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INDUCED LACTATION
1
Relactation &
Induced Lactation
Jane Bradshaw
RN, BSN, IBCLC, RLC
Objectives
Define induced lactation and relactation
Describe historical and cultural examples of cross-
nursing, relactation and wet nursing
Describe indications for induced lactation and
relactation
Describe the physiological and hormonal
requirements for lactation without a pregnancy
(nonpuerperal)
Discuss 2 different methods to induce lactation
List at least 3 herbal, 2 nutritional and 2 prescription
galactogogues
Describe methods to encourage a baby to nurture or
feed at the breast when the mother does not have a
full milk supply
2
The Dream
3
Breastfeeding is important for infant survival
and is extremely flexible
4
Wet-nurses from Spreewald
(region in East Germany)
http://www.youtube.com/watch?v=k
TkZ6RhL6i8
5
Australian
Breastfeeding
Association
Products: www.mothersdirect.com.au
Resources
Relactation: Review of
experience and recommendations
for practice
Authors: World Health Organization
Number of pages: 38
Publication date: 1998
Languages: English, French,
Spanish
ISBN: WHO/CHS/CAH/98.14
Go to WHO website:
http://www.who.int/en/
Search: relactation
6
June 29, 2012 storm power outage
PROPERTIES
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7
Breastfeeding an Adopted Baby
and Relactation
by Elizabeth Hormann
Full price$10.95 Online price$9.95
Your Price/Member price$8.95
Soft cover Book/Single Item
Description
Did you know that induced lactation
and relactation are possible? Author
Elizabeth Hormann explains how in this
book. Some of the topics discussed
include: preparation for adoptive
breastfeeding; substances that
stimulate milk production; beginning
breastfeeding with an adopted baby;
and sources of support for adoptive
parents. Ideal for mothers who wish to
breastfeed an adopted baby or
relactate, as well as for the health
professionals who assist them.
http://store.llli.org/public/search?utf8
=%E2%9C%93&q=Relactation&commi
t=Go
8
Why relactate?
Convinced of the benefits of breastfeeding,
dont want baby to miss out
Infant may be doing poorly on formula
Mother intended to breastfeed but
circumstances hindered it
Desire to experience all the aspects of
mothering
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Survey of 366 women who
relactated
Some went to the breast easily
39% baby nursed well on 1st attempt!
32% babies were ambivalent about BF
28% baby refused the breast
BUT within 1 week 54% had taken the
breast well
By 10 days 74% taking the breast well
Time, patience and persistence important
Midwifery Today E-News (Vol 1 Issue 8, Feb. 19, 1999)
10
The Five Protective Factors
http://www.childwelfare.gov/preventing/preventionmo
nth/factors.cfm
Nurturing and attachment
Knowledge of child development
Parental resilience
Social connections
Concrete support for parents
Protective factors
Protective factors are conditions in families and
communities that, when present, increase the health
and well-being of children and families. They are
attributes that serve as buffers, helping parents who
might otherwise be at risk of abusing their children
to find resources, supports, or coping strategies that
allow them to parent effectively, even under stress.
Research has shown that these protective factors
are linked to a lower incidence of child abuse and
neglect.
11
Nurturing and attachment
Infant care and strategies that promote
bonding and attachment (e.g.,
breastfeeding, rocking, using a baby
carrier, responding to crying, talking
lovingly, consistency within and across
caregivers, and stability of primary
caregivers)
Myths
Many women cannot produce enough milk
It is common for the milk to dry up at any
point in breastfeeding and there is no
reason or remedy
It is natural for a baby under 6 to 9
months, even before solids are begun, to
wean himself
12
Myths
A mother is selfish for wanting to induce
lactation or reestablish breastfeeding
There is no benefit or reason to restart
breastfeeding baby got all the benefits in
the first few weeks
It is too stressful and not worth it to
relactate
13
Relactation issues
Emotions
Will baby take the breast?
