Breastfeeding Without Birthing: Induced Lactation

Lactation is the production of milk in female mammary glands, and occurs naturally during pregnancy and post-pregnancy breastfeeding. Lactation is governed by pituitary hormones (as opposed to ovarian hormones) and, therefore, any woman can stimulate lactation, regardless of her obstetric or gynecological history.  Women may want to induce lactation if they are planning on adopting a baby or are an intended parent via surrogacy.

Understand how induced lactation is possible. Although it may seem surprising, it is indeed possible for women who are not or have not been pregnant to produce breast milk. This is usually undertaken by a mother who wishes to feed her adopted baby.
  • The body's production of breast milk is usually triggered by the complex interactions between three hormones - estrogen, progesterone and prolactin - during pregnancy.
  • If the production of these hormones can be mimicked through physical stimulation and/or hormone supplements, then breast milk can be produced outside of pregnancy.
  • Prolactin ( the main hormone involved in milk production) is produced in the pituitary gland, not the ovaries. Therefore, it is possible for women to induce lactation even if their uterus has been removed. However, the induced lactation process is usually more successful in women who have previously been pregnant.
  • The induced lactation process can take several months, so it is a good idea to begin the process as soon as you have an idea of your baby's arrival date. Adoptive/Intended mothers have the greatest chance of their baby "latching-on" successfully if the baby is younger than three months.
Understand the pros and cons. Inducing the production of breast milk is a huge undertaking, so the pros and cons should be carefully weighed before any final decisions are made.
  • Pros: Obviously the main advantage of producing your own breast milk is the benefit it will have for the baby. Breast milk contains important antibodies, proteins, fats and vitamins that will help your baby to grow and gain weight, and fight off infections and disease. In addition, breast feeding is wonderful, intimate way for mother and baby to bond. This is especially true when the baby is adopted, as the bonding process can take time. This is also the most natural method of feeding your baby, and can eliminate the need to use store-bought formulas which may contain chemicals.
  • Cons: The major drawbacks of induced lactation mainly involve the time and effort required to be successful. Stimulating the production of milk requires huge dedication and commitment, as breast pumping and stimulation needs to be performed 6 to 12 times a day, including night-time sessions which involve waking up in the early a.m. This process can be painful and uncomfortable on your breasts, and if you're using hormone therapies, you may experience mood swings and disruptions to your menstrual cycle.
 Prepare for the changes that will take place in your body. Before you begin the process of inducing lactation, it's important to aware of what will happen to your body, and the possible side effects.
  • The side effects of induced lactation will be more severe if you are taking hormones, as you are essentially tricking your body into thinking you are pregnant. You can expect enlarged breasts, swollen or sore nipples and irregular menstruation.
  • You will probably experience fatigue and increased hunger, as your body believes it is eating for two. You should increase your calorie intake by 200-500 calories per day, but try to make healthy food choices in order to minimize weight gain.
  • You may also experience mood swings and periods of depression and anger. This is why it is helpful to have a supportive partner, friend or family member to help you through the process and to remind you of the importance of the end goal. Your sex drive may also be affected by the hormones.

Stimulating Milk Production 

There are a number of different ways to stimulate milk production.

Traditional Protocol:  This is a very simple protocol based on observations of mothers in developing countries.  It simply involves waiting until your baby arrives, and breastfeeding very frequently.  Whatever the baby does not get from breastfeeding is supplemented using a cup.  (No herbal or pharmaceutical medications are recommended.)

Avery ProtocolThe Avery protocol involves manual stimulation of your breasts and nipples to start the process rolling, then breastfeeding with an at-breast supplementer when your baby arrives.  (No herbal or pharmaceutical medications are recommended.)

Pumping Protocol:  This protocol, unlike those above, makes use of a multi-user breast pump to stimulate the breasts to start making milk before baby arrives. Then, when baby arrives, you begin breastfeeding using an at-breast supplementer as needed.  (No herbal or pharmaceutical medications are recommended.)

Herbal Protocol:  This protocol resembles the Pumping Protocol with the addition of herbs reputed to build mammary breast tissue or boost hormones responsible for making milk.

