Expert: Sally Wendkos Olds - 9/18/2009

Question
i have flat nipples and for the first three weeks i used nipple shields to feed my son.Then i got sore nipples so i started expressing the milk with the breast pump and fed my son using the bottle.
Now my baby is 8 weeks old and im trying to breastfeed him but he cries continuously for more than 30 minutes and He doesnt even try to latch on even he is hungry.
Its really frustrating for both of us...is there any way i can breastfeed him directly...i want to breastfeed him so badly,please help

Answer
First, congratulations for giving your son the best start in life by breastfeeding him! By giving him your precious breast milk you have already given him important antibodies and nutrients.

Now that your baby has become used to getting milk from a bottle, it will be difficult to provide all of his milk from nursing alone. However, you can still bring him to your breast so that both of you will get the emotional benefits of breastfeeding. And although relactation -- that is, restarting to breastfeed after you have stopped nursing at the breast for a while -- is difficult, it's not impossible. I'm attaching an excerpt from my book (see below) which may help you get started again.

Good luck!

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 haven’t 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. It’s quite likely that you won’t be able to provide all of your baby’s milk needs. 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. One mom talks about the “psychological calories” she has given her baby, which is the most important aspect of this kind of nursing. If you hold up quantifiable measures like the amount of milk you produce 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 the box on page tk should help you and your baby to achieve a happy nursing relationship.

BOX
Succeeding at Induced Lactation or Relactation
• Ask yourself whether you’ll be happy with the experience of nurturing your baby at your breast, and not necessarily completely nourishing him from your breast. If so, 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 rare in western countries for all of a baby’s nutritional needs to be met with induced lactation for adopted babies 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 partner, doctor, lactation consultant, La Leche League leader, and, ideally, another woman who has done what you want to do, either relactated or nursed an adopted baby. You can find some of this support online.
• You’ll find it easiest to relactate if your baby is under three months old.
• Expect initial resistance from your baby, who’s used to getting milk some other way. It may take ten days or longer for him to nurse well, but after that he’s very likely to become an avid nurser.
* If your baby resists strongly, feed her another way and try again another time.
• 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 and breast pumps or hand-expression. (Pumped or expressed milk can be fed through a nursing supplementer, which will stimulate your breasts.)
• Nurse your baby frequently, whenever she shows any signs of hunger, like increased alertness, squirming, smacking her lips, making sucking motions, or moving her head around in search of the breast. Don’t wait until your baby begins to cry, which is a late sign of hunger and is likely to result in her rejecting the breast.
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 twenty to twenty-five 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) during efforts to induce lactation. 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.
* Follow the same practices that encourage all breastfeeding: close contact (lots of it skin-to-skin), frequent feedings, and rest and help for the mother. The success of induced lactation and relactation in developing countries rests on the expectation that all babies will be breastfed and on the practices that support nursing. While mothers in the west cannot duplicate cultural milieus in other societies, we can adopt some of their practices.
• Monitor your baby very carefully for adequate weight gain. The suggestions given in the section beginning on page tk will help you and the doctor assess whether your baby is being well enough nourished for healthy development.

Helpful Techniques:
* Breastfeed frequently.
• Increase your fluid intake and the amount of protein in your diet;
• Rest as much as possible, and lie down to nurse when you can;
• Ask your doctor to prescribe a drug for the first week or so, which may help to increase milk supply;
• Stroke your baby while she’s nursing to help you relax and let down your milk;
• Provide as much skin contact as possible. (See the description of “kangaroo care” earlier in this chapter.)
*  Put a little pumped breast milk or formula on your nipple and areola to lure her onto the breast by showing her how good it tastes.
• See the suggestions on page tk 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;
• For adoptive mothers, trying to stimulate the breasts with the nursing infants of friends (those babies usually refuse to suckle at a breast that’s not producing milk).  
END BOX

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