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The sucking skill is inherent in babies by nature. A newborn who is put to the breast knows what to do to get milk. For almost all children, this mechanism turns on automatically. In some cases, when the mother has problems, the baby is first given a bottle , after which the child refuses the breast . A similar problem can also arise if a nursing mother needs to go away and in her absence the baby will be fed expressed milk from a bottle.
What is relactation?
In my work as a breastfeeding consultant and a physician, I often conduct classes among doctors, and I talk, among other things, about relactation, and even experienced doctors familiar with anatomy and physiology are surprised at this, and for many mothers this seems simply an impossible miracle. Where did this “new fashion trend” in GW come from?
In reality, this is far from a new and fashionable trend in breastfeeding, but a well-forgotten experience of generations, which is actively remembered and applied today. Such traditions and experience are completely unfairly forgotten. Until the twentieth century, the very fact of relactation or the feeding of a baby not by its own mother, but by a grandmother or other relative who might not even have given birth yet, was difficult to surprise anyone. Then there were no stores with adapted artificial formulas, and women often died during or after childbirth, or they had to work in the fields and care for other children and livestock. Then grandmothers could take care of newborn children, putting the babies to their breasts and feeding the children with their milk. This was quite a common tradition.
There were other traditions, especially in the nomadic tribes of the Mongols and Tatars - sons were born into the family, they grew up and left families, building their own families. If a daughter was born into a son’s family, she was reproached by the son’s wife, and if the firstborn was a son, he was given to his grandparents to be raised, as if giving them a grandson instead of themselves. Then the mother-in-law took care of the child, and she breastfed him thanks to relactation. Such traditions of peoples were an absolutely normal phenomenon, and no one perceived them as something special.
And today there are a sufficient number of cases of successful relactation, described by WHO and other authoritative breastfeeding support organizations, when bottle-fed children are successfully returned to full breastfeeding. In addition, many mothers of adopted children taken from the maternity hospital successfully breastfeed thanks to relactation.
A survey conducted by WHO among 366 women who tried the relactation method on themselves proved that more than half of them returned to full breastfeeding within a month. For another quarter of the mothers surveyed, this process took longer, and the remaining women maintained, if not complete, but at least mixed feeding with a sufficient volume of breast milk in it.
But it is worth immediately warning women that the process of relactation is very difficult and does not happen very quickly. In order to at least partially, or better yet completely, restore breast milk production, you need a lot of patience and desire from the woman herself, a lot of effort on her part and full and qualified help from consultants, support from family and friends.
Is relactation really possible?
From a physiological point of view, lactation is a stimulated and hormone-dependent event in a woman’s life. In fact, if a situation arises in a woman’s body when milk production is necessary, then the female body activates the processes that are responsible for its production. However, this is simple in theory, but in practice it is necessary in each case to develop a correct and suitable scheme for managing relactation in each mother-baby pair.
It is simpler and easier to return breast milk, increase its quantity, or start lactation for the first time if the child is very young, up to about three to four months. It is especially good if the child has been attached to the breast and fed on it for at least some time in his life, and therefore knows how to suck from the breast.
It is easier to teach the baby to take the breast again if he was not fed with a nipple from a bottle, but was fed from a cup or special soft spoons, sippy cups or a special SNS supplementary feeding system. In such cases, the child will quickly remember his innate reflexes for correct latching on the breast, which will be one of the most important successful components of relactation.
The relactation process is much more difficult and longer if the baby was bottle-fed. In this case, a lot of strength and patience is required from the woman. When feeding from a bottle, as well as when sucking a pacifier, confusion arises in the child, since the mechanisms of sucking breast and artificial breast substitutes are different. At first, the baby may persistently refuse to breastfeed in favor of pacifiers and bottles.
It will be more difficult to undergo the process of relactation without skin contact if the child has rarely been picked up before and has rarely been carried naked, pressed against the mother’s bare belly. It is difficult if the baby is already older than four months and if he has not known at all in his life what milk from the breast is, as, for example, this happens during adoption.
But all these difficulties do not mean that relactation is impossible. In my practice, I had a mom who switched her baby back from formula to full breastfeeding at eight months and successfully nursed her baby until she was two years old.
Refusing the bottle
To restore the sucking reflex to the child, you need to show all the benefits of feeding from the breast. It is necessary to complicate the process of bottle feeding. Reduce the hole in the nipple for milk, and the newborn will need more strength to suck the milk. Having tried the breast, the baby should like to eat this way, and not tiresomely suck on the nipple.