Newman-Goldfarb Protocol:  This popular protocol for inducing lactation is the most involved of them all.  It begins with several months of pharmaceutical medications to simulate the hormonal state of pregnancy.  Then the pharmaceutical medications shift simulating birth, and you begin pumping with a multi-user breast pump for several weeks prior to baby's arrival.  Once baby arrives, you begin breastfeeding using an at-breast supplementer as needed.  

Breastfeeding - Starting Out Right

For breastfeeding to be well and properly established, getting off to the best start from the first days can make all the difference in the world.  The basis of breastfeeding is getting the baby to latch on well. A baby who latches on well gets milk well.  Many health professionals actually have had very little training on how to prevent breastfeeding problems or how to treat them should they arise. Here are a few ways breastfeeding can be made easier:
  • The baby should be skin-to-skin with the mother and have access to the breast immediately after birth.
    The vast majority of newborns can be skin-to-skin with the mother and have access to the breast within minutes of birth. This process may take only a few minutes or take up to an hour or longer, but the mother and baby should be given this time (at least the first hour or two) together to start learning about each other. Babies who “self-attach” run into far fewer breastfeeding problems.
  • The baby should be kept skin to skin with mother as much as possible immediately after birth and for as much as possible in the first few weeks of life.
    Incidentally, studies have also shown that skin-to-skin contact between mothers and babies keeps the baby as warm as an incubator. It is true that many babies do not latch on and breastfeed during this time but generally, this is not a problem, and there is no harm in waiting for the baby to start breastfeeding. The skin to skin contact is good and very important for the baby and the mother even if the baby does not latch on.
  • Skin-to-skin contact helps the baby adapt to his new environment: the baby’s breathing and heart rate are more normal, the oxygen in his blood is higher, his temperature is more stable and his blood sugar higher. Furthermore, there is some good evidence that the more babies are kept skin-to-skin in the first few days and weeks of life (not just during the feedings) the better their brain development will be. As well, it is now thought that the baby’s brain develops in certain ways only due to this skin-to-skin contact, and this important growth happens mostly in the first 3-8 weeks of life.
  • A proper latch is crucial to success. This is the key to successful breastfeeding. Unfortunately, too many mothers are being “helped” by people who don’t know what a proper latch is. If you are being told your two-day old baby’s latch is good despite your having very sore nipples, be skeptical and ask for help from someone else. Before you leave the hospital, you should be shown that your baby is latched on properly and that he is actually getting milk from the breast and that you know how to know he is getting milk from the breast.
  • The mother and baby should room in together. There is absolutely no medical reason for healthy mothers and babies to be separated from each other, even for short periods, even after caesarean section. Health facilities that have routine separations of mothers and babies after birth are not doing right by the mothers and babies. Studies showing that rooming-in 24 hours a day results in better breastfeeding success, less frustrated babies and happier mothers date back to the 1930’s. 
  • The baby’s feeding cues. The baby shows long before he starts crying that he is ready to feed. His breathing may change, for example. Or he may start to stretch. The mother, often being in light sleep in sync with her baby, will wake up, her milk will start to flow and the calm baby will usually go to the breast contentedly. A baby who has been crying for some time before being tried on the breast may refuse to take the breast even if he is ravenous. Mothers and babies should be encouraged to sleep side by side in hospital. This is a great way for mothers to rest while the baby breastfeeds. Breastfeeding should be relaxing, not tiring.
  • Artificial nipples should not be given to the baby. There seems to be some controversy about whether “nipple confusion” exists.  Nipple confusion includes a range of problems, including the baby not taking the breast as well as he could and thus not getting milk well and/or the mother getting sore nipples. Just because a baby will “take both” does not mean that the bottle is not having a negative effect. Since there are now alternatives available if the baby needs to be supplemented (see the information sheets Lactation Aid, and Finger and Cup Feeding) why use an artificial nipple? Using a lactation aid, finger feeding or cup feeding to supplement when the baby does not need a supplement is only marginally better than using a bottle to supplement.
More resources: 
"Breastfeeding Without Birthing:A Breastfeeding Guide for Mothers Through Adoption, Surrogacy, and Other Special Circumstances" by Alyssa Schnell
"The Nursing Mother's Companion" by Kathleen Huggins
"Breastfeeding the Adopted Baby" by Debra Stewart Peterson
"The Ultimate Breastfeeding Book of Answers" by Dr. Jack Newman and Teresa Pitman
"The Breastfeeding Book" by Martha Sears, and Dr. William Sears  

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