Induced lactation refers to the process of stimulating milk production in an individual who has not recently been pregnant, often used by adoptive parents, intended parents through surrogacy, or those in same-sex partnerships. This effort requires significant dedication, typically involving breast preparation and frequent stimulation. To enhance the body’s ability to generate a milk supply, a prescription medication called domperidone is often used as a galactagogue. This aid supports physical stimulation by influencing the hormones responsible for milk synthesis. The combination of medication and mechanical stimulation is intended to mimic the hormonal and physical changes that occur during a typical pregnancy and postpartum period.
The Biological Mechanism of Action
Domperidone works by targeting the hormonal pathway that regulates milk production in the body. The medication acts as a dopamine-2 receptor antagonist, meaning it blocks the effects of the neurotransmitter dopamine. Dopamine naturally acts to suppress the release of prolactin, the primary hormone responsible for stimulating the mammary glands to produce milk.
By blocking the dopamine receptors, domperidone effectively removes the inhibitory brake on prolactin secretion. This action causes the pituitary gland to release significantly higher levels of prolactin into the bloodstream. Elevated prolactin levels then signal the secretory cells within the breast tissue to begin the process of milk synthesis.
Establishing the Necessary Stimulation Protocol
Achieving induced lactation requires a meticulous stimulation protocol that must run concurrently with the medication. The most established approach involves a preparatory phase to maximize breast development. This initial stage can last for months and may include taking a combined oral contraceptive pill to simulate pregnancy hormone levels, followed by discontinuing it to mimic birth. This hormonal shift is intended to prepare the mammary glands for the onset of milk production.
Once the preparatory phase is complete, or if time is limited, the physical stimulation phase begins, which is non-negotiable for success. This requires highly frequent and consistent breast emptying, typically through pumping or hand expression. A schedule of 8 to 12 sessions every 24 hours is recommended to signal the body that milk is needed. The frequency of milk removal is more influential than the duration of each session in establishing a long-term supply.
It is particularly helpful to include one pumping session between 1 a.m. and 5 a.m. Prolactin levels naturally peak during this time, maximizing the hormonal response to the stimulation.
Expected Timeline for Supply Initiation and Maturation
The time it takes to see results from induced lactation varies significantly among individuals, depending on their unique hormonal responses and the diligence of the stimulation protocol. Once domperidone is started alongside the frequent pumping regimen, some people may notice initial drops of fluid, which may be clear or cloudy, within three to seven days. This initial sign indicates that the milk-making machinery has been successfully activated.
A measurable increase in the volume of milk produced typically takes longer, often appearing within two to four weeks of consistent medication use and pumping. During this period, a medical professional may titrate the dose upwards based on the individual’s response. The goal is to find the lowest effective dose that maximizes the prolactin response while minimizing side effects.
Achieving a mature, stable milk supply that could potentially sustain a baby often requires a much longer commitment, generally taking four to twelve weeks or more. For those who have never been pregnant or are adopting, the treatment duration may extend for several months, sometimes for the entire duration of the nursing relationship. It is important to manage expectations, as the ultimate goal is often a combination of breastfeeding for bonding and supplemental feeding, rather than a full milk supply.
Safety Profile and Tapering Off Domperidone
Domperidone is generally well-tolerated, but like all medications, it carries a safety profile that requires careful consideration and medical supervision. Common side effects include dry mouth, headache, or occasional weight gain. However, the medication has also been associated with rare but serious cardiac warnings, specifically the potential for QT prolongation, which is an electrical disturbance in the heart rhythm.
This cardiac risk is primarily associated with high intravenous doses or existing heart conditions, but it necessitates a thorough medical history and sometimes an electrocardiogram (ECG) before starting treatment. Individuals taking other medications that can also prolong the QT interval, such as certain antibiotics or antifungal drugs, require particular caution. Due to these potential risks, the use of domperidone for increasing milk supply is considered an off-label use in many regions and should only be undertaken under the guidance of a healthcare provider.
Once the desired milk supply is established and maintained for a period, the medication must be discontinued carefully to prevent a sudden drop in milk production. The process involves a slow, controlled tapering of the dosage over several weeks rather than an abrupt stop. Rapid cessation can also lead to withdrawal symptoms, including neuropsychiatric effects such as anxiety or insomnia. A gradual reduction allows the body to adjust and helps the individual maintain the established milk supply through the continued, frequent physical stimulation of pumping or nursing.