Alyssa Schnell, St. Louis, Missouri, USA
Alyssa Schnell is an International Board Certified Lactation Consultant (IBCLC) based in the United States. She speaks internationally about inducing lactation and relactation and specializes in helping parents who have not given birth (non-gestational parents) to breastfeed their babies. In this article Alyssa discusses how parents who have not given birth can breastfeed by inducing lactation and how La Leche League Leaders can support them.
Breastfeeding is a special gift a baby receives from their gestational parent. However, many non-gestational parents—adoptive parents, intended parents (through surrogacy), parents whose partner is birthing, and transwomen—are finding out that this wonderful experience is also available to them. Because parents who haven’t given birth do not have the hormones of pregnancy to get their bodies started with making milk, they need more information and support to make breastfeeding a reality.
Why Would a Non-Gestational Parent Choose to Breastfeed or Chestfeed?
- Attachment. Breastfeeding helps the parent and baby form a secure attachment, a particular concern when babies are separated from their gestational parent or gestational carrier (in surrogacy).
- Nutrition. Human milk provides the optimal nutrition and necessary immunities for human babies.
Healing. Breastfeeding can help heal the heartache of infertility, and provides a biological connection between mother/parent and baby. Breastfeeding is much more than breast milk. Breastfeeding is a close, intimate, physical and emotional relationship between two or more people who love each other.
- Sharing. When both parents are breastfeeding, they share the caregiving role.
Facts about breastfeeding without birthing
- Women have breastfed babies they did not birth throughout history. With the easy availability and common use of bottles and infant formula in modern developed countries, culture has largely lost track of how breastfeeding can also be an option for non-gestational parents.
- Non-gestational parents can start preparing for breastfeeding as soon as they decide to grow their family, after an adoption match has occurred or once their partner or gestational carrier is pregnant. They can even wait until the baby is in their arms.
- The amount of milk produced when inducing lactation can vary widely. While some parents make no milk and others make all the milk their babies need, most will make a partial milk supply. Fortunately, breastfeeding is possible no matter how much or little milk is produced—even if it is none at all! Human milk feeding can be simulated with a nursing supplementer: a bag or bottle that holds human milk or formula carried to the nipple via a tiny feeding tube. Parents who are not making any milk may also choose to feed with a bottle while their baby comforts and connects with them by suckling at the (dry) breast.
- Newborn babies are wired to initiate breastfeeding, but with gentle and patient encouragement, along with a few handy tools and techniques, even older babies can learn to breastfeed.
- Some mothers will take medications or herbs to help them make more milk, but this is not essential. The only necessary component to induce lactation—the official term for making milk without pregnancy and birth—is to stimulate and drain the breasts. That stimulation or emptying can happen with baby breastfeeding, with an electric breast pump, or using a variety of manual techniques.
- The composition of milk produced by inducing lactation is comparable to that produced following birth., The milk does not contain dangerous levels of artificial hormones—in fact, it very rarely contains any artificial hormones at all. In most cases, the only artificial hormones that are taken are estrogen and/or progesterone before there is milk production (Step 1 below.) Progesterone and estrogen levels are high during pregnancy and taking these hormones artificially may help to make the body think it is pregnant. Estrogen and progesterone play a role in breast development in pregnancy.
- It is not necessary to be fertile—or even to have ovaries or a uterus—to breastfeed. The hormones responsible for milk production (prolactin) and milk ejection (oxytocin) are released from the pituitary gland located at the base of the brain.
- Both parents, whether or not one has given birth, can share the breastfeeding role. This is called co-nursing.
How to induce lactation
As stated above, the primary way to induce lactation is through breast emptying: breastfeeding, pumping, or hand expression. The effectiveness of these physical techniques can be enhanced with the use of galactogogues: medications, herbs and homeopathic remedies that support the production of milk. These tools can be put together in a variety of ways to be effective and applicable to each individual parent. While the use of medications, herbs or homeopathic preparations is an individual choice, parents should always discuss their individual situation with their health care providers.
Generic protocols are available (such as Dr Jack Newman’s protocol) or an experienced International Board Certified Lactation Consultant (IBCLC) can work with parents to develop a personalized protocol customized to meet their specific health history, circumstances, and values. The process can be broken down into three steps:
Step 1: Preparing the Breasts for Lactation
This step mimics the hormonal and breast changes that occur during pregnancy. This step is not about making milk; it is about growing and developing the glandular breast tissue in preparation for making milk. Many parents will take hormone therapy for a period of time to achieve this. However, this step is optional.
