needs.

BreastfeedingDay one, the latch hurt.  A lot. I asked the nurse to have the hospital’s Lactation Consultant check in. She was not much help. By the end of the day, my nipples hurt so bad that I dreaded each feeding. Day two, Nate refused to latch and he began to get jaundiced. Day three, we fed him formula through a syringe because he wouldn’t latch and my milk hadn’t come in yet so pumping was fruitless. Nobody offered donor milk as an option.

Thankfully, after my milk came in, we were able to get him to latch again. I went home with him from the hospital totally terrified about nursing. This was a disaster. I was almost ready to give up right then and there. I cried. I sobbed. I prayed. I was destroyed. This was not the story I had pictured in my head. However, my heart was set on doing this. I knew in my soul that breastfeeding was important and that my baby had a right to have access to the nourishment God intended for babies. I desperately wanted my new baby boy to have all the benefits breastfeeding provides.

So I pressed on and contacted the Lactation Consultant I had seen while I was pregnant. She was incredibly helpful. She came to my home, watched me nurse, helped me nurse, and imbued me with confidence. She came as often as I needed her. She brought lanolin for my sore nipples. She worked with me for six weeks and though it got better, nursing was still really painful. The latch looked right. There was no thrush or physical abnormalities. She didn’t find a tongue tie. It simply hurt to nurse. I started to feel crazy and like a giant failure. There was no reason visible for nursing to be this painful.

Nate began to develop some other puzzling symptoms also. He coughed and choked a lot while nursing. He was extremely gassy and fussy after nursing. He had a hard time maintaining his grasp on the nipple and easily slid off or lost suction. Nursing sessions lasted upwards of an hour and so on. The Lactation Consultant recommended I take Nate to the local Dysphasia Clinic. She was out of answers and felt he may benefit from the more specialized kind of care they could provide.

BreastfeedingThe first visit at the Dysphasia Clinic was wonderful. The specialist confirmed that I was not crazy, the latch was perfect, but Nate was not using his mouth and tongue normally. She noticed that his suck/swallow/breathe rhythm was a little disorganized and that he was using a chewing instead of a sucking motion. This was the source of the pain.

Imagine my surprise when she assured me with some special exercises and time, Nate would learn to nurse properly and it would stop hurting!! She assured me that this was all within the range of “normal” for babies and that some just need a little more help to learn the skill of nursing than others. She also felt that his tongue might have been a little tighter than normal, but not enough to warrant surgical correction. She also broke the news to me that my milk supply was most likely low because he was not efficiently removing milk.

Over the following weeks, I was to nurse, then pump, then feed what I pumped to Nate in a special bottle using a special technique. This would empty my breasts more adequately, thus increasing my milk supply and give Nate the opportunity to strengthen his suck and learn the proper suck/swallow/breathe rhythm.

I saw dramatic improvement within the first few visits! Although it was hard work and nursing was still not completely comfortable, we had come a very long way from the first few weeks where I cried before every nursing session in anticipation of the pain. I knew now that I would continue nursing Nate until he was ready to be done. Oddly enough, this struggle gave me a lot of confidence as a mother. I knew that I had what it takes to surmount challenges. I knew I would push through to do what was best for my children despite personal pain or hardships, that I would be able to put my children’s needs above my own.


Adoptive Breastfeeding

Breastfeeding My Adopted Baby

Mary Straits HeadshotKaren Lytle is the mom of four kids so far, three biological and one handsome adoptive son.  She has had the amazing privilege of breastfeeding all four of them, including her adopted son. Karen’s story is as unique as each mother’s breastfeeding journey, but she shares it hoping that some of it helps to inspire other adoptive moms as to the wonders of intimacy that can be a part of nursing adoptive children.

When our oldest was 15 months old, we brought home two beautiful, identical twin girls. Life was busy, but good. I was learning the joys and challenges of nursing multiples. When the girls were 6 weeks old the Lord told us it was time to start a process of adoption. We had always known we would adopt, but he told us the time was now.

We explored foster care, international, but in the end for this time, God was leading us to adopt a newborn – one who fit the qualifications of “more difficult to place.” We were matched when the girls were 14 months old, and Isaac’s birth mother was 37 weeks pregnant. I was still nursing the girls twice a day at this point, and I started weaning them the day after we met Isaac’s birth mother. As I weaned them, I began to pump every 1 1/2-2 hours including a nightly pump to get ready for the demands of breastfeeding my adopted baby.

