Induced Lactation

By: Barbara Wilson-Clay, BSE, IBCLC

Throughout human history there have been infants who have been nursed by surrogate mothers. Non-maternal lactation may have occurred as a result of maternal death or illness, or because the birth-mother gave over or shared the care of her baby with another woman. Sometimes, the surrogate was already breastfeeding another baby, and her milk supply simply increased due to additional demand to meet the growth needs of two (or more) babies. In the event that no already-nursing mother was available, anthropological reports from several continents describe efforts by non-lactating woman to induce lactation by putting the baby to breast. (1) Such infants were probably helped along with teas or gruels until sufficient milk appeared. While there must have been a high mortality rate in orphaned or abandoned babies, induced lactation evolved as a cultural solution to their plight in the era before artificial milk formulas.

In the United States, especially among La Leche League members, induced lactation has been embraced as a way to provide an enhanced bonding experience for women who are adopting babies. The special closeness fostered by breastfeeding can be profoundly comforting for both mother and child. Many women who have struggled with fertility problems value the experience of breastfeeding, even if the volume of milk they produce is small. The range of milk produced varies considerably from woman to woman, and it is difficult to predict the results of induced lactation. It is unusual in the US to find women who bring in a full supply of milk, but also rare to find women who make no milk. If a mother understands that the young infant will need supplementation with formula, she can relax, enjoy the experience, and nurse her infant without fear of compromising growth. While any amount of human milk is valuable to infants, La Leche League and most lactation consultants counsel that the emphasis be kept on the positive aspects of nurturing and closeness rather than on volume of milk actually produced.

How does induced lactation work? Basically, it is important to remember that prolactin and oxytocin, the hormones which govern lactation, are pituitary, not ovarian hormones. Therefore, even if a woman has had a hysterectomy, she may lactate, providing her over-all health is good. (Estrogen, in the form of birth control pills or for replacement therapy, is a lactation suppressant.) Both prolactin, the milk-making hormone, and oxytocin, the milk-releasing hormone, are produced in response to nipple stimulation. While there are now several regimens which use hormone therapy to assist in bringing in milk, many women have induced lactation with only mechanical stimulation. This consists of breast massage, nipple manipulation, and sucking — either by a baby or a hospital grade electric breast pump. Some adopting mothers rent a breast pump in anticipation of the infant; other mothers simply put the adopted infant to breast.

Hormonal therapy to induce lactation generally consists of administration of estrogen to simulate the high-estrogen state of pregnancy. The estrogen is then abruptly withdrawn to mimic the rapid hormonal changes following delivery. A course of a prolactin-enhancing drug such as metaclopromide (Reglan.) is then instituted. Sucking stimulation (with a pump or by baby) is begun at this point. Milk production typically begins between 1-4 weeks after initiating mechanical stimulation. One study of induced lactation using medications describes onset of milk production between 5-13 days. (2) This is similar to case reports of inductions using only nipple stimulation. At first, the mother may see only drops. During the time that milk production is building, women may notice changes in the color of the nipples and areolar tissue. Breasts may become tender and fuller. Some women report increased thirst, and changes in their menstrual cycle or libido.

Is human milk produced in such circumstances adequate for infant growth? In a study done in New Guinea, 24 infants of mothers inducing lactation were found to be well-nourished at follow-up. (3) A study done by Kleinman, et al, looked at the chemical composition of milk produced by non-biological mothers. (4) Two of the studied women had previously delivered babies; three had never been pregnant. Milk samples were collected from five women with adopted infants who had induced lactation by infant sucking. Milk production (at various levels) was established within 11 days without medication. Milk samples were collected during the first five days of milk production and compared with samples of milk from five biological mothers. The mean protein concentration in the induced lactating women was identical to that of transitional milk of post-partum donors. There were differences in the concentration of albumin, IgA and *-lactalbumin concentrations in the milk produced during the days immediately following birth. Levels of these constituents were higher in the colostrum of the biological mothers. Sucking alone is apparently not sufficient to produce colostrum; other hormonal influences associated with pregnancy seem to be involved. The milk brought in by non-biological mothers, in other words, skips the colostral phase and more closely resembles transitional and mature breastmilk. Kleinman’s study does not look at other nutritional characteristics (such as fats, carbohydrates, or micronutrients.)

Since induced lactation produces low volumes of milk initially, and skips the colostral phase, how is the baby’s nutritional status guaranteed in the early days of the process? Many women use a feeding tube device. This is a bag or bottle which is worn suspended on the mother’s chest. These devices have thin, silicone feeding tubes which are taped to the nipple with hypoallergenic surgical tape. The baby sucks the breast, and milk flows through the tubes as through a straw, delivering donor milk or formula directly at the breast. This is one way to avoid conditioning a baby to expect the quicker flow and more formed nipple of bottle teats (thought to be the reason for the condition called “nipple confusion”.) Medela Inc. manufactures a device called the Supplemental Nutrition System (SNS)* and Lact-Aid International manufactures the Lact-aid Nursing Trainer.* Both companies have web pages and their addresses are listed at the end of this article in the “Resources” appendix. Mothers who are attempting to induce lactation profit from assistance and support from informed sources. Local La Leche League Leaders will be able to help women obtain printed information on the subject and may be able to network an adopting mother with another women who has induced lactation. Lactation Consultants provide equipment (feeding tube devices, electric breast pumps) networking with other similar clients, and expertise to help the adopting mother initiate lactation. The Lactation Consultant (LC) may be a good referral source to physicians in the community who are supportive of the process. Many US doctors do not know that induced lactation is possible. Hopefully adopting families will seek open dialog and free sharing of information with the baby’s doctor, both for growth monitoring purposes and to help make this a learning experience for everyone!

References:
1. Jelliffe, DB and Jelliffe, EFP. Human Milk in the Modern World, Oxford University Press, New York, 1978.
2. Nemba,K. Induced Lactation: A Study of 37 Non-puerperal Mothers, Journal of Tropical Pediatrics, 1994, 40:240-242. (see abstract below)
3. ibid.
4. Kleinman,R. et al. Protein Values of Milk Samples from Mothers without Biological Pregnancies. Journal of Pediatrics, 1980, 97:612-615.

Additional Reading:
Auerbach,K and Avery,JL. Induced lactation: a study of adoptive nursing by 240 women, Am J Dis Child, 1981, 135:240-243.
Jelliffe, DB. and Jelliffe, EFP. Non-Puerperal Induced Lactation, Pediatrics, 1972, 50:170-171.
Sutherland,A. and Auerbach,K. Relactation and Induced Lactation, Lactation Consultant Series (Unit 1), 1985, La Leche League International.
Internet Resources:
La Leche League International at: //www.lalecheleague.org/
International Lactation Consultant Association (ILCA)at: //www.erols.com/ilca/ilca.html
Medela Inc. at: //www.medela.com
Lact-Aid International at: //www.lact-aid.com
Parent-L Breastfeeding Resources (on-line parent support) at: http://www.greatstar.com/lois/parent-l.html

Abstract of Induced Lactation: A Study of 37 Non-puerperal Mothers, by K. Nemba
Summary
“Of a series of 37 non-puerperal women aged between 19 and 55 years who requested bottle-feeding, 27 were known to have completed a lactation induction programme and 24 (89 per cent) of these women were known to be successfully breast feeding well nourished children. All 11 women who had never previously lactated were successful. Of the three mothers in whom induction was unsuccessful, two obtained a bottle from other sources and both their children were malnourished.

This study indicates that given a high degree of motivation combined with medication, support, and encouragement, lactation induction is likely to be highly successful and may thus be an important factor in child survival.” Papua, New Guinea.

November 1996