If your toddler is feeding formula from a bottle, has not tried mother's milk and does not take the nipple, you need to strain the milk into a bottle and offer it to him. Give expressed milk gradually and then offer the breast. The baby should feel the difference in the milk and, smelling the smell of mother's milk, will take the nipple.
After the bottle, you can wean your baby to the breast using a deceptive method. Special silicone nipple covers are sold. A newborn may not notice the difference with a pacifier and will take the nipple. Such covers will prevent cracks from appearing on the nipples.
By following the appropriate rules, you can quickly learn how to put your baby to the breast.
How can this be done?
Milk is produced by the mother's body as a result of the action of a special pituitary hormone - prolactin. There is another “milk” hormone - oxytocin, which is responsible for the release of milk from the breast. The pituitary gland is one of the most important endocrine glands in the body and is controlled by the woman’s nervous system. The pituitary gland is especially dependent on the influence of the cerebral cortex and subcortical structures. Milk hormones react sensitively and quickly to the mother’s emotions, her desire and desire to breastfeed, her conviction in the benefits of milk and the need to breastfeed the baby. It is due to the desire of the mother and her positive attitude that the pituitary hormones responsible for inducing lactation become more active and faster. Due to a positive attitude and motivation, stable lactation will be further maintained for as long as the mother and baby need. Maternal instincts with the direct participation of the baby will also be very important here - his sight and smell, the touch of his skin - all this triggers a cascade of positive emotions, influencing the depths of the subconscious, which helps in activating lactation. If the baby suckles at the breast, he actively stimulates the nipple, which gives powerful impulses to the brain and triggers milk production processes.
Knowing this information brings us to two important conditions necessary for a successful relactation process, and it is with them that all work on establishing breastfeeding will begin. The first condition is the mother’s indispensable desire to breastfeed and her positive attitude, confidence in the success of the matter and the desire to act in this direction, the help and support of loved ones and their confidence in success. On the part of the mother, she will have to expend a lot of effort and show patience, put aside household chores and focus only on lactation.
The second condition is the child’s desire to attach to the mother’s breast. This condition is more difficult than the first, especially if the baby was bottle-fed, but now the mother has no milk at all or very little of it, and the baby does not get enough to eat when suckling at the breast. In this case, the help of consultants and a doctor is important in calculating supplementary feeding (breast milk or formula, donor milk) taking into account the increasing volumes of breast milk during relactation.
Why won't my baby latch on after a bottle?
A bottle with a nipple is a substitute for the mother's breast. But in fact, the process of sucking on a mother's breast is not at all like drinking from a bottle . A baby who is fed from a regular bottle is forced to activate completely different mechanisms and muscle groups than when breastfed.
A regular nipple is harder or too soft than the mother's breast. A baby who is fed from a bottle often begins to pinch the nipple with his gums, and in the case of a bottle with a narrow neck, the baby stops making a wide grip - it is not possible to do a similar maneuver with the mother's nipple.
Also, with breastfeeding, the child opens his mouth wide and he has to make special peristaltic movements with his tongue to stimulate lactation. When the first feeding is done with a bottle, the child perceives this as the norm, and the breast seems to him a foreign object. Approximately the same problem awaits families where the baby is temporarily fed only from a bottle. As a result, the baby experiences “nipple confusion .
The process of returning the baby to the breast
Based on everything that was said earlier, the most important stage should be the baby’s beginning to suckle at the breast, his desire to latch on and stimulate the breast. And the question of milk flow is only a matter of active stimulation of the pituitary gland and some time. Without stimulation of the breast by sucking, relactation will not be successful. Even if you practice pumping, it will not be effective and you won’t get much milk. Of course, pumping also plays an important role, but the key to relactation is stimulation through sucking.
But if a child does not want to take the breast at all, refuses it, how can he be persuaded to do so? This will be the most difficult task for the mother and the lactation consultant, requiring patience and desire to do it all.
It’s worth starting with skin contact, bodily touching, of which there should be as much as possible. The ideal option would be 24-hour skin-to-skin contact with the baby. This awakens in the child the memory of being in the mother’s womb and his unconditioned reflexes, and in the mother it starts the process of stimulation of reflex zones and active irritation of the pituitary gland. Constant bodily contacts trigger complex psychophysical connections in the woman’s cerebral cortex; the mother’s tenderness and love for the baby leads to an increase in the level of love and pleasure hormones - endorphins and prolactin, which stimulates milk production. As contacts progress, the baby awakens to the memory of sucking the breast as one of the integral moments of contact with the mother, and he shows a desire to attach to the breast and suck. This is one of his innate instincts: immediately after birth, the newborn can find the breast and nipple on its own, and attach to the breast if it is placed on the mother’s stomach. Skin contact gives him the opportunity to remember all these instincts, and at this time his mother gives him the breast for unlimited sucking.
