Ask Our Expert...
Ask Our Expert provides a way for you to ask some of your general breastfeeding and adoption and surrogacy questions. Our expert, Lenore Goldfarb, Ph.D., IBCLC is a lactation educator, International Board Certified Lactation Consultant (IBCLC), researcher, and co-founder of the Goldfarb Breastfeeding Clinic and Program located at the Jewish General Hospital in Montreal, Quebec, Canada. She is President of the Canadian Breastfeeding Foundation and co-author of the Newman-Goldfarb protocols for Induced Lactation: The Guide for Maximizing Milk Supply with Dr. Jack Newman. Dr. Goldfarb is married with two sons born via gestational surrogacy and breastfed via The Newman - Goldfarb Protocols for Induced Lactation. You can find additional information and resources on the Creating a Family Breastfeeding and Adoption and Surrogacy Page and at Dr. Goldfarb's website Ask Lenore. Keep in mind, that all information presented here is for educational purposes. Consult your physician regarding the advisability of any opinions or recommendations with respect to your individual situation.
E-mail your breastfeeding and induced lactation questions to firstname.lastname@example.org
Q: Hi! I am an intended mother and my surrogate is going to deliver in four weeks! I have been on the protocol for 3.5 months now. One day before my six week before the baby is due I tested out the pump and after two minutes of the pump on my breast I received colostrum! I talked to a lactation consultant at the hospital that we will be delivering and we decided to stay on the protocol until questions were answered. So my question is... Since a baby is the best form of pumping, can I wait until the baby arrives to stop birth control? That way my baby gets all that it needs without freezing. Or do I stop now, with four weeks to go? And won't that be like feeding my baby four week old milk? When it's only a newborn? I don't want to mess up and I feel like I don't have enough information. I am so lost!
A: If the intended mom is following our protocol as we suggest, then it is important that she stop her birth control pill, maintain her domperidone, and start pumping at this point. The reason for this is that the milk supply of an intended mom does not ramp up as quickly as that of a birth mom because we are only able to provide 3 of the 4 hormones available during pregnancy, namely prolactin (via domperidone), progesterone & estrogen (via the birth control pill which is used to build the milk making structures of the breast, not for contraception). Once the baby arrives, the priority is not to then build a milk supply or to depend upon the baby to build the mother’s milk supply but rather to feed the baby. So now is the time! Good luck!
Q: Have there been any studies of the breast milk produced by women using the Newman-Goldfarb protocol to see how their milk compares to the breast milk of mothers who lactate naturally as the result of pregnancy?
A: In 1981 there was a study of the milk of mothers who induced lactation and it was found to be equivalent to that of birth mothers at 10 days post partum. As for the milk of mothers who induced lactation using our protocols, some did have their milk tested and it was found to be….breastmilk. In a study conducted in 2010 of mothers who induced lactation by any means, 94% of mothers reported their infants met their developmental milestones.
Q: My baby does not show much interest in the breast and I’m guessing it’s because I am not producing enough milk. I have been supplementing with a bottle. Should I switch to only supplementing with a lactation aid? Do you have any other suggestions for getting him more interested in nursing?
A: What you are describing sounds similar to breast/bottle confusion/preference. The best way to avoid breast/bottle confusion/preference is to supplement at the breast with the help of a lactation aid. Babies learn to breastfeed by breastfeeding and mothers learn to breastfeed by breastfeeding. Kindly see this document for instructions and this video. As you become more proficient with the use of the lactation aid, your milk supply should increase with the action of your baby at the breast. For further assistance, please seek out the assistance of an International Board Certified Lactation Consultant in your area. You can turn this around with a little work and patience. At the very least, your baby will be at the breast receiving all kinds of immune benefits and other good things.
Q: We are hoping to adopt and I’d love to breastfeed. In your experience what are the odds that I will be able to produce the full milk supply for my child if I carefully follow the Newman/Goldfarb protocol and am very motivated and we adopt a newborn? What are my chances if the child we adopt is over 6 months and has been exclusively fed by bottle before she/he comes to us?