Time since termination of
breastfeeding
Support system
Should not be approached as
an all or nothing activity,
although exclusive
breastfeeding is certainly
possible and optimal
Relactation issues
Mother needs
Factual, accurate information
She may have myths and misinformation about
breastfeeding that may have caused her to stop
Education about relactation
Mother needs
Validation and praise for
Her mothering & choices she has made
Her efforts and any amount of breastfeeding
14
Relactation issues
Mother needs
Support throughout the process
Weight checks for baby
To assures baby gains well throughout the
process
Dictates the safety of reducing supplements
15
Goals
To establish/reestablish the breastfeeding
relationship and to create a milk supply so
baby receives his mothers breastmilk
AAP & WHO goals
AAP: Breastfeed at least 1 year
WHO: Breastfeed at least 2 years
US Breastfeeding Committee
Increase duration of breastfeeding
50% at 6 months
25% still breastfeeding at 1 year
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Induced lactation issues
Primary goal is to nurture the baby at the
breast
Any amount of breastmilk is a bonus
17
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18
Physiology of induced lactation
Necessary Unnecessary
Breasts
19
Breast preparation
With a normal pregnancy
Prepares the breast
Estrogen and progesterone, and Human placental
lactogen cause proliferation of the ductal and
alveolar system
Without a pregnancy
Breast stimulation alone increases the hormones
from the anterior pituitary and causes mammary
growth
Women have used hand expression or a
breastpump before the baby arrives to start the
process
20
Pre-baby breast preparation, or not
Depends on timing of arrival of baby and
mothers preference
Some mothers choose to pump, weeks or
months in advance
May begin gradually with 5 min three times a
day, then 10 minutes and increase to every four
hours
Drops may appear in about a month
May begin galactogogues
OR upon receiving baby, mother may just
put him to breast with tube device with no
breast prep
(Newman/Goldfarb protocols)
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Newman & Goldfarb protocols
www.asklenore.info
www.asklenore.info
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Newman & Goldfarb protocols
Regular Protocolmothers have produced
enough milk for 60% to 100% of babys
needs
Accelerated Protocol25% to 50% of
babys needs
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23
Creating a milk supply
Relactation
Milk may increase rapidly or slowly
depending on circumstances and length
of time since weaning
Induced lactation
No colostral phase
Typically begins 1 to 4 weeks after
initiating breast stimulationmuch
sooner with hormonal preparation
Galactogogues:
Prescription medications
Metoclopramide (Reglan)
AAP: Listed as drug of concern
Caution due to side effects--depression
Taper slowly to reduce rapid drop in milk supply
Domperidone
Does not cross blood-brain barrier
AAP: Listed usually compatible for BF
In US may be available thru a compounding
pharmacistmuch political controversy
Sulpride
Thyrotropin-releasing hormone
Chlorpromazine
Human growth hormone
Theophylline
Oxytocin: Can be compounded as a nasal spray to
enhance MER
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Galactogogues: Nonprescription herbs,
foods & others
Acupuncture
Hypnosis--
visualization
Lactation cookies
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Composition of induced lactation breast
milk
http://www.fourfriends.com/abrw/Boot%20Camp/bc1.htm
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Hindrances to a milk supply
Some medications
Hormonal birth control
Low thyroid (hypothyroidism)
Anemia
Smoking
Rapid weight loss
Hx hormonal problems, breast surgery or injury
Retained placenta
Insufficient glandular tissue
Breastfeeding management issues
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What may hinder milk supply?
Herbs & foods
Sage
Thyme
Mint
28
Signs of breastmilk production/intake
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Supplementation
1st choice:
Feeding at breast
Tube devices: SNS, and
Lact-Aid
Syringes (periodontal),
droppers
2nd choice:
Cups, spoons
3rd choice:
Bottles: socially acceptable
& easy
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30
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Supplementation
Offer ample amounts to produce
appropriate weight gain of baby
Can estimate amount of breastmilk baby is
receiving by calculating:
Babys weight X 2.5 to 3 = 24 hr total of ounces
baby consumes
Subtract amount of formula consumed in 24 hrs
= approximate amount breastmilk baby is
receiving
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Decreasing supplements--relactation
Weight checks are essential to prevent
stressing baby by underfeeding
May initially weigh every 2 -- 4 days
Can decrease supplementation gradually as
long as baby is gaining
Add amounts back if baby stops gaining
Let the baby decrease the supplements on
his own
Breastfeed twice before giving a
supplement
Divide supplement into more smaller feeds
Supplements
32
Getting the baby to breastfeed
33
Mother/Baby time
Nipple shield
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Tube devices
35
Using the Lact-Aid
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Pitfalls
Magic milk syndrome
Exaggerated expectations
Socially unacceptable
Expectation to turn
lactation on and off, due
to embarrassment or
social situations
Burnout
37
Case study
3 month old infant
Mother had difficult birth, sore nipples and
gave up breastfeeding within 3 weeks after
the birth
Regretted missing out on breastfeeding
Began skin to skin
Pumped every 2 to 3 hours
Case study
Began coaxing baby to breast using a
nipple shield with a tube device
Within 3 days receiving most of his
feedings at mothers breasts
Weight checks every 3 to 4 days to assure
appropriate gain
After 2 weeks baby was taking less and less
formula
By 1 month baby was completely breastfed
without formula or nipple shield
38
The breast is an amazing organ!
Breast stimulation alone can produce
hormonal changes to cause growth and
proliferation of the milk glands, and milk
production.
Hormonal protocols are available & can
prepare the breasts, like pregnancy and
women have been able to produce more
milk: Up to full a milk supply in some
circumstances.
In summary
Women can resume breastfeeding after
stopping and should be helped and
supported to do so
Women who birth through adoption or
surrogacy can also look forward to enjoying
mothering their babies by breastfeeding
They can produce milk, varying on the
preparation time and circumstances
39
In summary
The non-milk benefits of breastfeeding are
extremely valuable and deserve as much
attention, praise and support as the milk
benefits
A partial milk supply and any amount of
breastfeeding should be celebrated
In summary
40
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41
Forum and Bibliography
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