The Reasons for Premature Weaning and Process of Relactation



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Counseling a Mother for Relactation



The Reasons for Premature Weaning and Process of Relactation


  • Take a lactation history to understand the reasons for the mother weaning

  • Work to help mother resolve the situation that caused weaning

  • If lack of information: provide correct information

  • If lack of support: help mother do all she can to build support from her family; refer to support groups

  • If a physical/medical/emotional problem was present: Be sure these are explored and resolved or being properly treated

  • Educate the mother about process of relactation and maintaining lactation once resumed.

  • Realistic expectations: If mother had a full milk supply, can still express drops of milk easily, and baby has only been weaned a few weeks the expectations of achieving a full milk supply are excellent. If weaned longer than 2 to 3 months, a partial supply is probable, with a full supply a possibility, but should be a welcomed bonus if it occurs.

The Mother: Making Milk


  • Begin nipple stimulation and breast emptying to reestablish milk supply

  • Encourage baby to suckle at the breast as much as possible.

  • Pump/express after every feeding, if baby is not yet willing to go to the breast, aiming for 8 or more pumpings per 24 hours. . A medical grade double pump is best.

  • Manual nipple stimulation by the mother and her partner can also increase prolactin.

  • Mother should rest, eat well, increase fluid intake and clear her calendar to allow time to spend with baby. Mother also should gather as much positive, practical help as possible from her support system.

  • Glactogogues, foods, herbs and possibly prescription (with caution and knowledge of side effects) may be used to promote more rapid increase in milk supply

  • As mother’s milk supply increases, formula may be decreased.

  • Baby’s stools will change back to breastfed stools as baby consumes more mothers’ milk.


The Baby: Back to the Breast


  • Continue to feed baby ample amounts of his usual formula, gradually replacing it with mother’s breastmilk, from breastfeeding or pumping as that becomes available.

  • The first rule is always FEED THE BABY!

  • Mother should keep a record of how much supplement, formula or breastmilk is given to baby daily. Breastmilk should always be used first as it becomes available and formula used to make up the difference of the total amount needed.

  • To assure proper nutrition for baby, weight checks every few days are recommended, especially if supplements are decreasing. Baby should continue to gain weight appropriately for his age and size.

  • If the baby in continuing to gain ½ oz to 1 oz per day the supplements can be decreased gradually by about ½ oz to 1 oz off the daily total of supplement given every few days.

  • Begin coaxing, “wooing”, baby back to the breast. This may take hours to weeks.

  • Begin lots of skin to skin contact and give direct breastfeeding a try. Some babies with amaze you by latching on after weeks and sometimes months away from the breast.

  • Try breastfeeding when the baby is sleepy.

  • Encourage as much skin to skin contact between mother and baby as possible, enhances mother/baby attachment and helps reawakens baby’s instincts to breastfeed.

  • If baby will breastfeed, provide nourishment at the breast via tube device or syringe. If possible accomplish all feedings at the breast.

  • A nipple shield at the breast sometimes works like magic. If the baby will breastfeed this way provide nourishment with a tube device or syringe under the shield and try to accomplish all feeds at the breast. Give baby a while, probably several days, feeding this way while increasing skin to skin contact, then begin taking the shield off from time to time and coax baby to take the breast.

  • DO NOT FIGHT WITH THE BABY AT THE BREAST! This is counter productive and gives both mom and baby negative feelings about the breast. Urge, coax, woo, cajole, but do not try to force the breast into the mouth of a screaming infant. Stop and feed the baby in whatever way that he accepts and work with other ways to woo baby to breast.

  • Skin to skin/body contact to woo baby to the breast

  • Add more skin to skin contact while bottle-feeding. Hold baby cheek to breast or cheek to mothers forearm. Mother should increase skin to skin contact in as many ways as possible: wear clothing that permit more skin to skin contact such as tank tops or bathing suit tops, take a bath with baby, nap skin to skin with baby, etc.