Adoptive Breastfeeding

I had always struggled with low milk supply issues, so I think like every adoptive mother who tries this, I went through all of those concerns of whether or not I would be able to produce enough milk. But I was determined to teach him to breastfeed. So, I began to research, and I put myself on a nursing mother’s diet. I drank barley water and ate a variety of foods and spices (such as anise) that helped to nourish my milk. I also took fenugreek and blessed thistle supplements.

We brought him home when he was two days old. And I still remember that night. I told my husband that I wanted to have that first night where it was just Isaac and me so that I could be totally relaxed and work just with him on his feeding while he was sleepy and just get him used to my heartbeat. I stripped him down to his diaper, and laid him on me skin to skin. Every time he stirred, I would offer him my breast, and within a few offers, he had latched on just suckling instead of nursing. But, by the end of that first night, he had nursed twice. We slept together skin to skin, or I should say dozed together, like this for about a week. And he rarely wore any clothes during those first days together. I wrapped him up next to my skin and held him almost the entire time.

Adoptive babies need to acquaint themselves with their adoptive mother’s heartbeat, scent, and touch. With a biological newborn there are changes outside of the body, but there is an instant connection with sounds and sensations when their biological mother holds them.

With an adoptive infant, those connections need to begin to form with that new adoptive mother’s heart rhythms and touch. While there is no physical memory at this point, a child still has something called cellular memory. So, imagine this as a time where you are helping them through a grieving process that they don’t even know they have.

Also while helpful for every infant, light infant massage can be especially helpful for an adoptive infant’s transition into your family. It has also been proven to heal and correct any sensory pathways that might have received slight damage due to stress in utero or stress during delivery.  For an adoptive infant there is the added stress of separation from their biological mother.

Big brother with adopted baby.

Big brother with adopted baby.

Now, truthfully, nursing wasn’t a perfect process. While he was nursing like a champ, I have always struggled with low milk supply, so we did supplement some. And the most difficult time nursing him actually came when he was about 3 months old. I had emergency surgery and was in the hospital for four days, and while I pumped, I couldn’t nurse him. Fortunately, my sister had just had a baby, and so while I couldn’t nurse him she was able to.  But, by the time I got out, my milk supply had dropped even lower.

I met with a lactation consultant two days after I came home, and for the next 2 weeks, I used an at-breast-tube-feeding device when I nursed him. I think the amount of pain I was in and my stress that I might not be able to keep nursing him was affecting my supply. But, we made it through that, and I was able to nurse him until he was a year old.

I hope this inspires other adoptive mothers. This is a precious time with your child; relax and do everything you can to make it happen. You will not regret it. Nursing builds intimacy and trust between a mother and child.

Adoptive BreastfeedingWhile it is their best nourishment for their body, it is also building their emotional well being, and promoting their brain development beyond just nutrition as well. And when you are nursing your precious infant, especially your adoptive infant, remember to use it as a time to look deep into their eyes.

There is a reason the eyes are called the windows of the soul, and science has proven that those moments of eye contact between a mother and child in those early years provides a foundation of trust and connection that supports them for years to come. And for an adoptive infant, these times are being built at placement rather than before, so by doing this you can recoup some of that
lost time.


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How is Milk Supply Established?

How is my milk supply established?

After 16 weeks of pregnancy, lactation occurs though it is kept in check by progesterone produced by the placenta. (This is why a mother who has a late miscarriage may still produce milk.)  Once the placenta is removed following birth, prolactin and oxytocin are greatly increased and your body begins to make copious amounts of milk (this is evidenced by your milk “coming in” 3-4 days postpartum).  Though the initial “coming in” of milk happens whether a mother has been breastfeeding or not, this autocrine control of lactation changes to endocrine control and, if milk is not removed, the body will not continue to make milk.

During the first six weeks or so following birth, your body is flooded with hormones that make and regulate your milk supply.  As you breastfeed, prolactin receptors are being laid down within the breast that can impact how much milk your body will make for the duration of breastfeeding.  Therefore, it is extremely important to nurse your baby on demand ensuring that you breastfeed often both night and day in the early weeks.  If your baby is in the NICU, or is unable to nurse effectively for whatever reason, pumping or hand expression as often as your baby would nurse is critical.  Prolactin levels are higher at night so it is especially important to nurse your baby during the night, especially in the early weeks, to help establish your supply.

