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Ask Dr. Sears: Breastfeeding Again

Q. I have a six-month-old baby that I have not nursed in three months. Is it possible to start again?

A.
Yes! It's called "induced lactation." It can be difficult, but where there's a will, there's a way. Even adopting mothers who have never been pregnant can produce enough milk for at least a partial feeding. Martha and I decided on induced lactation for our eighth child Lauren, whom we adopted as a newborn. (Why should she miss out, just because she's adopted?) It should be easier for you, since you started out breastfeeding your baby. Even though your baby has been off the breast for three months, I would encourage you to try again.

Here are some tips on how you can start back to breastfeeding:

Think milk! The milk-making process begins with the hormones in your brain. Practice visual imagery: Imagine yourself warmly breastfeeding your baby in your favorite chair, sitting on the couch, or lying in bed. Imagine your breasts leaking milk. Picture the satisfied look your baby gets after nursing and think of the tranquil feelings you get while breastfeeding. Those hormones will start to kick in.

Prime the pump. Rent a breast pump and use it every three hours or so throughout the day. Best is a hospital-grade breast pump with a double-pumping system. With this type of pump, you can pump the most milk with the least amount of discomfort. Also, studies have shown that milk-making hormones are highest when pumping both breasts at once. Expect to get milk by pumping within a week or two.

Woo baby back to the breast. A baby can get milk from a bottle more easily than from a breast. Your baby has gotten used to this. It might take some creative "marketing" to get him back to the breast. Return to the places where your baby enjoyed feeding the most -- in a rocking chair, in bed at sleep time, or wherever. Try keeping him close to your breasts by wearing him around in a sling several hours a day. Then there's nap-nursing: Lie down with your baby and let him fall asleep using your nipple as a pacifier.

Be sure he latches on properly. When he's ready to feed, make sure his mouth is open wide and his lips are turned out. You should feel the sucking pressure at least an inch above the nipple. Breastfeeding is most efficient when the milk sinuses beneath the areola are compressed. With a bottle, he could simply suck on the tip of the nipple and still get milk. If he sucks the same way from your nipples, he won't get much milk, and you will likely become tender and sore.

Get professional guidance. Seek help from a lactation consultant (LC). You can find recommendations through your healthcare provider, maternity ward, or from La Leche League. Ask if your LC has experience in induced lactation. Perhaps even ask if she has any experience helping adopting mothers to breastfeed. The LC can help you choose the right breast pump and show you some techniques to teach baby proper latch-on.

Trick the baby. You might want to try a nursing supplementer, also known as a supplemental nutrition system or SNS. This ingenious device feeds milk to the baby through tubing that is secured with tape about a half inch past your nipple. When baby latches onto your breast, he also takes the tubing into his mouth. You can also try to insert the tip of an orthodontic syringe (ask about these at your dentist's office) into baby's mouth while he is latched onto your breast. Squirt a few drops into the side of baby's mouth with every suck. Use baby's customary formula at first, and then move to your own pumped breast milk. The younger the baby, the more likely he will take to these gadgets -- by nine months, many infants reject them.

Try milk-making medicines. There are some medications to boost the level of milk-making hormones. The medication with the best track record is metoclopramide (Reglan). Oxytocin nasal spray, though harder to find, will also stimulate the milk-ejection reflex. Your doctor and lactation consultant can advise you whether or not these medicines would be right for you.

Be patient. Expect it to take several weeks before your baby comes back to the breast. And once he does, expect it to take a week or two before he'll be getting enough milk from breastfeeding alone. You may need additional milk or formula to top off your baby. But don't obsess about how much milk your baby is getting. You are giving more than your milk -- you are reintroducing that special touch that goes with breastfeeding. Rather than worrying, just try to enjoy the relationship of holding your baby in your arms and at your breast.

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