Hi Diane,
These are my observations based on my experience of relactation and what I
know about the physiology of non-puerperal lactation.
It is my understanding that the breast stimulation without milk removal is
building the milk making structures within the breast. During pregnancy,
oestrogen, progesterone and prolactin (and some other hormones) prepare the
breast to make milk. However, prolactin can make the same changes by itself
and breast stimulation results in the secretion of prolactin (I wish I had
more info just on how prolactin does this so if anyone knows of anywhere
where this is setailed I'd appreciate the cite). So the structures develop
and milk "appears" however, to start with it is a very small amount and
unless this is removed the amount will not increase. This scenario happens
all the time, women see breast changes, feel their breasts develop but they
do not have MERs in response to pumping and they just can't get milk out and
get no further than having big heavy breasts (which is one reason why
preplacement prep for adoptive breastfeeding is not always a good idea, this
is very discouraging and not an indication of ability to make milk). So milk
removal is necessary.

> >If it were not true that just stimulating the breasts without actually
> >removing milk "told" the breasts to make more, how would a mom relactate
> >after weaning or induce a milk supply for an adopted baby?  When a mom is
> >starting with "nothing" as in an adoptive situation, we all know that
milk
> >will eventually be produced just by pumping and/or the baby suckling at
the
> >breast with a supplementer.  I couldn't explain the physiology behind it,
> >but in the beginning, no milk is being removed, yet done often enough,
milk
> >appears.

Yes, I was in the same situation. I had weaned my son nearly 6 years
previous to relactating and could express a yellowish drop a day from each
breast.

> In a non-lactating woman, any existing ducts/alveoli aren't air-filled.  I
> know I can hand express tiny drops from either side, nearly 2 decades
after
> lactating, if I work at it.  I don't get a drop on the first go; I have to
> work at it.  Once I've gotten that first drop, I can get a few small
> subsequent drops more easily.

Yes, I'd believe you might but breast stimulation in addition to milk
removal is required and so just removing milk a couple of times a day isn't
going to cut it for providing enough breast stimulation so there would be a
point pretty early on where the amount you could express would stall unless
you were expressing a lot!

> Might I get still more, even more easily, if I tried again a couple hours
> later?

Possible....but those high prolactin levels are needed also. Some very
interesting ideas.

> Maybe what the adoptive mom does in those early weeks with her pump is to
> slowly gather the minuscule amount of existing ductile/alveolar fluid, to
> the point where she actually begins to get some out.  Once she's shifting
> fluid from higher up to lower down, even before it escapes the nipple, she
> really is doing "milk removal", from an alveolar perspective, however tiny
> the quantity.  And maybe from that point, those alveoli respond by
replacing
> what she removes.

Personally I think that hand expression is of great assistance in cases of
relactation/or induced lactation when there is not a suckling child. I found
that I could get out small quantities of breastmilk and that those
quantities increased long before the pump could get anything out. We were
still hibernating at home post-adoption when I relactated so it was easy for
me to walk around braless with breasts easily accessible and hand express
20x a day (in addition to pumping 6x for 20-30 mins). Let me tell you
though, when you've worked all day to gather every tiny bit of moisture and
got less than 5 ml you have a real appreciation for the value of breastmilk
and never want to hear about anyone throwing milk out again! After my 5 ml
day I got 8 ml the next, 12ml the next etc. It was probably a week before
the pump got any out that could be saved and I always hand expressed after
pumping. Hand expressing was not something I had done before and I didn't do
it as shown in texts etc but the milk came out and it didn't hurt (just got
some calluses on my breasts where my thumb moved, looked a bit odd).
Measuring and recording my output each day was a real help in continuing and
I always continued expressing to get that little bit extra out so my supply
increases daily until I had all required.

Could she speed the whole induction process by several
> weeks if she used fairly aggressive hand expression at the start, until a
> pump could get drops out as well as she could?


Karleen Gribble
Australia

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