Milk supply is governed by the law of supply and demand: an empty breast makes more milk.  Therefore, nursing frequently, and having a baby effectively drain your breasts, is the best way to establish a strong milk supply.

While it seems that hormonal imbalances or a lack of glandular tissue (whether from hypoplasia and/or breast surgery) get a lot of attention, the majority of women who experience low milk supply do so because of infrequent or ineffective milk removal.  Every woman’s body and breast milk supply are different.  While one mother’s body may be more forgiving if a bottle is given on occasion, this could very detrimental to another mother’s supply.  One mother and baby dyad may be able to survive scheduled feeds, while another baby and mother may have significant problems that lead to a dissatisfied baby and low milk supply. This is why there is no “one size fits all” approach to feeding a baby, despite what some parenting books may want us to believe.

Regardless of what has happened to cause a low milk supply, there are strategies you can employ to help increase your milk, even while continuing to nurse your baby at the breast.


Krista-Elliot-Featured

Breastfeeding After Reduction: A Mom’s Journey

Krista Elliott HeadshotKrista Elliott is the mother of two little boys, aged 4 years old and 9 months, and is currently on maternity leave from her job as a regional communications coordinator for a multinational conservation organization. Connect with her on Twitter @Quackerflack.

Women have a strange relationship with their breasts. Some love them. Some hate them, and some, like me, have a relationship that is storied and not a little complicated. I was what is euphemistically called an “early bloomer”, meaning that I wore my first bra at age nine. No training bra, though. My breasts needed no training. They were already close to a B cup by this point. I soon outgrew the B cups, roared past C, D and DD, to eventually settle on the unheard-of (to me) size of 38G.

I hated them. My breasts overwhelmed my average frame. Buying bras and bathing suits often frustrated me to the point of tears. And it goes without saying that I received a lot of attention from boys, and that the attention was entirely the wrong kind – the kind that confuses and overwhelms a 14-year old girl just learning to navigate her sexuality and the self-esteem issues that are often tangled up therein. I could not run or play sports. I quit the swim team. More alarmingly, my shoulders started to round and my posture started to suffer. I wanted a breast reduction.

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Photo courtesy of Wonkyeye Photography.

Fortunately, I live in a country with universal health coverage, and my reduction was considered medically justified. So cost was not an issue. We met with a surgeon, and asked many questions: healing time, loss of sensation, when I could resume activities, etc.

We never asked about breastfeeding. It didn’t occur to my 16-year old self, nor did it occur to my mom, who had had her babies in the 1970s, when formula feeding was pretty much de rigeur. I just wanted to have normal-sized breasts, and babies were the last thing on my mind.

The surgery was a success, and I moved on with my life and my much more manageable-sized breasts. The hate was gone. I now adored my perky, perfect C-cups. I went to university, graduated, worked, fell in and out of love, and eventually, at age 26, met the man who would become my husband (and who would actually change my previous “no kids” plans).

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At 33, we decided to start a family. Suddenly, I wondered…could I breastfeed? Would it be worth a try? With a fierceness that surprised me, I realized that I very much WANTED to breastfeed. I wanted to nourish my baby from my body and I wanted the baby to have all of the benefits of breastfeeding. I wanted it to work. I ordered “Defining Your Own Success”, and read it cover to cover, dog-earing dozens of pages.

I thought I was ready to make it work. When my breasts started leaking colostrum at week 36, I shrieked for joy. Sam was born in August of 2009. A beautiful little boy, delivered after an induction, an epidural, and intervention after intervention. I was determined to nurse him, and being in pain from the episiotomy, I figured that nursing him lying down would work. And it did.

We got a semi-workable latch, and I could see his tiny ears moving as he swallowed that precious colostrum. We were on our way! Doubts and trouble crept in, though. A well-meaning nurse gave him a bottle. Another nurse basically bullied me into trying a cross-cradle hold while sitting in a rocking chair, bringing me to tears of frustration.

I was getting conflicting advice from everybody, and became confused and bewildered. It only got worse when I got home. I just wanted to nurse (and pump, to build my supply), but was still too bashful to nurse in front of anybody but my mom and my husband. And yet, visitors kept coming to see the baby.

