You are on page 1of 34

RELACTATION

and
INDUCED LACTATION

by Marie Rose S. Yabut, MD


Fellow, Philippine Obstetrical &
Gynecological Society
Consultant, Department of
Obstetrics & Gynecology
Amang Rodriguez Medical Center
Cardinal Santos Medical Center
INDUCED LACTATION
process by which a nonpuerperal
woman is stimulated to lactate
RELACTATION
process by which a woman who has
given birth but did not initially
breastfeed is stimulated to lactate, or
may have initially breastfed her infant,
weaned him, then wishes to
reinstitute lactation
RELACTATION
Milk supply re-established after
lactation has stopped
*infant weaned prematurely because of illness

Breastfeeding began after prior


postpartum lactation suppression
*sick or premature infant cannot be fed initially
*to nurse an adopted infant
*delayed desire for breastfeeding

Breastfeeding resumed after weaning


to formula feeding
*infant allergic to formula
INDUCED LACTATION
Milk supply is established for
an adopted baby (adoptive
breastfeeding)
Mother never pregnant
Mother has not been pregnant
for years

Goal: NURTURING with the emphasis on


nursing, not on “breastfeeding” or
nutrition
Historically:

To provide nourishment for an


infant whose mother has died in
childbirth or unable to nurse the
baby for some reason

Used in times of disaster or


epidemics to provide safe
nutrition to weaned or motherless
infants
COMMON PROBLEMS

Baby imprinted to artificial nipples


Baby tires at the breast
Mother’s guilt feelings
Baby is older, mother’s hormone level
is low
Lack of nipple stimulation
Adoptive mother has no prolactin
level elevation
SUCCESSFUL RELACTATION or
INDUCED LACTATION

• Mot iva tion


How m uch doe s s he
wan t?
Why doe s s he wan t?
• Emo ti ona l prepa ra ti on
Bab y’ s i ni ti al re sistan ce
Fre quency o f suckli ng
• Patie nce , Su pport, Spec ial
Techniqu es
RELACTATION
BASIC TECHNIQUE

Better prenatal preparation


Nipple stimulation
Diet supplementation (fluids &
calories, esp. protein
Reading, learning, & communication
with others with similar experience
Support system
From physician, counselor, other
mothers, husband
Cont. RELACTATION BASIC TECHNIQUE

Preparatory hormones &


lactagogues may be considered
Induction of let-down
Oxytocin nasal spray Frequent
nursing
On demand, unrestricted
Use of lactation supplementing
devices
Nursing supplementer

SYRINGE SUPPLEMENTER

LACT-AID NURSING TRAINER SYSTEM


Drugs to Induce Relactation
(works in breasts primed by mammogenesis)

Thyrotrophin-releasing hormone

Pituitary
↓ ↓
TSH Prolactin

Drugs that block hypothalamic PIF


 Phenothiazines
 Reserpine
 Meprobamate
 Amphetamines
 Ά-methyldopa
 Metoclopramide
10mg orally q 8hrs x 7 – 10 days
 Sulpiride
INDUCED LACTATION
BASIC TECHNIQUE
Induce lactation around one to
two months before baby arrives
Basic learning in lactation
management
Breast pumping/manual breast
expression/nipple stimulation
Manual manipulation (gentle traction,
or horizontal & vertical stretching,
fondling & suckling of the breasts by
the husband)
Onset of lactation 1 – 6 wks
Cont…..INDUCED LACTATION BASIC TECHNIQUE

Herbal teas & galactagogues


Good nourishment for the mother
Positive attitude, commitment &
determination
Be present at the delivery of baby
for bonding
for first feeding
Cont…..INDUCED LACTATION BASIC TECHNIQUE

Stimulate as much as possible


the natural biological techniques
of breastfeeding
Be present in as many feedings as
possible while baby is in hospital
Breastfeed before any other
nourishment is given
Avoid stressing baby with hunger
Cont…..INDUCED LACTATION BASIC TECHNIQUE

When supplementing, use


donor human milk or
appropriate infant formula (not
cow’s milk with its long stomach-
emptying time)
Cont…..INDUCED LACTATION BASIC TECHNIQUE

Avoid rubber nipples or


pacifiers
Provide other supplements by
dropper, spoon, cup, or
nursing supplementer)
Medela’s Supplemental Nursing
System or Lact-Aid Nursing
System
Create positive atmosphere
Cont…..INDUCED LACTATION BASIC TECHNIQUE

Monitor:
amount of supplement
number of wet diapers
bowel movements
weight of baby
Follow all instructions for
relactation
Drugs to Induce Lactation:

Oxytocin nasal spray (Let-down reflex)


