What is relactation?

Relactation is the process by which breast milk supply is restored once again after it has decreased or disappeared altogether. It is the process to return from mixed feeding to exclusive breastfeeding. When starting relactation, you must be very cautious, as it is essential to know that you cannot suddenly stop supplementing additional formula when the baby drinks more than 100 ml of formula milk per day. With amounts greater than 100 ml, it is necessary to do this gradually and give the mother’s body time to increase her milk supply. If the baby has 100 ml or less of formula a day and is gaining weight appropriately, the additional formula top-up can be removed at once.

The first step to reducing formula supplementing is the most complicated: you have to trust in your own abilities, be patient and persevere. This is a process that can be slow and needs the support of your family as well as expert support. Here we explain, step by step, the basics to start relactation:

• First of all, try to find out what went wrong and why the additional formula supplementing was necessary: ask for help from an IBCLC lactation consultant to check your breasts, the baby’s sucking, a possible tongue-tie, or hormonal causes. All of these are situations that can compromise breast milk supply, so make sure that there are no obstacles that could interfere with breastfeeding.
• Babies usually breastfeed better when they are half asleep; you don’t need to wait until they are too awake. If they refuse the breast, it is better not to force them and not to bring them close to the breast. Skin-to-skin contact and “seducing” should be the next step. Let the baby feel comfortable near the breast; make it to be their choice and not an obligation.
• Encourage skin-to-skin contact and be imaginative: take a bath with your baby, play under the bed sheets, or read stories on the sofa.
• Offer the breast as much as possible, at least every two hours during the day, every three hours at night, or whenever the baby wants to feed.
• Enjoy co-sleeping as a form of rest and as a way to make nighttime feedings easier.
• Ideally, eliminate pacifiers and bottle teats so the baby can focus on sucking only at the breast. As formula milk still needs to be offered, look for other methods of feeding, such as finger-syringe, cup, sippy cup, sports bottle, or spoon.
• During the first few days of trying to increase breastmilk supply, and if the baby is mostly on formula, continue to give the full amount of formula recommended for the age (remember that formula is also offered on demand) and begin to stimulate the breast with a breast pump and/or by hand.
• It is advisable to give expressed milk (breast or formula) with non-invasive supplementing techniques.
• Using a supplemental nursing system (relactation device) can be considered if the baby accepts to suckle and shows interest but gets frustrated when they suckle for a while, and the milk does not come out as much as they want.
• It is important to monitor the baby’s weight gain (30 grams per day for the first 6 weeks) and observe 5-6 wet diapers per day with clear urine, to ensure that the baby is getting enough milk. Some babies will stagnate in weight or lose a few grams at the start of relactation, but this loss should not be excessive.
• If the baby is not getting enough milk and the weight gain is not in line with these guidelines, or the baby is restless, do not reduce formula feeds for a few days and, if necessary, increase the amount of formula for a day or two.
• If the baby is unsettled when approaching the breast or has difficulties latching on, you can try the drop method. Use a dropper pipette or cup and directly drip milk from the top of the breast towards the nipple; let the milk flow in drops down the breast while the baby is suckling.

How to increase breastmilk supply:

• Start stimulating your breasts with a breast pump and finish with manual hand expression as you get better stimulation and more milk with this technique.
• Do this as often as possible during the day; it only takes a few minutes. The more times, no matter how few minutes, the better.
• Pump once when the sun goes down and once when the sun comes up first thing in the morning. And, if possible, once every two or three hours throughout the day.
• Consider the possibility of adding a galactagogue; for this, you need to consult your doctor.
• In this article, you can find more information on how to pump more milk.

A useful way to reduce formula when breastmilk supply has increased is as follows:

Reduce the amount of formula given in 24 hours: about 60ml in total. This reduction is maintained for a few days. This amount can be divided among several feeds: for example, reduce 10 ml in five of the formula feeds, or reduce two feeds by 30 ml each.

Continue with the reduced amount of formula for the next few days. If your baby shows by their behavior that it is enough and if, after a week, they have gained 125 grams or more in weight, reduce the formula supplementing again by the same amount for a few days and recheck the baby’s weight. If the baby shows signs of hunger or has not gained enough weight at the end of one week, do not reduce formula supplementing and continue with the same amount for another week. If the baby continues to show signs of hunger or still has not gained weight after another week, increase the supplementing formula back to what it was before the reduction.

There are several routines for supplementing formula, and each mother chooses the one that works best for them. Some mothers prefer supplementing with formula only at some feeds. Another common pattern only to breastfeed during the first few hours of the day, and in the evening, when the breasts feel softer, and the baby seems more uncomfortable, give the formula. Supplementing with formula alternately at some feeds is also possible.

Relactation is not simple or easy, but it can be done!