  • If baby is refusing the breast, introduce parent’s clean finger for pacification as often as possible to introduce the taste of skin into baby’s mouth.

  • Use a comfortable cloth baby carrier, the sling type work well, and carry baby between feedings during moms normal activities.



Reducing Baby’s Dependency on the Bottle


  • Replace some bottle feedings with cup, spoon-feeding, or finger feeding along with lots of body contact with mother.

  • If baby has been using a short bottle nipple, replace with the longest, widest nipple available to teach baby to open wide and take nipple into his mouth deeply.

  • If baby rejects these methods, do not force him. Feed with bottle while increasing the skin to skin contact, holding him to the breast during bottle feeds and after feeds for loving.

Supporting the Mother


  • Praise and encourage the mother throughout this process.

  • Praise and applaud every small bit of success

  • Counsel patience—Mother’s expectations may or may not be realistic

  • Point out progress to the mother. Sometimes the mother cannot see the progress she is making.

  • Monitor baby’s weight gain and decreasing supplementation carefully assuring baby is well nourished throughout the process.

  • Remain available to her throughout this process.

  • If possible offer other mothers for her to talk to who have gone through this process and can offer encouragement.

  • Accept mother’s decisions, remembering that total breastfeeding is the optimum, but any amount of breastmilk and loving mother-infant contact is advantageous

© Jane Bradshaw RN, BSN, IBCLC, RLC



September 2012
Counseling the Mother for Induced Lactation

The Process of Induced Lactation/Adoptive Breastfeeding


  • Take a reproductive, medical and lifestyle history. General health, medical conditions, family situation and support, etc. Mother may never have been pregnant, may have struggled with infertility or may have biological children who she may have breastfed previously. Is she taking any medications that may inhibit milk production, such as hormones (estrogen), antihistamines, decongestants?

  • Educate mother about induced lactation while being factual but optimistic, and help her toward realistic expectations, especially toward the unknown amount of milk she may produce.

  • Educate and value both the milk and non-milk advantages to breastfeeding.

  • Value even small amounts of breastmilk she may produce as a wonderful bonus for her baby.

  • Educate about her choices of supplementation devices.

  • Give her resources, reading materials, web sites, and phone numbers of other mothers who have breastfed adopted babies.

  • Be positive and encouraging, but factual, about induced lactation and the results of her efforts, especially regarding her potential milk supply.

  • Be accepting of her feelings, questions, attitudes and decisions.



The Mother: Inducing a milk supply

  • Hormonal simulation of a pregnancy can be used if 1 month or more before receiving baby. (Newman/Goldfarb protocols: www.asklenore.info) Follow plan for hormones, when to discontinue and begin pumping and begin galactogogues.

  • Breast/nipple stimulation

  • If mother chooses and placement of baby is expected within 4 to 6 weeks, mother may begin using a breast pump, medical grade double electric pump, several times a day, increasing the frequency as she is able up to 8 to 12 times each 24 hrs.

  • May not be able to do any stimulation before receiving the baby, but begin by first introducing baby to the breast as soon as baby arrives.

  • Mother may eliminate pumping when the baby breastfeeds well for all feeds.

  • Encourage mother to use her breast for comfort suckling without the tube device anytime. This added stimulation further enhances induced lactation

  • May take prescription or non-prescription Galactogogues



The Baby: Introducing the Breast

  • Begin coaxing, “wooing”, baby to the breast. This may take hours to weeks.

  • If baby is a newborn, consider breast refusal just like you would for any other newborn and don’t take “no” for an answer.

  • Give direct breastfeeding a try. Some babies with amaze you by latching on immediately even after weeks in foster care and bottle feeding since birth.

  • Try breastfeeding when baby is sleepy and after feeds.

  • When working with baby at the breast for feeds, always provide immediate nourishment at the breast via tube device or syringe to build the association in the baby’s mind that the breast is a source of food and satisfaction.

  • If possible accomplish all feedings at the breast and encourage a period of several weeks where baby is only fed by the mother at the breast. This encourages bonding thoroughly before any bottles are used for outings or if mother must return to work.

