By Dr Ananya Mandal, MD
Lactation induction may be necessary in several cases. For example, in case the milk does not come in or if the baby is an adoptive one and the mother wishes to breastfeed the baby.
While some women may be comfortable taking prescribed medicines to induce lactation, some may prefer herbal medications.
In addition some mothers may wish to breastfeed naturally while others may be amenable to express breast milk once it comes in.
The mother should be the one who helps guide the physician and the lactation consultant on her preferences. This helps foster coming of the milk.
Dr. Jack Newman
There are several protocols that guide the induction of lactation. These were first given by Canadian pediatrician Dr. Jack Newman who tried it with a mother Lenore Goldfarb. The protocol was then called Newman and Goldfarb protocol 2000.
Dr. Newman’s book “Dr. Jack Newman’s Guide to Breastfeeding” (Harper-Collins, 2000) formed the first published protocol while in the United States the book title is “The Ultimate Breastfeeding Book of Answers” by Dr. Jack Newman (Prima Publishing, 2000).
Three protocols for induction of breastfeeding
There are three protocols for induction of breastfeeding. These include:-
Regular Protocol - This is for women who have six months notice before the arrival of the adoptive baby.
Accelerated Protocol - This is for women who have less than six months notice. This is also suitable for women who wish to renew lactation after having stopped it for a while. Milk production may be significantly lower with this protocol than that achieved with the Regular Protocol.
Menopause protocol - This is for women who have had surgical removal of their reproductive organs or who have had their menopause naturally.
Active oral contraceptive pill
The basis for lactation induction is taking one active oral contraceptive pill. The pill usually contains 1 to 2 mg of progesterone and no more than 0.035 mg of estrogen.
These pills need to be taken without interruption each day to help the grow breast tissue.
Along with this is given a medication called domperidone that is commonly used as anti-vomiting and anti-nausea pill. This helps to increase the milk supply.
After the oral contraceptive pill is stopped there is a drop in the mother’s progesterone level while the domperidone that is continued stimulates an increase in her prolactin level.
Prolactin is a hormone that stimulates making of the milk in the breast. This allows the milk to come in. to facilitate coming of the milk, the mother may need to pump and express both her breasts every three hours with an automatic double pump.
Along with pumping the mother should take adequate water and fluids. Caffeine containing beverages like colas, coffee, tea etc. should be avoided as they may cause excess water excretion.
For the accelerated protocol Yasmin or Microgestin is taken for 30-60 days without interruption together with the domperidone 20 mg 4 times per day.
If breast changes are seen within 30 days, the oral contraceptive is stopped and the domperidone is continued along with breast pumping. Breast changes mean an increase in breast size (1 cup), feeling of painfully heavy and full breasts.
Herbs that may induce lactation
Some of the herbs that may induce lactation include Blessed Thistle herb (recommended 390 mg per capsule) and Fenugreek seed (recommended 610 mg per capsule). The dose used is 3 capsules of each, 3 times a day with meals. Along with these domperidone is given 30 minutes before meals.
The American Academy of Pediatrics
The American Academy of Pediatrics approves the use of oral contraceptives and domperidone in breastfeeding mothers. These protocols may not produce enough milk for complete nourishment of the baby and may need to be topped up with artificial formula feedings.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)
Last Updated: Feb 28, 2013