Podcast: Breastfeeding stories ... relactation

Monica's story about relactation

Monica’s breastfeeding journey got off to a rough start and she ended up weaning her baby before she was ready. With the right information and a lot of persistence and support, she was able to relactate (start making breastmilk again) and bring her baby back to the breast. In this episode, she shares her story with Laura and we ask Dr Karleen Gribble to explain how relactation works.

Information discussed in this episode:

• Relactation 
• Breastfeeding and adoption
• Purchase our booklet, Breastfeeding: relactation and induced lactation
• When breastfeeding doesn’t work out
• Increasing your breastmilk supply
• Medication to help increase your supply (galactagogues)
• Breastfeeding supplementer / supply line
• Nipple Shields
• Engorgement
• Over-supply (or too much milk)
• Expressing and storing breastmilk 
• Breastfeeding and Postnatal depression and anxiety
• Visit PANDA for more mental health support

Credits:

This episode is presented Laura Wellard. Featuring Monica Box and Dr Karleen Gribble. Special thanks to Jacqui Cook.

Audio editing and additional reporting by Jessica Leonard. Show notes by Emma Pennell. Transcription by Madina Hajher. Produced by Belinda Chambers, Jessica Leonard and Eleanor Kippen.

MONICA: From the first few days I think after I had my daughter, I felt like I was in this real, strange whirlwind bubble where I was in a lot of shock about ‘oh my God, I actually have a physical baby …’

LAURA: Welcome to Breastfeeding … with ABA. A podcast brought to you by volunteers with the Australian Breastfeeding Association. Breastfeeding … with ABA is a podcast about breastfeeding, made by parents for parents. In this episode we’ll be sharing a breastfeeding story.

ABA was started in 1964 as Nursing Mothers’, or NMAA, a group for mothers wanting to support other mothers through all stages of breastfeeding and early parenting. Evidence-based information, sharing stories and experiences, and learning from one another was an important part of ABA back then and continues to be today.

We are recording this podcast in different parts of Australia. We would like to acknowledge the traditional custodians of the land on which we are recording and you are listening to this podcast. We pay our respects to elders past, present and emerging and to any Aboriginal people who are listening today. We also acknowledge the long history of oral storytelling on this country and the indigenous women of Australia who have been living, working, birthing, breastfeeding and raising children successfully on this country for tens of thousands of years. In each episode you will hear from different mums around Australia.

My name is Laura and I’m a volunteer breastfeeding counsellor with the Australian Breastfeeding Association, and a mum to three children. I am speaking from Geelong, Victoria and Wadawarrung country. This episode our guest Monica is going to share her breastfeeding story. Monica, can you tell us a bit about yourself and your family?

MONICA: So, I am a mum to three daughters, I have Sofia who’s 8, Mia is 6 and Philippa, my youngest, she’s 3. And we live at home with my husband and we have a couple of dogs and a cat and some chooks.

LAURA: Wonderful, sounds like a very busy household that you’ve got there!

MONICA: Yeah, it definitely is!

LAURA: How long did you breastfeed Sofia, your eldest, for?

MONICA: So, all up, I think we breastfed for about 6 months. 

LAURA: And what was that experience like for you breastfeeding your first daughter?

MONICA: It was a very new experience, I felt like it would be very natural, I thought it would be easy, I thought it was like what you see in the movies, you know, very easy to breastfeed a baby and we had quite a lot of difficulty.

LAURA: So, breastfeeding wasn’t quite what you were expecting in the beginning. What sort of difficulties did you have?

MONICA: Like many mums, I had trouble with just the basic positioning and attachment, I think. I had quite severe engorgement after roughly about, I think it was about 36 hours, it was quite soon after she was born. I remember waking up at approximately 1 am in the morning with really hard, engorged breasts and I was in so much pain and discomfort and I had no idea what was happening. I was lucky enough to have some continuity care with the midwife who I phoned at 1 o’clock in the morning just in a panicked state asking her what was going on and how could I fix it? And I wish I’d known to call ABA in that time, actually. 

She didn’t probably provide me with the best suggestions, so I sort of said to her you know ‘would it help if I, like I think I need a pump like I feel like my breast must be full of milk this is what’s happening?’ I tried hand expressing and didn’t really have much of an idea how to do it, tried to feed and really struggled through that and I think that was probably the beginning of getting a little bit of damage to my nipples which was really, really tricky which then led me on to starting to express which I had very little difficulty doing. I found expressing really easy so I know many mums have a lot of difficulty expressing but I seemed to have so much milk that it was really easy. I then developed an oversupply which then led me to develop mastitis so … and I was quite unwell with that, yeah. I got to the point after having a second bout of mastitis within 3 weeks, I fell into quite a pit of despair, I did develop postnatal depression and I sort of felt like I got those baby blues that didn’t really disappear, and I started to feel really stressed and really overwhelmed with having a little baby that I felt like I had no idea what I was doing with and didn’t feel like I was doing anything right, that sort of thing. And so I actually stopped breastfeeding at 3 weeks. My partner had just said to me one day, I was in tears and he said to me ‘Maybe we should just try some formula, she will be okay if we give her formula.’ And I just remember in that moment feeling completely heartbroken as though I had completely failed, but I also felt like I couldn’t continue breastfeeding at that point so, I just sort of succumbed to the idea that you know, she would be fed and she would be happy and that would be good enough at the time, yeah.