From the consultant's practice: the baby does not latch on to the breast
Kiryusha is a beautiful, strong boy, with an angry voice and light fluff on the top of his head. He was born on his own, on time, mother Karina felt good after the birth, but there was no colostrum in the first day, according to her, at all. The baby sucked persistently, cried a lot, and sucked again. The doctors said that he was hungry and needed to be fed, and they began to bring them bottles of formula. And by the evening it turned out that my mother had a piece of placenta left, and they sent her for cleaning.
Karina said that the next day the colostrum did not appear, in the evening she had another ultrasound and was again sent for cleaning. And they told me not to put it on my chest - there’s nothing there anyway. So the baby ate formula from the bottle again. And on the morning of the third day, colostrum came, and in the afternoon - milk. Everything seemed to be fine, but Kirill no longer wanted to suck his mother’s breasts full of milk. He sucked from the bottle willingly and greedily, and took the breast into his mouth, winced, licked it, spat it out and cursed terribly.
Mom had to express with a breast pump and give this expressed milk from a bottle. The boy ate a fair amount, but did not fall asleep, tossed around, and whimpered. Karina was afraid that the baby was crying because he was not eating enough, which meant there was not enough milk. That’s why I supplemented Kirill’s diet with formula. After the mixture, the boy fell asleep, and for a long time, he could sleep for four hours at a time.
Here, too, problems began with the breasts - it was difficult to empty with a breast pump, and it began to ache. During these few days at home, my mother was so tired that she was already thinking about stopping breastfeeding, but Karina’s grandmother, who fed her mother until she was two and a half years old, convinced her to try to persuade Kiryusha to breastfeed. And Karina’s friend told her just in time that there are people who will teach the baby to negotiate with the breast. Well, let's start negotiations.
I arrived in the morning, Kirill was still sleeping, and at that time my mother and I discussed why the baby was worried at the breast and refused to take it. The fact is that breast and bottle sucking are very different; completely different muscle groups are involved. And the material of the nipple itself is much more rigid than living breast tissue. Babies get used to pinching the bottle nipple with their gums, and then they try to do the same with the breast: they can’t hold it, and they cause pain to their mother. In addition, when extracting milk from a bottle, you do not need to open your mouth wide, nor do you need to create peristaltic movements with your tongue in order to extract the milk and move it further. And if a bottle is put into the baby’s mouth first for feeding, then it is this “material” that he takes as the norm, pushing out the breast like a foreign object.
But he was worried and did not fall asleep because he wanted to suck in order to calm down and fall asleep, and not because he was hungry. The mixture, which is much heavier for the gastrointestinal tract of babies than breast milk, “switched off” him, like a boa constrictor that had just swallowed a rabbit. That's why he slept for so long - he digested it. Breast milk is digested much faster, which means babies wake up more often and are ready to feed again.
There is a big plus in the fact that Kiryusha is only a few days old. He has not yet had time to “forget” how to suckle. After all, this mechanism is embedded in it on a subconscious level - all babies (maybe with the exception of children weakened by difficult childbirth, very premature or with developmental features of the maxillofacial apparatus) know how to suck, although no one taught them this. And the need for sucking is very great; this is one of the basic needs of a child, which is needed not only for food, but also for development. The method of returning to the breast is based on this: we remove everything that sucks except the breast (bottles, pacifiers, we don’t allow finger sucking) - the child will have no choice but to start sucking what is given. And this is what my mother and I need.
Of course, as long as the child “remembers,” no one leaves him hungry. Mom feeds with expressed milk or formula, but from non-sucking objects - a spoon, cup, syringe, etc. will do. Newborn babies usually quickly understand the new rules of the game, the main thing is the mother’s clear actions.
Karina is a very anxious mother, she was worried, she said: I won’t torture my son, I don’t want him to cry, I’d rather bottle feed him. Here it is very important to show that no one is going to torture the child: we don’t let him cry, we offer the breast without pressure, we act very gently and with love. Then Kiryusha woke up, and we went to practice the technique.
