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How To Get Started
With Re-Lactation

By Ken L. Smith

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There is one thing that seems to be common to many of the ANRs (Adult Nursing Relationships) that are having problems, and that is wanting to know how long it will take to establish lactation. I would emphasize to everyone that does not feel they have achieved the level of lactation they wish to achieve by this time, that lactation takes a lot of patience, effort and time to achieve. It is not automatic for everyone, unless they go through the 9 months of pregnancy that usually precedes a woman lactating. I don't think too many of you are willing to do THAT, just to establish an ANR. To accomplish re-lactation, it will require both of you to be very committed to a strict and regular schedule to make it work. This also requires a deep commitment to each other.

Before you start on this venture, I would strongly encourage you to visit your OB/GYN or a qualified breast-care medical facility to bring your mammography history up to date, and for a good CBE (Clinical Breast Examination) to be sure that you are aware of what may be occurring in your breasts at this time. This is important, because once you start to induce lactation, your breasts will become more dense, larger in size, and will start getting "strange bumps" that you are not used to finding., but it is also possible that by paying closer attention through your increased physical contact, you have noticed problems that were there before you started inducing.

When you start paying closer attention to your breasts (because of this induction process), you may notice some changes in your breasts. Any changes in your breasts that cannot be attributed to known causes should be checked by your OB/GYN or breast-health provider, to be sure something is not happening that needs to be taken care of. If you have already started to induce lactation, those changes are likely caused by the oncoming lactating duties (if you have started to develop the acini (milk-producing) tissues or producing milk). If your medical practitioner is not aware of your lactation intent, the reader of your mammograms may see cause for alarm. Your age may rule out the likelihood of your being pregnant, so breast changes would suggest hormonal difficulties or breast changes such as calcification or cancer or  a tumor on the pituitary gland, and further tests will be recommended. This can be avoided if you make sure that the doctor that schedules your mammograms is aware that you are attempting to lactate. Most women find this difficult to discuss with their doctor, but it would avoid a lot of difficulties if you get that settled at the beginning of your breast examinations. Some doctors are actually quite supportive of couples having established ANRs. If they are not, remember that your doctor works for you, is paid by you, and can be "fired" by you, and you can move on to a doctor that is more favorable of allowing you to choose your own lifestyle.

Some ANR couples have not achieved lactation, but have been satisfied with the closeness and bonding that they have established during the attempt, and are quite pleased to merely have the time together and the physical contact, even without the anticipated milk. That is certainly nothing to overlook. This article is to help couples to achieve milk production, but remember that there is much beauty in the travel, even if you never get to your intended destination.

What I suggest to anyone that approaches me with the desire to establish lactation (without the aid of having delivered a child recently), no matter what may be their reasons for doing so, is the following:

POINT ONE:
Tell your body what you want. Reach up and squeeze your breast as if to squeeze something out, and you have already started the process. By requesting your milk from your breasts, your body will likely do its part and provide that milk. But not yet. This requires you to express milk from your breasts on a closely regulated "schedule" (our bodies really do like schedules). Your brain, body and breasts have to "get the message" that milk is needed, and that can only happen if every 3-4 hours over the 24-hour day, all seven days of each week, each of your breasts is being completely "emptied". If you are not producing breast milk yet, express your breasts AS IF YOU ARE PRODUCING MILK for 10 - 15 minutes (each breast), whether anything comes out of them or not. If you express for less than 10 - 15 minutes on each breast or you miss one of those sessions your body begins to reverse the process and reverts back toward the non-lactating condition, and that will require several more sessions just to return to the point you had achieved before you skipped a session. Do Not Miss A Session! Your breasts will stop producing milk if you wean your child, and if you take less milk for one session, or skip a session or two, your brain, body and breasts take that to mean that you are weaning a child, so your breasts reduce their milk production and shut down. 

POINT TWO:
Choose the method by which you will express your milk. You may use more then one method, of course, but try to be as consistent as you can until you reach full milk production.


