How to Get Started With (Re)Lactation
by Ken L. Smith

In the time that I have enjoyed being part of SNCLIST, I have seen that there is one thing that seems to be common in many of the ANRs that are having problems. I would emphasize to anyone that does not feel they have achieved the level of lactation they wish to achieve by this time, that lactation 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 regular schedule to make it work. This requires a lot of time, a lot of effort, and a deep commitment.

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 their reasons for doing that may be, is the following:

POINT ONE:
Tell your body what you want. Reach up and squeeze your breast as if to squeeze something out of it, and you have already started the process. By "taking" your milk from your breasts, your body will do its part and provide that milk. This requires you to express milk from your breasts on a very regulated "schedule" (our bodies really do like schedules). Your brain, body and breasts have to "get the message" and that can only happen if every 3-4 hours over the 24-hour day (and the seven days of each week) each of your breasts is being completely emptied. If you are not producing breast milk, express AS IF YOU ARE PRODUCING  for 10 - 15 minutes, 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. It will take several more sessions to return to the point you had achieved before you skipped a session. Do Not Miss A Session! Breasts will not produce if you wean your child, so by taking less milk, or skipping sessions, your brain, body and breasts take that to mean that you are weaning, so the breasts slow down and shut down their level of milk production. 

POINT TWO:
Choose the method by which you will express your milk.
The BEST choice is a mouth used 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 your 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 onto" 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 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-nipple.html 

and

http://www.breastnotes.com/anatomy/anatomy-insidebreast.html

It will help you to see what you are working with. Do not slide your fingers on your skin… move your breast skin with your fingers. Work completely around your breast. Your lobules and ampullae are arranged in a circular arrangement completely around your breast, and you need to express from each cluster of lobules. Continue expressing each breast for either 10 - 15 minutes or until your breast is empty, which ever is LONGER. Repeat for the same amount of time with your other breast.
The THIRD best choice is to use a breast pump. The breast pump does not usually do as good a job at emptying your breasts, nor does it provide the deep stroking that is beneficial in starting lactation. Completely empty breasts signals your body and brain that you need milk, or MORE milk. The pump will help you empty your breasts after you are producing as well as you want, if your partner is not available to empty them orally. Remember that a mouth or manual (hand) expression should be used alternately with the pump, to completely empty your breasts. Do Not Stop Pumping when your milk stops coming. 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. Suction merely picks up milk after it is produced, so if it is not coming out, do not increase suction. One important feature that a good breast pump provides is a rapid-pulsing stimulation of your areolar nerves which is good to help stimulate lactation.

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 your hormones that start your breast alveoli producing milk. We believe that the use of a TENS module will be most effective during the period of time before lactation is established. 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… and you wish to continue to do these things without others being aware that you are being stimulated. If you would like to explore this idea, or have questions regarding the use of a TENS module, please ask me about what we have currently learned and how to go about using one.

POINT THREE:
AFTER… 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 start producing less milk per session than you want to settle with, then add another session during the 24 hour day.

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 shut you down or allow milk to be produced. 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 or recipient, and is influenced heavily by images of things such as your baby, sounds like a crying baby or your loving partner, 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, it almost becomes automatic and requires less outside stimulus, but if you are having trouble lactating, 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, the nipple does nothing but feel good and look good. You do not squeeze the nipple to get milk. When a baby latches on, it places as much of the breast into its mouth that will fit, and the breast will literally take on a more flattened shape to allow proper expression of the 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. 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” also. Everyone is very different in how their bodies function. I am bothered 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 the herb usage with their doctor or medical care-giver before they use it. 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. Too many of us do not drink what we should. It is suggested that you can determine the minimum amount of water that you should drink 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, but then, I'm not lactating. :-)

CONCLUSION:

If, after a couple of months of doing what this article says, and 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 see if there is anything 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
www.BreastNotes.com
Breastcare@comcast.net

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