  • Eliminate all pacifiers and bottles if possible. If baby is refusing the breast use mother’s or father’s clean finger for pacification and skin to skin contact for comfort as much as possible.

  • A nipple shield at the breast sometimes works like magic with a baby who is thoroughly bonded to the bottle, and can be a good transitional tool. If the baby will breastfeed this way provide nourishment with a tube device or syringe under the shield and try to accomplish all feeds at the breast. Give baby some time, probably several days, feeding this way while increasing skin to skin contact, then begin taking the shield off from time to time and coax baby to take the breast with just the tube device.

  • Do not fight with the baby at the breast and never stress the baby with hunger! This is counter productive and gives both mom and baby negative feelings about the breast. Urge, coax, woo, cajole, but do not try to force the breast into the mouth of a screaming infant. Stop and feed the baby in whatever way that he accepts and work with other ways to woo baby to breast and try again when baby is calm.



Skin to skin/body contact to bond and woo baby to the breast


  • If baby is refusing the breast add more skin to skin contact while bottle-feeding. Hold baby cheek to breast or cheek to mothers forearm.

  • Mother should do most or all of the feedings so baby bonds with her as primary caregiver and source of food.

  • Mother should increase skin to skin contact in as many ways as possible: wear clothing that permits more skin to skin contact such as tank tops, bathing suit tops, etc., take a bath with baby, take naps and sleep skin to skin with baby at night, etc.

  • If baby is refusing the breast, introduce parent’s clean finger for pacification as often as possible to introduce the taste of skin into baby’s mouth. This should be stopped and replaced with the breast for comfort as soon as baby is willing.

  • Use a comfortable cloth baby carrier, the sling type work well, and carry baby between feedings during moms normal activities.



Reducing Baby’s Dependency on the Bottle


  • Feed baby at the breast as much as possible. Give pumped milk or formula at breast. Equipment: tube device, nipple shield, syringe, dropper.

  • Replace some bottle feedings with finger feeding, cup, or spoon-feeding along with lots of body contact with mother.

  • If baby gags easily and has been using a short bottle nipple, replace with the longest, widest nipple available for some time, and gently teach baby to open wide and take nipple into his mouth deeply.

  • If baby rejects these methods, do not force him. Feed with bottle while increasing the skin to skin contact, holding him to the breast during bottle feeds and after feeds for loving comfort and bonding.

Supplements and Determining Mother’s Milk Supply


  • Continue to offer the appropriate amount of formula for the baby’s weight and age. Baby may gradually decrease the amount of formula consumed, indicating he is getting more milk from mother, leaving formula in the tube device or bottle and acting satisfied.

  • Monitor baby for continued appropriate weight gain. Baby must gain appropriately, or supplemental feeds should be increased enough to produce the needed gain.

  • Teach mother signs of milk transfer, breasts firmer before feeds, softer after, audible gulps when suckling at the breast when supplement is not being offered.

  • Observe baby for stools changes that indicate breastmilk consumption: stools becoming looser and more frequent, more yellow and seedy like a breastfed stool.

  • Do not attempt to limit the amount of formula baby consumes, but you can work to increase the amount of time baby breastfeeds by dividing up large feedings into smaller portions so baby is willing to breastfeed more often.

  • May reach a plateau of supplementation or progress to a full milk supply depending on the situation. Remember the benefits feeding at the breast and of partial breastmilk feedings are great. The goal is a happy mother and baby and as much breastfeeding as

Supporting the Mother


  • Praise and encourage the mother throughout this process.

  • Praise and applaud every small bit of success

  • Counsel patience—Mother’s expectations may or may not be realistic

  • Offer resources and support groups, (local and online) other mothers who are nursing adopted infants.

  • Point out progress to the mother. Sometimes the mother cannot see the progress she is making.

  • Remain available to her throughout this process.

© Jane Bradshaw RN, BSN, IBCLC, RLC



September 2012


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