The BEST choice is using a mouth, and using it properly. The tongue squeezes your breast up against the roof of the mouth. The tongue presses on your breast at a point an inch or more behind your nipple, not ON your nipple. The tongue should do a "rolling" action to coax your milk to move toward your nipple. Think of your tongue trying to empty a toothpaste tube. Minimum suction is needed because the recipient does not suck milk from your breasts, he/she merely picks up any milk that has been pressed out of your nipples. When "latching on" to your breast, your recipient should literally attempt to reach their uvula (that little hangly-down thingy in the back of their throat) with your nipple. I said ATTEMPT… they cannot actually reach it unless your breast is pendulous and very thin (and some are). Stay OFF the nipple; that has no milk in it. Milk just passes through it.


The SECOND best choice is manual expression (expression by hand), either your hand or your partner’s hand. What you are doing is putting some pressure on your lobules (acini), then stroking forward, squeezing the milk that is inside your ducts, and stroking it forward to your nipple. You are also emptying your ampullae that gather your milk behind your nipple. If you take a look at the following:
http://www.breastnotes.com/anatomy/anatomy-inside_of_the_nipple.htm  or Click Here

and
http://www.breastnotes.com/anatomy/anatomy-inside_of_the_breast.htm or Click Here

you will see what you are working with. Do not slide your fingers on your skin… move your breast skin with your fingers, sliding your skin over the inner parts of your breast. Move your "grip" on your breast to express each of your ductal "systems" that are arranged in a circular arrangement completely around your nipple. You need to express from each cluster of lobules to get each one to send a signal to your brain to activate each cluster. Continue expressing each breast for 10 - 15 minutes or until your breast is empty, which ever is LONGER. Repeat this procedure for the same amount of time with your other breast. If you would like a more-detailed description, please request "Manual Expression of Your Breasts" from BreastCare@comcast.net..


The THIRD best choice is to use a breast pump. The breast pump does not usually do as efficient a job of emptying your breasts, nor does it provide the deep stroking that is beneficial in starting lactation. Manual expression or expression by mouth will usually do a better job of providing that deeper manipulation of your breast tissues. The pump works quite well AFTER you are lactating fully, to empty your breasts when your partner is not there to help you.

If you do choose to induce with a breast pump, remember that completely empty breasts send signals that tell your body and brain that you need milk (or MORE milk) in future sessions. Do Not Stop Pumping when your milk stops coming out. Continue to pump for the full 10-15 minutes to encourage more milk production. Keep the suction rather low, because the suction does nothing but cause pain. If you find the skin on your nipples or areolae turning white and staying white for a period of time after you have removed the pump, you are probably using too small of a cup on the pump or you are using too much vacuum. Suction merely picks up milk after it is produced from your nipple, so if milk is not coming out of your nipple, do not increase suction. After you are producing milk, mouth or manual (hand) expression should also be used after you use the pump, to completely empty your breasts. Leaving milk in your breasts can cause your ducts to become blocked, and that can lead to mastitis, which is difficult to deal with. It will also signal to your brain and breasts that you do not need as much milk, and you will start to produce less milk.

NOTE #1: If you are doing manual expression, the use of a pump does provide some extra stimulation of the nerves that surround your nipple, and five minutes of pumping AFTER you complete the full ten – fifteen minutes of manual expression of each breast, could be beneficial to you. A good breast pump provides a rapid-pulsing stimulation of your areolar nerves which is good to help stimulate lactation.

NOTE #2: Be sure and take a note from breastfeeding mothers: Do not allow your partner to come off your nipple until the suction is removed. That can cause some temporary damage and pain to your nipple. If you are using a pump, be sure to remove the vacuum before you bring the cup off your breast. A finger slipped under the cup flange will break the vacuum.

An ALTERNATE choice that some ANR enthusiasts are trying is the use of a TENS module. The theory of the use of a TENS module is that tiny electrical currents are used to stimulate the areolar nerves in your breast, sending the signals to your brain to turn on the hormones that start your breast alveoli producing milk. The use of a TENS module will be most effective during the period of time before lactation is established, as there is no way of collecting any milk that is produced by the TENS unit. The benefits of this unit include the chance for it to stimulate your breasts while you are at work or school or in meetings or fixing dinner or when other members of the family are around… or what have you, and you wish to continue to do these things without others being aware that you are being stimulated. It is recommended that you not use the TENS for all of your sessions, but only those where you are not able to sit and express your breasts properly. If you would like to explore this idea, or have questions regarding the use of a TENS module, please request "How Do I Use A TENS Unit To Re-Lactate?" from BreastCare@comcast.net. No cost to you, of course. You can also read the article here on BreastNotes by going to this location.

