The Protocols for Inducing Lactation and Maximizing Milk Production:

The Protocols for Inducing Lactation and Maximizing Milk Production

The Accelerated Protocol

Suitable for intended mothers or adoptive mothers who have little time to prepare, or for mothers who wish to relactate

  • Milk production may be significantly lower with this protocol than that achieved with the Regular Protocol but there is more to breastfeeding than breastmilk.
  • Yasmin or Microgestin is taken for 30-60 days non-stop, only active pills, no sugar pills, together with the domperidone 20 mg 4 times per day. If significant breast changes occur within 30 days, the birth control pill is stopped while maintaining the domperidone, and the pumping schedule begins.
  • Significant breast changes include an increase in breast size (1 cup) and breasts that feel full, heavy and painful. Note: stopping the protocol before these breast changes occur is not recommended.
  • Milk production is not as great on the accelerated protocol but the supply is usually sufficient to provide a significant amount of the baby’s needs.  The mother can use the feeding tube device filled with either breastmilk or artificial infant milk to breastfeed her baby while she is going through the protocol. There are milk banks and milk exchange services that can provide the adoptive mother with breastmilk if it is not feasible for her to ask the birthmother to provide breastmilk.  Many adoptive mothers and intended mothers have asked the birth mother to provide breastmilk for a limited amount of time ranging from two weeks to 1 month or more in order to provide colostrum to the baby. Many birth mothers are happy and willing to provide the child with a healthy start in life. At least one birth mother has reported that providing breastmilk helped her to cope with the adoption process. Many surrogate mothers have provided expressed colostrum and breastmilk for their couples to give their children. This has become more common in recent years.
  • If the mother has 4 weeks or less or even if the baby has arrived and the mother suddenly decides that she wants to do the accelerated protocol, she can. The Yasmin or Microgestin (taken once a day) is started immediately, regardless of the mother’s cycle day, (see the section that describes the medications above) together with 20 mg of domperidone 4 times a day. The mother can expect to feel fatigued due to the rapid start of medications. If the mother can take the Yasmin or Microgestin together with the domperidone for at least 30 days she will have a good result.
  • Once the mother has completed at least 30 days on the combination of Yasmin or Microgestin and domperidone and has experienced significant breast changes she can stop the Yasmin or Microgestin, maintain the domperidone and begin pumping with a double electric breast pump. A hand pump is just not up to the job. See the section on breast pumps. Significant breast changes include an increase in breast size (at least 1 cup) and breasts that feel full, heavy and painful.
  • It is recommended that the mother pump every 3 hours and once during the night. (See “pumping instructions”.)  A mother’s serum prolactin levels naturally rise between 1 am and 5 am. Pumping during the night takes advantage of this natural occurrence. Additionally research has shown that frequency of breast emptying is more influential on milk supply than duration of breast emptying. The more often the mother pumps, the more milk she can store, and the better her supply will be.
  • Once the mother has started pumping she can add the herbs Blessed Thistle herb (390 mg per capsule) and Fenugreek seed (610 mg per capsule). The recommended herb dosage is 3 capsules of each, 3 times a day with meals. The domperidone should be taken 1/2 hour before meals for best absorption. Many mothers on the protocols have noticed a significant increase in their milk supplies when they began to add oatmeal to their diets regularly.
  • Fluids are very important. The human body naturally consumes and excretes the equivalent of 8 – 10 glasses of water per day. It is recommended that mothers drink at least 6 – 8 glasses of water a day if possible. Usually if mothers drink water when they are thirsty during the day, adequate fluid intake is achieved. Beverages containing caffeine should be avoided as they cause rapid excretion of fluids.
  • The arrival of the milk supply while pumping follows a particular pattern. It begins with clear drops, which become more opaque and whiter in color. Drops will appear, followed by milk spray, and then a steady stream of breastmilk. It may take a few days, a week, or two, or more for the mother’s milk supply to come in. Everyone responds differently.
  • Remember that if the mother is fertile, she must use an alternative method of contraception. It is advisable for the mother to store as much breastmilk as she can. Once her baby arrives, or if her baby is already here, the baby should be fed on demand.  The baby can be supplemented if necessary using a feeding tube device filled with either the stored breastmilk, donor milk from a milk bank or milk exchange service, or artificial infant milk until the mother’s milk supply is well established. Remember, not all the milk has to come from the mother. Whatever amount of breastmilk she can provide to her baby is a precious gift.  There is more to breastfeeding than breastmilk.
  • Note that the birth control pill and domperidone are both approved by the American Academy of Pediatrics for use in breastfeeding mothers.

The Regular Protocol

Suitable for intended mothers expecting a baby via surrogacy or adoptive mothers with a long lead time

Most of the women who have followed this protocol were able to meet most if not all of their baby’s breastmilk needs and sustain until weaning.

