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Induced / Adoptive Lactation

If you are adopting a baby or having one through a surrogate carrier, it may be possible for you to produce some breastmilk for the baby, as well as nurse the baby on your breast.

First you need to think about what your goals are. Some women want to give the baby as much breastmilk as possible and do not feel the need to nurse the baby on the breast. Others may be more interested in feeding the baby on the breast and not so much in how much breastmilk the baby gets. Most women would like to have some combination of the two.

Nursing only, no pumping:

If you are only interested in feeding the baby on the breast and are not very concerned about how much milk your breasts will make, consider using a supplemental nursing system. This system is composed of a bottle attached to a very small feeding tube that can be taped to your nipples. When the baby latches on the breast, he/she will be enticed to stay and suck by the flow milk from the tube. You can put formula or banked breastmilk into the bottle to feed the baby.

Before the baby is born, I suggest contacting the lactation consultant in the birthing hospital. Speak with her/him about what you would like to accomplish. Many times, the lactation consultant will make herself available to help you latch the baby on the breast with the supplemental nursing system shortly after the birth. If you plan to nurse the baby on the breast with a supplemental nursing system at least 5 times per day, and you can take herbs and medication to help increase your milk production.

Pumping to induce milk production:

If you do want to produce as much breastmilk as possible, the recommendations on how to do this depend on how much time you have before the baby is due.

Due date is in 2 months or less: This time period is too short for use of oral contraceptives to induce milk production. For this amount of time, I recommend pumping and taking medication.

Pumping

  • Rent a hospital grade pump.
  • Make sure your pump flange is not too small. 24/25mm is the standard size. 27mm, 30mm and angled flanges are also available.
  • Put olive oil on your nipples and areolae before pumping to decrease friction.
  • Pump every 3 hours during the day and every 4 hours at night (if you have the energy).
  • Pump for 15 minutes.
  • Start at minimum and slowly go up on the suction to the highest level that does not cause you pain.
  • **The more frequently you pump, the more milk you will be able to produce.**

Medications

At the same time you start pumping, you should take a medication that increases prolactin levels.

Most women are prescribed domperidone.Speak with your doctor to see if you are able to take domperidone.The dose is 20 mg four times per day. If you are not pumping at night, take the domperidone during the times when you are pumping. Do not take a dose if you do not plan to pump sometime in the next 3 to 4 hours.

Oxytocin is a naturally occurring hormone that causes smooth muscle contraction of the breast ducts. It does not affect milk production, it only helps ducts “squirt” the milk out, this is called a “let down”. If your breasts are producing some milk by the time the baby is born, you may want to take oxytocin to help with let down for the first one or two weeks of nursing. The increase in flow caused by the oxytocin may entice the baby to suck more effectively at the breast. The bonus is that oxytocin is a “feel good” hormone with other added benefits. Speak with your doctor about getting oxytocin nasal spray compounded.

Herbs

Once you start to see milk falling to the bottom of the bottle, you may also want to take herbs to increase the production. We do not know how the herbs work to increase milk production, but we do know that they are minimally excreted into the milk and pose no known significant risks to the mother or baby.

Herbs used to increase milk production are Fenugreek, Blessed Thistle, Fennel, Red Rasberry, Anise and others.

Due date is more than 2 months away:

There are two paths you could take here.

1. You could pump for many weeks and take domperidone and /or oxytocin as above.

2. You could try to mimic pregnancy by taking estrogen and progesterone in the form of oral contraceptives without the placebo week. This is contraindicated if you are prone to blood clots, have hypertension, history of stroke, history of breast cancer or breast cancer in the family. You need to speak with your doctor to see if it is safe for you to take the oral contraceptives in this way. When taking the oral contraceptive, you do not pump and you would also take domperidone to increase prolactin (trying to simulate the higher levels seen in pregnancy). A few weeks before the due date, you would stop the oral contraceptive and continue the domperidone (now mimicking delivery and breastfeeding). At this time, you would start pumping every 3 hours as above and consider taking oxytocin nasal spray for one or two weeks.

Assuming you have no contraindications to taking any of the above medications, the decision between pumping for many weeks prior to the birth versus taking an oral contraceptive and then pumping only in the weeks closer to the birth should be based on a. Your ability to pump so frequently for many weeks. Take into consideration your work schedule, travel plans, energy level.

b. Your comfort with taking an oral contraceptive without placebo for more than two months.

What to expect:

When you first start pumping, you may only start to see beads of milk on the tip of the nipple after 1 ½ to 2 weeks of pumping. It may take another week before any milk starts to fall to the bottom of the bottle. Little by little, the production will increase. As stated before, the more frequently you pump, the more milk you will end up making. If using the oral contraceptive route, beads of milk may be seen in the first few days of pumping.

Many of my patients who pumped 6 or more times per day for at least 6 weeks before the birth were producing approximately one ounce of milk per pumping session. The longer and more frequently they pumped the more milk was produced.

Also, don’t be alarmed if you had been pumping some milk and once the baby is born, your production drops. This is an extremely happy time, but can also be stressful because of logistics. Do not worry, your milk will increase again within a few days. Just try to pump regularly when time permits.

***Expect to supplement with banked breastmilk or formula. See Bottlefeeding.

Induced lactation is a slow, labor intensive and imperfect process. Despite what you may have heard elsewhere, very few mothers who induce lactation and lactation are able to produce enough milk for their baby without having to supplement with banked milk or formula. The majority of my patients who did produce major amounts of milk had gone through a full term pregnancy and breastfed previous children. Then they adopted or used a surrogate and chose to induce lactation; their breasts were previously primed to breastfeed. I have had only one patient over the past eight years who without going through a full term pregnancy was able to feed her baby exclusively from her own breastmilk and she did so for over a year. That being said, all of my patients who went through this process, whether they produced a little or a lot of milk, whether the baby nursed on the breast or not, felt very good about themselves and what they were able to do for their babies. The key is not to put too much pressure on yourself and to know when you are attempting to do more than is physically and psychologically comfortable for you.