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The doorbell rang all day long. I was too shy to nurse or pump in front of these well-meaning aunties and uncles, but where they’d come to see the baby, I couldn’t very well disappear upstairs with him either. I stewed and stressed and cried about it, and just wanted everybody to go away. My doubts were further exacerbated by my own hungry baby. I’d nurse Sam for a half-hour, and then offer him a bottle to top him up. He’d drink all four ounces, convincing me that he’d gotten absolutely nothing from my breasts.

My love for my breasts had turned into a sort of tired disgust. Sure, they looked good, but as far as I was concerned, they were useless. This went on for 6 weeks, until I finally threw in the towel. He went onto formula and bottles, and I put my nursing bra away and returned my rented breast pump. I was disappointed, but also relieved that the ordeal was over.

No longer stressed out, I could enjoy Sam and bond properly with him. 3 years later, I became pregnant with Alex. A bit older and a bit wiser, I was determined to not let fear derail me. At my first prenatal visit, I told the doctor that I wanted a prescription for Domperidone. I knew that herbs alone would not be enough, and wanted every possible bit of help. I also ordered a Lact-Aid supplemental nursing system, to supplement at the breast, which would help my supply much more than bottles would. Being realistic, however, I bought a case of concentrated formula.

cutieAlex’s birth was the polar opposite of Sam’s. My labour was unmedicated and quick, with him being born just 5 hours after my water broke. I looked at my little boy with his ridiculous shock of black hair, and remembering all the lessons I had learned from Sam, carefully latched his tiny mouth onto my nipple, where he clamped on like a small crocodile and drank greedily. The nurses marvelled at how beautifully he latched. I smiled ruefully, knowing that the only reason the latch was so good was because I had taught myself how to do it, during those tearful nursing sessions with Sam.

Armed with my Lact-aid, Domperidone, fenugreek, goat’s rue, and a mastered football hold, Alex and I were on our way. My goal was to not have to supplement more than 50% of his intake. My fear of nursing in front of others had been replaced by a complete lack of damns given about who might see my breasts. I nursed in front of my in-laws and other visitors.

I bought an “udder cover” and nursed in public, using that until I mastered the art of the discreet latch. A friend from a Facebook nursing support group gave me the tip of wearing a snug camisole under a loose top, and lifting the top, lowering the cami, latching the baby, and then draping the top. Shortly after that, I gave the nursing cover away.

I nursed at McDonald’s. I nursed at the park. Would you could you nurse in a boat, with a goat, in the air, everywhere? Oh yeah. Definitely. I nursed him in the football hold, the cradle hold, the cross-cradle hold, and even upright in the Ergo. We were PROS at this thing! One day, I realized that Alex was only drinking about 3 ounces of formula a day. I stopped cold, my mind reeling. Could I do it? Could I exclusively breast-feed? I hadn’t even considered it, any more than I had considered sprouting wings and flying.

2013-04-12 14.22.16It seemed impossible for a BFAR mom to exclusively breastfeed, but we were SO close…so very close. I figured going a few days without formula wouldn’t starve him and taking a giant breath (and a couple of extra doses of goat’s rue), took the leap of faith.

I watched Alex’s weight closely. Would he lose weight, confirming the need for formula? Or would he hold steady, or even gain? I remember looking at the scale with joyful tears in my eyes when I realized that he was gaining weight. My baby was gaining weight off of ONLY my breast milk.

I wanted to stop strangers in the street and shake them by the shoulders and tell them what I had accomplished. I wanted to take out ads in the newspapers. I wanted a damn medal. I was doing it! I was exclusively breastfeeding my baby, and he was gaining weight!!! I had succeeded beyond my wildest dreams. My breasts were now beloved.  Older and a bit tattered, but full of priceless treasure.

I would stare at my baby, marveling, as he latched on and drank, looking up at me with the heart-swelling trust that an infant has in his mother. Alex is now 9 months old, and has been on solids for a few months. He is pulling himself up on the furniture and trying to eat everything in sight. He’s in the 50th percentile for weight and the 90th percentile for height. He still gets the odd bottle of formula if we go out for a date night or if his cluster feeds have rendered my breasts in need of a break.

