Ask any breastfeeding mother why she’s chosen to breastfeed. She’ll probably tell you about the benefits to herself, her baby and her family, as well as the joy and satisfaction of meeting her baby’s needs for food, protection and security through breastfeeding. Mothers who give up after a difficult start may miss this experience. And when a much-longed-for baby is adopted or born by surrogacy, the reasons for breastfeeding can be just as powerful and compelling. Breastfeeding is more than the provision of milk, with its protective and nourishing qualities. An adoptive mother may choose to nurture her baby at the breast, regarding any breastmilk as an added benefit. And mothers who relactate often do so to re-establish the breastfeeding relationship.
Will I make enough milk?
Relactation—a second chance at breastfeeding
Breastfeeding an adopted baby
Increasing Milk Supply By Breastfeeding
When a baby is reluctant to breastfeed
Moving away from supplements
Define your own success
Maintaining Milk Production
This will depend on your individual situation. Many mothers find they can produce enough milk to be able to give up supplements totally. While there is no guarantee that you will be able to meet all of your baby’s needs, you can maximise the amount of breastmilk he receives. Any amount of breastmilk is beneficial. Even if you haven’t managed to cut out supplements totally by the time your baby is over six months old, solid foods can gradually start to replace any formula supplements
It can be easy to give up breastfeeding, even if things are going fairly well. Many mothers fail to establish breastfeeding because of difficult circumstances such as lack of access to accurate information and/or lack of support. They end up giving up breastfeeding, but then regret their decision.
An induced birth and separation led to feeding difficulties and Toby losing too much weight. He had to be treated for jaundice and was later hospitalised with an infection. Vicky started to bottle-feed her baby with infant formula to ensure he started gaining weight. After all she had been through, she felt sad and guilty but also slightly relieved.
“Back home we settled into a routine of bottle-feeding, but day by day I became more and more upset by my decision. My baby would turn to me to try to breastfeed and I couldn’t believe that I couldn’t do it. After a week of not breastfeeding I deeply regretted my decision and contacted La Leche League, where I was offered the support and encouragement I needed. At the time I had no idea it was possible to restart breastfeeding once you had given up. I started by putting my baby to the breast as often as possible and before every formula feed.
It was only a couple of days before I felt the milk coming in and my breasts started to feel full before feeds. I found I didn’t really have time to express as I was breastfeeding a lot of the time. Some afternoons I spent hours breastfeeding but I didn’t let this worry me and just sat down with a good book or a movie. I continued to supplement with formula, writing down the amount I was giving at each feed and gradually started to reduce it. In fact, as I was reducing the last bit Toby suddenly jumped up in weight so I realised he actually didn’t need the top-ups and I just needed confidence that I had enough milk to feed him.
I am so pleased that I made the decision to give it another go. It has been hard work but never a chore. Every day I continue to feed Toby I feel amazed at what I’ve achieved. He’s now four months old and is a big, healthy baby.”
From LLLGB’s Breastfeeding Matters issue number 178.
It is possible to establish milk production for an adopted baby, even if you have never been pregnant or given birth.
“Carly came to us at 12 weeks. Her foster mother from day two had been lovely to her. She had Carly on infant formula feeds. The first time I put Carly to my breast she happily latched on, even though there was no milk and no supplementer.* Wow! I’d forgotten the strength of a baby’s suck. It didn’t make me sore and soon I was used to it and loved having another baby to nurse.
Her big brother (who was home-made) had fully weaned three years before. My attempts to assemble the supplementer were hopeless for the first day or two. Not that it’s difficult, but I was anxious, so her dad got it ready for me to just hang round my neck. Carly easily did the switch from bottle to breast with supplementer. Pretty soon I noticed her dirty nappies showing breastmilk stools (yellow, runny, sweeter smell) along with the artificial infant milk ones. I soon had a thirst at feeding times and needed a glass of water next to me.
Then a couple of weeks or so on I had a go at expressing and saw some drops of real live breastmilk! I knew a lot of theory but still doubted my body’s ability to lactate without childbirth. Nearly three months on, Carly didn’t need any more infant formula than she had at 12 weeks old, so my breasts were making the rest of her requirements. Her skin glowed in that breastmilk way. I really felt like I was her mum.
The breastfeeding, along with using a baby carrier lots of the day and keeping her nearby at night, helped me bond. Certainly it wasn’t just as easy and convenient as fully breastfeeding, but it was worth the effort. I shall always be thankful for such a good start to mothering our adopted child.”
* Nursing supplementer—a device worn by a mother through which her baby receives other milk whilst nursing at the breast. For more information, see Supplementation (below) and our page on Nursing Supplementers.
