Relactation

It sounds as though you faced many challenges with the initiation of breastfeeding in spite of your best efforts. Though I cannot predict your personal likelihood of being able to relactate (stimulating a milk supply after ceasing breastfeeding for a time), I can tell you that women have successfully relactated or induced lactation (stimulated a milk supply without having been pregnant) for adopted infants close in age to your daughter - and older. (For one example, see the article Nursing Julia: My Supreme Challenge, by Darillyn Starr at.) Approaches to relactation vary based on mothers' preferences and the options and support available to them. Some women use galactagogues (herbal or prescription medications known or believed to increase milk supply); some do not. Each mother's response to breast stimulation varies depending on her personal body chemistry (Mohrbacher & Stock 2003, p. 397). Strategies for relactation include (but are not limited to):

• Breastfeeding at least eight to twelve times per day (every one and one-half to two hours during the day and at least every three hours at night).
• Making sure that the baby latches well and is positioned well during breastfeeding.
• Offering both breasts at each feeding.
• Letting the baby finish the first breast first and not arbitrarily limiting the length of feeding (so that the baby gets the higher calorie milk available in an emptier breast).
• Using breast compression during feedings whenever the baby seems to not be actively nursing.
• Using a nursing supplementer to allow the baby to receive extra nourishment as well as comfort at the breast.
• Avoiding bottles, pacifiers, swings, and other soothers to maximize the amount of time baby spends at the breast.
• Picking times to nurse that the baby is not too hungry or too sleepy.
• Choosing a comfortable and private place to nurse, free from distractions for baby and mother.
• Providing baby with a lot of skin-to-skin contact and cuddling, along with offering the breast.
• Attempting breastfeeding while the baby is sleeping, if he or she has difficulty breastfeeding while awake.
• Breastfeeding in the bathtub with the baby's body submerged and his or her face above water.
• Approaching breastfeeding sessions as times of closeness and special attention.
• Avoiding feeling pressured about how the baby responds to nursing sessions.
• Considering partially inducing lactation for an older baby or toddler: a partial milk supply may be all that is needed if a baby has already begun eating table foods.
• Using herbal or prescription galactagogues after consultation with a physician.
• If the baby is unwilling or unable to breastfeed, expressing milk 8 to 10 times a day (including the night).
• If the baby is nursing, expressing milk after feedings to drain the breast more completely.
• If the mother is using a breast pump, using a full-size, automatic double pump that provides between 40 and 60 suction-and release cycles per minute.
• If the mother is expressing milk, continuing expressing until two minutes after the last drop of milk is seen.
• If the mother is using a breast pump, double pumping because doing so may increase milk supply than single pumping.
• Resting and eating well so that it is easier to cope with the time and effort that relactation takes.
• Accepting all offers of help so that more time and energy are available to work on relactation (Mohrbacher & Stock 2003, p. 390-398).

I don't know what challenges you faced in your earlier experience with breastfeeding - or whether any of them still exist. For example, an unsupportive social environment may undermine a mother's most vigorous efforts to breastfeed - and to relactate. A mother might have difficulty developing an adequate milk supply because the baby is tongue-tied and cannot effectively empty the breast. Breastfeeding may be painful and difficult because the baby has a high palate. A mother might have had breast surgery or injury to her breast or inadequate glandular development that has decreased her ability to fully breastfeed. A hormonal imbalance may need to be treated in order for breastfeeding to be possible. Also, a baby's ability to take the breast and suckle effectively varies with age, interest, adaptability, distractibility, basic temperament, and previous feeding experience (Mohrbacher & Stock 2003, p. 397). Identifying and addressing such factors are important steps in relactation.

As far as breastfeeding management goes, your situation is similar to that of a mother who has adopted a baby and would like to breastfeed. Therefore, adoptive breastfeeding resources may be useful to you. Resources published by LLLI and/or available from the LLLI catalogue include:

• Can I Breastfeed My Adopted Baby? a section in LLLI's online collection of Frequently Asked Questions.
• Adoptive Breastfeeding, a collection of links to online articles by mothers who describe their experience with adoptive breastfeeding. The articles are reprinted from New Beginnings, LLLI's journal for breastfeeding mothers.
• Breastfeeding the Adopted Baby (revised edition) by Debra Stewart Peterson. This book offers a step-by-step description of the process of inducing lactation in a woman who has not given birth.
• Nursing Your Adopted Baby, a 22-page pamphlet by LLLI providing information on bonding and attachment, building a milk supply, supplementing, and finding a support system.
• The Breastfeeding Answer Book by Nancy Mohrbacher and Julie Stock (2003). This book offers detailed information on relactating, inducing lactation, increasing milk supply, encouraging a baby to take the breast again, and coping with a wide variety of breastfeeding challenges.

Another issue to consider is whether an inadequate level of experience or training of the "lactation consultants" who worked with you could have contributed to your initial breastfeeding challenges. Many mothers do not know that anyone can call him- or herself a "lactation consultant," a "lactation specialist," a "breastfeeding counselor," etc. Some people holding such titles may not have enough training or experience to be fully effective. The title is completely unregulated. However, only people who have qualified to take and have passed the exam of the International Board of Lactation Consultant Examiners are entitled to call themselves "International Board Certified Lactation Consultant" (IBCLC). For more information on that certification and to find an IBCLC near you, see the website of the International Board of Lactation Consultant Examiners at: http://www.iblce.org. Other sources of breastfeeding support and information are La Leche League (LLL) Leaders. These women are experienced breastfeeding mothers who have been trained and accredited by La Leche League International. They are backed up by an extensive support system from which they can seek more information whenever it is needed. To find an LLL Leader near you, see the website of La LecheLeague International.

Asking about the credentials, training, and experience of lay or professional breastfeeding counselors is always appropriate. You have the right to request a referral to someone more experienced if the people working with you are not able to effectively help you. And, regardless of their credentials, lay or professional breastfeeding counselors or other healthcare providers should never let themselves be the last stop for a mother trying to overcome breastfeeding difficulties. The odds are good that the situation is not entirely unique and that someone out there has more information on and/or experience with it.

Best wishes to you and your baby, whatever decisions you make!

References
Mohrbacher, N. and Stock, J. The Breastfeeding Answer Book. Schaumburg, IL: La Leche League International 2003.
Starr, D. Nursing Julia: My Supreme Challenge. New Beginnings 1993; 10(5):135-136.