Short duration of use only
Chlorpromazine (increase Prolactin)
25 – 100 mg TID x 7 – 10 days
Theophylline (increase Prolactin)
Metoclopramide (increase Prolactin)
IV, IM, oral
Lactagogues
LACTAGOGUES

Special food, drinks, or herbs


believed to increase milk supply
Don’t work like drugs
Psychological effect (?)
Nutritional effect
Cont. LACTAGOGUES
Malunggay
tulya/halaan/other shellfish broth
other soups & herbal teas
milk (?)
alcoholic drinks (???)
fenugreek seed
blessed thistle herb
brewer’s yeast, oats
warm cereal drinks
garlic capsule
DRUGS TO INCREASE MILK
SUPPLY
Chlorpromazine
phenothiazine derivative
dopamine antagonist
tranquilizer, antiemetic
sedative effect
in large doses in women, causes
moderate breast engorgement &
lactation
Dose: 25mg TID x 7 – 10 days
may repeat course once
Cont….DRUGS TO INCREASE MILK SUPPLY

Metoclopramide
dopamine antagonist
induces release of prolactin without CNS
effects of phenothiazines
Dose: 10 to 15mg TID for up to 3 months
Theophylline
Domperidone (Motilium)
Dopamine antagonist
Anti-emetic/anti-nausea
Increases prolactin levels
Not readily cross blood-brain barrier
Dose: 20 -20 mg QID till milk secretion is fully
established
Cont….DRUGS TO INCREASE MILK SUPPLY

OCP (Yasmin or Microgestin)


3 mg Drospirenone
For breast development

OCP + Domperidone = milk production

OCP + Domperidone + Baby =


copious milk production

OCP + D + B + Herbs, Oatmeal + Water =


RECIPE FOR INCREASED MILK SUPPLY
SUMMARY

Don’t be too focused on how soon


and how much milk will be produced
or the length of time they nurse their
babies. Few mothers ever produce a
quantity or quality of milk that will
totally satisfy baby and provide all his
needs. It is realistic to be prepared to
need some supplemental formula.
Look at the effort in terms of the
enhancement of the mother-baby
relationship.

While total nourishment by breast milk


may not be possible in all cases of
relactation and induced lactation, mother
and baby can still enjoy the emotional
and physical benefits of breastfeeding.

What is important is the whole act of


breastfeeding and the close bonding it
entails.
Remember, it is the quality of your
relationship, not the quantity of milk,
that is desirable.
It is possible the baby may not be
totally breastfed.
The ultimate goal of
breastfeeding is
the nurturing of a
happy, healthy baby.
PROTOCOLS for INDUCING
LACTATION & MAXIMIZING MILK
PRODUCTION:

The REGULAR PROTOCOL:


Suitable for intended mothers expecting a
baby via surrogacy or adoptive mothers
with a long lead time
1.Six months (or longer) before birth:
Take the “active” pill OD +
Domperidone 10mg QID x 1 wk, then
increase to 20mg QID.
Cont REGULAR PROTOCOL

1. Five months before baby is due, “active”


birth control pill + Domperidone 20mg
QID
2. Four months before baby is due, same
regimen
3. Six wks before birth, stop birth control pill,
continue Domperidone 20mg QID. Over
the next 2 weeks: Pump breasts every
3hrs:
a) Pump 5-7 min on low or
medium setting
b) Massage, Stroke, Shake
c) Pump 5-7 min
Cont REGULAR PROTOCOL

1. One month before baby is due, continue


Domperidone 20mg QID & pumping
(during the day + at least once at night).
> Once pumping has started, can add
HERBS:
Blessed Thistle herb 390mg
cap- 3 capsules TID
Fenugreek seed 610mg cap-
3 capsules TID
> Domperidone taken ½ hr before
meals
> Oatmeal for breakfast at least 3x a
week
Cont REGULAR PROTOCOL

1. Once baby arrives, Domperidone


20mg QID until substantial milk
supply is achieved or mother is
ready to wean.
The ACCELERATED PROTOCOL:
• Yasmin or Microgestin is taken for
30-60 days non-stop (active pills
only) + Domperidone 20mg QID.
• If significant breast changes occur in
30 days, pill stopped & pumping
schedule begins + herbs.

Pumping with a double


electric breast pump. A hand
pump is just not up to
the job.
The MENOPAUSAL PROTOCOL:

• Yasmin or Microgestin once a day x 60


days +
• Domperidone 10mg QID x 1 wk then
increase to 20mg QID
• Once with significant breast changes,
stop Yasmin, maintain Domperidone &
begin pumping with double electric breast
pump. Can add the herbs.
THANK YOU!!!