POINT THREE:
AFTER you are producing the amount of milk that you want to produce, you can cut back on the number of expression sessions that you do per day. If you notice that you start to produce less milk per session than you want to settle with, then add another session back during the 24 hour day. The more milk you request beyond what you currently produce, the more you will make. It is a case of supply meeting demand.

POINT FOUR:
…and this is actually a very important step. Your milk will not come out of your breasts until your breasts RELEASE it. You have some teeny tiny muscles in there that can either shut you down or allow milk to be released. Your mind controls them, and will only release the milk if you are emotionally "into" the activity. This is referred to as the "Let-Down Reflex", and is stimulated by your deep emotions and your desire to provide milk to your child and recipient, and is influenced heavily by your seeing images of things such as your baby, hearing sounds like a crying baby or your loving partner, smelling aromas such as baby powder or your partner’s cologne, and deep concentration on what you are doing (turn off the TV news). After you become used to it, like any ‘reflex action’, it becomes automatic and requires less outside stimulus, but if you are having trouble establishing lactation, add those stimuli back into the session. Warm baths and warm (not hot) hot tubs work too.

POINT FIVE:
When you are lactating with a newborn, you have the advantage of certain natural hormones in your body that sort of jump-start all of the previously mentioned steps for you, thank goodness. Seldom does a new mother have trouble lactating, but more often, they will have difficulty understanding the "latching on" process with the baby and the nipple (remember, your nipple does nothing but feel good and look good. You do not squeeze your nipple to get milk). When a baby (or partner) latches on, he/she places as much of your breast into their mouth that will fit, and your breast will literally take on a more flattened (temporary) shape to allow proper expression of your milk. In lieu of those natural hormones, some people (women or men) may rely on herbs to fill that service. I usually do not recommend using them unless you have exhausted the other steps and find that after several months of true conscious efforts, milk has just not come through. Many perceive the use of herbs to be an easier and faster road to lactation, and I certainly have no problems with those that use them. I support anyone that is trying to lactate, no matter what methods they use. Some may tend to rely on the herbs to do the ‘work’, hoping to bypass the physical part of the lactating process or trying to reach their goal quicker. Some women do not get the results from the herbs they expect and become frustrated. Some have the same frustration from lack of success while not using herbs, hormones or other "stimulants" (galactagogues)  also. Everyone is very different in how their bodies function. I am concerned about side-effects that some herbs can have on some people, as well as possible interactions with drugs that they may currently be taking, and I would encourage that they discuss usage of herbs or hormones with their doctor o
r medical care-provider before they use them for lactational purposes. If the herbs are working for someone, then that is good.

POINT SIX:

Also, remember to hydrate yourself. You should drink at LEAST what you SHOULD be drinking each day normally. Too many of us do not drink what we should. It is suggested that you can determine the amount of water that you should drink daily by using the following formula:


(Your weight (in pounds) divided by two equals the number of OUNCES of
water you need). If you weigh 120 pounds, then it would be:

120 lbs / 2 = 60 oz of water per day


I don't personally reach that goal either. :-)

Be aware that you CAN over-hydrate, and lactating does not really require much more water then you normally require. Just getting up to the normal amount of water should help you lactate.

CONCLUSION:

If, after a couple of months of doing what this article says, you are still not successful in achieving lactation, look this article over again and see if there is any part that you may be missing, or perhaps if there may be something that you can do longer… or better… or with more concentration. The more closely you can follow these steps, the easier it should be for you to reach lactation.

Please do not hesitate to ask other questions, or ask about something that you may not understand clearly in this article. If reading this has brought other questions to mind, just ask.

 

I hope that this helps you reach your exciting and natural goal.

Ken L. Smith
Breast Health Facilitator for the American Cancer Society
http://www.breastnotes.com/
Breastcare@comcast.net

This article is only my opinion and does not reflect the philosophy or opinion of the American Cancer Society.



