Sunday, April 25, 2010

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.

24 comments:

  1. What wonderful resources!! thank you!

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  2. I just found this blog. It's wonderful! Oddly enough I have my 6.5 month old (adopted at 9 days, latched instantly) nursing as I type this. Well, currently he's broken off to babble at the window but if I give him a second he'll be back on again :) I didn't follow any real protocol, just domperidone under doctor's supervision and pumped for almost 7 months (which was unplanned but it took longer for us to be matched than we thought!). I have to say, I only wanted to nurse because, well, that was always what I saw as "the norm" and I just wanted to give my baby the best start in life. Now I find that it's not only very convenient and easy, but it's one of the most wonderful experiences I've ever had and I'm so grateful for it :) I hope other woman hoping to adopt read what you've written and know that this is entirely possible and there are so, so many of us doing it now and getting great results! I myself was able to achieve full supply and was able to send milk to my baby while he was in respite care, so that he's been formula free since 2 days old :) Of course, I got lucky and have a very accepting agency, willing to transport breastmilk, let me pump at their office during a required education course (they reserved an empty room just for me!), didn't bat an eye at the cloth diapers and sling, and even kept the hospital from circ'ing upon our request. I know not everyone out there is so lucky.

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  3. Megan,

    Thank you so much for sharing your story!! How amazing that you were able to give your exclusively human milk from Day 2 and that he is nursing with a full supply now at 6.5 months.

    Although many articles on induced lactation state that a lot of mothers will not reach a full supply (maybe so that moms are not over zealous in their efforts?) the majority that I have met DID in fact reach a supply that was enough to provide all that their child needed. There are some key components in making this happen, but it is doable for many mothers.

    Thank you again for sharing your insight and best wishes for you and your son. :)

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  4. Perfect timing! I have a friend who is on the road to adoption playing the waiting game now. She has been seeking out every bit of info she can on inducing lactation so thi spost will hopeuflly come in handy for her! Than you for an amazing blog!

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  5. We had a mum in clinic recently on her second baby by gestational surrogate and she had induced lactation successfully with the first. This time she had done the full hormonal induction and at the equivalent of 30 weeks she was able to hand express a stream of milk across the room!! and that was before she even started on the pumping protocol!

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  6. SOOOOOO inspirational!

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  7. awesome!! What a truly great bonding experience!!

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  8. wow what an encouragement!!! we are waiting for a referral to adopt and i have always wanted to nurse!!! how encouraging to see that supply really isnt the most important thing!! I ♥ the idea of comfort nursing!! :D thanks for sharing :D

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  9. http://milkshare.forumotion.com/

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  10. I wish this information had been available 8 years ago when I was trying to re-lactate for my dairy allergic baby who had suddenly stopped feeding from me at 8 weeks! May it help other mothers like myself.

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  11. When my mother adopted my sister with Downs at 5 months, the only thing that seemed to soothe her was for my mother to put her to the breast. My sister adored that, and I am pretty sure that my mother inadvertently relactated without knowing. I was only 10 at the time and unaware of breastfeeding norms, but it wouldn't surprise me that she did, having successfully breastfed me when the world told her not to.

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  12. I so wish I had this info a few years ago. The feeding system so would have helped me. I mourned for my loss of breast feeding. =(

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  13. I couldn't be bfing today with out my SNS

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  14. I am excited about my future surrogacy with a traditional couple. The intended mother will be inducing lactation and I've been sending all the material I can find on the matter to her to prepare. It's a couple years away still, but something we're both looking forward too with great relish!

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  15. Veronica, you may want to read "Nourishing Traditions", by Sally Fallon, she's got some great info on BF/lactation and diet, as well as other pregnancy stuff.

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  16. What a wonderful amazing blessing are the breasts.

    Q for Helen - had this mother previously been pregnant, even at least for one trimester? i have been told by LC's that you don't develop milk ducts unless you've been pregnant ... but i also believe men can lactate so i'm not sure if it's necessary ... just curious about that though.

