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kaygigi in 2_mommies

Inducing Lactation

Hi everyone!
After much delay, I wanted to update you all about our trip (yesterday) to a lactation specialist who is also a pediatrician and maternal medicine doctor.  Basically her entire practice is breastfeeding and lots of the local adoption agencies refer adoptive moms to her for info on inducing lactation, so we're in pretty good hands!  She also does a fair number of two mom couples who both want to breastfeed, or where the birthing mom can't so the other one wants to, etc.

Basically, the ideal amount of time if inducing fresh (no previous pregnancies) is 3-4 months to prep the breasts.  Her standard regimine is 3-4 months of non-stop birth control, the kind that has both estrogen and progesterone (so typically the old fashioned pills, not the newer ones), plus high doses of fenugreek (we're talking like 2400 mgs 4times a day) and lots of mother's milk tea (if a person doesn't mind licorice).  If that kind of BC doesn't work, she goes for the progesterone only ones, but the ones that have estrogen work better.  When doing the progesterone only ones, she recommends an herbal supplement that contains estrogen-like chemicals.  Basically the non-stop BC mimicks the hormones of pregnancy (high estrogen to swell the breasts, high progesterone to prevent them from actually expressing milk) while the fenugreek and mother's milk stimulates prolactin production, which allows the breasts to make pre-milk (somehow only actually pregnant woman make colostrum - while pre-milk is still nutrative, it doesn't have the anti-bodies or enzymes of colostrum to prep the intestines of the newborn).  When starting the routine, many women experience very mild first trimester symptoms - morning sickness, swollen and tender boobs, gastrointestinal discomfort, etc.  But these aren't as bad as real pregnancy and they are usually very tolerable.  The woman inducing lacation should also massage her boobs a couple of times a day (I volunteered for this, obviously, such a chore!) and try pumping occasionally towards the end of the pregnancy.

When the kid is born, if both are bfing, the birthing mom feeds the kid exclusively for the first two weeks or so, to establish a milk supply and give the kid the colostrum.  However, the non-birthing mom should put the kid to her own breasts after about a day or two, so the kid can also establish a latch.  The non-birthing mom is still on the BC and fenugreek, so no milk will come out, but the kid won't get "nipple confusion" and learn how to work both sets of boobs (though this doctor said that nipple confusion was overblown and any kid could be taught how to do both bottle and nipple, or two sets of nipples, or even how to breastfeed after exclusive bottle feeding if under a certain age - and since that is exactly what she does for a living, I'm inclined to believe her).  It will also help prep the non-birthing mom's boobs for breastfeeding.  After about  a week, week and a half, the non-birthing mom stops the BC but not the fenugreek and may add raspberry leaf tea.  This simulates labor and delivery.  After a few days, she will also experience let-down and start producing real milk.  

The best way to do two sets of boobs without worrying about losing supply is to set a feeding schedule.  The boobs will get into a schedule, too, so the overall milk supply won't drop, it will vary in accordance with the feeding schedule set.  Of course, each mom might have to pump to keep up the supply, but it is very much a supply and demand system.  Extra milk can be put on hand in the freezer as back-up, or can be donated to the local milk bank.  She said she would work with us after the baby is born to establish a schedule that works with our schedules and our supplies and the needs of the baby.  

The inducing lactation process is easier if the non-birthing mom has previously breastfed, especially recently.  In many of those cases, a woman needs to just take some fenugreek and do the hand expression/massaging just before the birth of the baby in order to get her supply up to speed.

She said that she used to use domperidone, but that recently the FDA has been cracking down on compounding pharmacies filling prescriptions for breastfeeding purposes, as well as doctors who order prescriptions for it from Canada.  She thinks the entire thing is political and shows how anti-woman and pro-formula the FDA is, but that the actual effectiveness of just BC, fenugreek and stimulation is almost as good as the domperidone regime, so she's not even sure she'd add it back in even if it were approved (at least as a routine thing - she always tries to work with a particular patient's body, so if the routine didn't work, she would obviously try something else).  

Our particular doctor was Christina Smillie, but the practice website is http://www.breastfeedingresources.com/.  If you're in the Connecticut area, and considering inducing lactation, I think it is probably worth it to see if your insurance covers them.  They are feminist, gay friendly, and just super nice.  If not, they have a really sweet video about baby-led breastfeeding available on their website, among other resources.

Comments

Domperidone is easily available online. Google "inhousepharmacy".
She said it has more recently become available again, but since her dom-free routine seems to work almost as effectively, she didn't see the point in going through the bother of getting it unless the dom-free routine didn't seem to be working for a particular patient. They have a compounding pharmacy in CT with whom they work to get dom when needed. :)
That's great that she's had similar success with fenugreek but that's really rare. I actually don't know a single person who was able to induce lactation without domperidone.(And I do have a good handful of friends who have done it successfully, both before ever being pregnant and after previously lactating.)
This is fabulous information and may come in use for us one day. Thanks for sharing.
No problem!
Thanks for writing this up! This will be useful info for later. I'd love to hear any other updates regarding this topic, as it has been something I've just begun looking into. If you don't mind my asking, how far along are you on the whole having kids thing?
I am 28.5 weeks pregnant! :D

Of course we'll let the community know how the routine is going. So far Z is lightheaded if taking the fenugreek without food (a common side-effect), but nothing big nor unexpected.

December 2011

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