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Did you know that anyone with mammary tissue can make milk? There are many ways to bond with your new baby, and if you are someone with breast/mammary tissue, nursing might be one of one them. For households with 2+ people with the desire to lactate, a whole galaxy of options opens up to how your might nourish and soothe your baby. If you or your partner are considering inducing lactation, I'm here to help! Read on for both general and local recommendations.
First, you will want to begin planning early. Some non-gestational parents engage in "non-nutritive" nursing: your baby sucks to soothe without getting any milk. Sucking is one of the 5 major ways that babies are soothed, so this is not a small thing! However, if you want to plan to actually make milk, you will need time. The more the better.
History on Shared Lactation ("Co-Nursing")
Before I dive into inducing lactation, I want to address some of the taboos around sharing lactation. Historians believe that humans (before formula) likely all co-nursed their babies in family units. A brand new baby would learn to suck at the chest of an experienced adult. A brand new lactating parent would feed older babies who already knew how to latch. If someone was sick and their supply took a dip, other members of the family unit would step in, sometimes even grandparents. Co-nursing is a beautiful way to feed your baby, but unfortunately a lot of that knowledge has been lost to time.
Inducing Lactation: The Newman-Goldfarb Protocol
Inducing lactation is not an exact science. Some people make a lot of milk, some make some, and some make very little. Their are so many factors related to milk production: how long you have been preparing, how often you tell your body to make milk through pumping, how much breast tissue you have - and more! Unlike gestational parents' milk supply, which comes in very quickly in the 3-5 days post birth, a non-gestational parent will need to work hard to raise their supply little by little over time.
The most common protocol used with a long lead time until baby is due is the Newman-Goldfarb Protocol. The NGP involves taking both birth control pills to suppress menstruation / period as well as domperidone, a drug not allowed in the USA.
A note on domperidone: This drug is legally allowed in Canada and other countries. In fact, it is often an over the counter drug! Like any drug, if it is used unsafely, it is unsafe. If used safely, it is safe. Many specialized lactation consultants will be able to help you determine whether or not domperidone makes sense for you and how to source it. This is not medical advice - just sharing what I know!
Ideally, you begin the NG protocol 6 months before baby is due. You begin pumping around 6 weeks before the due date for about 15-20 minutes total every 3 hours. Humans are not machines, so each person will need individualized care and guidance going through any lactation induction. Needless to say, this is not a small undertaking. There is an accelerated protocol if you do not have 6 months to prepare, but you are not likely to produce as much milk. In a household with multiple lactating parents who are planning to co-nurse, that may be less of a concern.
Note that this is not the only protocol (by far!) but it is the most commonly used one as a starting place. You may pick and choose certain aspects of several different protocols to find the combination that is right for you.
Can I Use Herbs to Induce Lactation?
While there are several herbs known for increasing milk supply, the reality is that inducing lactation usually requires a heavier hand than herbs can offer. Many people who are using a medical protocol also supplement with herbs and find them to be helpful. Since inducing lactation means that you will increase your supply little by little, gradually over time, then herbs can be helpful with getting you just a little more.
If you want to read more about which herbs to use and their safety, I recommend Breastfeeding Without Birthing, a book listed below.
Do I Really Need to Pump in the Middle of the Night?
Many people inducing lactation are worried about exhausting themselves before the baby comes. Remember that making milk is a supply & demand system. Your supply will not come in all of the sudden like a gestational parent. Instead, you will have to ramp it up. Babies eat in the middle of the night, so you'll need to tell you body to make milk in the middle of the night.
I've seen IBCLCs recommend drinking a large glass of water right before bed. This will usually cause your bladder to wake you naturally during a light stage of sleep and you can pump after getting up to use the bathroom. The more you pump, the more you make!
Trans Women Can Lactate, Too!
There is a now-famous study from 2018 co-authored by Zil Goldstein (sidebar: she was my PCP in NYC and the first person to ever give me a consensual exam; she's the fucking best). The study details the protocol used to help a 30 year old trans woman induce lactation, and by 3 months of treatment she was producing 8oz of milk per day! Her baby was born 2 weeks later and she was able to exclusively breastfeed for 6 weeks before needing to supplement.
Often trans women choose to work with their endocrinologist as well as a lactation consultant. Here is an interview with another trans woman who lactated and fed her baby and it is a helpful read for anyone thinking about inducing lactation as she goes into her thought process as well as the logistics of inducing lactation.
Although many trans women find lactation to be gender affirming, some genderqueer, trans masc, and non-binary folks experience gender dysphoria related to their chest, and that is ok. How you feed your baby can be complicated and nuanced. I want to hold space for all the ways that you might feed your baby.
Co-Nursing
Sharing the breastfeeding journey is beautiful: someone who can swap with you and get up to feed the baby in the middle of the night, and someone who understands what you are going through. The biggest hurdle after actually inducing lactation is figuring out what you want your experience to be:
When will the non-gestational parent begin co-nursing?
What do you want a 24 cycle in your household to look like?
What does success look like to you?
How will you communicate your plan to providers (pediatrician, your midwife/OB)?
Inducing lactation is a big deal: lots of work, lots of potential reward. Communicating clearly is very important. I've been at a birth where the provider discouraged the non-gestational parent from latching her baby because the provider was worried about the birthing parent's milk supply. This is a totally valid concern, but my client was devastated. She had spent months pumping around the clock in anticipation of this moment - feeding her newborn baby.
Providers often don't fully understand co-nursing and might make big assumptions if they aren't given clear guidance and communication. You'll want to share your plans in advance in something like your birth plan as well as in conversation at your appointments.
The reality is, we don't have a ton of information about co-nursing that is well documented. There is an article on The Atlantic, "The Moms Who Breastfeed Without Being Pregnant." Alyssa Schnell also wrote a research paper about co-nursing that is worth reading as well, Successful Co-Lactation by a Queer Couple: A Case Study. You can contact me or her for a copy. La Leche League also has an article written by her that is worth checking out, although it is generalized to anyone wishing to induce lactation, not just queer families.
You might also choose to have just one parent feed the babies. In some families, the parent who carried focuses on healing while the non-gestational parent takes on nursing.
Book Recommendations:
Making More Milk is a guide to increasing production that will help you better understand the factors that go into milk production and explore many ways to increase supply. Part IV of the book will be particularly helpful and includes a short section on co-nursing and induced lactation for trans women. There are also chapters on additional therapies to increase milk (think: acupuncture) and what galactagogues to explore.
Breastfeeding Without Birthing is specifically about inducing lactation and one that can be used by anyone who is looking to bodyfeed their baby. Note that is was written very much for adopting and intended parents of surrogacy. There is no information about co-nursing or trans women, but there are many specific protocols and guidance for choosing what works for you. I have personally connected with the author, who supports people virtually all over the world from St. Louis, and found her to be thoughtful and inclusive.
Facebook Groups
Queer Liquid Gold: not specific to inducing lactation, but a great resource
Chicago Specific Resources
Here in Chicago, if you are looking for more support, please schedule a consult with me! I've working with co-nursing families and trans women. I am always happy to help families begin to make a plan and to support your co-nursing or induced lactation journey. If you feel that you want a higher level of expertise from an IBCLC and information on getting domperidone, I recommend reaching out to Alyssa Schnell for virtual support or Jeni Gentri for in-person support.
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