A person might wish to induce lactation if:
- They are adopting a baby
- They have a gestational carrier for her biological baby
- If they are in a relationship with another woman who is pregnant and wishes to help in breastfeeding the baby
- Another relationship, often transgender, where one or both of the partners wishes to breastfeed
How can someone breastfeed if they have never been pregnant?
Our approach basically tries to make the body of the person inducing lactation believe that they are pregnant.
The hormonal milieu of the body during pregnancy includes:
- High levels of estrogen
- High levels of progesterone
- High levels of prolactin
- High levels of human gonadotropin hormone
- High levels of other hormones
These hormones begin to rise with the onset of pregnancy. Each hormone has a role to play in the preparation of the breasts to make milk, with milk production starting about 16 weeks of pregnancy.
If a person has previously breastfed, this fact does increase the possibility of that person producing a full milk supply, but not necessarily so. Some persons inducing lactation have produced all the milk the baby needs, but I would think the majority do not.
What if I can’t produce all the milk a baby needs?
It would be nice if you did, but it should be remembered that breastfeeding is much more than breastmilk. Breastfeeding is a relationship, a close physical and emotional relationship between two people who usually love each other. Furthermore, breastfeeding helps to develop that close emotional relationship.
If you cannot produce all the milk the baby needs, you can, and we recommend you do, supplement the baby at the breast with a lactation aid. As shown in the video.
Supplements may include donated breastmilk or formula.
The medications and the process
We generally start the person inducing lactation on a combination birth control pill (which gives them both estrogen and progesterone) as well as domperidone which increases the prolactin levels.
In theory, the combination birth control pill should have higher levels of progesterone, but this is theory, and which combination birth control pill is used probably does not make a big difference. If the birth control pill has placebos (that is “sugar pills” or pills without any effect), the person inducing lactation should not take them but rather jump to the next cycle of pills without a break.
The person inducing lactation should be on the combination birth control pill for at least 16 weeks and continue it until about 6 to 8 weeks before the baby is born and then stop the combination pill completely. This implies a period of 22 to 24 weeks total.
Domperidone increases the prolactin levels in the person inducing lactation and we recommend continuing the domperidone at least until the baby is born and even after that. Indeed, it is likely the domperidone will need to be continued for the entire period of breastfeeding. The dose of domperidone? We start with a dose of 30 mg (3 tablets) 3 times a day and sometimes go up from there in two steps, first to 40 mg (4 tablets) 3 times a day and then 40 mg (4 tablets) 4 times a day, or 50 mg (5 tablets) 3 times a day (for convenience). The main reason not to go to the highest dose immediately is to prevent side effects which may not occur at 9 pills (90 mg/day), but may at 15 pills (150 mg/day).
The side effects of domperidone include weight gain, headache which is transient, lasting no more than a couple of days and usually mild, and dry mouth. The notion that domperidone is dangerous if you have any sort of heart problem is nonsense and is due to formula company disinformation. The only situation where domperidone may cause problems is if you have a prolonged QT interval on an electrocardiogram and an electrocardiogram can easily be done to rule out a prolonged QT interval. If you have a heart murmur, if you’ve had heart surgery, if you have high blood pressure, if you have other findings on electrocardiogram, this is not a reason to avoid domperidone. Our experience with tens of thousands of our patients taking domperidone, is that is generally a very safe drug.
Some women may have menstrual irregularities with domperidone, but if they are taking the birth control pill with fairly high levels of estrogen and progesterone, this should not happen. If it does, she should see her doctor to make sure there is not another source of bleeding.
When the person inducing lactation stops the combination birth control pill, if that person is a woman, she will have a brisk vaginal bleed. This should not last more than a few days.
Once the birth control pill is stopped, the person inducing lactation should start expressing the breasts to stimulate the production of milk. Note that men can produce milk, so that the approach is the same for men. Pumping or expressing the milk should, in theory, be the same as if the baby were breastfeed, but in fact, babies vary in their feeding frequency and persons inducing lactation often work outside the home and do not have frequent opportunities to express while at work.
What if I don’t have 22 to 24 weeks time before the baby is born?
My preference is not to use the birth control pill, but then to take only the domperidone. The problem is that the birth control pill will inhibit milk production, so recommending continuing the birth control pill until the baby is born, or longer, is not going work well. So, is 14 weeks on the birth control pill plus domperidone okay? Possibly, but it is cutting the time short.
An exception is when one of the partners is pregnant and plans to breastfeed and the non-pregnant partner is inducing lactation. In that case, the non-pregnant partner can stay on the birth control pill even after the baby is born to increase the time of her body “thinking it’s pregnant”.
When do I start putting the baby to the breast?
As soon as possible after the baby’s birth. In many jurisdictions the person inducing lactation can take the baby immediately at birth, in the delivery room. In other jurisdictions, this is not possible, but the person inducing lactation should let the hospital staff know in advance that you will be the parent of this baby and that they should avoid feeding the baby with a bottle. A newborn can be fed by spoon or open cup without difficulty.
Should the birth mother feed the baby at the breast?
There are certainly advantages to her doing so. The baby will get the opportunity to receive breastmilk (colostrum) exclusively for a few days or even longer. This also helps the birth mother to prevent painful engorgement. Some are happy to do so, others not. In theory, the birth mother may bond with the baby if she feeds the baby. This has not yet happened amongst couples attending at our clinic to induce lactation.
You and your family doctor
It is important your family doctor know you are taking these medications in case side effects arise. And, it is important s/he know you are inducing lactation, in case side effects of any sort appear and may be related to inducing lactation.
One last point
Some persons have not used any of these medications and have just put the baby to the breast. Some have produced milk, even all the milk the baby needed, but this must be a rare situation. Still, if the issue is breastfeeding and not breastmilk, this is an option for those persons.
Need help with breastfeeding? Make an appointment at the Toronto International Breastfeeding Centre.
Copyright: Jack Newman, MD, FRCPC, 2017