Induced Lactation

The following is an excerpt from the excellent resource book, The Breastfeeding Mother's Guide to Making More Milk, by Diana West, IBCLC, and Lisa Marasco, M.A., IBCLC. If you work with new mothers and/or breastfeeding women, or if you are a nursing mom concerned about your supply now or in the future, pick up a copy of Making More Milk today.


Induced lactation is the process of creating a milk supply for a child you have not birthed. With a long historical tradition in native societies, it is becoming more common as women learn that it is possible. (1, 2) For both adoptive mothers and mothers of surrogate babies, breastfeeding is about more than the milk-it's a way to connect at a deeper level with your new baby and contribute to his growth beyond the pregnancy. Although it will require time, motivation, perseverance, tenacity, and patience, breastfeeding your baby can be tremendously rewarding.

As with relactation, the younger the baby, the more likely he is to latch onto the breast easily. A baby older than three months is liable to have more difficulty learning what to do than a newborn. All babies nurse more willingly when there is more milk, so it helps to do all you can to maximize your production. Achieving a full supply may be possible provided there aren't underlying problems such as hormonal dysfunctions or underdeveloped breast tissue. If you struggled with infertility in particular, there may be a hormonal problem that could limit your milk-making capability. However, most mothers can make at least some milk, and the total amount of milk need not interfere with a satisfying breastfeeding relationship. While you won't produce true colostrum, the milk you make will be the same quality as a birth mother's mature milk. (3)

If you're currently nursing but want to breastfeed a new baby you did not birth, you may not be able to increase milk production enough to meet the new baby's needs fully because you are in the autumn season of lactation now. But it's always worth trying because your new baby will benefit from whatever extra you can make.

Methods of Inducing Milk Production

In traditional cultures, women have successfully stimulated milk production just by putting the baby to the breast very frequently. Our Western approach relies more often on breast pump technology, but pumping is an imperfect way to induce milk production because it is cold, mechanical, and vacuum-centered only. Plus, it takes time to become comfortable and proficient at pumping. Even birth mothers with excellent milk production aren't always able to pump effectively, especially in the beginning. A nursing baby adds a positive emotional element; not only does suckling stimulate milk ejection, but the psychological effect of baby's smell, sight, and sounds triggers additional oxytocin releases that a pump can not. If possible, combining pumping with nursing baby using an at-breast supplementer can provide the best of both worlds. Adding galactogogue medications and/or herbs can result in significantly higher milk production.


Basic Pumping Protocol for Induced Lactation

1. Two to four weeks (or more) prior to the baby's arrival, begin manual massage of nipples and breasts for ten minutes eight to ten times per day for two weeks.

2. After two weeks, begin double pumping with a hospital grade pump for ten to fifteen minutes eight to ten times per day. If you find pumping without a flow of milk to be uncomfortable, try putting a bit of breastfeeding-grade lanolin on your nipples or lubricate the funnel with a bit of vegetable or olive oil before pumping.

3. When baby arrives, use an at-breast supplementer to provide feedings at the breast (pictured above). [Note: Commonly used at-breast supplementers include the Lact-Aid (preferred by most mothers interviewed by DrMomma.org) and the Supplemental Nursing System. Find human milk donations to use in the supplementer through a variety of resources.] Pump after feedings or several times per day, as time permits (this is also called "Power Pumping"). Keep a close watch on baby's weight gain to ensure that he is getting enough nutrition.

4. As your breasts begin to feel full, heavy, and slightly tender, see if baby will nurse at the· breast without supplementation for the first few minutes of the feeding ifhe is willing. Continue to watch diapers or track weight gain.

5. As long as hunger cues aren't frantic and weight gain is sufficient, gradually decrease either the amount of milk in the supplementer or the length of time the milk is allowed to flow from the supplementer during the feeding. Eventually, you may reach a point where you can no longer decrease the amount of supplement you offer without leaving baby hungry. That is the amount that will be needed for now, and maybe for the long term.

In the beginning, you have only your standby skeletal crew of lactocytes to start up milk production. Be patient. Induced lactation really is more like building a milk factory by hand from bricks and mortar instead of having the construction company, pregnancy, do it with all their specialized parts and equipment. Not as fancy and takes longer, but sooner or later new workers and assembly lines will slowly start to kick in, and your production will pick up.

Hormonal Simulation

Hormonal protocols for inducing lactation attempt to artificially simulate a pregnancy in order to build a milk factory. The amount of hormones used is less than what is normally produced during pregnancy. A birth control pill containing estrogen and progesterone is taken for a specific amount of time in order to stimulate the growth of more milk-making breast tissue. Then a prolactin-stimulating medication is introduced. Finally, pumping is begun to remove milk and further stimulate milk production.