But I give him formula on MY terms, not on anybody else’s, and not because I feel I have to. Most days, he still drinks only my milk. And I still stare at him in wonderment as he drinks, as this precious, beautiful little boy takes his nourishment from my body. From my breasts. From me.


Adoptive Breastfeeding

Adoptive Breastfeeding

There is an increasing trend today of mothers who are interested in breastfeeding their adopted children.  Breastfeeding, in general, is on the rise in western cultures and many adoptive parents don’t want their infants to miss out on either the nutrition or bonding that nursing provides.  Whether the child is a newborn or toddler, many adoptive parents are researching what it takes to be able to breastfeed when it’s not a mother’s biological child.

Important questions to consider

There many factors that must be considered:

  • Has the mother ever breastfed a child?
  • If so, how long has it been since she nursed a child?
  • How long did she nurse the child and why did she wean?
  • How much time does the mother have until she will receive her baby?  ie does she need to begin lactating immediately or does she have time to prepare her body hormonally?
  • How old is the baby to be adopted?
  • Has the baby ever nursed before? What is the likelihood of baby latching to breast?
  • What are the mother’s goals – full breastfeeding, partial breastfeeding, comfort at the breast, nursing at the breast with at-breast tube feeding device, etc.?
  • Does the mother have a supportive network around her?

Frequent breast stimulation and milk removal are critical

Even when an adoptive mother has never had her own biological children, it is possible to induce lactation and breastfeed a child. There are many things that are important for success with adoptive breastfeeding, but, if a mother wants to nurture her child at her breast with milk (rather than just comfort nursing and snuggles) then frequent breast stimulation and milk removal are critical.

It doesn’t matter what else a mother does – hormones to mimic pregnancy, being surrounded by a supportive network of friends and family, skin-to-skin contact with baby, galactagogues to increase milk production, etc. – if the breasts are not stimulated at regular intervals throughout the day and night and milk effectively removed once production begins, then a mother’s body will not build a milk supply.  Frequent and effective milk stimulation and removal are essential!

How can a mother who hasn’t given birth make milk?

Hormones in pregnancy prepare a mother’s body for breastfeeding.  Breast milk is kept in check by progesterone.  When a mother delivers the placenta her progesterone levels dramatically decrease and the body begins to rapidly make milk – which a mother notices as her milk “coming in” between days 2-5.

However, the mammary glands can also be stimulated by suckling – with a baby, breast pump, or hand expression – which facilitates the growth of mammary tissue and release of hormones essential for lactation. Frequent suckling is what allows this process to continue.

Keys to successful lactation

  • Maternal motivation
  • Support system surrounding mother including supportive partner and mother-to-mother breastfeeding support group
  • Excellent breastfeeding counsel from a qualified lactation consultant
  • Baby who can effectively suckle at breast or pump/hand expression system
  • Frequent and effective milk stimulation/removal…remember, an empty breast makes more milk.

Things to be aware of:

  • Oxytocin, one of the hormones essential to lactation, can be inhibited by stress.  Make sure to have a tribe of support surrounding and encouraging you!
  • If you have breastfed before, the longer the gap since this experience, the longer the time it will take for milk stimulation1 But, even if you have never breastfed, inducing lactation is completely possible!
  • Babies younger than 2 months are more likely to suckle on the breast naturally2
  • Babies and toddlers of any age can learn to breastfeed.  In fact, many infants who have never breastfed may initially refuse the breast.  This doesn’t mean they always will though.
  • Children who were breastfed before adoption may naturally seek the adoptive mother’s breast as well.
  • Some mothers will achieve a full milk supply while others will not.  Even if a mother doesn’t make enough milk for exclusive breastfeeding, she can exclusively feed her adopted baby at the breast through an at-breast tube feeding device.
  • It can take weeks to begin to see the first drops of milk once frequent, effective breast stimulation occurs.
  • Milk typically creeps in – as opposed to a mother’s milk “coming in” following birth where she may experience engorgement
  • Having a support system around you cannot be overestimated!  Having family and friends that can support and encourage you as well as getting involved in a local mother-to-mother breastfeeding support group are critical to your success.  There will be moments when you wonder why you are doing all of this and having others to encourage you and share their experiences will help you tremendously.

