Monday 15 July 2019

Induced Lactation Protocol

Induced lactation is the practice of assisting a woman who has not been pregnant to produce milk; these women may have welcomed their child to the world via adoption or surrogacy. Induced lactation can also be utilised for women who have been pregnant but are not able to produce enough milk, if any at all. My cousin, who was also my IM, shared her story on my blog recently. However, how she followed the protocol was slightly different due to time constraints.

The protocol for Induced Lactation involves a combination of medication, herbs, and pumping. The main medication needed to produce milk is domperidone, which in the UK can be difficult to obtain as it is not used specifically to induce lactation; it is actually used to treat side effects of medication for Parkinson's Disease. The production of milk from the breast is actually a side effect of this medication. In order to be prescribed it, a series of tests would need to be done and the patients medical history would need to be considered.
Ideally the protocol should start as soon as the woman knows that a baby is due, however it can also be started around six months before the due date. These timescales are guidelines, but are recommended for the best possible results.
At this time, a birth control pill, such as the mini pill, should be taken each day,  alongside 10mg domperidone four times a day. This dosage should last a week and then increased up from 10mg to 20mg. During this time, the breasts will swell and it is completely normal. 
This protocol needs to be maintained until six weeks before the due date. At this point the birth control should be stopped but the 20mg dosage of domperidone of four times per day should be maintained. The stopping of the birth control pill will result in the woman experiencing vaginal bleeding which again is normal. 
Over the period of two weeks, the woman should start pumping on a low to medium setting for approximately five to seven minutes, along with massage techniques. Pumping should be done every three hours.
As the pill has been stopped whilst the domperidone is still being taken, along with pumping, would cause a decrease in the serum progesterone level whilst causing an increased serum prolactin level; this mimics what happens after a normal pregnancy/birth and should result in the milk supply coming in. 
A month before the due date, the 20mg domperidone four times daily and the pumping should continue, including night time pumping. Once pumping has started, herbal supplements can be taken, usually a combination of Fenugreek, Blessed Thistle, and Goats Rue. Three portions of each supplement should be taken three times a day. Foods rich in oats should also be eaten during the protocol such as oatmeal, along with plenty of water.
Once milk arrives it tends to follow a distinct pattern; clear droplets will appear first which eventually become more opaque and white. After drops, a steady stream of milk supply will be produced. This can take anywhere from a few days to a few weeks; everyone is different in how their body responds.
Once the baby has been born, the domperidone should be continued at the 20mg rate four times a day until an ample supply has been established. Skin to skin immediately after birth is encouraged if possible, along with on demand feeding. Pumping is still encouraged to help establish the mother's milk supply and the herbal supplements should be continued again until the milk supply has been established.
Once an ample supply has been established, the mother can slowly wean herself off the domperidone and the herbal supplements.

I hope that this information helps some mothers who wish to breastfeed their child born through surrogacy or adoption. However, I must advise that I am not a qualified lactation consultant. This protocol was provided to my cousin whose daughter was born through surrogacy; she is still breast feeding her daughter eight months on.
If you are interested in breastfeeding your child, please seek a referral to a qualified lactation consultant.


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