In most cases, hormonal protocols result in more milk production than simple pumping. The more time you spend in the pregnancy-mimicking phase, the more milk-making tissue will be created. Starting at least four months before baby is expected to arrive produces the best results. You can initiate a protocol even after your baby arrives, but the shorter the lead time, the less you should expect to produce.

Milk does not come in until the pumping phase and first appears as clear drops that eventually become more opaque and white in color. As the milk volume increases, you may begin to see small sprays that eventually become streams of milk. The amount of time it takes to reach the streaming phase varies from mother to mother and depends on the type of protocol that she follows. It may take days, weeks, or months for milk production to begin. You'll know your body is gearing up to make milk when your breasts increase at least one bra cup size and feel full, heavy, and slightly tender. If you don't experience at least some tenderness within fifteen days, it may be necessary to increase your progesterone intake.

Because hormonal protocols entail the use of prescription drugs, it is essential to consult a physician. Present the entire protocol and explain that the birth control pill is not being used as a contraceptive but rather to develop lactation tissue. The medication can be started at any point in the menstrual cycle because the purpose is to simulate a pregnancy rather than prevent one.

Mothers who have blood clotting problems (a history of thrombosis), heart conditions, or severe blood pressure problems (hypertension) should not use hormonal protocols. Nor should mothers who wish to tandem nurse, because the existing milk supply will be reduced initially.

The Newman-Goldfarb protocols were developed by Lenore Goldfarb, B.Comm., B.Sc., IBCLC, in consultation with Dr. Jack Newman, as a result of her personal experience and subsequent work with other mothers, and are still evolving. They represent a new strategy that has not been formally tested in clinical trials but has been described theoretically by Dr. Peter Hartmann and his research group in Australia. (4) Many mothers have found the protocols to be effective. Similar but more limited protocols using medications to stimulate lactation hormones have been tested and found to be effective as well. (5, 6, 7, 8)

There are several versions of the Newman-Goldfarb protocol to accommodate the varying amounts of time available before baby arrives and the mother's hormonal situation. Mothers who prepare for six months or more by following the "regular protocol" are more likely to induce a full milk supply, while mothers who do so for fewer than six months and follow the "accelerated protocol" are often able to induce a 50% supply. Mothers who follow the "menopause protocol" may produce a 25% or less milk supply." Since these protocols are still evolving, visit the Ask Lenore website for specific details and more information.


For further information about induced lactation:

The Adoptive Breastfeeding Resource Website

Dr. Jack Newman & Enith Kernerman: Breastfeeding Your Adoptive Baby or Baby Born by Surrogate

Adoption.com's section on breastfeeding

One woman's experience: Breastfeeding My Adopted Child

Dr. Jack Newman Lactation Aid (homemade instructions)

Ask your local La Leche League leaders and/or lactation consultants for names of mothers who have nursed their adopted children.

Check out the book, Breastfeeding the Adopted Baby, by Debra Peterson.

Many of the same techniques used to trigger milk supply for working mothers who must be away from their babies all day, every day, are the same gentle parenting measures that will help adoptive moms increase supply as well. For further information on these natural-hormone boosting ideas, see: Balancing Breastfeeding: When Moms Must Work.

For breastmilk donations, look into a variety of resources available.

Additional breastfeeding resources can be found here.

References

1) Jelliffe, D & Jelliffe, E. Non-puerperal induced lactation. Pediatrics. 1972; 50(1):170-1.

2) Auerbach, K & Avery, J. Induced Lactation: A study of adoptive nursing by 240 women. Am J Dis Child. 1981; 135(4):340-3.

3) Kulski, J., Hartmann, P., Saint, W., Giles, P., Gutteridge, D. Changes in the milk composition of nonpuerperal women. Am J Obstet Gynecol. 1981;139(5):597-604.

4) Hartmann, P., Atwood, C., Cox, D., Daly, S. Endocrine and autocrine strategies for the control of lactation in women and sows. In: Hannah Research Institute Conference on Intercellular Signaling in the Mammary Gland. New York: Plenum Press; 1994:203-25.

5) Bryant C. Nursing the adopted infant. J Am Board Fam Med. 2006;19(4):374-9.

6) Biervliet, F., Maguiness, S., Hay, D., Killick, S., Atkin, S. Induction of lactation in the intended mother of a surrogate pregnancy: case report. Hum Reprod. 2001;16(3):581-3.

7) Petraglia, F., De Leo, V., Sardelli, S., Pieroni, M., D'Antona, N., Genazzani, A. Domperidone in defective and insufficient lactation. Eur J Obstet Gynecol Reprod Biol. 1985;19(5):281-7.

8) Nemba, K. Induced lactation: a study of 37 non-puerperal mothers. J Trop Pediatr. 1994;40(4):240-2.