Hello Nicky The success of induced lactation and relactation is very dependant on the individual woman and also on her management. This may include physical preparation by nipple stimulation and expressing, sometimes with the use of galactogogues, and also emotional support. There has been success even if a woman has never been pregnant. It may be easier to induce lactation if a woman has been pregnant before and to relactate if she has breastfed before. There are leaflets available on this and the topic is covered well in some text books. I hope that Karleen will respond as she is a renown expert in this field. Cheers Sue

Hello Nicky Lactation is driven by nipple stimulation. If a mother simply allows a (willing) infant to suckle at her breast frequently enough, lactation will be initiated and sustained. A woman need never have been pregnant or have lactated before to initiate breastfeeding. Women whose own children are grown (such as grandmothers) can relactate quite successfully. I have never seen or heard of galactagogues used in emergency settings. Frequent suckling means 10 or more times during the day and shared mother/infant sleep where the infant has access to the breast all night. This feeding pattern may be unusual for women who live in places where artificial feeding is the norm. However, where breastfeeding to two years or more is widely practiced, this is not an unusual feeding pattern. That said, women attempting relactation will need support in the form of priority access to food and water, help caring for and securing food for older children - and perhaps monetary support if the frequent feeding prevents them from engaging in livelihood activities. In my experience it takes about 10 days for the mother to begin producing substantial quantities of milk (such that the baby can be heard swallowing at the breast) and from about 21 days, artificial feeding can begin to be withdrawn. Actually, I suspect that some of the mothers in our program began withdrawing artificial feeding earlier than this just because it preparing it and using it was so onerous. The baby must be fed during the relactation process and a decision must be made about how to go about this. In the community, cup feeding small amounts of infant formula between breastfeeds (8 or more times a day) is probably the most feasible option. In most emergency settings, the use of powdered infant formula cannot be made safe and minimising the risks by carefully disinfecting all equipment, using hot water to reconstitute the powder and feeding the infant with a cup is terribly time consuming. I doubt whether someone attempting this in an emergency setting would be able to do anything else. In Christchurch ready to use infant formula was distributed to mothers of artificially fed infants. In combination with disposable cups, this could ameliorate some of the issues that make artificial feeding so difficult in the field (finding sufficient fuel to boil at least 3 litres of water for 5 minutes 8 times a day!). However, RTF formula is more difficult to transport because it is heavier and more bulky. In an in-patient or clinic setting, an at-breast supplemental feeding system can be used so that the infant gets his or her supplemental feeds at the breast. This involves taping a fine tube (paediatric ng-tubes work well) to the mother's breast - one end at the nipple and the other end in a cup of infant formula. There are a couple of potential issues with this method. One is that the tubing is very difficult to clean and so unless it can be syringed with a disinfecting solution after every use, it should be discarded after each use. Second, when mothers see malnourished infants health improve markedly with the use of supplemental feeding, they may feel that breastfeeding is not sufficient for their babies and try to secure any white liquid they can to supplement the baby once they are discharged. This can have disastrous consequences for the baby. Third in-patient care may not be feasible for women who have other responsibilities in their families or communities. Both of these approaches must be accompanied by supportive breastfeeding counselling that both educates mothers (how milk is made on a supply/demand basis; the disastrous consequences of feeding babies anything other than breastmilk in the first six months of life; how, when and where to get medical care for their infants; how to monitor their infants health etc) and helps them to develop strategies to maintain frequent feeding for their baby in amongst all the other demands on them as women and mothers.

Hello Nicky, Relactation and induced lactation are fascinating topics in my opinion! By far the best publication on the subject is the WHO's booklet http://www.who.int/child_adolescent_health/documents/who_chs_cah_98_14/en/index.html which provides comprehensive and accurate information. Unfortunately there is a lot of misinformation on the subject about the place so this resource is very valuable because it is an accurate reflection of the research. On whether women who have never been pregnant are able to lactate, the answer is yes, they can. There is a physiological difference between woman who have previously been pregnant and those who have not in that the final stage of breast maturation (mammogenesis) occurs during pregnancy. However, we don't know whether this makes any difference in the ability of women to make milk. My feeling is that other factors, such as the willingness of woman and child to facilitate frequent effective suckling and the availability of good lactation support are more important than the previous pregnancy and lactation history of the woman. I hope this information is useful to you. Karleen

Hello Nicky, I apologise that I omitted the most important type of nipple stimuation which is very frequent breastfeeding- with hand expressing necessary only when breastfeeding is impossible/impractical or baby will not yet go to the breast. Thank you for covering this so well Nina. My experience is also that most women respond very quickly. Cheers Sue

Thank all for your precious guideline and experience sharing. If you have the publication and pdf. links about those issues, Please share me. Now, I am using those facts and guideline in my training on Awareness raising training on IFE in my work site. Thanks again.

HI, i am a mother of 13 months toddler, i want to do relactation, my baby only latch on my breast on first month, and the following nine months i pumped (only about one oz a day) and he had a good health even with this little supply. but his always getting sick after i stopped pumping breast milk for him from 9 to 13 months now. so i want to give him breast milk again. but i hope this time he can back to my breast and this will produce more milks. Anyone here can help me for more info on how to guide a toddle back to breast? my email is goonhooiling@gmail.com thanks,