Milk induction helps with breastfeeding without pregnancy – 10/25/2023 – Balance

Together for 13 years, librarian Aline Souza and her wife Camila Tavella, journalist, had been planning the arrival of a baby for some time.

In 2022, when Aline became pregnant through assisted reproduction, Camila thought about undergoing medical treatment to generate milk and thus breastfeed the child even without having gone through pregnancy — a way of sharing this role with her wife.

“I knew about the possibility because a friend had tried. In her case, it didn’t work, but I thought: ‘if there is a possibility, why not try?’ I was motivated by the idea of ​​sharing the tasks of motherhood, which can be heavy when not shared.”

Camila consulted with professionals who helped her on her journey and explained that she would probably have less milk than the pregnant mother — but that she could still contribute to the baby’s nutrition, and that her milk would have as much quality as her partner’s.

“I started without much expectation, but the induction went very well for me. The first drops of milk appeared nine days after starting the protocol — something that I know doesn’t happen to everyone who tries”, describes Camila.

Her case, according to health experts consulted by BBC News Brasil, is, yes, a little rarer — and should be considered a success.

For her, milk production was so intense that it resulted in donations to milk banks, which stock up on premature babies or those who for some reason cannot be breastfed directly by their mothers.

“There were still three months left before the birth of our son, so I wanted to make good use of that milk. At the peak of production, I even donated a liter in a week”, he says.

How is breastfeeding induced?

During pregnancy, levels of the hormones estrogen and progesterone are elevated to keep the pregnancy viable and inhibit milk production before the baby arrives.

At the time of birth, the placenta —the main source of these hormones— is expelled, and prolactin, the hormone responsible for stimulating milk production, has a free path to perform its function in the body.

Whether for mothers in dual motherhood or for those who adopt a child, achieving induced lactation, that is, without going through pregnancy, consists of imitating the same biological process that occurs in a pregnant person.

If the person has several months to prepare, the doctor may prescribe hormonal therapy, with estrogen and progesterone, to mimic the effects of pregnancy, accompanied by a medication with galactagogue – a substance that promotes lactation.

The most commonly used is domperidone, present in anti-nausea medications such as Plasil.

This drug, although not approved by Anvisa (National Health Surveillance Agency) as a remedy for inducing lactation, has an off-label effect, that is, in addition to its main purpose, which usually works well for this purpose.

For health reasons, some people cannot use hormones.

Contraindicated groups involve people who have had deep vein thrombosis, heart disease, uncontrolled high blood pressure, a history of stroke, breast cancer or other hormone-sensitive cancers.

But the most essential part of the process, sucking, is independent of medication, so even without hormones it is possible to have a good result, says pediatrician Honorina de Almeida, a breastfeeding specialist from the IBCLC (International Lactation Certified Advisory Committee, its acronym in English).

“The electric pump is the most effective method to simulate the sucking that the baby does on the breast”, explains she, who is a founding partner of Casa Curumim, in São Paulo, where there is the Mame+ outpatient clinic, which offers consultancy and loan of pumps and other materials free of charge.

Sucking — from the baby or simulated — is necessary to release prolactin, which acts on milk production, and oxytocin, the “love hormone”, which causes contractions in the mammary ducts, causing milk to be pushed towards the nipples.

These two hormones are part of a complex hormonal process that is triggered by the pituitary gland, a small gland located at the base of the brain, just below the hypothalamus, which receives the information that milk production is necessary.

“It is important to mention that the amount of milk produced by this mother may not be the same as that of the biological mother, as she went through the breast maturation process during pregnancy”, recalls Renata Iak, obstetric nurse and breastfeeding consultant.

In the case of Camila and Aline, mothers of Nicola, who is now four months old, the milk from Camila, a non-pregnant mother, was sufficient and necessary, as his wife Aline produced a small amount after having complications during childbirth.

But for most couples, Iak explains, there’s an important difference. “To compensate, it may be necessary to use a method called ‘translation’, in which a tube with breast milk is placed in the breast of the non-pregnant mother. While the baby sucks the nipple, it stimulates the breast and the brain understands the message to produce more milk.”

The obstetric nurse explains that, when the process is carried out with monitoring, there is no risk.

“This double breastfeeding cannot be considered cross-breastfeeding because the non-pregnant person will also undergo tests to ensure that they are in good health and that they are not putting the baby at risk.”

Transgender and non-binary people can also induce breastfeeding

In the case of transsexual men, they have the ability to breastfeed, as long as they have not gone through a process of complete removal of the mammary gland, common when there are surgeries to harmonize the chest, explains doctor Honoria de Almeida.

“Often, part of the mammary gland is preserved to build the male chest. Depending on the amount of breast tissue remaining, a trans man can produce a greater or lesser amount of milk. In addition, the use of male hormones should be evaluated, as testosterone can affect the ability to get pregnant.”

The expert points out that when considering lactation induction in trans men, it is essential to evaluate not only physical issues, such as the presence of breast tissue, but also each person’s individual desires.

“Although natural breastfeeding is valued and very important, not all trans men like a newborn baby want to breastfeed. The decision can be influenced by several factors, including the need for a reduction or suspension of male hormones, which increases the risk of gender dysphoria [o sofrimento que pessoas transgênero podem experimentar pela discordância entre sua identidade de gênero e o sexo designado ao nascimento].”

For trans women, someone whose assigned sex at birth was male but whose gender identity is female, breastfeeding can be a slightly more challenging process, but it is also doable.

Typically, a person receives female hormones as part of the transition process, which leads to breast development.

“The more time she spends in the feminization process [hormonioterapia], the more developed your breasts will be. Breast development is a gradual process that takes time, so after a few months of feminization, the breasts may not be fully developed. On the other hand, if years have passed, many trans women manage to develop fully functional breasts”, explains the doctor.

Jennifer*, a non-binary person who considers herself within the transsexual spectrum, began her hormonalization process to transition to female in the same month that she discovered that her partner was pregnant.

“When I started the treatment to generate milk, I didn’t know if it would work, because my mammary glands were still starting to develop and my partner was already six months pregnant – it was a short time to prepare.”

In some cases, like Jennifer’s, in addition to the use of lactogogue medications, to allow breastfeeding, it may be necessary to temporarily increase the dose of female hormones that the transitioning person is taking.

“This is done to somewhat mimic the increase in hormones during pregnancy, as occurs in cisgender women,” says Almeida.

Jennifer, although she produced less milk than her partner, was successful in the process.

“Breastfeeding is not the only way to create a bond and share the tasks of caring for a baby. But in my family it ended up working very well: my partner had already been breastfeeding for 10 years as she already had three other children, and I, who I didn’t even consider having a baby, I can have the incredible experience of the feeling of feeding my baby.”

Milk quality

The quality of milk from those who have not been pregnant is equally good nutritionally.

“The nipple, the outermost part of the human breast, functions as a sensory ‘auditor’ during the act of breastfeeding. It evaluates the characteristics of the baby’s saliva and sends a message to the body of the person producing the milk about what the child needs. It’s impressive how the body is capable of personalizing milk production in real time”, says Renata Iak.

Recently, a study published in the Journal of Human Lactation showed that human milk produced by non-pregnant transgender women and non-binary parents on estrogen-based gender-affirming hormone therapy is nutritionally rich and suitable for feeding newborns.

According to the doctor who published the study, Amy K. Weimer, from the University of California, USA, for some people, “the ability to nourish their babies through the production of their own milk can also be a profoundly affirming experience. of gender.”

This report was originally published here.

^{*The name of the interviewee has been changed at her request}