Back to Breastfeeding
Relactation, breast refusal, oral aversion
Sometimes breastfeeding is interrupted to the point when you need to reboot the whole thing.
Relactation
The decision to stop trying to overcome breastfeeding problems is often made at our lowest point and when we feel there is no other option. This might be following advice from health professionals, opinions of family members, feedback from your partner or overwhelming emotions and tiredness.
Relactation is the process of stimulating milk production after a period of not removing milk regularly by direct feeding or expressing. This is usually weeks or months down the track. The human breast is a complex system and its flexibility is surprising. Even if you have only small signs of lactation, like being able to squeeze a trace of milk from the breast, you can boost production to once again meet some or all of your baby’s daily needs! In fact, women who have never been pregnant or breastfed can establish a breastfeeding relationship with adopted babies!
Breasts are amazing!
Some people find they can still express breastmilk months or even years after they stopped feeding or pumping!
It needs to be acknowledged that the process of relactation is demanding and time consuming initially.
Understanding your motivation is an important part of preparing to relactate. You might find it useful to discuss this with a breastfeeding counsellor or IBCLC lactation consultant.
Feelings of regret or even guilt can be common when breastfeeding proved too hard and sometimes we need to work through these emotions. How would you feel if relactation did not work out for you? Would that experience lead to you feeling better or worse?
Have health issues in your baby led to you feeling your breastmilk would be a better option for them? Have you discussed this with your medical team? Is this an immediate or potential need? Could donor milk be an option in the short-term?
Do you feel supported in pursuing relactation right now? Who would be there to help you care your baby, home and self while you spend time re-establishing milk production? Are your partner and family members going to understand your decision and help you achieve your goals? Is this something your doctor or nurse will understand and support? Who can you turn to for support - local breastfeeding support group? IBCLC lactation consultant? Midwife?
How does relactation work?
Stimulation of the nipple area and removal of milk from the breast work together to mimic your baby and trigger the hormones responsible for lactation. The hormones prolactin, progesterone and oestrogen prepare breasts to make milk during pregnancy. However, prolactin can also to do this independently, which means you can stimulate lactation by putting your baby on the breast to suck or hand expressing. Once things kick in, you can add in pumping but using your hands is most efficient initially. When lactation begins again, regular removal of milk supports ongoing milk production - the more you take out, the more you make.
Relactation is a lot easier if your baby is happy to go on the breast. Even if your milk production has been suppressed, “dry nursing” will help to activate it again. If your baby is reluctant to attach, there are ways to encourage them. These can also be useful when breastfed babies are refusing the breast or for babies who have developed aversions due to medical intrusion into their mouth and need to learn to trust the breast.
When babies are reluctant to go on the breast.
Breast refusal can occur suddenly, for no apparent reason or can follow a negative experience at the breast. Babies who have been predominantly bottle fed with expressed milk, donor milk or infant formula can become confused and seem to lack the skills to attach to the breast. Babies who have been fed through naso-gastric tubes or have been fed through alternative feeders due to clefts of the lip or palate may not know they can be fed at the breast.
Patience is the key to helping babies learn to breastfeed, and to support babies who do not have a positive experience of being fed. Refusal to breastfeed can feel like rejection and you might worry that your baby hasn’t bonded with you or has a preference for other caregivers. All of these feelings are valid.
Make the breast their “happy place”
Skin-to-skin contact can be of enormous help for you and your baby on the journey to the breast. Approach this with zero expectations that your baby will attach. Where practical, go about your normal infant care dressed with minimal clothing between you and your baby. Bottle feed with your chest bared and your baby dressed just in a nappy. Share a bath with your baby. Wear them in a baby carrier which has no fabric between you. Massage your baby while they are in skin contact with your lap or chest. Make the sight, feel and smell of your chest a place they are calm and relaxed. Minimise scented skin and body care products so your scent is dominant.
Baby-led attachment will allow your baby to take the lead if and when they are ready. This won’t be about feeding initially. Feed your baby as usual and while they are in a quiet, alert state after a feed, lie them against your chest and see what happens. If your baby usually falls asleep after bottle feeding, try offering most of the feed but hold some back to finish the feed after some time against you. The newborn reflexes which trigger seeking and attaching are still present for several months and your baby’s instincts might kick in, even if breastfeeding has not been a recent experience.
Offer a bridge between the bottle and the breast.
A nipple shield can feel a lot like a bottle teat and babies who are familiar with bottle feeding can be tempted to feed using one. If you have a milk supply but a baby who is wary of the breast then they might latch on. You might be able to switch from bottle to shield without them noticing if you baby is sleepy or no longer ravenously hungry.
If you are working on stimulating milk production, a nipple shield plus a Supplemental Nursing System can give your baby an experience of sucking at the breast and receiving milk while taking the available milk from your breast and stimulating production.
Babies who gain comfort from sucking and use a dummy might be happy to suck at the breast with a shield in place instead. Limit comfort sucking on a bottle by offering the breast and shield towards the end of a feed. Use a cup instead of a bottle so your baby will fill the sucking bucket at the breast instead.
Take advantage of your sleeping baby!
Some breast refusers will contentedly breastfeed when they are asleep. Some will even refuse all day but breastfeed all night! Breastsleeping is a useful tool in this instance as babies take a surprising amount of the daily intake during the night. This nighttime sucking does wonderful things for you breastfeeding hormones as well.
A baby in a light stage of sleep might not notice a change to what they are feeding from.
There are no promises when it comes to getting babies back to the breast. Every situation is unique and outcomes are so variable that we cannot compare experiences easily. Sometimes the timing just isn’t right. There are babies who are happy and content on formula and it doesn’t feel right to make changes because of how you feel. Babies might be enthusiastic and take to the breast eagerly but you can only partly meet their need for milk at the breast and mixed feeding continues. Any breastmilk matters and whatever path you take your relationship with your baby is most important.
