Expert: Sally Wendkos Olds - 10/1/2009

Question
I breastfed my first two kids, and with my third she was born very under weight. she was born at 37 weeks and only weighed 3lbs 14.9oz.  The doctor said she had IUGR (intra uterine growth restriction).  I wanted to breastfeed her as I had with the other two.  The doctors suggested that she needed more calories at first than breast milk had.  She needed 22 calories per serving, and breast milk has 20...  I was ok with that as long as I could supplement with breastfeeding.  Well I tried and for a while it went great.  For a time I was even able to get her entirely off of the formula.  As circumstances would have it I had to go to work full time when my daughter was six weeks old as my husband had lost his job. I pumped for a while at home so I would be able to leave her some milk when I was working and I started giving her formula again... I couldn't pump at work, I work at a grocery store and there is nowhere I could have privacy.  Well slowly she has weaned herself from the breast (she is now 6 moths old)  I have been trying so hard to keep it up but now she wont even try to breastfeed.  I am at my wits end.  I feel like a terrible mother I mean first I work all the time now I can't even breastfeed my baby.  Can I get her to start again?  any tricks you may have to help me out.

Answer
Dear Monica,

First, congratulations for giving all your children the best start in life by giving them your precious breast milk! Despite the problems with your youngest baby, by giving her your breast milk during those first six weeks, you gave her vital antibodies and nutrients. You're not a terrible mother at all -- you sound like a very good mother, caring for your children and working to support your family.

It's sometimes possible to restart breastfeeding after having stopped, but it's very difficult, especially with a baby your daughter's age. I'm attaching an excerpt from my book (see below) about the process of relactation, but given your baby's age and your work situation, I would advise you not to try this, but instead to focus on caring for your baby and your other children as well as you can. You can, for example, still give your baby the closeness that comes with breastfeeding -- holding her when you give her bottles, rocking her, sometimes holding her against your bare skin, walking around with her in a carrier next to your body, etc. As I say in my book, "A baby raised in a loving home can grow up to be healthy and psychologically secure no matter how she or he receives nourishment."

Good luck to you and your family...

Best regards,

Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Eiger & Olds, 3rd edition 1999, published by Workman Publishing & Bantam Books, and available in most public libraries, bookstores & La Leche League chapters. Now in revision for a fourth edition, with pediatrician Laura M. Marks, M.D.
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  RELACTATION AND NURSING AN ADOPTED BABY
Sometimes a woman decides, or is advised, not to breastfeed her newborn infant; or she begins to nurse and then stops for one reason or another. Then, as soon as one week or as late as several months later, she wants to nurse -- either because her baby has grown stronger and is now able to nurse, because he has a digestive or allergic problem that makes it difficult for him to take formula, or for some other reason. In such a case, it is often possible to initiate breastfeeding. This process is known as relactation.
  In other cases, women who have adopted babies have been able to lactate, even if they have never been pregnant or have not been pregnant for years. This process is called induced lactation.
  Neither of these endeavors is easy; both call for a great deal of time, effort, and dedication. Both also require very close observation of the baby to be sure he is gaining weight properly. Many women who have made the effort, however, have been happy with their decision, especially if they look at it not for its value as a feeding method, but for how it can enhance the mother-baby relationship. This is the most important aspect of this kind of nursing. If you hold up quantifiable measures like the amount of milk you produce, the ability to provide all of your baby's milk, or the length of time you nurse your baby, you may be disappointed and frustrated. Based on several studies of women who have done this, the guidelines given in Box 16-2 should help you and your baby to achieve a happy nursing relationship.
  
  BOX 16-2 SUCCEEDING AT INDUCED LACTATION OR RELACTATION
  * Ask yourself why you want to do this. If you'll be happy with the experience of nurturing your baby at your breast, and not necessarily nourishing him from your breast, you're likely to have a more positive experience than if you have your heart set on providing a set amount of milk. It's very rare for all of a baby's nutritional needs to be met with induced lactation and may even be difficult with relactation.
  * Be prepared for a stressful first few weeks, during which time your baby may resist suckling at the breast, your milk may be slow in coming in, and you'll be nursing almost constantly around the clock and supplementing your baby's diet with formula.
  * Find a support system, consisting of people who will encourage and help you through the difficult days. These people can include your husband, doctor, lactation consultant, La Leche League leader, and, most important, another woman who has done what you want to do, either relactated or nursed an adopted baby.
  * You'll find it easiest to relactate if your baby is under three months old.
  * Expect initial resistance from your baby, who is used to getting milk some other way. It may take ten days or longer for him to nurse well, but after that he is very likely to become an avid nurser. Don't give up too soon.
  * Nipple stimulation is the most important mechanism for bringing in your milk. The best kind of stimulation is your baby's suckling. Other techniques include breast massage, nipple rolling, and hand expression or breast pumps. (Expressed milk can be fed through a nursing supplementer.)
  * Nurse your baby frequently, whenever she shows any signs of hunger, such as increased alertness or activity, smacking her lips, making sucking motions, or moving her head around in search of the breast. Do not wait until your baby begins to cry, which is a late sign of hunger. In one study, most of the relactating babies nursed eight times a day, at intervals of two to three hours, with two night feedings. (This is an average; some babies need to nurse more often than this at the beginning.) The average duration of each feeding was about 20 to 25 minutes.
  * The most popular form of supplementing the baby's diet is the use of a nursing supplementer (see Chapter 15 and the Resource Appendix). This ensures your baby of adequate nutrition while providing stimulation to your nipples. Many women who considered their experience highly successful continued to use a supplementer throughout the course of breastfeeding.
  * It is extremely important to have your doctor follow your baby carefully for adequate weight gain. The suggestions given in Box 6-4 in Chapter 6 will help you and the doctor assess whether your baby is being well enough nourished for healthy development.

TECHNIQUES THAT ARE HELPFUL INCLUDE:
  * Increasing your fluid intake and the amount of protein in your diet;
  * Resting as much as possible, and lying down to nurse when you can;
  * Asking your doctor to prescribe some other drug, like chlorpromazine or theophylline for the first week or so;
  * Stroking your baby while she's nursing to help you relax and let down your milk.
  * Providing as much skin contact as possible between you and your baby. (See the description of "kangaroo care" earlier in this chapter.)
  * Also see the suggestions given in Chapter 15 for encouraging a baby who's gone "on strike" to nurse.

TECHNIQUES THAT ARE NOT HELPFUL INCLUDE:
  * Keeping the baby hungry to try to encourage him to nurse;
  * Using nipple shields;
  * For adoptive mothers, trying to stimulate the breasts with the nursing infants of friends (the babies usually refuse to suckle at a breast that's not producing milk).

For some of the situations in this chapter -- the ones that require separation from your baby -- you will want to collect your milk to give to her. The next chapter describes the different ways you can do this and offers suggestions for making it easier to give your baby the benefits of breast milk even during those times when she cannot nurse directly.
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ADDITIONAL RESOURCE:

An excellent book, “Breastfeeding an Adopted Baby and Relactation” by Elizabeth Hormann is sold by La Leche League International (www.lalecheleague.org).