She helped Karina hold the baby comfortably, we learned how to make a fold that was easy to grasp, offered the breast in motion, reassured her, offered her again. Kirill clearly wanted to take her, but he couldn’t do it - the breast slipped out, milk splashed in all directions, on Karina and me, on the baby’s face, he winced angrily and swore. We tried to apply it from under the arm - the same picture, he was indignant right with the breast in his mouth. But then I sprayed milk from a syringe into the corner of his mouth, and he sucked it in! Apparently, this helped Kiryusha create a vacuum, and things went well.
He sucked with wide open surprised eyes. “Oh, what am I doing?!” - it was written on his face. And Karina had a look of relief and anxiety on her face: “Now you leave, but how will I do it myself?” The boy sucked for about ten minutes and fell off. Mom began to try again so that she could do it too. After several unsuccessful attempts, she herself sprayed it into his mouth, also from a syringe with expressed milk - and he sucked again, for about two minutes. He was about to doze off, his chest slipped out, and the boy instantly woke up.
We fell behind for a while with breastfeeding, the mother praised, hugged, kissed the baby, and told him what a great fellow and hero he was. Then I showed Karina how to syringe feed. Mom quickly understood and gave me some expressed milk. And when Kiryusha began to close his eyes again, he again put his breast into his mouth and, with a practiced movement, splashed milk into the corner of his mouth - and Kirill began to suck again. And then he fell asleep, letting go of his chest. Mom and I sat down in unison on the floor next to the sofa: we felt as if a carload of coal had just been unloaded. But Karina had a completely different mood than at the beginning of our meeting - a feeling of victory and that everything would work out.
I left her with this wonderful feeling and agreed to call the next evening. Karina called - everything is fine with them. After I left, they never used the bottle again and didn’t even need supplemental feeding from a syringe! Several more times she gave the breast the same way as during the consultation - with a small supply of milk from a syringe into the mouth at the beginning of the application, and by the evening even this was no longer necessary: Kiryusha remembered everything and began to take the breast himself. True, so far only in the position from under the arm, but on your own! I really praised them, they did such a powerful job. Another week later, Karina said that her son agreed to eat both in sitting positions and lying down, so that at night everyone finally managed to get some sleep.
If your very young child does not want to take the breast because he was bottle-fed in the maternity hospital, and you really want to return him to the breast - know that it is possible! If mom is determined, that’s more than half the success. The baby himself will help you. Well, we, consultants, will also try.
Problems returning to breastfeeding
One of the most important problems with relactation is the reluctance of children to return to suckling at the breast, especially if there is little or no milk in it. You should not be persistent and constantly give the baby the breast if he turns away and is heartbroken from hunger. You need to develop complete trust in the breast, and not reinforce a categorical refusal of it. For this reason, in the first stages of relactation, the baby will definitely need supplementary feeding (formula or expressed milk). But for complete success, this supplementary feeding should not be given from bottles with nipples. It is also important to completely stop using pacifiers.
If you do not remove nipples and pacifiers from your daily routine, relactation simply will not work, since the mechanisms of sucking a nipple and breast are fundamentally different and involve completely different muscle groups. Sucking on a bottle is easier because the liquid from it practically drips into the mouth, while milk from the breast must be extracted with effort.
You can use a pipette for supplementary feeding if the child is very small, or a special Hageman sippy cup, as well as a 20-50 ml syringe with a tube at the tip so that supplementary feeding can be carried out directly on the chest. Also, for supplementary feeding at the breast, especially if the volume of supplementary feeding is very significant, they use a special soft spoon or a special supplementary feeding system - SNS. This system allows the baby to suckle at the breast in the correct position, and at the same time receive the nutrition he needs, since if the baby is hungry, he will not at all want to help stimulate the mother’s empty breast.
You need to offer the breast for latching and sucking when the baby is completely calm, when he is sleepy or relaxed. You can do this on the go, while rocking the baby and communicating with him, stroking him. An excellent help for relactation is the use of special designs for carrying children - slings (they are sewn from fabric and put on in such a way that the child is always at the breast, freeing up the mother’s hands). The sling can be used from birth almost around the clock, which provides full skin-to-skin contact.
A mandatory recommendation is to co-sleep with your baby and give him unlimited access to the breast at night. This is important because lactation hormones are released in maximum quantities at night, and their peak concentrations are reached between three and eight in the morning. Therefore, latching on to the breast and sucking at night will be one of the mandatory components of relactation; this process should not be abandoned.
The “nesting” method can be used perfectly, which involves privacy in a room with the child alone, listening to quiet music, with the windows curtained, in a state of complete rest. You should try to spend the maximum amount of time in this “nest” so as not to be distracted by anyone or anything except going to the toilet and eating. Such contact and communication calms mother and baby and allows them to achieve breastfeeding and sucking. To make the child do this more willingly, gently drip milk or formula onto the nipple of the breast, the child will taste and lick the liquid, thereby trying to latch on and suck the breast. Gradually, the child will do this more often and more willingly.
