What are the requirements for inducing lactation in an adopting mother?

Induced Lactation for Adoptive Mothers

Adoptive mothers can successfully induce lactation through a combination of regular breast stimulation (pumping), galactagogue medication (domperidone), and in some cases hormonal preparation, though advance planning of 3-6 months before the child's arrival optimizes success.

Core Requirements

Breast Stimulation Protocol

• Begin pumping 3-6 months before the expected arrival of the child using a double electric breast pump combined with manual expression 1, 2
• Pump regularly and frequently to simulate infant feeding patterns, as consistent mechanical stimulation is the primary mechanism for milk production 2
• Continue pumping even if initial milk production is minimal, as volume typically increases over weeks to months of regular stimulation 2

Pharmacological Support

• Domperidone is the preferred galactagogue with a relative infant dose of 0.01-0.35%, well below the 10% safety threshold recommended by the American Academy of Pediatrics 3, 4
• Standard dosing is 10 mg three times daily, which stimulates prolactin release and increases milk production 5, 6
• Domperidone has extremely low infant exposure due to high plasma protein binding and favorable milk-to-plasma ratio 4
• Treatment duration typically ranges from 1-3 months, though some women may require longer courses 2, 7
• Domperidone levels in breast milk average 2.6 ng/ml with regular dosing, significantly lower than other galactagogues like metoclopramide 6

Optional Hormonal Preparation

• Some protocols include hormonal birth control prior to pumping to simulate pregnancy hormones, though this is not always necessary 7
• One successful case achieved donor-level milk production without any hormonal pretreatment, using only domperidone and pumping 2

Expected Outcomes

Realistic Milk Production Goals

• Full milk supply is not always achieved—many adoptive mothers produce partial supply requiring supplementation 2, 7
• In one documented case, an adoptive mother produced sufficient milk to become a human milk donor 3 months after starting the pumping protocol 2
• Success varies widely based on individual physiology, consistency of stimulation, and duration of preparation 7

Timeline Considerations

• Milk production typically begins within weeks of starting regular pumping, but optimal volume may take 2-3 months 2
• Starting the protocol 6 months before adoption provides the best chance for adequate supply 2
• Shorter preparation periods (3 months) can still result in meaningful milk production 2

Critical Success Factors

Non-Pharmacological Support

• Proper breastfeeding management and counseling should always precede pharmacological intervention 8
• In one study, 71.7% of mothers with perceived lactation failure increased milk production through counseling alone without medication 5
• Access to lactation consultant support improves outcomes 1

Monitoring and Adjustment

• Track daily milk volumes to assess response to the protocol 5
• Prolactin levels increase significantly with domperidone (from baseline ~70 ng/ml to ~223 ng/ml at day 7) 5
• No significant adverse effects have been reported with domperidone at standard doses 5

Important Caveats

• Maintenance of milk production after the child arrives can be challenging due to the complexity of establishing breastfeeding routines and defining parental roles, particularly in same-sex partnerships 7
• The infant must be willing to breastfeed at the breast, as some babies may refuse if they have been bottle-fed 1
• Supplementation with expressed milk or formula may be necessary even with successful induction 2, 7
• The process requires significant commitment, time, and emotional investment over several months 2, 7