What are the options for inducing lactation in a non-postpartum person?

Inducing Lactation in Non-Postpartum Individuals

For non-postpartum individuals wishing to induce lactation, a combination of hormonal therapy, galactagogues, and mechanical stimulation offers the most effective approach, with domperidone being the most evidence-supported pharmaceutical intervention. 1, 2

Pharmacological Methods

Hormonal Therapy

• Progesterone is a key hormone for lactation induction, typically started at 100mg daily and potentially increased to 200mg daily 1
• Estrogen therapy may be used to mimic pregnancy hormonal states before beginning lactation induction 3
• Withdrawal of progesterone (mimicking post-delivery hormonal changes) can help trigger milk production 3

Galactagogues

• Domperidone is the most effective pharmaceutical galactagogue, typically started at 10mg three times daily and titrated upward based on response 1, 4
  • Important note: Domperidone is also used clinically to increase milk supply in lactating individuals 5
• Metoclopramide may be used as an alternative galactagogue, with the added benefit of increasing milk supply 5

Herbal Supplements

• Goat's rue and malunggay (moringa oleifera) have been used successfully as complementary treatments 4
• These should be considered adjunctive to pharmaceutical and mechanical approaches

Non-Pharmacological Methods

Breast Stimulation

• Regular breast stimulation using an electric pump is essential for successful lactation induction 1, 2
• Increasing frequency of pumping directly correlates with milk production success 1
• Breast massage before and during pumping sessions may enhance results 4

Supportive Care

• Professional lactation support significantly improves outcomes 4, 2
• Acupuncture has been reported as a complementary approach in some successful cases 4

Expected Outcomes

• Successful cases report milk production beginning within approximately one month of starting a comprehensive protocol 1
• Initial production may be 3-5 ounces per day with potential for increase 1
• Complete replacement of infant nutritional needs is uncommon; supplementation is typically required 6
• The bonding experience is often cited as the primary benefit, even when exclusive breastfeeding is not achieved 6

Protocol Timeline

1. Preparation Phase (2-4 weeks)

   • Begin hormonal therapy (progesterone)
   • Start breast stimulation with electric pump 6-8 times daily for 15-20 minutes 1, 2

2. Active Induction Phase

   • Add galactagogue (domperidone 10mg three times daily, titrated upward as needed) 1
   • Continue frequent breast stimulation, increasing to 8-10 times daily 1, 2
   • Incorporate breast massage before and during pumping 4

3. Maintenance Phase

   • Continue galactagogue and pumping regimen
   • Monitor milk production and adjust protocol as needed

Special Considerations

• Previous pregnancy or breastfeeding experience may influence success, though evidence is mixed 2
• The age of the child and previous bottle feeding may affect the infant's ability to latch and suckle effectively 2
• Support from healthcare providers knowledgeable about induced lactation is crucial for success 6, 2

Common Pitfalls

• Insufficient frequency of breast stimulation 2
• Inadequate duration of protocol before expecting results 6
• Lack of professional lactation support 6, 2
• Unrealistic expectations about milk volume and exclusive breastfeeding 6

While induced lactation can be challenging, with appropriate medical support and a comprehensive approach combining hormonal therapy, galactagogues, and mechanical stimulation, non-postpartum individuals can successfully produce breast milk and experience the bonding benefits of breastfeeding.