Lactation is the wonderous process by which the body is able to produce breastmilk, to nurture and nourish an infant. The beginning of lactation usually occurs early during pregnancy (around 15-20 weeks gestation), where the mammary glands of the breasts begin to mature due to hormonal changes. The breastmilk sits tight in the mammary glands until the birthing process. The removal of the placenta at birth triggers another cascade of hormonal changes, releasing the stored breastmilk, in readiness for breastfeeding.
One would therefore assume that pregnancy is a prerequisite for lactation to occur. However, and perhaps surprisingly, this is not the case. This information guideline will shed light on an even more fascinating aspect of lactation- and that is relactation.

Relactation is when the production of breastmilk is re-activated in the absence of pregnancy and can occur after variable time gaps, which may be days, weeks, months and even years, after not producing breastmilk.

Cases of Relactation

There are many anecdotal cases of relactation where valiant grandmothers started breastfeeding their grandchildren - infants who were either abandoned or orphaned. There are also cases of aunts, friends and strangers doing the same. Relactation is also applicable in cases of adoption. I have even had colleagues, who when helping certain families to breastfeed or studying for their lactation exams, found that they started producing breastmilk!

Ordinarily, there are some mothers who consider relactation as they did not or could not breastfed initially (for various reasons), yet they yearned for the breastfeeding experience. Whilst others who had initially breastfeed and weaned their infants, simply wanted to start again.

What does relactation involve?

The process of relactation involves two main aspects:

1. Building a breastmilk supply

Establishing a supply of breastmilk is achieved by breast stimulation and the removal of breastmilk from the breast (even when there isn’t any initially). Lactation works on the basis of demand and supply. So, by creating a demand, supply is stimulated and increased. This can be done by hand expressing, use of a breast pump, and allowing the baby to suckle at the breast. It is important to note that nipple stimulation and removal of breastmilk needs to be done consistently (every 2-3 hours) in order for relactation to be successful. This includes pumping throughout the night. Duration of pumping and milk removal is recommended to be a minimum of 10 minutes up to 20 minutes. The more frequently you stimulate the breast, the more quickly you will be able to build your supply.

The amount of breastmilk that each woman is able to produce will vary, depending on many factors such as: previous lactation experience, health conditions and lifestyle. Even though many mums are able to achieve satisfactory breastmilk volumes, some women may still require supplementation in order to meet the energy needs of their baby.

Here are recommendations of how you can initiate and build your supply of breastmilk when relactating:

• Preparing your mind to relactate
• Preparing your body to relactate (diet, exercise, lifestyle)
• The use of a double electric breast pump/hospital grade pump
• Breast massage
• The use of medication (these require a prescription from your doctor)
• The use of herbal supplements (fenugreek, milk thistle, shatavari, moringa, oatmeal, Mrs Milk Bars)
• Seek help from a certified lactation consultant for questions and concerns about any of the above recommendations.

2. Getting the baby used to feeding from the breast

In order for direct suckling to be successful, the baby must be offered many gentle opportunities to gain comfort at the relactating woman’s breast, even if there is no milk as yet. Breastfeeding is learned behaviour and it is therefore important not to force the baby to suckle or to create a negative association at the breast.

From what is understood about relactation, the younger the age of the infant, the better the chance of relactation. Also, the shorter the gap between weaning and relactation, the quicker or easier it is for a woman to reach partial or full relactation.

This does require patience as some babies are able to adapt back to feeding at the breast faster than others. These are recommendations of how you can get your infant to suckle at the breast. If these do not work, remember that even by expressing your breastmilk (regardless of the volume), your baby will still get the benefits of your breastmilk.

• Increasing skin to skin contact
• Use a supplementary nursing system
• Use a nipple shield
• Trying different breastfeeding positions and checking for a good latch
• Use a pump after feeds (to ‘empty’ the breast and stimulate more milk production)
• Check your baby’s growth is on track
• Alter the way in which supplemental feeds are given

The importance of support

The time frame and the volume of breastmilk that can be produced, through relactation can vary amongst women. Relactation can sometimes be a long and intense experience that can bring about several physical and emotional changes. It is therefore recommended that you discuss your intention to relactate with your family, friends and health care providers. This is so that your personal and professional support systems can be established and maintained through the relactation process. It is also recommended that you are realistic about your expectations and what this process will involve. It is important to think about your reasons and motivations of relactation and what it means to you and your baby. Seek the help of a certified lactation consultant, who in collaboration with your doctor, will be able to guide you according to your family’s specific circumstances. Every drop of breastmilk counts! Relactation is not always easy, but it is possible!

References

• https://ibconline.ca/relactation/
• https://academic.oup.com/tropej/article-abstract/27/1/52/1696265
• https://www.sciencedirect.com/science/article/abs/pii/S0378378297000546
• https://academic.oup.com/tropej/article-abstract/39/1/45/1706927
• https://kellymom.com/bf/got-milk/relactation/
• https://www.motherlove.com/blogs/all/want-to-start-breastfeeding-after-stopping-our-guide-to-relactation
• https://exclusivepumping.com/relactation-pumping-schedules/
• https://www.llli.org/breastfeeding-info/relactation/
• https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/supporting-families-withrelactation.html