As most of you know by now, we welcomed Luca, our baby boy in April of 2020. Because I could no longer carry a baby, we turned to surrogacy to have our long-awaited second child. Since we started the surrogacy process, I yearned to breastfeed my new baby, just like I did with his older brother, Nico. I did some research, and although it would definitely involve more work, it was not an impossible idea. It even has a name- "induced lactation," which is most commonly used by mothers of adoptive children and surrogacy.
Why induce lactation?
As a holistic nutritionist, I have spent countless hours researching the benefits of mother's breastmilk. Not only is it the best source of nutrients for a human baby, it is easiest to digest and boosts infant's immune system with its multiple immune-boosting compounds. As many people refer to it, breastmilk is liquid gold. I wanted to provide my baby with the best nutrition possible and give him the same gift I gave to his older brother. But aside from all this, I also wanted the bonding experience that breastfeeding provides. Since I didn't carry Luca in my womb for nine months, I wanted to nurse him so I could develop a more intimate relationship with him.
Induced lactation may not be a very common practice, but there is plenty of information out there and lots of successful stories to learn from. I first joined an induced lactation Facebook group and bought a book about it. I then hired a lactation consultant to guide me through the process and hold my hand. Surrogacy is such an emotional journey, and I needed all the support I could get.
Upon the first appointment with my lactation consultant, Breanna Duncan from The Mama Mantra, we determined the Newman-Goldfarb protocol would be the right approach for me. We had 6 months before baby arrived and I was willing to take hormones and other medicine to stimulate production. This was the protocol with the highest success rate (production of 40%-95% of breastmilk requirements) and since I had already breastfed my older son, I was optimistic that I would be successful. Success on my book was producing milk, even if not a full supply.
The process takes about six months, and there are basically three stages:
Phase 1: Preparation by growing breast tissue and milk ducts through taking continuous birth control (BC) pills, herbs and a medicine called Domperidone. This phase takes about 4-5 months.
Phase 2: Starting to build a supply by mimicking birth by stopping BC, start pumping every 3 hours, taking lactation supporting herbs, and continue with the Domperidone. It is recommended to start this phase about 6 weeks before the due date.
Phase 3: Once the baby comes, breastfeeding as much as possible and continue pumping to increase supply. Continue with the Domperidone and herbs.
The continuous birth control pills simulate pregnancy and breast growth via estrogen and progesterone, and the Domperidone increases prolactin to start creating breast milk. Domperidone is a medicine that is not available/approved in the US, so it needs to be ordered from another country, mainly from an online pharmacy in Canada.
I started with birth control and then added the Dom. The side effects from taking Dom were pretty severe for me (nausea, vomit, diarrhea) and after trying to to make it work for about a month, I decided to stop taking it, and hoped that the birth control would be enough. Birth control was not without its side effects either; weight gain, moodiness and fatigue, but I felt like I could handle those for a few months. Birth control pills deplete our bodies from B vitamins and mess with your gut bacteria, so I started taking a B vitamin complex and doubled my probiotics. I took the pill for 5 months until it was 6 weeks before baby's due date.
When I stopped the birth control, I rented a hospital grade pump, a Medela Symphony. I also started taking herbs and supplements to increase milk production and made sure I was pretty hydrated. On my first pumping day, I pumped for 15 minutes 7 times a day, but nothing happened. I heard it was pretty normal for it to take about a week or so to produce even one drop of milk, so I just kept going. By the third day, I finally saw one drop out of each breast! That one drop was so encouraging because it meant that this was working.
I continued to pump every 3 hours during the day and woke up once between 3:00 – 5:00 am to pump at night.
Even though I was producing milk, I didn’t produce colostrum. I’ve been told you can only produce colostrum when you are pregnant because colostrum production starts with the placenta. The characteristics of the milk that you produce with induced lactation is the equivalent of what a mother of a 6-month old would produce, not in quantity but in composition.
My production started increasing every day and by weeks 3-4 I was producing 4.5 ounces, but then it kind of stabilized there. I then realized this was caused by my period returning after 6 months! It is considered normal, even for breastfeeding mamas, to see a dip in supply when they get their period. I continued pumping and added one power pumping session and more herbs and supplements to boost supply. Power pumping means, instead of your regular 15-20 minute pump session, you pump for 20 minutes, then rest for 10, then pump for 10 minutes, then rest for 10 and then do a final 10 minute pump. This is the equivalent of cluster feeding in babies and stimulates more production.
Power pumps seemed to work and I started producing 6, then 8 and peaked at 10 ounces per day, on the week of my baby’s due date. I have been saving all my milk since I started producing 1 oz and freezing it. I am still in awe of what the human body can do. Every night as I poured the milk I collected during the day into freezer bags to store, I thought to myself: I can’t believe I made all this, and I thank my breasts for their hard work :-)
As the founder of a supplement company myself, I truly believe in the power of nutrients for overall health as well as to support lactation. Here is what I currently take:
· Prenatal / Postnatal by Mother Nutrient. I want to make sure the milk I produce has all the nutrients baby needs and also that I am not left depleted by milk production
· Cash Cow a lactation booster by Legendairy Milk. They are also an Austin based company that makes all kinds of organic lactation supplements without fenugreek, since fenugreek is a legume and can disrupt digestion in mothers and babies. The blend I am taking contains moringa, nettle, alfalfa and goat’s rue.