  1. Six months (the longer the better, if the mother can start as soon as she knows a baby is on the way it would be great) before the baby is due, take an “active” birth control pill each day + 10 mg domperidone 4 times per day for 1 week.  Then increase the dosage to 20 mg 4 times per day. The breasts will swell. This is normal.  The birth control pill actually suppresses milk supply mimicking what happens during pregnancy. No pumping or herbs please until 6 weeks before the baby is due. Pumping before the breasts are ready is not a good idea.
  2. Five months before the baby is due, take an “active” birth control pill each day + maintain the domperidone dosage at 20 mg 4 times per day.  The milk supply will still be suppressed. Still no pumping or herbs.
  3. Four months before the baby is due take an “active” birth control pill each day + maintain the domperidone dosage of 20 mg 4 times per day.  Do not exceed this dosage. The milk supply will still be suppressed.
  4. 6 weeks  before the baby is due, stop the birth control pill and continue the domperidone dosage of 20 mg 4 times a day. The mother should experience vaginal bleeding.  This is normal withdrawal bleeding. If the mother does not experience withdrawal bleeding and is fertile, it is recommended that she be examined for potential pregnancy.Over the next two weeks, start pumping as follows:
    • Pump for 5-7 minutes on the low or medium setting
    • Massage, Stroke, Shake (see pumping instructions)
    • Pump for 5-7 minutes

    It is suggested that the mother pump every three hours. Note: Stopping the birth control pill while maintaining the domperidone and then pumping, should cause a rapid decrease in the mother’s serum progesterone level while causing an increase in the mother’s serum prolactin level.  This process attempts to mimic what happens after a normal pregnancy and birth. This should cause the mother’s milk supply to come in.

  5. One month before the baby is due, the mother should continue the domperidone dosage of 20 mg four times a day. Pump as above and at least once during the night.  A mother’s serum prolactin levels naturally rise between 1 am and 5 am. Pumping during the night takes advantage of this natural occurrence. Additionally research has shown that frequency of breast emptying is more influential on milk supply than duration of breast emptying. The more often the mother pumps, the more milk she can store, and the better her supply will be.Once the mother has started pumping, she can add the herbs Blessed Thistle herb (390 mg per capsule) and Fenugreek seed (610 mg per capsule). Take 3 capsules of each 3 times a day with your meals. She should take her domperidone 1/2 hour before meals for best absorption. She should try to eat oatmeal for breakfast at least 3 times a week. Many mothers on the protocols have noticed a significant increase in their milk supplies when they began to add oatmeal to their diets regularly. Fluids are very important as well. The human body naturally consumes and excretes the equivalent of 8 – 10 glasses of water per day. We recommend that mothers drink at least 6 – 8 glasses of water a day if possible. Usually if mothers drink water when they are thirsty during the day, adequate fluid intake is achieved. Beverages containing caffeine should be avoided as they cause rapid excretion of fluids.The arrival of the milk supply while pumping, follows a particular pattern. It begins with clear drops which become more opaque and whiter in color. Drops will appear, followed by milk spray, and then a steady stream of breastmilk. It may take a few days, a week, or two, or more for the mother’s milk supply to come in. Everyone responds differently.
  6. Once the baby arrives, the mother should continue the domperidone dosage of 20 mg 4 times per day and continue until either she achieves a substantial milk supply or is ready to wean her baby off the breast. The mother should put her baby to her breast as soon as possible, in the delivery room if she can.  She should feed her baby “on demand” as often as possible.  It should be emphasized to the mother that the pumping schedule outlined for these protocols represents the bare minimum needed to establish a milk supply and that a newborn typically breastfeeds 10-16 times per 24 hours.While the mother’s milk supply is still building, it is advisable for her to pump for 10 minutes after each feeding. This will help to increase her milk supply, until it is well established.  The mother should maintain the herbs fenugreek and blessed thistle and continue until her milk supply is well established and throughout the entire time she is breastfeeding if necessary. Once the mother’s milk supply is well established it might be possible for her to slowly decrease the domperidone and even eliminate it completely. See the section on “stopping the domperidone”.