During pregnancy, hormones cause the milk-making cells and milk ducts in the breast to enlarge and multiply. Colostrum (low volume milk, high in protein and antibodies) is produced from late in pregnancy. After birth, milk is produced and released in response to the baby’s suckling and the hormones prolactin and oxytocin. For a mother who has previously breastfed, stimulating the breasts to produce milk without pregnancy and childbirth is called relactation. If you have never had a baby before, this process is called induced lactation.
Milk production depends upon a number of factors, including:
• Your baby’s age and willingness to breastfeed effectively.
• Frequency of breastfeeding and/or milk expression.
• Whether you have ever been pregnant, and how long ago.
• Effective treatment of any medical conditions you have, eg thyroid problems or diabetes.
• Extent of any previous damage to your chest/breasts/nipples eg surgery, burn or other injury.
• Extent of any previous damage to the pituitary gland in your brain (where the necessary hormones are produced).
• Reason for any infertility.
• Practical and emotional support available to you
It’s possible to induce lactation successfully and increase milk production just by breastfeeding frequently and/or expressing. It can take anything from a few days to a few weeks to be able to express a few drops of milk. You can express as you prepare for the arrival of your baby and/or while you encourage him to the breast. Certain hormonal, herbal, pharmacological and dietary treatments can also help stimulate milk production (see Galactagogues below).
If you are adopting, you can also stimulate breast development and induce lactation using oral contraceptives. www.asklenore.info describes various protocols, depending upon how long it will be before you are likely to welcome your new baby into your family. However these methods are not suitable for mothers who can’t take oral contraceptives or are taking medications to suppress oestrogen levels.
Medical conditions and breastfeeding
If you have a medical condition and/or are taking any medication, tell your doctor that you are planning to breastfeed. Lactation can affect the management of certain medical conditions. Mothers often find medical conditions improve or are easier to manage while they are lactating. If a medication you are taking is incompatible with breastfeeding or may affect milk production there are usually alternatives. An LLL Leader can research information about any medications you take and about breastfeeding with specific medical conditions.
Learning to breastfeed
Your baby will probably have already experienced bottle-feeding, and breastfeeding may be a totally new experience for him. He may take to it quickly or need time and patience to get used to this new way of feeding. Mothers have found that even babies older than three or four months can still learn to breastfeed. Breastfeeding may be a new experience for you too so finding good support and information on the basics of breastfeeding, including comfortable positioning and attachment will be invaluable. Check out the Further Reading section on p20. If you are relactating it may also help to talk to an LLL Leader about the issue that caused you to stop breastfeeding in the first place. If possible attend your local LLL group. You can be sure of support and information, even if you attend while bottle-feeding.
Close contact really helps
Offer lots of close contact and carrying, either skin-to-skin or lightly dressed, to help your baby associate close contact with pleasure and comfort. Offering to breastfeed before he is too hungry or when he is sleepy may help him respond instinctively to the sensations of being held at the breast. Breastfeeding, rather than using a dummy, when your baby needs to comfort suck can encourage him to nurse more too.
At first you will probably need to supplement some breastfeeds with your expressed breastmilk or infant formula. Alternatives to using a bottle can help your baby with the transition to breastfeeding, depending on his age and previous feeding experiences. Nursing Supplementers has details of how to use supplemental nursing systems. Nursing supplementers are devices worn by a mother through which her baby receives other milk whilst nursing at the breast. For older babies, cups are also an option. There is more information on managing and reducing supplements in My Baby Needs More Milk.
If bottles are used
If you choose to use a bottle to give supplements, the following tips can help your baby switch to breastfeeding.
• A smaller teat hole prevents a baby being overwhelmed with milk; a larger one means he has to suck less strongly.
• Hold him in an upright position, using your hand to support his neck and head.
• To encourage your baby to open wide, place the teat across his upper and lower lips with the tip at the ridge between the upper lip and nose.
• Allow your baby some control. Let him take the bottle teat into his mouth himself. Avoid pushing the teat into his mouth.
• Tip the bottle just enough to give a gentle flow so your baby isn’t overwhelmed with milk. As the bottle empties, you’ll need to gradually tip the bottle more and lean your baby back.
• Encourage frequent pauses to mimic breastfeeding.
• Allow your baby to decide when he has had enough.
If you have expressed breastmilk, give this first, before you give your baby any infant formula supplement. To make the most of your precious milk avoid mixing the two together. Infant formula supplements need to be prepared just before use and according to current safety guidelines (see below). Allow prepared powdered formula to cool to body temperature or below so as to avoid burns. Although expensive, using ready-to-feed formula may be more convenient when you are out and about or at home without help. Concentrated and ready to feed forms of infant formula are less likely to clog nursing supplementer tubing than powdered forms.