A: There are several factors that determine a successful/satisfying outcome. Inducing lactation is a two phase process: Phase 1: Build the breast tissue and Phase 2: Bring in the milk supply. In our experience, mothers who developed the largest peak milk supplies and who reported success and satisfaction from their experience were those who followed a protocol or process that involves the use of hormones (suitable birth control pill if under the age of 35, and prometrium/progestin if over the age of 35) together with domperidone for a period of time followed by pumping with a suitable dual electric breastpump. The guide to the protocols may be found here and the NG Decision Tool can be found here. Inducing lactation is one aspect of the process the other aspect is getting baby to the breast. Whether breastfeeding an adopted newborn or older child, most mothers find it helpful to obtain the services of a lactation professional who is familiar with adoptive breastfeeding. The International Board Certified Lactation Consultant (IBCLC) is the gold standard in lactation consulting as they are clinically trained to assist mothers with a variety of lactation issues. You can find one here. Another source of support is La Leche League International which has support groups that mothers can attend to share experiences and offer peer support. Most cities have local chapters. You can find one near you here.
Q: We have been matched with a birth mother that is due in 6 months. I really want to try to breastfeed our adopted baby. How soon in advance should I start following your protocol? Can you briefly outline the steps I should take. Thank you so much for the show you did on breast feeding and adoption. I am so excited about the possibility.
A: The protocol most moms in your situation follow is the Regular Protocol which involves the use of medications and herbs to bring in their milk supplies. The medications involve a specialized birth control pill (not for contraception, for your breasts) and domperidone to increase your prolactin. These medications provide some of the major hormones involved in lactation. Basically we are simulating what happens during pregnancy. It's not perfect but it has helped many women to bring in their breastmilk supplies. It is a two phase process. Phase 1: Build the breast tissue Phase 2: Bring in the milk supply. The sooner you begin the medications the better your ultimate result.
The medications recommended by Dr. Jack Newman and the doctors at our breastfeeding clinic are Ortho 1/35 (once daily, only active pills, no sugar pills, no periods) and domperidone (10 mg 4 times per day for the first week and then increase to 20 mg 4 times per day) and continue until about 6 weeks before your baby is due to arrive.
NOTE: If you are over the age of 35 you would need to replace the Ortho 1/35 with either Provera 2.5 OR prometrium 100 mg. There are health risks associated with the use of the combination birth control pill over the age of 35 that you need to discuss with your doctor. And this is why we replace the bcp in our regular protocols with Provera 2.5 OR prometrium 100 mg for the regular protocol for women over 35.
Since you would be taking the Ortho 1/35 OR the Provera OR the prometrium to develop the milk making structures of your breasts and not for contraception, you can start the protocols at any time with your doctor's knowledge and support.
The sooner you can begin the bcp/domperidone combination, the more breastmilk you can expect. The starting dose of domperidone that our doctors recommend is 10 mg 4 times per day for the first week and then increase to 20 mg 4 times per day.
Kindly stop the Ortho 1/35 (or the Provera OR the prometrium)approximately 6 - 8 weeks before your baby is due to arrive, maintain the domperidone, add the herbs and begin pumping with a good electric breastpump. Hand pumps are not up to the job.The double electric pump fools your body into thinking you have a really hungry set of twins at the breast and is the fastest way to increase your milk supply. You’ll need to pump every 3 hours (a minimum of 8 times in 24 hours for 20 – 30 minutes each session).
Once you’ve started pumping you can add the herbs Blessed Thistle herb (approx 390 mg per capsule) and Fenugreek seed (approx 610 mg per capsule). Most mothers take 3 capsules of each 3 times a day with their meals and their domperidone ½ hour before meals for best absorption.
They also try to eat oatmeal for breakfast at least 3 times a week and drink 6 glasses of water a day but it's important that you don’t overdo the water. Just drink water when you’re thirsty.
You can expect clear drops, which become more opaque. Then spray, then stream. It may take a few days, a week, or two, or more for you milk supply to come in. Everyone is different.
If your baby arrives before you have completely built your milk supply, you simply maintain the domperidone/herbs, and put your baby to the breast with the help of a supplemental feeding tube device filled with either donor breastmilk or formula. It helps to pump for about 10 minutes after most feeds to further build your milk supply.
For more information kindly read our guide to the protocols available here.
We also have a message board where you can discuss your progress with over 1200 women at various stages of the protocols.
Before you begin any protocol please check with your doctor to be sure there is nothing preventing you from following a protocol to induce lactation and to be monitored while following it.
Q: I am 48 and hope to have a baby through a gestational carrier. I would like to breastfeed my baby. Does my age matter? What I mean is will it affect my chances of success?
