By: Barbara Wilson-Clay, BSE, IBCLC
Throughout human history there have been infants who have been nursed by surrogate mothers.
Non-maternal lactation may have occurred as a result of maternal death or illness, or because
the birth-mother gave over or shared the care of her baby with another woman. Sometimes, the
surrogate was already breastfeeding another baby, and her milk supply simply increased due
to additional demand to meet the growth needs of two (or more) babies. In the event that no
already-nursing mother was available, anthropological reports from several continents describe
efforts by non-lactating woman to induce lactation by putting the baby to breast. (1) Such
infants were probably helped along with teas or gruels until sufficient milk appeared. While
there must have been a high mortality rate in orphaned or abandoned babies, induced lactation
evolved as a cultural solution to their plight in the era before artificial milk formulas.
In the United States, especially among La Leche League members, induced lactation has been
embraced as a way to provide an enhanced bonding experience for women who are adopting babies.
The special closeness fostered by breastfeeding can be profoundly comforting for both mother
and child. Many women who have struggled with fertility problems value the experience of
breastfeeding, even if the volume of milk they produce is small. The range of milk produced
varies considerably from woman to woman, and it is difficult to predict the results of induced
lactation. It is unusual in the US to find women who bring in a full supply of milk, but also
rare to find women who make no milk. If a mother understands that the young infant will need
supplementation with formula, she can relax, enjoy the experience, and nurse her infant without
fear of compromising growth. While any amount of human milk is valuable to infants, La Leche
League and most lactation consultants counsel that the emphasis be kept on the positive aspects
of nurturing and closeness rather than on volume of milk actually produced.
How does induced lactation work? Basically, it is important to remember that prolactin and
oxytocin, the hormones which govern lactation, are pituitary, not ovarian hormones. Therefore,
even if a woman has had a hysterectomy, she may lactate, providing her over-all health is good.
(Estrogen, in the form of birth control pills or for replacement therapy, is a lactation
suppressant.) Both prolactin, the milk-making hormone, and oxytocin, the milk-releasing hormone,
are produced in response to nipple stimulation. While there are now several regimens which use
hormone therapy to assist in bringing in milk, many women have induced lactation with only
mechanical stimulation. This consists of breast massage, nipple manipulation, and sucking --
either by a baby or a hospital grade electric breast pump. Some adopting mothers rent a breast
pump in anticipation of the infant; other mothers simply put the adopted infant to breast.
Hormonal therapy to induce lactation generally consists of administration of estrogen to
simulate the high-estrogen state of pregnancy. The estrogen is then abruptly withdrawn to
mimic the rapid hormonal changes following delivery. A course of a prolactin-enhancing drug
such as metaclopromide (Reglan.) is then instituted. Sucking stimulation (with a pump or by
baby) is begun at this point. Milk production typically begins between 1-4 weeks after
initiating mechanical stimulation. One study of induced lactation using medications describes
onset of milk production between 5-13 days. (2) This is similar to case reports of inductions
using only nipple stimulation. At first, the mother may see only drops. During the time
that milk production is building, women may notice changes in the color of the nipples and
areolar tissue. Breasts may become tender and fuller. Some women report increased thirst, and
changes in their menstrual cycle or libido.
Is human milk produced in such circumstances adequate for infant growth? In a study done in
New Guinea, 24 infants of mothers inducing lactation were found to be well-nourished at
follow-up. (3) A study done by Kleinman, et al, looked at the chemical composition of milk
produced by non-biological mothers. (4) Two of the studied women had previously delivered
babies; three had never been pregnant. Milk samples were collected from five women with
adopted infants who had induced lactation by infant sucking. Milk production (at various
levels) was established within 11 days without medication. Milk samples were collected during
the first five days of milk production and compared with samples of milk from five biological
mothers. The mean protein concentration in the induced lactating women was identical to that
of transitional milk of post-partum donors. There were differences in the concentration of
albumin, IgA and *-lactalbumin concentrations in the milk produced during the days immediately
following birth. Levels of these constituents were higher in the colostrum of the biological
mothers. Sucking alone is apparently not sufficient to produce colostrum; other hormonal
influences associated with pregnancy seem to be involved. The milk brought in by non-biological
mothers, in other words, skips the colostral phase and more closely resembles transitional
and mature breastmilk. Kleinman's study does not look at other nutritional characteristics
(such as fats, carbohydrates, or micronutrients.)
