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Calculating Relactation Success Rate

This question was posted the Infant and young child feeding interventions forum area and has 13 replies.

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Isabelle Modigell

IYCF-E Consultant

Frequent user

29 Apr 2022, 12:10

The TIPS ON NUTRITION INTERVENTIONS for the Humanitarian Response Plan proposes "Proportion of mothers who successfully relactated" as a standard outcome indicator to use within IYCF-E programmes. However, no definition is provided. 

Can you please share guidance / practical experiences of how to define the criteria for "successful" relactation?

Thank you! 

Pamela Morrison

Lactation Consultant

Normal user

29 Apr 2022, 14:49

I would define "successful" relactation as a mother being able to bring in sufficient breastmilk to supply all of her baby's milk needs, and for him to gain enough weight.  So success would depend on the age of the baby.... birth to 6 months could be as much 750-900ml in each 24 hours.  An older baby, say 9-12 months that would be about 500ml/day.  And the shorter the interval between weaning and relactating, the more likelihood there is of success.  

Jennifer Yourkavitch, MPH, PhD, IBCLC

Normal user

29 Apr 2022, 20:42

While complete relactation is the goal and likely possible in most cases, "success," as defined by meeting all of an infant's milk needs, will be affected by the duration of BMS use (see Mehta et al. 2018 for a study description). It would be great to also measure partial relactation, since human milk and breastfeeding are critical for survival and some is better than none. You could think about indicators such as: percentage of infant feeds that are human milk (or breastfeeding) in 24 hrs (output level), along with infant growth (outcome level). Studies have found that relactation was possible for all participants, but a minority achieved partial, rather than complete, relactation.

Karleen Gribble

Normal user

30 Apr 2022, 00:44

Hi Isabelle, I would start by defining what is meant by relactation. Sometimes relactation is used to mean increasing milk supply in a situation where the woman has a low milk supply because she has been mixed feeding for example. I would not use that definition but rather say that relactation is a process whereby a woman has ceased lactating and then reinstitutes a milk supply. I think it's useful to consider relactation success with two measures, one being 'partial relactation' meaning that the woman is producing milk but not sufficient for the infant and BMS is still needed and 'full relactation' where the woman is producing all the milk the infant requires and no BMS is needed. The latter need not mean the infant is exclusively breastfed if they are more than 6 months of age. If you can only use one measure I would use 'full relactation.'

Karleen Gribble

Normal user

30 Apr 2022, 00:45

Hi Isabelle, I would start by defining what is meant by relactation. Sometimes relactation is used to mean increasing milk supply in a situation where the woman has a low milk supply because she has been mixed feeding for example. I would not use that definition but rather say that relactation is a process whereby a woman has ceased lactating and then reinstitutes a milk supply. I think it's useful to consider relactation success with two measures, one being 'partial relactation' meaning that the woman is producing milk but not sufficient for the infant and BMS is still needed and 'full relactation' where the woman is producing all the milk the infant requires and no BMS is needed. The latter need not mean the infant is exclusively breastfed if they are more than 6 months of age. If you can only use one measure I would use 'full relactation.'

Rukhsana Haider

TAHN Foundation

Normal user

30 Apr 2022, 07:11

Hi Isabelle. Good question. I agree with Karleen that "partial" relactation, with the use of BMS, and "full" relactation, not requiring any BMS would be useful indicators. I think the aim should be to get the mother to start lactating again after she had ceased to do so, but not to make it stressful or her. As Jennifer mentioned, even some breastmilk is better than none for infant's nutrition, health and survival. The impact on mother's mental health when she starts to re-lactate must not be overlooked. Thanks.

Alessandro Iellamo

FHI360

Normal user

30 Apr 2022, 12:36

Hi Rukhsana and Karleen

greetings!

I see where you are coming from, but I would be conscious in setting such a definition.....as it may discourage more than encourage ....

Relactation is successful by any means when the mother/caregiver is able to breastfeed the child ...(partially, fully, exclusively, while providing CD etc)...depending on the age of the child and starting point...and these factors differ for all

again, I would be very conscious in setting a standard...that may be misinterpreted....we should encourage and promote the practice as well as the skilled support needed to stimulate and embrace the practice...

Thanks to all

Karleen Gribble

Normal user

30 Apr 2022, 12:44

Hi Alex,

This is not a conversation that you would have with a mother or caregiver. I would certainly discourage suggesting to anyone who had partially relactated that she was not a success! The question as I understand it is for data collection, quite a different matter.

Karleen

Alessandro Iellamo

FHI360

Normal user

30 Apr 2022, 12:45

Thanks Karleen

I think we need to consider how health workers interpret it ....as well. That is my comment...

Thanks again 

Karleen Gribble

Normal user

30 Apr 2022, 12:51

Most certainly. Perhaps te solution might be to remove 'success' from any indicator and instead to collect data on 'full relactation.'

Karleen

Alessandro Iellamo

FHI360

Normal user

30 Apr 2022, 12:52

Briliant idea....i concurr!

You are a star Karkeen!

ciao

Karleen Gribble

Normal user

30 Apr 2022, 13:02

Thanks Alex!

Karleen

Pamela Morrison

Lactation Consultant

Normal user

30 Apr 2022, 13:14

Alex, Karleen and Rukhsana, it's good to consider the many aspects you raise about how relactation will be measured. I've always thought that definitions are really important, so that we can track health outcomes, the quantity of breastmilk substitutes that are needed and the "success" of any relactation programme.  I also find that mothers like clear information and goals that they can work towards as well our support and affirmation that we know they are doing the best that they can.  Miriam Labbok left us a good legacy in her work on breastfeeding definitionos.  Would it be feasible to use WHO definitions of what "breastfeeding" means when a mother is working to relactate?  See  https://apps.who.int/iris/handle/10665/62134 

Jodine Chase

IFE Core Group Facilitator

Normal user

7 Jun 2022, 12:51

Just popping into this interesting discussion, which came to my attention as I review en-net content in my new IFE Core Group Facilitator role. I've noted this thread for possible action.

As an aside, I'm also reflecting that we may need to consider how we refer to supplemental or replacement feeds when discussing or increasing or restarting lactation, so that we don't inadvertently communicate that the only option, or that the preferred option, is BMS.

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