Using infant formula
You will probably need to use infant formula whilst you work to increase your milk production. Powdered infant formula is not a sterile product. To reduce health risks associated with using infant formula, follow carefully the NHS guidelines for preparing it.
It may take a little patience to get your baby to nurse effectively. If your baby is willing, offer the breast every one to two hours and at least 10–12 times in every 24 hours. Cut out any dummy use and let him breastfeed for comfort as well as food to help stimulate milk production. Be prepared to encourage night-time and frequent evening nursing, as this can be particularly good at increasing milk production. Laid back breastfeeding positions also boost the levels of the hormones that increase your milk. A soft carrier or sling can be a handy way of keeping your baby close and encouraging breastfeeding.
Start and finish at the breast
Babies expect fast flowing milk at the start of a feed when they are thirsty. So: 1. Breastfeed first from both breasts, using breast compression (see box below) to encourage flow, until your baby begins to fuss. 2. Offer a supplement until he is not quite satisfied. 3. Then finish the feed at the breast, using breast compression again. This can work well even if you need to give larger amounts of supplement. If your milk production is very low you can start feeds at step 2 until it increases a little.
Try breast compression
This technique can encourage a baby to breastfeed actively and take more milk.
1. Support your breast with one hand—thumb on one side, fingers on the other.
2. Wait while your baby breastfeeds actively, his jaw moving all the way to his ear. When he stops swallowing, compress your breast firmly to increase milk flow and prompt swallowing. Hold it squeezed while he continues nursing actively then release your hand.
3. Rotate your hand around the breast and repeat step 2 on different areas of the breast.
Go gently—this should not hurt. Experiment to find what works best for you. Try switching breasts at least two or three times during each feed—when he comes off the first breast on his own, or when breast compression no longer keeps him breastfeeding actively. With time, your baby will need less and less breast compression to keep him actively nursing, until you will find that you no longer need to do this.
A deep, comfortable latch
Attention to positioning and attachment will help ensure your baby is feeding effectively. You can try experimenting
with different feeding positions. Many mothers find laid back or Biological Nurturing™ a good way of encouraging a baby to nurse really well. Many babies instinctively seek the breast and attach deeply and comfortably if they can snuggle up close to their mother’s chest for periods of time. Try letting your baby lie on your body, skin-toskin or lightly dressed, as you recline so both his chest and tummy are against you. As your body supports your baby, this leaves your hands free to help with latch on. See Positioning & Attachment for more information.
Some babies who are accustomed to taking a dummy or supplements from a bottle may not take a big enough mouthful of breast and might need to be coached to get a wide enough mouth. Try opening your own mouth very wide and encouraging your baby to look at and imitate you. If you can’t get comfortable speak to an LLL Leader who can give you further suggestions.
Take a ‘baby moon’
Get some help with household jobs, ignore the dust and eat simple, easily prepared meals for a week or two so you can concentrate on breastfeeding your baby. A couple of days’ bed rest together with your baby can really boost your milk production. Even if you can’t manage this, do plan some time each day to sit or lie down with your baby.
Signs that your milk is increasing include:
• Hormonal changes, such as a brief slump in mood before your milk appears.
• Breasts feeling hotter, tingling, fuller or heavier.
• Feeling thirsty when breastfeeding.
• Leaking milk and/or being able to express more milk.
• Your baby gains weight and produces more wet and dirty nappies, especially yellow, mustard-coloured poos.
• Your baby starts to refuse supplements.
Some babies don’t take to breastfeeding straight away. It can be enormously frustrating if he refuses but patience and gentle persistence can work wonders.
Ideas to try
• Offer close contact skin-to-skin or lightly dressed for sustained periods of time each day even if your baby is reluctant to latch on at all.
• Letting your baby doze on your chest in Biological Nurturing™ or laid-back positions may prompt him to seek out the breast instinctively. Bathing and sleeping together can also have the same effect.
• Express a little milk to stimulate your let-down so your milk flows as soon as he latches on.
• Or offer a little supplement to take the edge off his hunger and help calm him before you attempt to breastfeed.
• If he will latch on, use breast compression to help maintain your milk flow. You can switch sides to maintain his interest too.
Encouraging a reluctant baby to nurse can become stressful. Try to keep calm and avoid conveying anxiety to your baby. Some mothers find relaxation exercises helpful. It’s quite possible that, once your baby is comfortable and relaxed with the closeness, he may latch on when you least expect it, especially if you are expressing to increase your milk production. And even if he doesn’t, you will still have pleasant memories of times spent in close contact together. Remember that you are spending time expressing as well as feeding and caring for your baby. You are doing far more than a mother who is simply bottlefeeding or breastfeeding alone. Be gentle on yourself and take time to meet your own needs for food and rest.