LAURA: So, Monica stopped breastfeeding her first baby at 3 weeks but then went on to breastfeed for around 6 months. That’s because she did something a lot of people haven’t even heard of called ‘relactation.’ To tell us what that means, here’s Dr Karleen Gribble. She’s an Adjunct Associate Professor in the School of Nursing and Midwifery at Western Sydney University. She’s an expert in infant feeding and relactation is one of her interest areas.

KARLEEN: So, relactation is the process by which somebody who hasn’t recently given birth or been breastfeeding is able to create a milk supply from scratch really, so, during pregnancy you’ve got the hormones estrogen, progesterone and prolactin that actually develop the milk making structures within the breast and prepare to make milk but the hormone prolactin can actually do all of that work on its own. And prolactin is produced in the body when there’s nipple stimulation. So, if you’ve got other babies sucking at the breast or you’ve got a breast pump that’s actually providing that nipple stimulation that’s producing prolactin and that will actually develop the structures within the breast and, once those are developed, they start making milk. Once you start removing that milk that’s been produced then more milk is made. How long it takes and how difficult that is depends on a few different things. If it’s only been a short time since you stopped breastfeeding, say your baby’s only a month or 6 weeks of age, you have never breastfed that child, that’s really only a very short period of time and in fact most women in those circumstances would still have some milk in their breast and they will be able to build from there. If it’s been a longer period of time that might mean it will take a bit longer to do but that doesn’t mean that it won’t happen so ... I’ve worked with some women where sometimes it’s been 20 years since they’ve breastfed, and they’ve still been able to relactate. So, it’s a normal, naturally process. It’s a back-up mechanism because there’ve always been these sorts of situations where a baby has needed breastmilk, and their mother hasn’t been available or there’s been a break in breastfeeding and that’s gotten started again. So, it’s an option that can work, if that’s something you want to pursue.

LAURA: There are lots of reasons people might try to relactate. For Monica it was something she felt like she wanted to do for herself.

MONICA: I always had it in my mind when I was pregnant with my eldest that I would breastfeed. So, after feeling like quitting breastfeeding contributed to developing postnatal depression, I felt like it was one of those things that it would help me a little bit which I think it did. But I also went through the rollercoaster of really kind of beating myself over a lot of it and not realising that breastfeeding comes with many challenges and the support is really needed so I think I needed to see whether I could give it another crack to really feel like I’d given it my best effort.

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JACQUI: My name’s Jacqui and you’re listening to Breastfeeding … with ABA. I initially heard about the ABA through my childbirth education class. After that session about breastfeeding, I still felt like I didn’t have enough information. But I didn’t know what I didn’t know, and I ignored my instinct to attend an ABA run Breastfeeding Education Class … mistake! I figured ‘breastfeeding is natural, I’ll figure it out!’ A few nights after coming home from the hospital during a night of cluster feeding, I rang the 24/7 Helpline convinced I was doing it wrong – I wasn’t. A few nights later I used the messaging system and again, a few nights later, until I decided it was finally time to join. And I was welcomed to an online community of wonderful volunteers and breastfeeding mums all over Australia with similar aged babies, similar questions and an insight into what phases might be coming next. My breastfeeding journey came to an end after 15 months when my daughter self-weaned, but the ABA supported me to make informed choices about feeding, returning to work while feeding, and the courage to continue through long nights.

JESSICA: To join our community on Facebook, search for ‘Breastfeeding … with ABA’, request to join the group and make sure you answer the joining questions so we can add you quickly.

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LAURA: It’s pretty normal for women to be able to hand express a drop or two of breastmilk even after they’ve weaned and that’s something that gave Monica a little bit of help.

[MUSIC FADES]

MONICA: I still had tiny volumes of milk just from hand-expressing so I was able to hand express just a few drops here and there which made me think ‘maybe I can try and stimulate my supply a little bit more’. Basically, I just started trying to express to begin with just to see how much milk I could express for her to have in a bottle because she wasn’t having a bar of going to the breast and I didn’t really know how I was going to go about getting her back to the breast, either so that’s basically how I started just a little bit of a combination of hand expressing. Other than I started doing a bit of reading on various websites, groups on Facebook as well which were also quite helpful. That’s basically how I started, yeah.

LAURA: Monica spoke to her health professionals about relactation. They talked her through things like medications to increase her supply. You can find information about that in the show notes, but it is something you need to speak to your health professional about. She also saw the lactation consultant at her local hospital. Expressing milk was actually something Monica found easy, but there were other things that were more difficult.