A: Although we do not put an age limit on inducing lactation, when a mom is over the age of 35 our recommendations are slightly different than if she was younger because there are some health risks associated with combination birth control pills over the age of 35. Before we can fully advise we would need to know whether the mom has any health problems. And we need to know when she plans to begin the surrogacy process. It would also help to know if she’s using her own eggs or an egg donor, if she still has her ovaries, and whether she’s had any breast surgery.
In your particular case, without knowing all the facts, I can tell you that according to the available research just about any mother can induce lactation if she has breasts and a functioning pituitary. Because you are over the age of 35 we would suggest a protocol that involves the use of progesterone (Provera 2.5 or Prometrium 100mg) together with domperidone for a minimum of 60 days (longer is better) and then stopping the progesterone approximately 6 weeks before your baby is due to arrive. At that time you would add the herbs fenugreek and blessed thistle and begin pumping with an excellent dual electric breastpump that can pump both breasts at the same time. You will need to pump 8 times in 24 hours, 20-30 minutes per session. Before you begin any protocol please check with your doctor to be sure there is nothing preventing you from following a protocol to induce lactation and to be monitored while following it.
Q: I have had breast cancer with a lumpectomy, chemo, and radiation. Our only chances of having a family are through either adoption or surrogacy. Will I be able to breast feed my child that we either adopt or have through a gestational surrogate?
A: Most mothers can and do breastfeeding following a lumpectomy. The location of the surgery is important (the forth intercostal nerve responsible for the let-down response runs through the breast at particular points and ducts can be severed etc). While we’re on this topic, I’ll just mention that many mothers have successfully breastfed on one breast following mastectomy as well.
It is important that you be completely free and clear of any chemotherapy prior to breastfeeding because this is one of the few times when a medication is not compatible with breastfeeding. Chemotherapy medications are designed to go after bad proliferating cells and so could go after the good cells of babies which proliferate at an extraordinary rate (so baby can grow), because the medication cannot determine the difference.
If you are considering a protocol to induce lactation, it is important for you to check with your doctor prior to beginning any protocol. Many mothers with a history of breast cancer have followed a non-estrogen protocol that replaces the combination birth control pill in our protocols (Ortho 1/35 or Yasmin) with a progesterone-only medication (Provera 2.5 or prometrium 100 mg) together with domperidone for a period of time, followed by pumping. The amount of time on the progesterone/domperidone combination is dependent upon when your baby is due to arrive. We recommend a minimum of 30 days but longer is better until about 6 weeks before your baby is due. At that time you would add the herbs fenugreek and blessed thistle and begin pumping with an excellent dual electric breastpump that can pump both breasts at the same time. You will need to pump 8 times in 24 hours, 20-30 minutes per session. Again, before you begin any protocol please check with your doctor to be sure there is nothing preventing you from following a protocol to induce lactation and to be monitored while following it.
Q: Working on inducing lactation to adopt and asked doctor for bcp and dom. The bcp he wrote for is Estarylla .25/.035. Is that an adequate bcp to induce lactation or should i also take prometrium orally once a day to help increase progesterone levels. Doc has hardly any experience with adoptive breastfeeding. Planning on 3 months of bcp before pumping. Doing newborn adoption, but may very well not have much if any warning on when we will get baby.
A: Dr. Lenore Goldfarb's reply: This mother is fortunate that her doctor is willing to assist her. Unfortunately the prescribed medication is what is known as a “mini pill” and not suitable for inducing lactation. It’s important for her health care provider to understand the birth control pill is not used for contraception but rather to develop the milk making structures of the mother’s breasts. Most mothers take a birth control pill that has no more than .035mg ethinyl estradiol and at least 1mg of norethindrone. It’s also important that the mother be monitored by her doctor. Not all mothers can take these hormones and there are risks associated with all medications. Also, there is more to our protocols than use of just the birth control pill. The mother would require a galactagogue as well. For more information please visit our website at www.asklenore.info.
Creating a Family reply: It is impossible to give adequate medical advice over the internet and Dr. Goldfarb is not a medical doctor. Take her reply as a general suggestion and show it to your medical doctor to get his/her opinion on the safety and efficacy . If your doctor needs education on inducing lactation for adoptive breastfeeding, haver her/him go to www.asklenore.info.