You may also be interested in reading 5 Challenges Adoptive Mothers Face with Breastfeeding as well as How to Encourage your Adopted Child to Breastfeed.


Induced Lactation

What is induced lactation?

Induced lactation is when a mother who has never had her own biological children stimulates lactation in her breasts.  The term is also used when a mother, who is not currently breastfeeding, adopts a child and goes on to nurse the infant (adoptive breastfeeding).  It is different than relactation, which occurs when a mother’s milk supply is stimulated to nurse a baby she gave birth to but has been weaned.

How do you induce lactation?

There are many techniques that women use to help induce lactation, however the most important is frequent and effective breast stimulation (and milk removal once milk begins to flow).  Many women around the world have effectively induced lactation solely by regularly nursing a baby and/or through pumping/hand expression.1 Conversely, no amount of additional tools (galactagogues, hormonal stimulation, skin-to-skin, etc.) will effectively induce a milk supply without this first step.

Strategies for inducing milk supply

  1. Breast stimulation on both sides for at least 100+ minutes every 24 hours.  A woman may start with shorter sessions, say 5 minutes or so, and build up to expressing 15-20 on each side 8-12 times a day, including at least once at night.  The more frequently the breasts are stimulated, the quicker the milk supply will build. A newborn eats approximately every 2 hours, 10-12 times per day so expressing this often would be ideal.
  2. It is not essential to express on both sides at once, though this is a great way to save time.
  3. The milk ejection reflex can be trained so thinking of your baby, nursing or pumping in the same place, listening to relaxing music, hearing a baby cry, etc. can help to stimulate it.  Conversely, stress can inhibit hormones involved with milk ejection.
  4. If you already have your baby, and if he is willing to nurse at the breast, try nursing with an at-breast tube feeding device. This allows your milk supply to be stimulated by your child rather than pumping or hand expressing to stimulate your supply.  It reduces a step because while you are “pumping” you are also feeding your baby.  As you begin to develop a milk supply you can reduce the amount supplemented in the tube feeding device.  It is important to make sure your baby has a good latch in order to effectively stimulate your milk supply.
  5. When nursing at the breast (and at other times throughout the day and night as well) make sure to spend time skin-to-skin with your baby.  There are many tremendous benefits for both mother and baby, but this time together will help you bond and help maximize a mother’s breastfeeding hormones.
  6. Taking pharmacological and/or herbal galactagogues while expressing/breastfeeding can increase breast milk supply.  Domperidone is generally considered the safest pharmacological option and fenugreek and blessed thistle are common herbal options.  Eating oatmeal several times a week or even daily may also increase milk supply.
  7. Acupuncture may also increase a mother’s milk supply through enhancing the secretion of the hormone prolactin, which is necessary for milk production.2
  8. Having a support system around you cannot be overestimated!  Having family and friends that can support and encourage you as well as getting involved in a local mother-to-mother breastfeeding support group are essential.  There will be challenges you face with adoptive breastfeeding.  Having others to encourage you and share their experiences will help you tremendously.

If you have several months before getting your baby

If you are in the process of adopting but will have to wait weeks to months, there are medications you can take that mimic pregnancy hormones in your body.  By taking an oral birth control pill with estrogen and progesterone, and skipping the week of “sugar pills” each month, your body’s hormones will mimic those in pregnancy.

In addition to the oral birth control pill, a mother would take Domperidone which is used in lactation to increase breast milk supply.  After at least 30 days on this protocol, but longer (6 months) if possible, a mother would stop the birth control pill and begin pumping or breastfeeding.  She could also take Fenugreek and Blessed Thistle – 2 herbal galactagogues known to help increase milk supply.  Please read here for further details on how to implement the Newman Goldfarb Protocols for Induced Lactation.  Though the treatment protocols for inducing lactation have not been tested in clinical trials, women from around the world have successful adoptive breastfeeding stories by using these strategies.

There are many challenges that adoptive breastfeeding mothers may face.  Arming yourself with knowledge is half of the battle!

You may also be interested in reading adoptive breastfeeding and how to encourage your adopted baby to latch.


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Relactation

What is relacation?

Relactation is a breastfeeding term for a mother who had a biological child and either never breastfed or has already weaned but later goes back and stimulates her milk supply to breastfeed that baby.  She may have nursed her child for a short or long time and it may have been recently or years earlier that she weaned her baby.  Either way, the “re”-lactating is reversing the weaning.  This is different from induced lactation where a mother hopes to stimulate her milk supply to nurse a child that she has not given birth to (adoptive breastfeeding).