POST SCRIPT:

There are some very common questions and concerns that are frequently asked so I will address them here:

  1. "How long will it be before I see milk?" This is probably the most frequently asked question, and the answer is not available. Everyone will react differently. How well you follow your schedule, how well you express your breasts, what level of production your various hormones are in your body, how long it will take for your acini (lobules) to develop, how long ago you were actively breastfeeding (if you did) and whether you have ever been pregnant (but did not breastfeed your child), what other hormones you may be taking at the time (birth control? Hormone Replacement Therapy?), and many other factors will affect how long it will take for you to lactate. I can tell you right now that it will take a lot longer then you would like for it to take. I would encourage you to expect it to take several months to establish a good supply of milk, and I would tell you that you may not be able to produce as much milk as you would like to produce. It would be great if you produce sooner then this and produce a lot of milk if that is what you desire, but remember that you are asking your body to do something that is natural but not in a normal sequence.
  2. "I see liquid coming out after only one week. Is that milk?" Any breast at any age will produce some liquid if you squeeze it. That is normal. It may even be anywhere from clear, yellow, brown, green or black, and that is normal too. If it is pink or red, it indicates blood in the ducts and should be checked this week by a breast surgeon or gynecologist to ascertain what is causing it. The liquids are basically keeping the inside of your breast ducts healthy. It will be several weeks before any milk will possibly come out, and it will be yellow or white. No matter what the color is, it is ok to be consumed.
  3. "I am pregnant. Can we stimulate lactation and nurse so I will have milk ready for my baby?" I would strongly encourage you to take a break and NOT ltry to induce lactation during your pregnancy. If you are already lactating, and you become pregnant, I encourage you to cease your lactating during the third tri-mester.This time is when your breasts will naturally prepare themselves for lactation and you will have to do nothing. It is a ‘freebie’. Your body is reacting to a finely-tuned and natural schedule of hormone balances and your stimulation for lactation at a schedule different from your body may confuse the situation. Another important issue is that your breasts will provide a pre-milk liquid that is colostrum and after providing life itself, colostrum is the second-most important thing that you will give to your infant. It carries most of your naturally-developed anti-bodies to many diseases in the world and transplants them into your child to give him or her the best start on life possible. You do not really want to mess up that process.
  4. "Can I feed my partner when I am feeding my child?" Absolutely, but you need to keep two things in mind. One is that you need to be sure that ALL of your colostrum goes to your infant. After a week or two, that will pretty much subside, and then your partner can share. Secondly, make absolutely sure that your infant gets ALL the milk that he or she wants. After the feeding session is over and his or her needs are met, what is left can be shared. Try not to wait too long for your partner to become involved because your breasts will need time to "re-group" for the next session. Giving milk to your partner shortly before your child nurses will take milk from the child. That is not good. If you are not making enough milk to satisfy your partner, have your partner suckle for five minutes on each side beyond your milk running out. That will tell your breasts and brain and body to make more milk. Be sure your child or your partner removes all of your milk or it could cause plugged ducts and mastitis. If you do not want more milk your partner should stop sucking when your milk stops.
  5. "While I am trying to re-lactate, should I tell my doctor?" I want to cover this again… it is very important. If you need to see your doctor for any reason that will require him or her to examine your breasts, or if you need a mammogram, I would encourage you to tell your doctor of your intent. A good doctor will respect your choice and not hassle you about it. If you do not tell them, they will suspect any of several conditions that may make your breasts to be full and firm, leaking milk from your nipples, or cloudy mammograms, and you do not want them to draw an incorrect conclusion and put you through unnecessary tests to find out "the reason". If they know ahead of time, they will be able to accept what they are seeing and move on. Also, If you are working with any type of hormone treatments or after-market or over-the-counter drugs or hormones, I would definitely encourage you to work with a doctor due to interactions with your medications, or possible side-effects that your current medications may experience from your hormone changes.
  6. "Do I need to worry about the medicines I take and my partner’s receiving the medication through my milk?" Absolutely. And this brings up something that is different from breastfeeding a child. Your partner may be taking drugs that no infant would be taking and your meds may conflict with his meds. Anything that you take in should be considered as being safe for breastfeeding mothers, just as if you are actively breastfeeding an infant. If they are not to be taken by breastfeeding mothers, they probably will either dry up your breasts or they will be passed through your milk. I again encourage your checking with your doctor on these issues. You do not want to cause problems with your partner’s health …or yours.

End Of Article

(Rev. 11/10)

 

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