Breastfeeding offers numerous advantages, fostering a strong bond between parent and child while providing essential nutrients and immune support for the baby. It also aids in postpartum recovery and reduces the risk of certain cancers for the breastfeeding parent. Induced lactation makes these benefits accessible to all parents, regardless of their pregnancy history or family structure.
What is Induced Lactation?
Induced lactation is the process of stimulating breast milk production in individuals who have not been pregnant. This allows non-gestational parents, such as adoptive parents, parents using a surrogate, transgender parents, and parents in same-sex relationships, to experience the unique physical and emotional connection that breastfeeding provides.
Typically, lactation is triggered by hormonal changes during pregnancy, specifically the rise of estrogen and progesterone, followed by the release of prolactin and oxytocin. These hormones regulate milk production and release. In induced lactation, these hormonal changes are simulated through various methods, including hormonal treatments, galactagogues (herbal or pharmacological supplements), and regular breast stimulation.
Induced Lactation vs. Relactation
It's important to distinguish between induced lactation and relactation. Relactation refers to re-establishing milk production in someone who has previously been pregnant and lactated but stopped or reduced breastfeeding. Induced lactation, on the other hand, involves initiating lactation in someone who has never lactated before. Relactation is often a simpler process because the body has already experienced the hormonal shifts of pregnancy and established a milk supply.
Reasons for Inducing Lactation
The primary reason for inducing lactation is to enable a non-gestational parent to breastfeed their child. This allows them to provide breast milk, with its protective and nourishing qualities, and experience the joy and satisfaction of nurturing their baby at the breast.
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However, some individuals may choose to induce lactation for other reasons. For example, transgender women may wish to connect with their gender identity through lactation, even if they are not breastfeeding a child.
How to Induce Lactation
The most crucial element in inducing lactation is consistent and frequent emptying of the breasts. This can be achieved through nipple stimulation, pumping, or even having the baby suckle, even if no milk is initially produced. This stimulation increases milk-making hormones in the body, signaling it to start producing breast milk. Regular milk expression encourages the body to increase its milk supply.
To further prepare the body for lactation, several options can be considered in the months leading up to the baby's arrival:
- Oral Contraceptives: Taking oral contraceptives for six months or longer can simulate the hormonal changes of pregnancy. Abruptly stopping these medications mimics the hormonal shift after delivery, potentially stimulating milk production.
- Galactagogues: Herbal supplements like fenugreek or prescription medications like domperidone may help initiate or boost milk supply when combined with regular breastfeeding or pumping. However, the use of galactagogues should be discussed with a lactation consultant, as approaches vary.
- Breastfeeding Protocols: Generic protocols like the Newman-Goldfarb Protocol can provide a starting point, but a personalized approach developed with an IBCLC (International Board Certified Lactation Consultant) is recommended. An IBCLC can tailor a protocol to your medical history and breastfeeding goals.
Prescription Medications
Currently, the U.S. Food & Drug Administration has not approved any drugs specifically for inducing or enhancing lactation. However, some medications prescribed for other conditions, such as metoclopramide, have been shown to stimulate milk production in some cases. These medications require a doctor's prescription and careful review of your medical history due to potential side effects. In some cases, oral contraceptive pills may be used.
Herbal Medications
Herbal medications, available in capsules or teas, have been used to stimulate or increase milk supply. However, it's crucial to consult with your doctor or a lactation specialist before using herbal medications, as they are not regulated for content, purity, or contaminants.
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Stimulation
Regardless of medication use, regular nipple and breast stimulation with a breast pump every 2 to 3 hours is essential. Once the baby arrives, encourage suckling at the breast. Pumping, hand expression, and infant suckling help establish a breastfeeding relationship and further stimulate milk production.
At-Breast Nursing Supplementers
While it's impossible to predict whether you'll produce enough milk to fully satisfy your baby's needs, many parents successfully breastfeed with the aid of a nursing supplementer. This device provides donor breast milk or formula while the baby nurses at the breast, encouraging continued stimulation and milk production.