While your baby is slow to gain weight or not breastfeeding well, keep offering the same amount of supplement. If you get to a point when you are expressing enough milk each day to meet your baby’s needs then you can encourage your baby to get all his milk at your breast instead and gradually cut out the expressed milk supplements. Offer frequent feeds making sure he is latched on well, and use breast compression to help maintain milk flow if his suckling slows or stops. Switching sides several times during a feed can help maintain his interest in nursing and maximise the amount of milk he takes.
Reduce supplements gradually
Once he is nursing and gaining weight steadily, and you are producing more milk, you can start reducing supplements gradually.
• Reduce the amount of supplement every few days so your baby continues to get plenty of milk.
• It’s best to reduce all or several of the day’s supplements by very small amounts, about 5–15ml for each one.
• At times of the day when you feel as though you have more milk, for example, in the morning, you may be able to reduce a supplement by 20–30ml.
• Keep an eye on your baby’s wet and dirty nappies so you know that he’s taking plenty of milk.
• Keep in touch with your health visitor or GP for regular weighing, and to discuss reducing supplements. Be prepared to take things more slowly if your baby becomes fussy or seems hungry. You may need to slow or temporarily stop reducing supplements.
Before your baby is breastfeeding
The more frequently you express, the more milk you are likely to make. Express at least 8 times each 24 hours, including once during the night if possible. Try to establish a routine you can sustain on a day-to-day basis, and fit in extra sessions on days when you have more time. Milk you express before your adopted baby arrives can be frozen for later use. Even a little breastmilk, however small, is beneficial for a baby. An actively nursing baby is more effective at stimulating milk production than any pump, so you can continue to work to induce and increase your milk supply once your baby arrives and/or is breastfeeding.
In addition to breastfeeding
You can express between feeds to stimulate milk production if your baby is reluctant to take the breast or is sleepy and not feeding effectively. You can also express after breastfeeds (either immediately or after a short break) to help stimulate milk production. Expressing even small amounts after feeding boosts milk production. You can give any milk you express as a supplement before you give formula. If your baby will go to the breast frequently, breastfeeding really is the best way of increasing your milk. Expressing milk is an extra, to give your milk production a boost. Mothers who breastfeed frequently (10–12 times a day or more) and don’t have the time to express any milk often increase their milk and establish breastfeeding fastest. Don’t be surprised if you don’t notice any increase in the amount of milk you can express. If you are nursing your baby frequently, he will take the extra milk directly at the breast without you realising.
Hand expression is very effective, especially for mothers producing small amounts of milk. The skin contact helps stimulate milk flow. Hand expression also works well when combined with pumping. Use it to stimulate your milk flow before pumping, to maintain flow whilst you are actually pumping and/or after pumping to express milk the pump has not reached.
Hospital-grade pumps are considered the most effective for mothers needing to induce or increase their milk supply. Pumping both breasts at the same time saves time, stimulates milk production and boosts milk-producing hormones better than single pumping. When pumping one breast at a time, try switching back and forth between breasts as your milk flow slows. Sterilise equipment once a day if your baby is healthy. Just like your milk, pumping equipment can safely be left at room temperature for short periods and refrigerated in a clean container for longer periods, giving you more time for your baby. See Storing Your Milk for details.
Making time to express
It can help to think of expressing time as an enjoyable break to have with a drink, snack or treat. Put your feet up and listen to, watch or read something you enjoy. Find something that makes you relax and smile. The less you think about the process, the more you may be able to express.
Try expressing your milk:
• In the evening if your baby sleeps—to ‘put in an order’ for more milk tomorrow.
• During or after skin-to-skin contact.
• Little and often—as frequently as you can manage.
More information about expressing your milk.
Medicinal herbs such as fenugreek or prescription medications such as domperidone can increase milk production in conjunction with breast stimulation. Galactogogues are effective only when combined with frequent nursing or expressing to ensure breasts are kept well drained.
Many mothers can increase their milk by nursing and expressing alone and don’t need galactogogues. Galactogogues can have side effects. They also need to be taken regularly and in sufficient doses. Even then, not all mothers respond to them. Milk production can drop if you suddenly stop taking a galactogogue so it’s best to cut back gradually and only once you feel confident you are producing more milk than your baby currently needs.
