Induced lactation is a physiological process that allows an individual who has not recently been pregnant to produce breast milk. This deliberate stimulation of the mammary glands is often termed adoptive breastfeeding or relactation, depending on whether the parent has previously lactated. The process is sought by intended parents using surrogacy, adoptive parents, non-gestational parents in same-sex couples, or those who wish to resume milk production after a significant gap. Successfully inducing lactation requires a structured, multi-step approach that mimics the hormonal and physical signals of pregnancy and childbirth.
Hormonal Preparation Protocols
The initial phase of induced lactation focuses on preparing the internal breast tissue by simulating the hormonal environment of pregnancy. Pregnancy involves high levels of estrogen and progesterone, which stimulate the growth of the mammary gland ductal system and the milk-producing cells (alveoli). The induced lactation protocol uses prescribed medications, often a combination of estrogen and progesterone, for several months to encourage this necessary physical preparation.
The actual initiation of milk production, known as lactogenesis II, naturally occurs when the placenta is delivered, causing a rapid drop in progesterone. This sudden decrease, while prolactin levels remain elevated, signals the mammary gland cells to begin synthesizing milk. In induced lactation, the individual stops taking the prescribed estrogen and progesterone, mimicking the hormonal shift of childbirth to activate milk synthesis.
Following this hormonal shift, other medications may be introduced to maximize the production of prolactin, the primary milk-making hormone. These medications are classified as galactagogues and are used off-label to increase milk supply. Domperidone and metoclopramide are two prescription medications that work by blocking dopamine, a hormone that naturally inhibits prolactin release. By removing this inhibition, circulating prolactin rises, signaling the body to produce more milk.
Herbal supplements like fenugreek and blessed thistle are sometimes used as additional support, though their efficacy is modest without mechanical stimulation. This preparatory stage must be largely completed before the activation phase, which relies on the physical removal of milk, can begin.
Establishing Supply Through Mechanical Stimulation
Once the hormonal foundation is laid, the process shifts to the principle of supply and demand, managed through frequent mechanical stimulation. The physical action of milk removal, whether by suckling or pumping, is the most powerful signal the body receives to increase production. This action triggers nerve endings, sending signals to the brain to release prolactin for milk synthesis and oxytocin for the milk ejection reflex (let-down).
The required consistency mirrors the feeding pattern of a newborn, meaning pumping approximately eight to twelve times within a 24-hour period. Each session should last 15 to 20 minutes, ensuring the breast is adequately emptied to signal future milk production. Pumping sessions should be spaced no more than three hours apart during the day to maintain consistent stimulation.
Pumping at least once during the night is important because prolactin levels naturally peak between 1:00 AM and 5:00 AM, making this period highly effective. A hospital-grade, double electric breast pump is typically required for the initial phase. Double pumping both breasts simultaneously also increases prolactin release more effectively than pumping one side at a time.
To maximize output, techniques like breast massage, hand expression, and breast compressions are integrated into the pumping routine. These actions encourage milk flow and fully empty the milk ducts. While a baby’s direct suckling is the most effective form of stimulation, pumping is often necessary to establish an initial measurable supply before the baby arrives.
Realistic Expectations and Support Systems
Setting achievable expectations is important, as the timeline for results varies significantly. Many parents see the first drops of fluid appear between four and six weeks after starting mechanical stimulation. A measurable, consistent milk supply typically takes longer, often becoming established between eight and twelve weeks after the full protocol begins.
The quantity of milk produced may not be sufficient to meet the baby’s full nutritional needs. Supplementation with donor milk or infant formula is a common and acceptable practice. Success is often measured not just in volume, but in the ability to create a nursing relationship and provide immunological and bonding benefits.
Professional guidance is highly beneficial, particularly from an International Board Certified Lactation Consultant (IBCLC) specializing in induced lactation protocols. These specialists can tailor hormonal and pumping schedules and monitor progress effectively. Consulting with a healthcare provider is also necessary to obtain prescriptions for required medications and ensure their use is medically appropriate.
For situations where the milk supply is still building, a Supplementary Nursing System (SNS) can be used. An SNS involves a thin tube taped to the breast, allowing the baby to receive supplemental milk while actively suckling. This system allows the parent to provide nourishment while reinforcing the physical stimulation needed for production.