When might non-puerperal induction of lactation be requested and what volumes of milk are realistic to expect?
Which patients may request non-puerperal lactation induction?
Some patients who wish to induce lactation may be planning to co-lactate with another birth parent. Others did not birth the child but may be the only lactating parent. Here are situations in which people may request support for induction of lactation.
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Cisgender female parents who are not birth mothers
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Adoption
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Gestational surrogacy
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Other parent
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Chestfeeding or breastfeeding in transgender women (i.e. individuals assigned male gender at birth (AMAB) and who affirm their gender as female)
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Non-binary persons who are AMAB and who wish to chestfeed their infants.
As a clinician, your selection of words to describe gender and also chestfeeding vs breastfeeding is determined by your patient's preferences. The appropriate use of terms needs to be checked out with the patient early on in the consultation.
Benefits of non-puerperal lactation induction
The composition of induced lactational milk does not differ in composition from puerperal milk.
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Protective effects for infant of breastmilk compared to formula
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Chest or breast can be used generously to dial down the infant's sympathetic nervous system, regardless of amounts of milk production
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Support and enhancement of parent-child psychological attachment
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Gender affirming?
If parents are co-breastfeeding, there is no reason to be concerned that the baby will develop 'suck confusion' as the baby moves between parents. Infant sucking is always adaptive and contextual. However fit and hold challenges may be relevant for some parent-baby pairs.
How much milk can an individual realistically expect to make with induced lactation?
As a clinician, it is important to have a conversation at the very beginning of an induction of lactation about realistic expectations for milk production.
The amount of milk that your patient will be able to make will be on the spectrum from just a few millilitres from each breast, to enough milk to exclusively meet the infant's caloric needs.
The volumes of milk your patient is able to make will depend on multiple factors, many of which are outside their control.
Factors which affect amounts of milk generated by lactation induction which are outside the patient's control include
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Genetic predisposition concerning milk production
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Medical history e.g. of metabolic dysfunction
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Transgender. You can find research papers detailing steps in induction of lactation for transgender patients here.
Factors which affect amounts of milk generated by lactation induction which may be in your patient's control are
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Number of weeks or months available for hormonal preparation (no evidence to suggest that more months of hormonal preparation help)
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Capacity to tolerate long-term domperidone use (no evidence to suggest domperidone helps)
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Frequency of mechanical milk removal each day
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Number of weeks or months preparing the breasts using mechanical milk removal.
Larger milk volumes are likely to result from induction when
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The patient has had a previous pregnancy. Pregnancy is a major modulator of mammary gland activity and the cells of retain a memory of past pregnancies which benefits future breastfeeding.
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The patient has lactated previously. For example, many cultures have a tradition of grandmothers lactating. Although the mammary gland involutes after weaning, the breast tissue is also irreversibly altered by each course of lactation. Typically, breasts have the capacity to produce more milk with each lactation.
You can read about induction of lactation in transgender persons here.
Recommended resources
Research about induction of lactation in transgender patients
Induction of lactation: taking a history and why each question matters
Case report of preparation for induction of lactation in a cisgender woman (NDC Clinical Guidelines)
NDC Co-lactation Feeding Plan (to be adapted adapted)
Selected references
McBride GM, Stevenson R, Zizzo G, Rumbold AR, Amir LH, Keir AK, et al. Use and experience of galactogogues while breastfeeding among Australian women. Plos One. 2021;16(7):e0254049
Other references available here.