    I so very much enjoyed nursing my son for 3+ years, i found it incredibly therapeutic since i was third generation non- breastfed. We are going to have more children ourselves, but we are also interested in adopting a child and i have decided that the only way we'd do that is if i can (and i would, whether "they" approved or not) breastfeed, even if the child is not a newborn (ie Morag's story w/ sister at 5 mos... wow that gave me goosebumps).

    Also, I am curious if any adopting parents have had issues with social services over not vaccinating. We would NEVER vaccinate our kids, so I'd probably not adopt if i would have anybody breathing down my neck about my parenting choices. maybe i'm ignorant to the process, but perhaps there are other moms who feel this way too about adopting babies. I would like to think that via open adoption, we can be completely honest about our parenting style and that the mother would choose us because of our family-bonding and empowered health values.

    Blessings in Ecstatic Mothering ♥

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  17. My sister is planning to adopt AND planning to nurse her baby. So excited for her and her new babe!! :)

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  18. Marna,

    I've never been pregnant but have a full supply for my baby boy (see comment above). I too had heard that you could never nurse if you hadn't been pregnant. Not true! It takes more work, certainly, and I don't think you can make colostrum without a pregnancy, but you can definitely make milk!

    Also, once you adopt a baby that baby is 100% your own, just as if you'd given birth, so legally you can do as you like (er, other than abuse, neglect, etc). You'd probably find more issue with doctors refusing you as a patient than with social services. This is not the case for foster care, where you can't even get the child a haircut without permission (in some states at least). We do vax, but we do fewer vaxes and delay a bit. I found a family doctor willing to work with us without issue and our adoption agency was fine with everything, including nursing and homeschooling (which we may not be doing anymore, but for our own reasons and not because we're being pressured in one direction).

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  19. I'm curious about inducing a supply for grandchildren. I had my first baby young and she is now grown. I am currently nursing baby number 5 and baby number 4 as well. When the time comes for my eldest to have her kids, I'd really like to be there for her and help care for the baby. In order to do this, I would love to breastfeed my grandbaby. Is menopause an issue? If you have been a very successful breastfeeder, shouldn't it be fairly easy to start up the flow again?

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  20. I nursed my first grandchild her first night back from the hospital when my daughter was overtired, and the baby was fretting at her breast, then tucked her in with my daughter and everything went well after that; I only nursed her when my daughter had to be away from her. But I was still nursing my two year old, so didn't have to relactate. I did put another grandchild to the breast after I no longer had milk; definitely felt a let down reflex and the baby sucked; I feel sure that if I had a baby that would nurse, milk would come back.
    I must have spent at least 16 years of my life nursing, though.
    I am glad to hear of the success of adoptive mothers. When I first read of this there were always the cautions about not developing a full supply.
    Susan Peterson

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  21. I have a lesbian client (I am a midwife) who is interested in info/experiences on the other partner (2nd mommy) lactating so their child can be bf when she goes back to work. Any thots?

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  22. My daughter is 20 months old and we are both still enjoying the closeness of adoptive nursing. I did the Newman-Goldfarb protocol and it worked gloriously. She has been nursing since her 3rd day of life. She wasn't allowed to nurse in the NICU until I put my foot down and demanded skin to skin and breastfeeding versus the morphine they wanted to give her for withdrawals from Celexa that her birthmother took. Nursing has been a wonderful calming agent for her. My husband used to have to bring her to me at work to make it through a 12 hour day. Breastfeeding is so much more than providing nutrition for her. It is bonding, comfort, sedating, centering and overall irreplaceable! I am so glad that my breasts are still able to help bring this high needs and sensory seeking little girl some relief from what ever it is in this world that brings her pain.

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  23. I am queer and we are planning for my fiance to have our first child, and for me to have the second. I would really like to nurse our first child too (the second child will be born 18-24 months-ish after the first is born, so my future wife will probably still be breastfeeding!). I'm hoping to try to take some pressure off my wife, especially at night. I don't want to compromise her milk supply though, especially while it's getting established. Plus, my milk will not resemble colostrum... Thoughts???

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  24. Lily and Allison, I saw this article awhile back and thought you both would like it :)

    http://offbeatmama.com/2011/02/co-breastfeeding?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+OffbeatMama+%28Offbeat+Mama%29&utm_content=FaceBook

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