Important questions to consider

  • Did the mother ever breastfeed this child? If so, for how long?
  • How long has it been since she last nursed this infant? The shorter the gap since last breastfeeding will typically mean it takes less time to re-stimulate a milk supply.1
  • Why did she wean?
  • Were there any maternal issues such as flat/inverted nipples, insufficient glandular tissue, low milk supply, or nipple pain?
  • Were there any infant issues such as illness, prematurity, tongue tie, poor latch, inability to suckle effectively, etc.? Have these issues been resolved?
  • How old is the infant? What is the likelihood of him latching again on the breast? In general, the younger the baby (particularly within first three months), or if the baby was breastfed for most of the first year, the higher the chances for the infant to latch and breastfeed again.2  Please read strategies for encouraging baby to breastfeed.
  • Is the mother able to be with baby throughout the day and night or is she separated for periods of time?  If she is separated, can she reduce/eliminate this separation temporarily while re-establishing her milk supply?
  • What are the mother’s goals – full breastfeeding, partial breastfeeding, comfort at the breast, nursing at the breast with an at-breast tube feeding device, etc.?
  • How motivated is the mother to relactate?
  • Does the mother have a supportive network around her?  Having a strong support network of family and friends, and a qualified lactation consultant to work with, are essential for successful relactation.

Strategies for relactation

  1. Frequent and effective breast stimulation/milk removal
    There are many things that will help a mother relactate but this is the most critical component.  In fact, no amount of additional tools (galactagogues, skin-to-skin, etc.) will effectively build a milk supply without this first step.  Until beginning solids somewhere around the middle of the first year of life, babies nurse 6-12 times a day (or more!).  You will need to stimulate your supply at regular intervals both day and night.
  2. Stimulate your supply while feeding baby
    If a baby will latch and suckle at the breast, a mother can use an at-breast tube feeding device.  This allows her milk supply to be stimulated by her child rather than pumping or hand expressing.  It reduces a step because while you are “pumping” you are also feeding your baby.  As a mother begins to develop a milk supply she can reduce the amount supplemented in the tube feeding device.  It is important to make sure a baby has a good latch in order to effectively stimulate the milk supply.
  3. Pump if baby will not accept breast
    Frequent and effective breast stimulation (and milk removal once milk appears) is essential.  If your baby will not accept nursing at the breast with an at-breast tube feeding device, pump (ideally with a double electric breast pump) regularly – at least 8 times every 24 hours, for 15 minutes on both sides.
  4. Skin-to-skin
    Lots of skin-to-skin time together!  Breastfeeding is about more than the nourishment but also a relationship.  Skin-to-skin is wonderful for bonding as well as a mother’s hormones that help her breast milk supply.  It’s not just for newborns either.  Mothers and babies need lots of time together to build a mother’s milk supply and skin-to-skin contact is a wonderful way to spend this time.
  5. Galactagogues
    Galactagogues are herbal or pharmacological substances that can increase a mother’s breast milk supply.  Domperidone is generally considered the safest pharmacological option and fenugreek and blessed thistle are common herbal options.  Eating oatmeal several times a week or even daily may also increase milk supply.
  6. Acupuncture
    Acupuncture may also increase a mother’s milk supply through enhancing the secretion of the hormone prolactin, which is necessary for milk production.3
  7. Surround yourself with a tribe of support
    Relactation is not always easy!  It can take a lot of determination, work, and perseverance.  Having a support system around you cannot be overestimated!  Family and friends that can support and encourage you as well as getting involved in a local mother-to-mother breastfeeding support group are essential.  There will be challenges with relactation.  Having others to encourage you and share their experiences will help you tremendously.

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5 Challenges of Adoptive Breastfeeding

Mothers who are inducing lactation, trying to relactate, or planning to breastfeed an adopted child will face many challenges.  These difficulties are not insurmountable by any means. Most mothers who have been through this are thankful for the opportunity and believe the challenges are well worth it.

In fact, breastfeeding will not only provide your baby with the best start in terms of nutrition and health but also to help forage a strong bond between mother and baby.  Breastfeeding is a normal part of development and will allow your adopted child to participate in this important stage of life.

