How to Induce Lactation: The Very Basics
By Jacob Engelsman, Lactation Consultant (IBCLC) & Postpartum Doula, specialized in helping non-gestational parents who want to induce lactation as well as queer, trans, and non-binary parents who have given birth & need support in lactation.
For many people, childbirth and everything that comes after it is full of surprises. In my (fairly specialized) experience, one of the biggest surprises is when people find out that for non-gestational parents, inducing lactation sometimes becomes part of the conversation. Often, when I tell people that part of my specialization as an IBCLC (International Board Certified Lactation Consultant) is to help induce lactation, somebody will say something to the effect of, “Wait, what?” As if to say, “I know what those words mean individually, but have never heard them next to each other like that.” Follow-up questions tend to follow a similar set. In preparation for my class on inducing lactation, the folks at boober thought it best for me to cover some of these ahead of time, to help you decide if the class is right for you to help you meet your chestfeeding or breastfeeding goals.
The first question interested parties tend to ask is: Can I do it if I (fill in the blank medical history)?
The short answer here is almost certainly, yes. The longer answer is that the hormones responsible for lactation are made by the pituitary gland so any adult human, regardless of age, medical history or gender can potentially lactate. The only exception is people who have had a radical or total double mastectomy. Postmenopausal and AMAB (assigned male at birth) people may need hormone treatments due to higher levels of testosterone and lower levels of estrogen and progesterone.
How long does it take, or; when should I start?
The short answer to the next few questions will be the same: It depends. One of the most important factors in when you can expect to make milk is if you've ever lactated or been pregnant (even if you didn't give birth). About 6 weeks into a pregnancy, milk lobules, alveoli, and milk ducts start changing permanently in ways that prepare them for making milk. Additionally, if you've previously induced lactation or delivered and nursed a baby, inducing this time (which is technically called relactating) will probably be much faster. If you haven’t ever lactated before, see the next question.
Do I need to pump?
Short answer: See above. It depends. Long answer: if you're relactating as opposed to starting from scratch then you could start producing milk just by letting a baby comfort-nurse you regularly. This is a great system if you're not the only milk-producing parent or you plan on giving your baby a bottle anyway. If you definitely want to be making as much milk as possible though, you're going to want to start pumping regularly (approximately 8 times a day with no more than a 6-hour gap at night) around 8 weeks before the baby is due to arrive. And be warned, you're not going to make much (if any) milk at first, so it might get a bit frustrating.
Do I need to take hormones/pills/supplements?
Short answer: See above. It depends. For this, the long answer is pretty long so let's tackle each one of these individually:
- Hormones: If you're postmenopausal, AMAB, or have history of hormone issues I would suggest discussing your plan to induce with an endocrinologist in addition to an IBCLC. There are documented cases of fathers and uncles (who were also born male) suckling a baby and eventually producing milk but these are almost always in extreme life-or-death situations, not clinically studied, and sometimes referred to as ‘miraculous.’
- Pills: There are two pills commonly recommended for inducing lactation, domperidone and metoclopramide; neither of which is FDA approved to be prescribed for the purpose. Domperidone is a nausea medication and while in many countries it is commonly used for lactation, it can also exacerbate heart conditions and has been known to cause cardiac arrhythmia. Reglan is used to treat gastroesophageal reflux disease (GERD) and nausea caused by chemotherapy. For people taking it without a prescription, it can actually cause nausea as well as severe neurologic disorders including severe depression.
- Supplements: There are a few herbs that have been shown in clinical tests to help lactation and many that have tradition behind them and don't hurt. Fenugreek, moringa, goat’s rue, and shatavari all have some evidence backing them up and probably won’t hurt. It’s worth mentioning that fenugreek is a legume, so if you’re allergic to peanuts or chickpeas you might be allergic to fenugreek and not know it. For some reason, people recommend mint for lactation and like to put it in lactation teas. This is specifically counterproductive because mint and anything that works as an antihistamine is going to be bad for lactation for basically the same reason that it’s good at drying out your sinuses. The problem with herbal supplements is that there is very little regulation so make sure you stick with a brand you know and trust and consult with a lactation consultant familiar with herbs and galactagogues for more personally tailored guidance.
Whether you’ve been considering inducing lactation for a while, or this is the first time you’ve seen those two words next to each other, I want you to know that it’s a very achievable goal. If you’re a non-gestational parent or parent-to-be who would like to chestfeed or breastfeed; or a lactation professional who’s interested in learning more, join this live, online class to learn the basics and if it's right for you. After that, if you’re a parent and want to make a plan; I recommend reaching out to me or another IBCLC for next steps. We are here to help.