Forcing lactation if you have more than 90 days to prepare

This is an article that details the steps you can take to induce lactation if you have more than 90 days to prepare ahead of you.

To see general steps as well as a Q&A about forcing lactation, see our main article about forcing lactation.

We also have articles if you have between 30 and 90 days to prepare or if you have less than 30 days to prepare.

The basic principle of forcing lactation is to trick the body into thinking there was a pregnancy that came to term. It's the so-called Newman-Goldfarb protocols for inducing lactation. You do this by taking hormones that mimic the hormones naturally released during pregnancy and birth giving.

Having more than 90 days to prepare is ideal and really maximizes the likelihood you'll successfully induce lactation. Here are the detailed steps you can follow.

Step 1: start taking pregnancy hormones

You need to take 3 hormones: progesterone, estrogen and prolactin. For the first two it couldn't be easier, you can simply take one birth control pill a day since it contains both hormones. We're speaking here of the so-called "1-35" birth control pill with typically 1 mg of norethindrone (a progesterone medication) and 0.035 mg of ethinylestradiol (an estrogen medication). 

Obviously you should only take so-called "active" birth control pills that actually contain hormones. Birth control pills often come in pack on 28 with 21 "active" pills and 7 inactive pills which are just placebos.

To generate prolactin hormone, you need to take Domperidone (often sold under the brand name Motilium, among others). Domperidone is generally recognized as the most effective medication to stimulate prolactin. It's widely available worldwide but it's sadly not yet approved by the U.S. FDA so if you're based in the U.S. you should look at taking Reglan (a brand name for metoclopramide) as a substitute. It fulfills the same role as Domperidone, although slightly less effectively.

To start with you can take 10mg of Domperidone, 4 times a day or the equivalent Reglan dosage if that's what you take.

Keep taking these dosage during 1 week.

Important: if you are over the age of 35 or are unable for some reason to use the estrogen-progesterone combination birth control pill, your doctor can replace it with either Provera 2.5 or Prometrium 100 mg. The birth control pill is not advised for women over the age of 35 because of health risks associated with its use, hence the replacement. Again, kindly discuss all this with your doctor to understand what most makes sense for you.

Also, it goes without saying: please consult your doctor to check whether those medications are appropriate for your specific situation. All those medications are prescription only so it's a necessary step to discuss your plans with a doctor.

Step 2: double the Domperidone dosage

Increase the Domperidone dosage (or the equivalent dosage in Reglan) to 20mg, 4 times a day. 

When you do so, your breasts will swell. This is normal and a very good sign.

You still won't lactate because the hormones contained in the birth control pill prevent it. This means that you shouldn't yet attempt to pump your breasts or express milk in any way.

Continue this regimen until 6 weeks before your target date for lactation.

Step 3: stop taking the birth control pill at once

Six weeks before your target date for lactation you need to stop taking the birth control pill suddenly. The pill contains both progesterone and estrogen, the hormones released by the placenta. The sudden drop will make your body believe that your placenta was released. To your body, this means birth has occurred and lactation can begin.

This means you'll probably experience vaginal bleeding. It's normal withdrawal bleeding

Progesterone and estrogen are also the hormones that inhibit the effect of prolactin, the lactation hormone you're getting from Domperidone (or Reglan as the case may be). By quitting them, you enable prolactin to kick off lactation. 

In the meantime, continue taking Domperidone with a dosage of 20mg, 4 times a day (or the equivalent dosage in Reglan).

Step 4: start pumping and drinking galactagogues

As soon as you stop taking the birth control pill in step 3 it's critical you start pumping frequently.

For the first 48 hours we recommend pumping at a frequency that simulates the needs of a newborn: every 2 hours by day and every 3 hours by night.

The recommended way to go about a pumping session is as follows:

• Pump for approximately 5 minutes on the low to medium setting
• Massage, stroke and shake your breasts (see below)
• Pump for another 5 minutes

To massage your breasts, move your fingertips in concentric circles while applying some pressure starting from your chest area and moving towards your nipples. This helps empty your alveoli (the grapes where the milk is stored) into your ducts and therefore drain your breasts.

To stroke your breasts, slide the fingernail side of your finger from the top of your breast towards your nipples. This also helps empty your alveoli into your ducts.

To shake your breasts, lean over and shake your body so as to move your breasts. This makes use of gravity to help once again empty your alveoli into your ducts.

To help create your milk supply, you should also start drinking galactagogue teas such as Milk Boost Tea. It's packed with 13 different natural plants that each play a role in supporting lactation. These plants have literally been used for millennia to help support women when they breastfeed.

For instance among its ingredients is Dong Quai, a root also known as the "female ginseng" for its wide range of health benefits for women. It also contains Sponge gourds (Loofah), famous for their ability to facilitate lactation. Yet another example is Longan, a fruit that has a great ability to nourish the Blood and relieve fatigue.

In the meantime, you should still continue taking Domperidone with a dosage of 20mg, 4 times a day (or the equivalent dosage in Reglan).

Step 5: keep pumping regularly for 6 weeks

While continuing to take 20mg of Domperidone 4 times a day, you should keep pumping at a frequency of every 3 hours. During the night you should have at least 1 pumping session.

Research shows that the frequency of pumping is more influential on milk supply than the duration of pumping. The more often you pump, the better your milk supply will be.

Each pumping session should proceed as described in the previous step, where you also massage, stroke and shake your breasts.

Keep drinking Milk Boost Tea as it helps you keep a steady production of breast milk and gives your body some of the fuel it needs to produce your milk. At this stage you should also still continue taking Domperidone with a dosage of 20mg, 4 times a day.

Step 6: you're done (hopefully)!

By your target date, you should hopefully be lactating like any breastfeeding mother!

At one stage, when you see that you're getting just as much milk as any breastfeeding woman, feel free to stop taking Reglan or Domperidone gradually. This is because by then the prolactin hormone doesn't matter as much anymore. Your milk volume is most driven by the demand and supply equilibrium. Your reduction needs to be gradual however. Reduce from 20mg 4 times a day to 10mg during a few days, then to 10mg twice a day during a few more days before finally stopping entirely.

If your purpose for forcing lactation was to feed a baby, feel free to replace your pumping by your baby's suckling on demand. If your milk supply is still building, you can keep pumping for 10 minutes after each feeding. This will help to increase your milk supply. Keep drinking Milk Boost Tea as well as it also helps build your supply.

As a breastfeeding woman you'll likely face problems such as engorgement and blocked ducts as well as supply issues. If you want more milk, read what you can do to increase your milk supply or, if you have too much milk, how you can decrease it safely.

Rarely you might struggle to get more than a small trickle of breast milk. This is sometimes due to your milk ducts not being large enough or being blocked somehow.

If that's your case you might want to give Unblock Nursing Tea a try. It's an herbal tea made of 12 natural herbs that's designed to help fight off engorged breasts and clogged ducts. It might be just what you need to unblock your milk ducts and transform that trickle into a nice flow!

Of course, while you drink the tea it it's critical you continue pumping your breasts very regularly as that gives your body the signal to keep up your milk production.