MONICA: The biggest hurdle that I found difficult was feeling rejected by my daughter. I think, just simply trying to breastfeed her was probably the most difficult part. After reading a few tips of ways to get your baby back to the breast, I tried a few of those so there were things like trying after a bottle of milk so whether that was formula or expressed milk, just kind of offering and just having her there. I started using some shields as well to try and mimic that sensation of a bottle teat and eventually that’s how I got her back to the breast. I just, I think, I just got the right time of when she was settled. I just remember that time that she finally latched back on with a shield and I was like, ‘oh my God, she knows how to do it!’ and so that really gave me a bit of confidence, and I was like ‘okay, I can do this again!’ Every day was a little bit hit and miss depending on like whether I was going to my mothers’ group, or whether I had to leave the house, that made it quite tricky and I tended to just use formula at those points in time I just didn’t feel quite comfortable juggling trying to get her back to the breast when we were in those early days.

LAURA: Using a nipple shield was one thing that Monica found helpful, another was something suggested by a lactation consultant.

MONICA: She actually taught me how to use a supply line as well to try and get Sofia back to the breast because I had quite a lot of difficulty with that.

LAURA: It’s difficult to explain what a supply line but picture a mum wearing a necklace with a bottle of milk hanging upside down, a little bit like a water feeder that you might see in a guinea pig cage but instead of a thick plastic tube it has a really fine tube that runs out of the bottle.

MONICA: And the end of the little tube you can just tape it or you can pop it in the corner of baby’s mouth when they’re on the breast so it’s basically a reward system where baby gets rewarded some milk for when they’re sucking at the breast.

LAURA: Supplementers or supply lines can be really fiddly. Some people use them really successfully for a long time but for others like Monica it’s not necessarily a long-term strategy.

MONICA: I did use the supply line a couple of times but I felt like my baby was a little bit too impatient for me to prepare it, get it ready, and have her settled enough that I could bring her to the breast and try and get her to latch on. My biggest hurdle I suppose then was trying to make sure that I could get enough milk for her, I guess. I was never quite confident in my supply from that point on as well so we did continue to use formula as well so we probably, I probably reached a point where we were doing 50/50 or maybe 60/40 so 60% breastmilk and 40% formula because, yeah, I was reassured by the fact that I had the formula there so that if she was hungry and if I wasn’t feeling confident in myself or she was flustered and she didn’t want to breastfeed that we had that as our back up, that was sort of my back stop. So yeah, we did that for up to nearly 6 months and I got to the 6-month period and felt like I had done us justice because ultimately 6 months is a big achievement. Yeah.

LAURA: There were challenges but there were really positive parts of relactating that made it worth it for Monica.

MONICA: From the first few days I think after I had my daughter, I felt like I was in this real, strange whirlwind bubble where I was in a lot of shock about ‘oh my God, I actually have a physical baby …’ and, because I went through the process of having bad mastitis and being so unwell in the first few weeks of her life, I felt like that really inhibited our bonding experience. So, I guess the aim of trying to relactate was to try and feel like I was re-establishing that bond with her but also trying to give her more. I don’t know, the best thing about it I think was that was the thing that we both had. It was our little thing, and that’s what I’ve always found with breastfeeding is that it’s our little thing, nobody else can do it, my babies have come to me for that and that’s something that I can do for them which is really special.

LAURA: Monica’s got a few pieces of advice for anyone who wants to try relactating. First – be realistic.

MONICA: Definitely be open minded about it, it may work or it may not work. For me I felt like I didn’t 100% get there, I didn’t get back to exclusively breastfeeding which I really wanted to. Be open minded about it, ask for help, ask for support.

LAURA: Second – recruit your loved ones to be your cheer squad.

MONICA: Even though my husband was the person that said to me at 3 weeks ‘she will be okay if we give her formula’, he was also the person who was really supportive of me wanting to breastfeed her again. So, in those times when I was trying to express all that milk and even just spending days with Sofia in bed he would be just like ‘how was your day’ you know ‘how did you go?’, ‘Do you need anything’ that sort of thing so to go on and have him as my supporter through feeding my next two babies, yeah, it was just, yeah, he didn’t need to do anything because I knew that he would support me and back me so that was good.

LAURA: Third – gather information before your baby arrives if you can.

MONICA: I definitely would have done some sort of education antenatally beforehand. There is so much focus on labour and birth and that’s something that I really recall that being pregnant the first time, you go to your hospital birthing classes. I don’t even remember them touching on breastfeeding but having done extra reading and talking to people and research and things like that between my next two babies that just … there’s no other word than feeling empowered because you’re armed with knowledge so that you can make decisions and then you can seek out support. And it sounds cliché coming out of my mouth, I’m like ‘oh, this is what everyone says!’ you know ‘make you feel empowered’ but it really does because you don’t feel overwhelmed, you don’t question yourself as much, you really think about ‘why is my baby behaving like this?’ and you think ‘have I tried this, have I tried that?’ you don’t sort of feel so helpless and so unsure about yourself and you don’t question yourself as much as whether it may be just baby being a baby.

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LAURA: Thank you Monica for chatting with us today and sharing your story. For more topics we discussed today check out the show notes for links and information. Please rate, review and subscribe to Breastfeeding … with ABA. Thank you for listening.

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