The baby has learned to latch onto the breast, what to do next?
If you have persuaded your baby to suckle, then you have gone through almost half of the relactation process, and now you only need to consolidate your successes and increase the volume of milk, without in any way limiting the baby’s ability to suck the breast. It is necessary to put the baby to the breast almost every hour or two, or at his request and desire, but not less than once every two hours. It is very good if the baby spends at least twenty minutes at the breast, and it is better if he falls asleep with the breast, not letting go of it and continuing to suck. But at the same time, it is important to monitor the attachment to the breast so that long-term feedings do not bring discomfort to the mother due to rubbing of the nipples, which occurs when the latch is incorrect. With prolonged and frequent feedings, the breasts are completely emptied, which means that this stimulates the addition of milk according to the “supply and demand” principle. The more milk is sucked from the breast, the more it arrives at the next feeding.
It is also worth worrying about additional portions of milk; frequent breast pumping will help with this, although at first there may be no milk or there will be very little of it. Frequent pumping and breastfeeding perfectly stimulate the release of lactation hormones. Pumping is carried out every two hours during the daytime, and lasts no less than 15-20 minutes, and also at least two to three times at night.
A warm shower in the area of the shoulder blades and back, relaxation and massage, as well as taking various types of lactogenic preparations - dishes, herbal infusions or teas - help well. In addition, it is important to eat well and rest as much as possible.
Sometimes, in special situations of inducing lactation, medications that have a lactogenic effect may be prescribed to help in milk production. These include metoclopramide or domperidone, they are taken according to a special regimen under the supervision of a lactation consultant. But just taking medications to stimulate lactation without the measures described above will not be enough; a whole range of actions for relactation is needed.
How can you solve the problem?
Almost all parents have to use a bottle for their baby. Today, there are bottles on the market that are designed specifically for breastfed babies. Physiological nipples of a special design minimize the likelihood that the baby will refuse the breast. An example of such products are feeding bottles from the Japanese brand Pigeon with an innovative physiological nipple that allows the baby to reproduce natural sucking movements. They differ from ordinary bottles in such qualities as:
- A nipple with a wide base - the baby has to open his mouth as wide as with breastfeeding
- Textured surface of the base of the nipple - allows lips and tongue to easily glide over the surface as if it were the skin of the breast (regular smooth silicone has the property of sticking).
- The diameter of the nipple corresponds to the sucking fossa - the Pigeon brand has four sizes of nipples for children of different ages
- The hole is the right diameter - you have to suck as hard as your mother's breast
- A special ventilation valve prevents air from entering the nipple, thereby minimizing the occurrence of colic in the baby from swallowing air.
- When sucking, the same muscles work as during breastfeeding.
Such a bottle will not create a problem with breastfeeding and the mother will be able to go about her business without weaning her baby from breastfeeding, but at the same time she must ensure constant support for lactation (!).
Pigeon bottles and nipples have undergone clinical trials to support breastfeeding at the Scientific Center for Children's Health of the Russian Academy of Medical Sciences (2013).
Breast milk is not only nutrition for the baby, but also a way to calm down and feel close contact with the mother. After breastfeeding is restored, you can also start using Pigeon bottles with an innovative nipple if additional feeding is necessary.
Controlling the relactation process
In order for relactation to be complete and effective, you need to constantly monitor the child’s condition and the sufficiency of his nutrition. It is important that the child does not experience nutritional deficiencies and gains weight. Another point should be monitoring the mother’s condition and her mood, the condition of the breast and contact with the child. Usually, after a difficult period and the appearance of the first success, mothers perceive the process with enthusiasm, and in the future the process proceeds more actively and confidently.
Mothers are recommended to keep a special diary or fill out special forms in which they will note the number of feedings per day and their duration, the baby’s reaction to all feedings, as well as the number and volume of pumping and the number of supplementary feedings. Adjustments to the relactation process are carried out approximately every five days with the help of a breastfeeding consultant or by the mother after training on her own. A guideline for the sufficiency of a child’s nutrition is the “wet diaper test” - the number of urinations per day produced by the baby.
Naturally, relactation is a labor-intensive process, long and painstaking, and to achieve success you need patience and desire, but the result is worth it. Not a single mother who successfully carried out relactation regretted her decision and the efforts expended.
Photo - Lori's photo bank