Important Considerations for Induced Lactation
Potential for Insufficient Milk Supply: Some parents may not be able to produce a full milk supply through induced lactation and may need to supplement with donor breast milk or formula. Prioritize putting the baby to the breast before and after supplementing to continue stimulating milk production. At-breast supplementers can help build supply while preserving the breastfeeding relationship. Remember that breastfeeding offers comfort and promotes intimacy, even if the baby isn't receiving a large amount of milk. Frequent skin-to-skin contact also strengthens the bond between parent and child.
Time Commitment: Inducing lactation is not an instantaneous process. It requires time and dedication. Ideally, start the process at least six months before the baby's arrival, or as soon as possible. Frequent pumping, at least 8-12 times a day for 20-30 minutes each session, including overnight, is crucial.
Latch Challenges: Some babies, particularly those not breastfed from birth, may have difficulty latching. An IBCLC can provide guidance and support to help the baby latch effectively. If the baby is unable to latch, expressed milk can be fed via cup, spoon, or paced bottle feeding.
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Seeking Support: Breastfeeding challenges are common. Don't hesitate to seek help from trained IBCLCs who can provide non-judgmental support and guidance.
The Process of Lactogenesis
Lactogenesis, the process of initiating lactation, involves several stages:
- Stage One: Begins around the 16th week of pregnancy and lasts until a few days after birth. Estrogen and progesterone increase, causing milk ducts to grow, breasts to become fuller, and mammary glands to prepare for milk production. The nipples darken, areolas enlarge, Montgomery glands secrete oil, and the body begins producing colostrum.
- Stage Two: Starts about two or three days after birth, when milk production intensifies. The drop in estrogen and progesterone triggers the release of prolactin, the hormone that produces milk. Milk production increases dramatically, often leading to engorgement.
- Stage Three: Describes the ongoing period of lactation. Lactation continues as long as milk is removed from the breast. The more milk removed, the more the body produces.
Hormones for Lactation
Prolactin controls milk production. Suckling stimulates nerves that signal the release of prolactin and oxytocin. Prolactin causes the alveoli to make milk, and oxytocin causes muscle contractions that push milk through the milk ducts. This release of milk is called a "letdown."
In induced lactation, medications mimic the hormones produced during pregnancy. Nipple stimulation through pumping or suckling initiates lactation.
Stopping Lactation
There are various reasons to stop producing milk. This can be done naturally or with medication.
Natural Milk Suppression
Lactation is a supply-and-demand process. Reducing the frequency of nursing or pumping gradually decreases milk supply. This can cause discomfort and engorgement, which can be relieved with over-the-counter pain relievers, a firm bra, or ice packs.
Medication Suppression
Medications can also be used to stop milk production.
Satisfaction, Emotions, Enablers, and Challenges in Induced Lactation
Research suggests that women who undergo induced lactation experience a range of emotions and levels of satisfaction.
Satisfaction
Studies indicate that most women are satisfied with their experiences inducing lactation, often expressing feelings of relief, enjoyment, and pleasure.
Emotions
Participants in studies have described feelings of awe, wonder, amazement, and love. Induced lactation can elicit maternal instincts in adoptive mothers, preparing them for motherhood and making them feel like breastfeeding is a pleasurable experience.
Enablers
Enabling factors for induced lactation can be psychosocial or technical. Psychosocial enablers include the development of love and an affectionate relationship between the adoptive mother and child, nutritional benefits, feelings of self-competency when producing breastmilk, support from others, and the desire to fulfill religious obligations. Technical enablers include pharmacologic (hormonal stimulation) and non-pharmacologic (breast stimulation) methods.
Challenges
Women inducing lactation face both internal and external challenges. These can include concerns about milk supply, finding time to pump, and issues related to breast pumps. Social cognitive theory suggests that environmental, personal, and behavioral factors all play a role in the challenges women face. Lack of support can lead to demotivation and difficulty adhering to the stimulation schedule.