Induced lactation: an in-depth analysis

Many new mothers decide to breastfeed, feeling that it is the best option for their baby. However, some mothers may experience difficulties in feeding their babies, leading to induced lactation. We speak to leading lactation consultant and tongue tie and infant feeding specialist Dr Sharon Silberstein who provides an in-depth analysis on induced lactation.

During my work as a breastfeeding doctor (medical doctor specialising in infant feeding) I have had many patients who express the wish to breastfeed their baby, who they haven’t given birth to.

There are various reasons why someone would want to induce lactation. Some of my patients have a child via surrogacy, some via adoption. Others want to share breastfeeding their baby with their partner in a same sex relationship. I also have several male-to-female transgender patients who breastfeed their babies.

Some are parents who have faced challenges, grappling with infertility or medical conditions like Mayer-Rokitansky-Küster-Hauser syndrome or Androgen insensitivity syndrome.

Others are part of same-sex partnerships or are transgender individuals seeking to share in the intimate act of nursing their baby. For a lot of parents, breastfeeding is something very intuitive, almost primal, a wish to nourish and nurture their baby. While some of the parents I work with aren’t able to carry their baby, it can be very healing for these women to be able to breastfeed their baby. It is the first thing a baby would do after they are born and many of my patients are able to breastfeed their baby immediately after birth, which is very special.

However, the knowledge and support for inducing lactation remain limited among healthcare professionals. Most are unfamiliar with the process, underscoring the importance of spreading awareness and expertise in this area. Through my practice, I've witnessed the transformative impact of empowering individuals to fulfil their dream of breastfeeding, fostering deep bonds with their children.

The cornerstone of inducing lactation lies in protocols like the "Newman Goldfarb Protocol," tailored to individual timelines and medical considerations. Depending on the available time until a breastmilk supply is needed the “regular” or the “accelerated” protocol is used. Generally, the more time available to prepare the breast for lactation, the better the result tends to be.

Adoptive parents face unique challenges in preparing for lactation due to bureaucratic hurdles and uncertain timelines for meeting their baby. In cases of short notice, an "accelerated protocol" involving a 30-60 day prescription of the Yasmin pill alongside Domperidone is used to initiate lactation. Menopausal women are advised to continue this regimen for at least 60 days or until significant breast changes occur before starting pumping. Women over 35 face increased thromboembolism risks, necessitating careful assessment and consideration of alternative medications like progesterone-only pills. Herbal galactogogues such as fenugreek and blessed thistle may aid breast development.

Domperidone, typically used as an antiemetic, is employed off-label to boost milk supply by increasing prolactin levels. While generally well-tolerated, it can cause side effects such as headaches and weight gain. Weaning should be gradual to prevent withdrawal symptoms, particularly in patients with pre-existing mental health conditions or underlying health issues. Despite concerns, Domperidone's impact on infants via breastmilk is minimal.

Success in inducing lactation isn't guaranteed, however, it is often a deeply gratifying journey, yielding varying degrees of milk production. While some achieve a full milk supply, others may rely on combination feeding, embracing the opportunity to breastfeed alongside supplemental nutrition. For those with partial supplies, innovative solutions like Supplementing Nursing Systems enable exclusive breastfeeding, bridging the gap between biological and non-biological parenthood.

Navigating the complexities of inducing lactation requires expertise at the intersection of medicine and lactation consulting. Few doctors in the UK hold dual certifications in both fields, highlighting the need for further training and specialisation in this area. As awareness grows, it's essential to expand access to knowledgeable healthcare professionals who can guide individuals through this transformative journey.

If you would like to learn more about lactation and book a consultation with Dr Silberstein, do not hesitate to do so by visiting her Top Doctors profile today.

Resources

https://www.gov.uk/drug-safety-update/domperidone-risks-of-cardiac-side-effects

Kanji S, Stevenson A, Hutton B. Sudden Cardiac Death and Ventricular Arrhythmias Associated with Domperidone: Evidence Supporting Health Canada's Warning. Can J Hosp Pharm. 2014 Jul;67(4):311-2. doi: 10.4212/cjhp.v67i4.1378. PMID: 25214665; PMCID: PMC4152973.

Grzeskowiak LE, Amir LH. Pharmacological management of low milk supply with domperidone: separating fact from fiction. Med J Aust. 2014 Sep 1;201(5):257-8. doi: 10.5694/mja14.00626. PMID: 25163368.

Asztalos EV, Kiss A. Early Breast Milk Volumes and Response to Galactogogue Treatment. Children (Basel). 2022 Jul 13;9(7):1042. doi: 10.3390/children9071042. PMID: 35884026; PMCID: PMC9315761.

McBride, G., Stevenson, R., Zizzo, G. et al. Women’s experiences with using domperidone as a galactagogue to increase breast milk supply: an Australian cross-sectional survey. Int Breastfeed J 18, 11 (2023). https://doi.org/10.1186/s13006-023-00541-9

Grzeskowiak L. Use of domperidone to increase breast milk supply: are women really dying to breastfeed? J Hum Lact. 2014 Nov;30(4):498-9. doi: 10.1177/0890334414552525. PMID: 25320114.