All About Inducing Lactation: An Informational Guide From an IBCLC
by Jacob Engelsman
Inducing lactation seems to be one of those things that many people don’t hear about until after it’s relevant to their life.
I don’t know how many times I’ve had someone shocked to learn it was an option, and dismayed that no one told them years ago when their partner had given birth. Thankfully, through acceptance of queer culture and advances in medical technology, it's relatively common for a baby to have two moms, dads, or parents of any gender through adoption, surrogacy, previous relationships, or any of the other ways babies come about these days.
Maybe you’re one of these lucky people, and you've just learned that inducing lactation is an option. You've done some research, but now you're knee deep in recommendations for herbs, protocols, and off-label medications you can only buy with bitcoin? Is that legit?
I’m an International Board Certified Lactation Consultant (IBCLC) and have spent years reading, writing, speaking, and listening to others speaking about inducing lactation.
I’m here today to give you an overview or primer on what you’ll actually need to know about and think about when you look into the specifics of inducing. This article isn’t meant to prepare you to induce lactation; instead, my goal is to offer an informational overview of what’s actually involved in the process so you can decide if it’s something you want to learn more about actively pursuing for yourself or your family.
Things to Consider As You Explore the Idea of Inducing Lactation
Before we get into the technical aspects of inducing, there are a few things you should think about. From your personal history to your family’s goals, the following questions can offer a starting point for your exploration.
History
Have you ever lactated in the past?
This doesn’t indicate how inducing lactation will go, but it is a factor that may impact your experience.
Put simply, if you’ve lactated at any time in the last three years, it might be more fair to say that you are relactating, and you might have an easier time producing milk.
If you’re still leaking periodically, you might start a regular pumping regimen and see if you start producing again. This is a different scenario than someone who hasn’t lactated previously, but you will still benefit from the information in this article.
Do you have any medical conditions or are you taking any medications?
There are a few medical conditions where they flat out say you should not make milk for your baby, but they are all very severe and you will know if you have them (ebola, brucellosis, and certain types of lymphoma).
Likewise, most of the medications contraindicated for lactation are for severe illness (cancer treatments and immunosuppressants used after organ transplants). You should always check if your medications are contraindicated for lactation, just in case. You can do that by asking your prescribing doctor any by checking the book Medications and Mothers’ Milk, which is updated every two years. Drugs and Lactation Database (LactMed®) is another resource you can consult.
Goals
As with most endeavors, having specific short and long-term goals can help focus your mind and motivate you.
Short term goals probably won’t have to do with making milk specifically but might include things like: get a pump, decide which (if any) medications to take, talk to your doctor about potential contraindications with your current medications, find a lactation consultant, etc.
For long-term goals, consider the following:
How much milk do you want to be making?
In my experience, it’s best to think about this in very general terms instead of ounces or milliliters. If you’ve never lactated before, you might be setting yourself up for frustration and disappointment if your goal is to make all of the milk your baby needs, but do you want to make most or some of the milk? Would you be happy to make any of the milk your baby eats? Remember that if the baby will have more than one lactating parent, both of you will need to do some pumping in order to maintain your supplies.
When do you want to be making milk by?
If you have a due date for the baby you’re inducing for, the usual recommendation is to start the process at the beginning of the second trimester.
If you’re adopting and could have a baby any time in two months or two years with little warning, you’ll have to decide if you would rather be doing this indefinitely or not be able to make milk until after the baby has arrived.
Ways A Non-Gestational Parent Can Make Milk
On to the technical details of how to make milk without giving birth to a baby.
One of the first things most people hear about is the name Newman-Goldfarb. Drs. Jack Newman and Lenore Goldfarb were among the first people to seriously research inducing lactation. In 2000, they published a protocol for achieving best results, called the Newman-Goldfarb Protocol. This protocol, which can be found here, is the basis for almost all research and writing on induced lactation done since then. The gist is that you’ll need to trick your body into thinking you're pregnant, gave birth, and now have a hungry baby.
While this isn’t as difficult as it sounds, it does take some doing. An important point to remember is that the Newman-Goldfarb Protocol assumes that you are a healthy, adult, cis woman. If you’re on hormone treatments or taking other medications, they’re going to complicate matters so you should talk to your doctor.
If you haven’t lactated in the past and you aren’t currently taking hormones for anything else, the easiest way to convince your body that you’re pregnant is to start taking combination estrogen and progesterone birth control pills. We usually recommend taking birth control for eight-twelve weeks, making sure to skip the sugar pills. If you’re uncomfortable taking birth control pills, you can skip this part and just start pumping. However, for most folks, the medications do help with milk production.
After a few months on birth control, the parent stops birth control and starts pumping that same day. This simulates having a hungry newborn. It will probably be a few weeks before you make any milk, but outside of latching your baby, maintaining a strict pumping schedule is the most important thing you can do to establish a milk supply. When I say ‘pumping schedule’ what I mean is at least eight times per day with no more than a six hour gap at night, twenty minutes per side. For many clients this is the most daunting part of the process, but there are a few tricks to help you along:
Use an electric pump that can attach to both sides at once. This means you’re only pumping for twenty minutes per session!