· Biotin gummies by Mother Nutrient. Biotin can do wonders for your skin, hair and nails, but it also helps with breast tissue renewal. My breast tissue is pretty dense, and biotin has helped in loosening the tissue and getting the milk to flow easier.
· Omega 3 by Mother Nutrient. Most Americans are deficient in Omega 3's, this essential fatty acid is super important for baby's brain development and mother's mental health, as well as a powerful antioxidant. On days when I don't eat fatty fish I take one capsule.
· Women’s probiotic by Mother Nutrient. Studies have shown that breastfed babies of mothers that took probiotics during pregnancy and lactation, suffered a reduction in colic, spit up and were 27% less likely to develop eczema, compared to babies of mothers who took a placebo. I didn’t take probiotics with my 6 year old and he was pretty colicky, so I am not risking it this time around.
· Breastfeeding probiotic by Mother Nutrient. When I breastfed my older son, I had 5 bouts of mastitis, not fun. I know I’m prone to mastitis, given my history and my dense breast tissue, so now I am taking this probiotic that has specific strains to prevent and help relieve mastitis.
· Endura by Metagenics. I did a lot of research on what to do to increase production and hydration is key. Some experts recommend nursing women to drink Gatorade, coconut water or electrolyte powders, but those are full of sugar. I found this awesome electrolyte powder that only has 2 gr of sugar and is sweetened with Stevia and it also tastes great. One packet of Endura in a glass of water is the equivalent of drinking 3 glasses of water!
· Mother’s Milk tea by Traditional Medicinals. I usually drink 2-3 cups per day, and have noticed how it helps keep my supply up.
· Lactation bites by Majka. These do have fenugreek but not in huge quantities, I like that they are made with organic unprocessed ingredients, are gluten-free and sweetened with dates.
· Organic Ashwagandha by Mother Nutrient. It is an ayurvedic herb that has been used as a galactagogue in India and reduces stress by decreasing the stress-hormone Cortisol and supporting the adrenal glands. It has really helped me when dealing with stress and anxiety about COVID-19 and having a baby in the middle of the pandemic.
· Organic Golden Collagen by Mother Nutrient. A delicious blend of superfoods and herbs that increase breastmilk production (moringa, fenugreek, cinnamon, ginger, cardamom) plus the powerful anti-inflammatory turmeric, and grass-fed collagen. I drink it hot or cold with coconut milk, add it to pancakes and smoothies.
Baby is here, now what?
Our surrogate had a beautiful home birth and both my husband and I were able to attend.
I actually caught my baby and did skin-to-skin as soon as he was born. He then latched right away to my breast and I've continued to breastfeed ever since. It felt so magical to be able to breastfeed my baby! We developed an instant connection and I fell deeply in love with him! The love I feel for him is the same as I feel for my 6 year old, there in one instant, my loved doubled and it no longer mattered that I didn't carry him in my womb.
In the first few days after birth, babies don’t need that much milk, but around day 4-5 they need the 10 oz the milk I was producing at that point, so I needed to breastfeed and keep pumping to continue increasing my supply. This sounds easier said than done, when in reality baby is cluster feeding, not sleeping and you are dealing with figuring out how to latch and all that. I haven't been consistent at pumping after baby came but I try to do it 2-3 times per day.
Most mothers that do induced lactation end up producing only a portion of baby’s needs. An average baby needs about 25 oz of milk per day. Since I was producing 10 oz, I expect my supply will increase, since suction is so much better with a baby than a pump. Babies also breastfeed more often, so that should help as well. At 1 week old, we started supplementing him with colostrum that our surrogate graciously pumped for him. We were also lucky enough to get donated breastmilk from a local mama, for when his need increases even more.
He is definitely a hungry little caterpillar and we want to make sure we meet his needs whether it comes from my breast, my freezer supply or eventually formula. We use an SNS (supplemental nursing system) to give him additional milk. It is a container that can be placed on the mother's chest or on a pole. The very thin, flexible tubes are fixed alongside the mother's nipples and release additional milk and supplements as the baby feeds. This allows for the baby to get additional milk, while still stimulating the breast to produce more milk. When my breasts are tender or need a break from cluster feeding, my husband feeds baby through the SNS using his finger.
Would I recommend it?
Pumping is not for the faint of heart, I almost quit twice when I had to deal with thrush likely caused by having taken BC for so long, and vasospasms, caused by my ill-fitting flanges. It has made me realize that even though breastfeeding is natural, there are a lot of nuances when it comes to producing and providing milk to babies. It can be very complicated and tiring, so no wonder many mamas decide to end their breastfeeding journeys early. Let’s be honest, it is hard work and we as a society should do a better job of supporting nursing mothers. I can’t imagine after going through all this, having to deal with shaming for breastfeeding in public.
I feel so blessed to have had such an awesome support system during my induced lactation journey. I am so grateful to my amazing lactation consultant, my super supportive husband, my very patient 6 year-old who has seen more than his fair share of dangling breasts, and all the encouraging messages from my friends and family when I shared my progress.
I hope my story inspires and motivates those of you thinking about inducing lactation, please feel free to share it with someone you think would benefit.