Inducing Lactation for Adoption or Surrogacy

Woman Pumping Breast Milk

 If you are an adoptive mother or brought your baby into the world through a surrogate pregnancy, you may want to induce lactation to provide your own milk for your baby. Induced lactation is the process where a mom who does not currently have a milk supply uses breast pumps or hand expression, and sometimes medication, to help her breasts lactate (Schnell, 2013). Choosing to offer your baby milk through induced lactation can help you develop closeness with your baby and provide the health and nutritional benefits of colostrum (first milk) and breastmilk (Ferri, 2020; Schnell, 2013).  

Studies on induced lactation show that mothers are more successful if they begin the induction process prenatally instead of after baby is born, if they direct-breastfeed as much as possible (meaning nursing the baby at the breast in lieu of using pumped milk bottles), if they pump frequently, and if they have a strong support system (Cazorla-Ortiz, 2020). 

If a mom has previously breastfed another baby, the process of rebuilding her milk supply is called relactation. Some of the same techniques are often used for inducing lactation and relactating. Oftentimes, moms experiencing relactation produce more milk than moms who are trying to produce milk for the first time. 

Stimulation and Pumping Protocol for Induced Lactation 

There are many variations of induction protocols, some which use medication and some which do not (Schnell, 2013). Whether you use medications or not, consistent milk removal is required to elevate your lactation hormones and induce lactation and is, therefore, the foundation of induction protocols. Stimulating/massaging your breasts can add additional benefits, so induction protocols often include both removal and stimulation. Here is an example of an induction protocol without medication (LLLI, 2018; Marasco & West, 2020; Schnell, 2013):  

  •  Around 2-4 weeks before your baby’s arrival, with your hands, gently massage your nipples and breasts for 10 minutes. Do this 8-10 times per day for 2 weeks. You may not have weeks to prepare for your baby’s arrival, so it is perfectly fine to start manual massage as soon as you can. Massage your breast starting at the top, using circular pressure on one spot. After a few seconds, lift up your fingers to move to the next area on the breast. Spiral around your breast with a circular pressure while moving towards the areola and nipple. Use the same amount of gentle pressure that a newborn baby’s hands might put on your breast while feeding. 
  • After 2 weeks, use a hospital-grade electric breast pump to pump while doing a small amount of massaging for 10-15 minutes, 8-10 times per day. If pumping is uncomfortable, add coconut or olive oil to the funnel. The discomfort may be caused by less elastic nipple tissue; (pregnancy hormones increase nipple elasticity). 
  • After your baby arrives, at the beginning of each feeding, have your baby suckle at the breast, Suckling helps to stimulate the letdown reflex and a hormone called oxytocin which helps release the milk from the milk ducts. Smelling, seeing and hearing your baby will trigger additional oxytocin to be released. Generally, having baby feed directly from the breast with a good latch will bring greater oxytocin surges and overall milk volume than the pump. 
  • Pump as time permits, ideally after each feeding, so that you try to get really productive milk removal by your baby or the pump at least 8-10 times per day. 
  • In the early days as you are building your supply, use a supplemental nursing system (SNS) to provide expressed milk feedings at the breast through a small feeding tube. Cut back on the length of time you use the SNS as your supply builds. Monitor the number of dirty and wet diapers and your baby’s weight gain to help confirm that the combination of your supply and the supplemental milk amount is sufficient. Some mothers will be able to completely stop using the SNS at some point, while other mothers may need to use the SNS supplemental milk long-term.

It is highly recommended that you work with an IBCLC (International Board Certified Lactation Consultant) during this process to meet your breastfeeding goals as well as to ensure your baby is getting enough milk and gaining weight. 

Hormone Therapy and/or Herbal Supplements to Induce Lactation

The purpose of using hormones when inducing lactation is to simulate the milk-making breast tissue growth (e.g., milk ducts and alveoli) that happens in pregnancy. Starting hormone supplementation at least 2½ to 5 months before your baby’s arrival will have the best likelihood of producing the strongest milk supply, but any amount of prep will help. (Cazorla-Ortiz, 2020). 

Because hormone therapy protocols require prescription medications, it is important to work with a trusted and knowledgeable healthcare provider who is familiar with inducing lactation. Since oral contraceptive pills are the hormones used to develop milk-making tissue and these pills have certain health risks, it is important to talk with your healthcare provider about your medical history (e.g., heart conditions, blood clotting concerns, high blood pressure) to assure your safety. Below is a summary of the hormone therapy protocol called the Newman-Goldfarb Protocols for LactationⓇ (Marasco & West, 2020; Schnell, 2013). It builds on the above stimulation and pumping protocol by layering in the medication. Medication will not work on its own to induce lactation.

  • Around 2½ to 5 months before your baby’s arrival, at any time in your cycle, take a daily oral contraceptive pill to increase the breast tissue that produces milk. Your doctor who is familiar with Newman-GoldfarbⓇ will know the correct levels of estrogen and progesterone needed. Only certain brands have the right levels and ratio of these hormones. 

  • At the same time, introduce a prolactin-stimulating hormone medication that is safe for long-term use. Prolactin is the hormone involved in milk volume. The medications often used are Metoclopramide and Domperidone (Schnell, 2013). Domperidone tends to have fewer side effects than Metoclopramide but is not approved by the Food and Drug Administration in the United States for use to increase lactation. Some side effects of Metoclopramide are drowsiness, depression, and tardive dyskinesia, a neurological disorder characterized by involuntary movements of the face and jaw (Nice, 2015; Schnell, 2013). Talk with a trusted healthcare provider about your options.

  • While taking the different medications, use the nipple stimulation and pumping protocol described above to assist in the milk production process.  

Herbal supplements with a galactagogue effect (a food or drug that promotes or increases the flow of human milk) are sometimes used in combination with nipple/breast stimulation and/or hormone treatments but are not necessary for the protocols to work. Common herbal supplements used as galactagogues include fenugreek, milk thistle, blessed thistle, alfalfa, and cinnamon tea. Please talk with your healthcare provider or lactation consultant before starting any herbal supplements to assure there are no health reasons you should not be taking them (e.g., interactions with other medications) (Nice, 2015; Schnell, 2013). 

Research has shown that with pumping only a mother can produce 50% to 75% of her baby’s nutrition needs, and with pumping and medication, she can produce 60% to 100% of her baby’s nutrition needs (Schnell, 2013). It is important for you to make the best choice of protocols based on your breastfeeding goals and your personal health circumstances.  

What If I Have Questions?

An IBCLC is an excellent resource to talk to about your induced lactation plans. You can schedule a one-on-one appointment with an Aeroflow lactation consultant here. We can also help you determine the best pump for you based on your needs and your health insurance coverage. Please visit us today so we can help. 

About the Author

Dr. Alena Clark is the Clinical Writer for Aeroflow Healthcare Lactation and an Instructor at Colorado State University, and has worked in lactation support for over 20 years. She is recognized as an outstanding educator and leader in lactation support in Colorado. She  developed the Toolkit for Establishing Lactation Support on University and College Campuses. She also wrote, published, and presented multiple papers on lactation support and nutrition education.

Information provided in blogs should not be used as a substitute for medical care or consultation.


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