Pump first thing in the morning and last thing at night from bed. Then you only need to pump six times during the day.
Other Ways to Support Lactation
There are a few other things that can help you start producing milk or increase your supply after it’s established. These are all options that you can disucs with your providers and lactation consultant to decide what makes the most sense for your body, family, and goals.
Medications
Domperidone - Alright, this is probably what most readers have heard of and have questions about given its reputation.
Domperidone is a gastrointestinal medication, whose primary use was to prevent people from vomiting during surgery while they are unconscious. It also has a side effect of increasing a person’s prolactin levels, so while it will sometimes cause people to spontaneously start making milk, if you already have a milk supply it will almost always increase your supply.
The reason it isn’t prevalent in the US is that it isn’t FDA approved due to a risk of cardiac arrhythmia. However, this risk primarily exists when people are being given injections instead of pills and for an older population who are more likely to have heart troubles to begin with.
This is definitely something amab people need to be aware of since they have a higher risk of heart disease, but healthy afab people are generally in the clear if your doctor approves.
While you can’t get it anywhere in the US, it is fairly easy to order online and can be purchased in Canada if you’re up for a road trip. One of the websites most known for selling it (Inhouse Pharmacy) was only accepting bitcoin for a while, but as of this writing it looks like they’re back to accepting US dollars.
Metoclopramide - Another medication that works by increasing your prolactin levels is sold under the brand name Reglan.
This is also for intestinal distress. Despite it being easier to access, I tend to steer people away from this medication because the side effects are more severe including depression and tardive dyskinesia, which causes uncontrollable movement of the face and arms.
Herbs and Supplements
There are a great many traditional recommendations for herbs and supplements to use while inducing lactation. Going through all of them could be a whole article itself, so I’ll just talk about the ones you are most likely to hear about:
Prenatal vitamins - for pretty much everybody, there is no downside to taking a daily multivitamin, and the added nutrients the body needs during pregnancy are the same that it needs while lactating.
Shatavari - This herbs is very nutrient dense, so it is recommended for many ailments and is considered ‘good for you,’ in a general immune-boosting sort of way. There’s not really a downside to taking it, unless you’re allergic to asparagus, which it’s related to.
Moringa - The same goes for moringa, which is also called malunggay. There’s no clinical data saying it will definitely help, but there’s no real reason not to take this antioxidant.
Fenugreek - Fenugreek has been shown to increase milk production if you take a lot of it (3,500-7,000 mg per day). This will also make you smell like maple syrup. You should also avoid this if you’re allergic to any legumes (beans or peanuts). Many people who are allergic to peanuts are also allergic to fenugreek but don’t notice until they start eating massive amounts.
Brewer’s yeast - This is a specific kind of yeast that people will add to smoothies and such as a health supplement, mostly because it has tons of vitamin B. You could also use nutritional yeast, which has similar nutritional benefits and is more commonly used as a food product.
Lactation cookies - The reason lactation cookies work is that they are calorie dense and generally have things like oats and brewer’s yeast which increase their vitamins. Besides that, there’s nothing really special about them. Again, there’s no downside to taking them as a bonus to a nutrient-dense diet.
Lactation tea - I tend to steer people away from lactation tea. It often contains mint, which tastes good but is actually bad for milk production.
Partner or Community Support
Single and adoptive parents have absolutely been successful in inducing lactation, and no matter what your family looks like, you will need and want community support. A partner or close friend or family member can offer emotional and practical support that may be a contributor to your success.
Support can look lots of different ways depending on your needs, but a few ways a support person can help include the following:
Keep the pumping area clean, stocked, and ready to go. Key items include snacks, water bottle, phone charger, pump parts, balm, and whatever else you need to be comfortable. This will be good practice for when you actually have a hungry baby to wrangle!
Help maintain the schedule and record the milk. Extra hands and/or shared labor may be helpful, but feel free to skip this if it feels like micromanagement.
Listen with compassion. Lactation is a journey, and the person inducing lactation may need space to process their feelings and thoughts along the way. Of course, this is good practice for any aspect of the relationship!
Navigating Your Unique Journey
Now that you’ve got the basics of inducing lactation, you can decide if this is something you want to actively pursue or learn more about for the future.
There are a few different books I recommend to clients depending on their history and emotional needs. If exclusive language is not a dealbreaker for you, Breastfeeding Without Birthing by Alyssa Schnell has been a standard since it came out in 2013 (although it hasn’t been updated). If you have a recent history of lactation, you should check out Relactation by Lucy Ruddle, which came out in 2020 so is more timely but narrower in scope. If you’ve got some time to do your research, I’ll also recommend my own book, Lactation for the Rest of Us, due out early next year which I wrote specifically because of the lack of gender inclusive lactation literature. I have a whole chapter on inducing!.
Jacob Engelsman is an International Board Certified Lactation Consultant who has been writing and speaking on inducing lactation and gender diversity in birth and lactation support since 2017. You can contact him through his website, and follow him on instagram for updates on his book, Lactation for the Rest of Us, due out in February 2025.