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Breastfeeding without pregnancy

Induced lactation can get anyone's milk flowing - even men

There is no debate about the benefits of breastfeeding: it is best for the baby, best for the mother, and best for family bonding and attachment. The specific list of breastfeeding's advantages is long and well documented. But what if you have a baby through adoption or surrogacy and still want to take advantage of the benefits of breastfeeding despite never having been pregnant?

It turns out that by following a set of protocols, which admittedly takes some effort, women in this situation can still breastfeed, even if they have never been pregnant. "There is even a case study of a woman who lacked ovaries successfully breastfeeding," says Debbie Stone, RN and lactation specialist at Toronto's SickKids Hospital. Called induced lactation, "with the right stimulation and hormone therapy, just about anyone can do it."

The chemistry of breastfeeding simplified

The hormonal changes the body undergoes that eventually lead to lactation are now well known. The induced lactation protocols attempt to mimic these changes, essentially tricking the body into first believing it is pregnant and then giving birth. "When you become pregnant, progesterone and estrogen are at high levels," says Stone. "During this time, the breasts are being prepared for lactation." This mechanism is well understood and forms the basis for the birth control pill. "The difference is that for induced lactation, you don't take any breaks from the pill."

During normal pregnancy, once a woman goes into labour, progesterone and estrogen level immediately drop and a different hormone, prolactin, is released which triggers the onset of lactation. Mimicking this process is also part of the protocol, however, rather than prolactin, the woman is given domperidone, a medication originally used to treat upper gastrointestinal problems, which triggers the production of prolactin.

Domperidone's ability to cause lactation, interestingly in both men and women, was at first simply an unusual side effect for a drug that is generally considered effective for gastrointestinal problems such as nausea, vomiting and poor motility. Soon however, doctors and nurses began to imagine that the drug could help women who were not producing enough milk. It should be noted that domperidone is not approved for use in the United States, though most other western countries have been using it for years. Medical science now knows of other drugs that can help stimulate the release of prolactin.

"It's recommended that this course of hormone therapy go on for about six months before a mother is expected to get her baby," says Stone, adding that in many cases, that much notice may not be possible. "With surrogacy, you pretty much know when the baby is coming. Adoption can be much less certain."

There are several versions of the protocols, each tailored to the amount of time a woman has to get ready for the baby's arrival. The protocols themselves were co-written by Dr. Jack Newman, a well-known Canadian breast feeding advocate.

"What's this white stuff coming out of my nipple?"

Hormone therapy is only one part of induced lactation. The other component is direct stimulation of the breast itself. "Generally we use a good double electric breast pump starting a few weeks before the expected date of the baby's arrival," says Stone. "The goal is to establish a milk flow before the baby begins feeding." This can mean pumping milk every three hours every day for several weeks before the baby is due. "It's a major commitment."

There are other ways, such as massage and compression, to stimulate the breast. Dr. Newman's protocols even suggest women's "partners can help" in this regard. Moreover, stimulation alone can initiate lactation. "We've seen teenagers who come in and say "Why has my nipple ring got white stuff coming out of it?" They are pretty surprised to learn they are lactating," says Stone, adding that stories like this underline some women's breastfeeding potential without pregnancy or hormone therapy.

The limits of induced lactation

While the ability to induce lactation in most who try and adhere to the protocols is not in doubt, whether a woman will be able to provide enough milk to breastfeed exclusively is another matter. "There are not that many cases where a woman got to the point where the baby was only taking the breast. It's more likely that some type of supplementation will be necessary," says Stone, after reviewing the limited literature on induced lactation. Supplementation can come in many forms: breastfeeding aids, finger feeding, or bottle or cup feeding are all options. "If an induced woman can breastfeed exclusively, it usually takes several weeks to get to that point."

The fact that exclusivity may not be achieved does not make the effort a waste of time. "The women who do induced lactation tend to want a 100% experience and breastfeeding is part of that," says Stone. Even without exclusivity, it's "a way to bond and nurture as well provide nutrition and immunological protection." On this last point, at least one study has shown the composition of breast milk, whether induced or produced naturally, though at ten days post partum, is the same.

What about men?

Since induced lactation is relatively new, there are only limited studies about it. What works best and for whom and under what circumstances, is likely to continue evolving. However, the existing techniques open up the possibility that men could also breastfeed.

As bizarre as this may sound, there is evidence that under certain circumstance, some males are able to lactate. As noted above, men who take domperidone​ can begin lactating. Male lactation has also been reported in men taking sex-change hormone therapy. There are also reports that prolactin levels can naturally increase in expectant fathers. Additionally, newborns, including male newborns, may briefly lactate immediately after birth. Called "witch's milk", it is suspected that the phenomenon may occur because the infant is subjected to high levels of prolactin during its last few hours in the womb, courtesy of the mother.

In the animal kingdom, two researchers found 10 male Dayak fruit bats lactating. This discovery, made in 1995, is the first documented natural instance of spontaneous lactation in male mammals of any sort.

The question is, even if it is possible, will men want to breastfeed? And will their partners allow them to try it? In other words, though the biology and technology are in place, what about the culture? If some men answer "yes", the age-old question "why do men have nipples?" may also be answered.

More information
Newman-Goldfarb induced lactation protocols:



Dr. Jack Newman's Guide to Breastfeeding. Dr. Jack Newman. Harper-Collins, 2000. (In the US, the title is The Ultimate Breastfeeding Book of Answers.    Prima Publishing, 2000.)

A Practical Guide to Breastfeeding. Jan Riordan, RN, MN, Jones and Bartlett, 1991.

Storey AE, Walsh CJ, Quinton RL, Wynne-Edwards KE. Hormonal correlates of paternal responsiveness in new and expectant fathers. Evolution of Human Behaviour. 2000 Mar 1;21(2):79-95.

Gabay MP Galactogogues: medications that induce lactation. Cann PA, Read NW, Holdsworth CD Galactorrhoea as side effect of domperidone. British Medical Journal, Clinical Residence Edition. 1983 Apr 30;286(6375):1395-6