The Menopause Protocol

  • If the mother is menopausal due to surgical removal of her reproductive organs or naturally occurring menopause, she can still breastfeed and bring in her milk supply. A woman does not need a uterus or ovaries in order to breastfeed. All she needs are breasts and a functioning pituitary.
  • The first step is to stop the mother’s hormone replacement therapy and replace it with Yasmin or Microgestin (once per day). The Yasmin or Microgestin contains enough estrogen and progesterone to keep the mother’s menopausal symptoms at bay while at the same time developing the milk making apparatus of her breasts. The mother also needs to take domperidone (10 mg 4 times a day for the first week and then increase to 20 mg 4 times a day). It is a good idea for the mother to stay on the combination of Yasmin or Microgestin and domperidone until she experiences significant breast changes. At least 60 days on the combination of Yasmin or Microgestin and domperidone are recommended for menopausal women. Significant breast changes include an increase in breast size (at least 1 cup) and breasts that feel full, heavy and painful.
  • Once the mother has completed at least 60 days on the combination of Yasmin or Microgestin and domperidone and has experienced significant breast changes she can stop the Yasmin or Microgestin, maintain the domperidone and begin pumping with a double electric breast pump. A hand pump is just not up to the job.
  • It is recommended that the mother pump every 3 hours and once during the night. (See “pumping instructions”.)
  • Once the mother has started pumping she can add the herbs Blessed Thistle herb (390 mg per capsule) and Fenugreek seed (610 mg per capsule). The recommended herb dosage is 3 capsules of each, 3 times a day with meals. The domperidone should be taken 1/2 hour before meals for best absorption. Many mothers on the protocols have noticed a significant increase in their milk supplies when they began to add oatmeal to their diets regularly.
  • Fluids are very important. The human body naturally consumes and excretes the equivalent of 8 – 10 glasses of water per day. It is recommended that mothers drink at least 6 – 8 glasses of water a day if possible. Usually if mothers drink water when they are thirsty during the day, adequate fluid intake is achieved. Beverages containing caffeine should be avoided as they cause rapid excretion of fluids.
  • The arrival of the milk supply while pumping follows a particular pattern. It begins with clear drops, which become more opaque and whiter in color. Drops will appear, followed by milk spray, and then a steady stream of breastmilk. It may take a few days, a week, or two, or more for the mother’s milk supply to come in. Everyone responds differently.
  • If the mother experiences menopause symptoms, please do not resume the mother’s hormone replacement therapy but rather suggest that she eat soya products to control her symptoms. Soya milk and/or soya butter are good choices because they contain phytoestrogens but the mother should eat only enough to stop “hot flashes” because too much will decrease her milk supply.

Medical Conditions and the Protocols

  • Previous history of thrombosis, cardiac condition, and severe hypertension are contraindications for the birth control pill portion of the protocols. Several women on the protocols who have been diagnosed with mild hypertension have responded well to Aldomet (methyldopa) enabling them to take the birth control pill. This medication has the added benefit of further increasing milk supply and is approved by the American Academy of Pediatrics for use in breastfeeding mothers.
  • Several women on the protocols with a history of depression have responded well to Zoloft (sertraline). Several studies indicate that this medication is compatible with breastfeeding.
  • Inability to tolerate the birth control pills is a concern for some mothers.  Several women have tried estrogen patches, external lotions, and progesterone creams together with the domperidone.
  • Fenugreek has been reported to affect serum glucose levels. Therefore, diabetic mothers are advised to use this herb with caution.
  • Fenugreek can aggravate asthmatic symptoms. Mothers with a history of asthma are also advised to use this herb with caution.

What to Do If the Mother Does Not Experience “Significant” Breast Changes

Significant breast changes include:

  • Breasts increasing in size by at least 1 cup size.
  • Breasts full, heavy, and painful.

These symptoms are indications of adequate growth of the milk making apparatus of the breasts. If the mother does not experience significant breast changes within 15 days of beginning either of the protocols, she may want to consider increasing her progesterone intake.

There are three reliable ways to do this.

  1. Replace her current birth control pill with Yasmin. This medication has three times the amount of progesterone that is in the “1/35” type birth control pills.
  2. Replace her current birth control pill with Microgestin. This medication has a third more progesterone than is in the “1/35” type birth control pills.
  3. Continue on the current “1/35” birth control pill and add at least 1 mg of progesterone another way such as by adding 1/2 a pill of Provera 2.5.
  • Adding progesterone usually solves the problem but option 1 works better than option 2 because of the nature of the progesterone contained in the Yasmin or Microgestin.
  • A word of caution about creams…they do not provide the needed level of progesterone in a reliable manner. An oral form of progesterone is consequently a better choice.
  • Each element of the protocol serves a specific function. Consequently, it is very important to follow the protocols as written. If any of the ingredients for success are left out, the mother is likely to produce less breastmilk.

How to Decide Which Protocol is Right for the Mother

Depending on when the mother expects her baby to arrive she’ll have to think like this

…she’ll need to pump for at least a month. The mother will need to be off the birth control pill when she starts pumping. She will need to be on the birth control pill-domperidone combination for at least 30 days non-stop. The longer the mother can be on the combination the better.

  • So if the mother has three months…she’ll be on the combination for 2 months straight.
  • If she has 2 months…she’ll be on the combination for at least 1 month straight.
  • After the mother is off the birth control pill and still on the domperidone, she’ll begin to pump. The mother will need to use a double electric breast pump such as either the Medela Pump n Style or Medela Lactina Select (see the section on breast pumps). And then she’ll need to take herbs…fenugreek and blessed thistle.

source: canadianbreastfeedingfoundation.org

 

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