How can I induce lactation after 19 years of not lactating?

Inducing Lactation After 19 Years: A Comprehensive Clinical Guide

You can successfully induce lactation after 19 years of not lactating through a combination of breast stimulation, hormonal support (when appropriate), and supplemental feeding systems, with success rates approaching 89% when proper protocols are followed. 1, 2

Core Protocol for Lactation Induction

Essential Components (All Must Be Implemented)

Breast stimulation is the single most critical factor and must begin immediately, regardless of whether pharmacological methods are used. 1 The protocol includes:

• Bilateral breast pumping 8-12 times per 24 hours, including at least once during nighttime hours when prolactin levels peak 3
• Each pumping session should last 15-20 minutes per breast 3
• Begin this regimen 4-8 weeks before the infant arrives if possible, though lactogenesis can be initiated within 10 days even without advance preparation 3

Pharmacological Support Options

Metoclopramide (Reglan) is the most commonly used galactagogue, typically dosed at 10 mg three times daily, which increases prolactin secretion 3. However, you must:

• Avoid dopamine agonists like bromocriptine entirely, as they suppress prolactin and directly inhibit lactation 4
• Avoid clonidine, which reduces prolactin secretion 4
• Consult current resources like LactMed for medication compatibility 5

Supplemental Feeding System

A supplemental nursing system (SNS) is essential during the transition period to ensure adequate infant nutrition while stimulating milk production through direct infant suckling 3. This device allows the infant to receive formula or donor milk while nursing at the breast, providing both nutrition and the critical breast stimulation needed for lactogenesis 1.

Critical Success Factors

Infant Age Considerations

Infants younger than 8 weeks are significantly more willing to nurse than older infants, making early initiation crucial 6. If your infant is older than 8 weeks, expect:

• Greater difficulty with latch and acceptance of the breast 6
• Increased need for patience and persistence 1
• Potential interference from bottle feeding habits 1

Your Previous Lactation Experience

Your 19-year gap since last lactating is actually favorable—previous lactation experience is associated with increased likelihood of milk production and decreased need for supplemental fluids. 6 Studies show that 89% of women who had previously lactated successfully induced lactation, compared to still-impressive success rates in nulliparous women 2.

Expected Timeline and Milk Production

Measurable milk production typically begins within 10 days to 4 months, with significant variation between individuals 3. Realistic expectations include:

• Initial colostrum or small amounts of milk within 1-2 weeks 3
• Gradual increase over 2-4 months with consistent stimulation 3
• Many women produce 4 ounces per breast by 4 months with optimal protocols 3
• Only 25% of women achieve exclusive breastfeeding without supplementation, but 75% report positive experiences regardless of milk volume produced 6

Environmental and Medication Precautions

Avoid environmental endocrine disruptors that impair mammary gland function, including 4:

• Perfluoroalkyl substances (PFAS) in non-stick cookware and water-resistant fabrics 4
• Bisphenol compounds (BPA, BPS) in plastics 4
• Smoking, which reduces milk volume by up to 30% 4

Nutritional Requirements During Induction

Consume an additional 500 kcal/day above your baseline requirements to support milk production 7. Specific requirements include:

• Protein: 19 g/day additional during first 6 months 7
• Hydration: 2.7 liters of water daily (700 mL more than non-lactating women) 7
• Omega-3 fatty acids: 250 mg EPA/DHA plus 100-200 mg additional DHA daily 7
• Vitamin D: 10 mg daily supplement throughout lactation 7
• Iodine: 250 mg daily through iodized salt 7

Support and Monitoring

Professional lactation support is essential for success—work with an International Board Certified Lactation Consultant (IBCLC) who can provide 1:

• Personalized protocol adjustments based on your response 1
• Troubleshooting for latch difficulties 1
• Emotional support throughout the process 8
• Monitoring of infant weight gain and hydration status 5

Realistic Goal Setting

The primary goal should be the maternal-infant bonding experience rather than exclusive milk production. 6 Studies consistently show that 75% of women rate induced lactation positively regardless of whether they achieved full milk supply, emphasizing that:

• Partial breastfeeding with supplementation is a successful outcome 6
• The bonding and skin-to-skin contact provide significant benefits independent of milk volume 8
• Duration of breastfeeding matters less than the quality of the experience 6

Common Pitfalls to Avoid

Do not introduce bottles before establishing breastfeeding, as this creates nipple confusion and reduces infant motivation to nurse 1. Instead:

• Use only the supplemental nursing system at the breast 3
• Avoid pacifiers during the first 4-6 weeks 1
• Never skip nighttime pumping sessions, as prolactin peaks during sleep hours 3

Special Medical Considerations

If you have hereditary angioedema, be aware that lactation may increase edematous attacks due to elevated prolactin levels 4. Discuss this risk with your physician before beginning induction 4.