Being aware of the challenges mothers face will help prepare and equip you for the potential difficulties as well as strengthen your chances for success.

These are five common challenges adoptive mothers face when breastfeeding:

  1. Not having enough preparation time before receiving baby
    Rarely do parents know exactly when they will receive their adopted child.  Many parents start the adoption process and it takes years to complete.  Other parents receive their babies with just a day’s notice.  Stimulating your milk supply years in advance is no more tenable than expecting to have a milk supply overnight.  Even when a mother begins to stimulate her supply thinking it will just be a few months away there could be a roadblock in the process that causes an unanticipated delay or a milestone that eliminates the waiting entirely.  So, not knowing when a mother needs to have milk can lead to a situation where, for one reason or another, she finds she is receiving her baby and she hasn’t stimulated her milk supply.If you find yourself in this situation, there are a couple routes you can take.  You can put your baby to the breast immediately using an at-breast tube feeding device so that you can begin to bond through breastfeeding while allowing your baby to stimulate your supply.In addition, you can talk with your health care provider about taking Domperidone – a medication that has been shown to increase breast milk supply.  You can also take herbal galactagogues such as fenugreek and blessed thistle, along with eating oatmeal, to further help your supply. Another option is to try the accelerated Newman Goldfarb induction protocol which requires waiting 30 days before beginning to stimulate supply.In most situations, if your baby is willing to latch on your breast, there are many advantages to stimulating your supply breastfeeding with an at-breast tube feeding device rather than waiting to have your baby suckle.
  2. Finding the time to stimulate your milk supply
    If you already have older children, work outside the home, or have other competing demands on your daily routine it can be challenging to find the time to add in regular pumping sessions throughout the day and night.  Women can begin to feel exhausted or overwhelmed and question whether their bodies will respond with a milk supply and if it is really worth it, especially when many adoptive mothers don’t even know if their baby will latch and take to breastfeeding.  Hang in there – with dedication, determination, and regular stimulation your breasts will begin to make milk!
  3. Stress and worry about milk supply
    It is common for mothers to worry if their bodies are producing enough milk, if their baby is getting enough milk, and how to maintain breast milk expression when a mother must travel (especially with international adoption) to pick up her baby.  When stimulating a milk supply for adoptive breastfeeding, it is important to have the counsel of a qualified lactation consultant to help you in your specific situation.  She can help you figure out how much milk your body needs to make, if your baby is getting enough, and give tips for how to express when traveling – including hand expression when electrical currents are different.
  4. Helping baby transition to the breast
    Building a milk supply takes dedication and work, and most adoptive mothers don’t know if their infant will ever take to nursing at their breast.  In general, the younger the baby (particularly within first three months), or if the baby has been breastfed before adoption, the higher the chances for the infant to latch and breastfeed from the adoptive mother.1  Mothers worry that all their hard work to build a supply might still not afford them the opportunity to nurse at the breast.  However, while there are no guarantees, many adoptive babies can transition to the breast with time and patience.  Expressing milk on the nipple before latching the baby on is one technique to encourage an adopted infant to breastfeed.  Lots of skin-to-skin contact and availability of the breast – but without pressure – are other great strategies.  It is important to give an older baby time to trust his adoptive mother and feel safe at the breast; always make the breasts a happy place!  (You may also enjoy reading Strategies to Encourage Your Adopted Baby to Breastfeed.)Ultimately, even if your child doesn’t take to nursing at the breast, you can give her your expressed milk and do so in a way that still promotes bonding – paced bottle feeding at the breast, skin-to-skin contact while feeding, etc. Your milk is a special gift of love no matter how your baby takes your milk!
  5. Pumping and equipment difficulties
    Adding a new little person to a family is a major transition.  Sometimes “small things” can present large amounts of stress in these times.  Learning to pump, ensuring the flanges fit properly, and setting up a routine can present worry and stress.  Other mothers use an at-breast tube feeding device which can present additional steps – filling the supplement in the bottle, running the tubing, working on proper latch, cleaning and sterilizing the equipment afterwards, knowing how much milk to supplement and when to decrease the amounts…you get the idea.  It cannot be overestimated how important it is to surround a mother with support – from family, friends, other breastfeeding mothers, as well as qualified lactation assistance.