Since induced lactation produces low volumes of milk initially, and skips the colostral phase,
how is the baby's nutritional status guaranteed in the early days of the process? Many women
use a feeding tube device. This is a bag or bottle which is worn suspended on the mother's
chest. These devices have thin, silicone feeding tubes which are taped to the nipple with
hypoallergenic surgical tape. The baby sucks the breast, and milk flows through the tubes as
through a straw, delivering donor milk or formula directly at the breast. This is one way to
avoid conditioning a baby to expect the quicker flow and more formed nipple of bottle teats
(thought to be the reason for the condition called "nipple confusion".) Medela Inc.
manufactures a device called the Supplemental Nutrition System (SNS)* and Lact-Aid
International manufactures the Lact-aid Nursing Trainer.* Both companies have web pages and
their addresses are listed at the end of this article in the "Resources" appendix.
Mothers who are attempting to induce lactation profit from assistance and support from
informed sources. Local La Leche League Leaders will be able to help women obtain printed
information on the subject and may be able to network an adopting mother with another women
who has induced lactation. Lactation Consultants provide equipment (feeding tube devices,
electric breast pumps) networking with other similar clients, and expertise to help the
adopting mother initiate lactation. The Lactation Consultant (LC) may be a good referral
source to physicians in the community who are supportive of the process. Many US doctors
do not know that induced lactation is possible. Hopefully adopting families will seek open
dialog and free sharing of information with the baby's doctor, both for growth monitoring
purposes and to help make this a learning experience for everyone!
1. Jelliffe, DB and Jelliffe, EFP. Human Milk in the Modern World, Oxford University Press,
New York, 1978.
2. Nemba,K. Induced Lactation: A Study of 37 Non-puerperal Mothers, Journal of Tropical
Pediatrics, 1994, 40:240-242. (see abstract below)
4. Kleinman,R. et al. Protein Values of Milk Samples from Mothers without Biological
Pregnancies. Journal of Pediatrics, 1980, 97:612-615.
Auerbach,K and Avery,JL. Induced lactation: a study of adoptive nursing by 240 women,
Am J Dis Child, 1981, 135:240-243.
Jelliffe, DB. and Jelliffe, EFP. Non-Puerperal Induced Lactation, Pediatrics, 1972, 50:170-171.
Sutherland,A. and Auerbach,K. Relactation and Induced Lactation, Lactation Consultant Series
(Unit 1), 1985, La Leche League International.
La Leche League International at: //www.lalecheleague.org/
International Lactation Consultant Association (ILCA)at: //www.erols.com/ilca/ilca.html
Medela Inc. at: //www.medela.com
Lact-Aid International at: //www.lact-aid.com
Parent-L Breastfeeding Resources (on-line parent support) at:
Abstract of Induced Lactation: A Study of 37 Non-puerperal Mothers, by K. Nemba
"Of a series of 37 non-puerperal women aged between 19 and 55 years who requested bottle-feeding,
27 were known to have completed a lactation induction programme and 24 (89 per cent) of these
women were known to be successfully breast feeding well nourished children. All 11 women who
had never previously lactated were successful. Of the three mothers in whom induction was
unsuccessful, two obtained a bottle from other sources and both their children were
This study indicates that given a high degree of motivation combined with medication, support,
and encouragement, lactation induction is likely to be highly successful and may thus be an
important factor in child survival." Papua, New Guinea.