Take three 500mg capsules, three times a day (nine per day in total). It takes 24–72 hours to see an increase in milk production. Possible side effects include perspiring more profusely and sweat and urine smelling like maple syrup. A few mothers have developed diarrhoea and a few mothers with asthma have reported aggravation of their symptoms. Two cases of fenugreek allergy have been reported (fenugreek is closely related to peanuts). Be cautious if you have diabetes, since fenugreek lowers blood sugar. If you develop any worrying symptoms, stop taking fenugreek and consult your doctor if necessary.
You will need a prescription from your GP. The dose usually recommended is one or two 10mg tablets three times a day. Domperidone is not licensed for use as a galactogogue.
From UK Medicines Information (document will download for viewing):
‘As there are limited alternative options for the stimulation of lactation, the use of domperidone can be considered provided there is evidence of thorough evaluation for treatable causes such as poor attachment, and when increased frequency of breastfeeding, pumping or hand expression of milk has not been successful. A maternal dose of 30mg daily for a maximum of 1 week should not be exceeded.
Domperidone should not be used if the mother or infant:
- have conditions where the cardiac conduction is, or could be, impaired
- have underlying cardiac diseases such as congestive heart failure
- are receiving other medications known to prolong QT or potent CYP3A4 inhibitors e.g. ketoconazole or erythromycin. If this is the case, metoclopramide is the preferred alternative.
- have severe hepatic impairment’
Relactation or adoptive breastfeeding can be a big commitment. Some mothers consider it but decide it is not for them. Whether or not you choose to go ahead with it, just knowing that it is a possibility can help you come to terms with what you have experienced and to feel in control.
Relactation or adoptive breastfeeding is probably best entered into with equal measures of optimism and realism. You might find it helpful to define your own level of success in what you aim to achieve. You may be able to bring in a full milk supply, but even small amounts of breastmilk are beneficial. If your main purpose is to enjoy the closeness of breastfeeding, you can aim to nurse for comfort whenever possible and use a nursing supplementer for feeds. Any breastmilk you produce is a bonus for your baby.
Every drop of breastmilk counts To maintain milk production as long as possible while supplementing with formula:
• Breastfeed often and as long at each feed as your baby is willing to, including nursing for comfort between feeds.
• Avoid going longer than eight hours without breastfeeding or expressing.
• Use breast compression to maximise the milk your baby receives each time he goes to the breast, and to help keep your breasts well drained.
• Give formula only after he has nursed. • Offer the breast again if he is willing after taking a formula supplement.
• Whilst your baby’s weight gain is steady, avoid increasing the amount of formula he receives.
Some mothers find their milk production drops temporarily just before or when they are menstruating. If you continue to breastfeed and/or pump, milk production will increase in a few days.
Out at work?
• Compensate for lack of daytime nursing by encouraging some night-time nursing.
• Make extra efforts to increase your milk on days when you are off work. As your milk production increases, or after days at home, your breasts may feel fuller. Be prepared to express milk while at work to keep comfortable, to prevent engorgement and to reduce the risk of mastitis.
There may come a point when you decide to stop because establishing breastfeeding isn’t working out. Pumping to keep up milk production takes a lot of time and is not a long-term option for many mothers when a baby doesn’t take to the breast easily. But whatever happens, be proud because every single drop of breastmilk you have given your baby will have been beneficial. You know that you did everything possible to make breastfeeding an option. If you have another baby, don’t hesitate to get in touch with La Leche League again. Making contact with LLL before your baby arrives means you can share your concerns and gather information to help avoid problems. Knowing who to contact means you’ll be able to get help quickly to prevent any minor problems in those early weeks from escalating.
LLL groups are a great source of support for all mothers who are working to establish breastfeeding, whatever their circumstances. If you plan to adopt or have a baby born by surrogacy, you can attend LLL meetings before your baby arrives just like other expectant mothers.
Written by Karen Butler, Sue Upstone, and mothers of LLLGB
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
The Breastfeeding Answer Book. Schaumburg, IL: LLLI, 2003.
Breastfeeding an Adoptived Baby & Relactation. Hormann, E. Schaumburg, IL:LLLI, 2006.
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, Tx: Hale Publishing, 2010.
The Breastfeed Mother’s Guide to Making More MilkK. West, D. and Marasco, L. McGrawHill, 2009.
Exclusively Pumping Breastmilk Casemore. S. Gray Lion Publishing 2013
Dummies and Breastfeeding
Expressing Your Milk
Hand Expression of Breastmilk
My Baby Needs More Milk
My Baby Won’t Breastfeed
Positioning & Attachment
Safe Sleep & The Breastfed Baby
Storing Your Milk
This information is available to buy in printed form from the LLLGB Shop
Copyright LLLGB 2016