Step 2: Starting to Make Milk Before Baby Arrives
Milk is often produced very, very slowly when lactation is induced compared with the sudden increase in milk supply between days 3-5 following birth. In order to have a milk supply by the time baby arrives, parents will often start the process of growing their milk production several weeks or months before. The main component of Step 2 for many parents is frequent pumping. Ideally, parents will express their milk as frequently as a baby nurses—just like for birthing parents, frequent breast drainage “places the order” for healthy milk production. Parents can store any milk they produce for use when baby arrives.
Step 3: Feeding Baby and Continuing to Grow Milk Production
This is the big payoff! Baby is here and the parent can begin feeding baby their milk. This step generally involves putting baby to breast.
Not every parent’s protocol will use all three steps. Each parent’s needs and circumstances determine which steps will be appropriate for them. For most parents with adequate information and support, milk production begins within 6-8 weeks of beginning the process of inducing lactation.
What is the role of a La Leche League Leader?
Although extremely rewarding, inducing lactation can be a challenging breastfeeding situation. Mothers/parents need and deserve all of the support they can get. While working with an International Board Certified Lactation Consultant (IBCLC) is highly recommended, La Leche League Leaders can also play a very valuable role. As always, Leaders provide essential information and encouragement. More specifically, La Leche League Leaders may:
- Refer parents to resources on inducing lactation (see below).
- Provide support for inducing lactation.
- Facilitate La Leche League Group meetings where older babies who are bottle-feeding can observe breastfeeding babies, and parents can participate in a breastfeeding culture. Group meetings are also opportunities for parents to connect with other mothers who are nursing in a variety of situations.
- Facilitate healthy social media information and interaction.
- Share information about donor milk.
Breastfeeding without birthing may not be easy, but it is possible and it is powerful. La Leche League Leaders can be part of the team supporting these parents and their babies.
Resources for La Leche League Leaders and parents
- La Leche League Inducing Lactation and Relactation Facebook Group
- “Breastfeeding an Adopted Baby”, LLLI website
- Breastfeeding Without Birthing by Alyssa Schnell
- Breastfeeding Outside the Box podcast or other podcast app
Alyssa Schnell has been helping parents and babies with breastfeeding for the past 17 years, first as a La Leche League Leader and now as an International Board Certified Lactation Consultant (IBCLC). Her private practice, Sweet Pea Breastfeeding Support, provides individual lactation consultations either in person or by phone or video-conference for parents throughout the United States and beyond. Alyssa is also the co-host of the Breastfeeding Outside the Box podcast, which is devoted to families breastfeeding or chestfeeding in extraordinary situations. Alyssa enjoys working with all parents and babies, but she has a special place in her heart for helping non-gestational parents to breastfeed/chestfeed their babies. She is the author of Breastfeeding Without Birthing: A Breastfeeding Guide for Mothers Through Adoption, Surrogacy, and Other Special Circumstances and is an international speaker on the topics of inducing lactation, relactation, and other related topics. Alyssa lives in St. Louis, Missouri, USA and is the proud mother of three breastfed children—two by birth and one by adoption.
 Some notes about language: The term “gestational” is used throughout this article instead of “biological.” In surrogacy, the intended mother is often the biological mother (baby is often conceived with her egg) even though she is not gestating (pregnant with) the baby. And oftentimes same-sex female couples will conceive baby via in vitro fertilization (IVF) using the egg of one parent (biological parent) implanted in the uterus of the other parent (gestational parent). This article also attempts to use gender-inclusive language such as parent versus mother and breastfeeding/chestfeeding versus breastfeeding. Some of the parents referred to in this article may be cis male, trans male, or non-binary.
 Note: inducing lactation with medication should not be started unless the parent has an approximate timeline for their baby’s arrival. Taking medication without a definite end could be hazardous.
 Other manual approaches might include breast massage, nipple manipulation (gently pulling out and twisting of the nipple), and a partner suckling.
 Kulski, J. K., Hartmann, P. E., Saint, W. J., Giles, P. F., & Gutteridge, D. H. (1981). Changes in the milk composition of nonpuerperal women. American journal of obstetrics and gynecology, 139(5), 597-604.
 Perrin, M. T., Wilson, E., Chetwynd, E., & Fogleman, A. (2015). A pilot study on the protein composition of induced nonpuerperal human milk. Journal of Human Lactation, 31(1), 166-171.