Relactation: an effective intervention to promote exclusive breastfeeding

Fifty mothers of hospitalized infants less than 4 months old with partial or complete lactation failure (LF) were randomly assigned to two groups of 25 each for relactation. Majority of enrolled mothers (86 per cent) had complete LF and 14 per cent had partial LF. Relactation was attempted in both the groups with motivation, support, and repeated suckling. Group II mothers, in addition, were given metoclopramide. The characteristics of mothers and babies, and socio-economic background were comparable in both groups (P > 0.05). The primary outcome variables measured included the time of appearance of first breast milk secretion (in complete LF), time for partial and complete relactation. Relactation attempt was successful in 49 mothers (98 per cent), with complete relactation in 46 (92 per cent) and only partial relactation in three mothers (6 per cent). Nipple confusion and frustration of the baby (4 per cent) in complete LF, small/retracted nipples (8 per cent), and sore/fissured nipples (4 per cent), which influenced the initiation of relactation, were overcome with drop and drip method, lact-aid support and proper positioning of the baby. All the outcome variables of the two groups were comparable (P > 0.05). The pattern of weight gain, the rate of reduction in the amount of top milk and subsequent weight gain in the follow-up was also comparable in both the groups (P > 0.05). Maternal factors like breast conditions, nutrition, parity, feeding practices in previous babies, lactation gap, and infants' initial refusal to suck at the breast did not influence the outcome variables as long as repeated suckling was ensured. We conclude that relactation is possible in most of the mothers without the help of lactagogues. Apart from educating and motivating the mother for exclusive breastfeeding during first 4-6 months, a strong professional support by a skilled health worker is needed to overcome the initial problems during relactation.