Frequently Asked Questions About Adoptive Breastfeeding/Induced Lactation

What is adoptive breastfeeding?

Adoptive breastfeeding is a term used to describe a mother who breastfeeds a baby that she did not carry herself. This term is gradually being replaced with the term induced lactation. You may be familiar with the term “wet nurse”, which refers to a woman who breastfed another woman’s baby. It was quite common among the European aristocracy prior to the 20th Century. The most famous “wet nurse” was actually Moses’. After he was plucked from the Nile his sister went to the Queen and suggested a woman to breastfeed him. The woman was Moses’ own mother. However in that case the “wet nurse” had actually carried the baby. It is not necessary to have been pregnant in order to induce lactation.

I had a total hysterectomy. Can I breastfeed?

Of course! It is not necessary to have been pregnant in order to breastfeed. It is not necessary to have a uterus or ovaries in order to breastfeed. If you have breasts and a functioning pituitary gland you can most likely breastfeed.

Do mothers inducing lactation produce the same breastmilk as birth mothers?

Mothers who induce lactation produce mature breastmilk that is comparable to the breastmilk of a biological mother at 10 days post partum. Because inducing moms are unable to produce human placental lactogen, they are unable to produce colostrum. However, since the amount of antibodies and other immune factors remains the same throughout lactation regardless of the volume of milk produced, mature milk contains ample amounts of antibodies, immune factors and other beneficial components that benefit both mother and baby.

How do I induce lactation?

In 1999 Lenore Goldfarb and Jack Newman, MD developed a protocol to help adoptive mothers to bring in their milk supplies. This method involves the use of medications, pumping and herbs, and in many cases has enabled adoptive breastfeeding mothers to bring in a full or nearly full milk supply. Basically the medications fool your body into thinking it’s pregnant, causing the breasts to produce breastmilk. Once the milk making apparatus of your breasts has been developed you can begin pumping and/or breastfeeding. It takes 2-3 weeks to build the milk supply.

Do I have to take medications to induce lactation?

No. Some mothers prefer to breastfeed with the use of a supplementary feeding tube device without the use of any sort of medical intervention. It may take several weeks or months but many mothers have been able to produce breastmilk with this method. However, in recent years, treatment options have been developed, which include the use of medications, pumping and herbs, to induce lactation, thereby enabling the mother to breastfeed with her own milk supply from the start. Lenore Goldfarb and Jack Newman, MD have developed the Newman-Goldfarb Protocols for Induced Lactation for this purpose.

I’m not sure when my baby will arrive. Can I still breastfeed?

Of course! If you know the due date and you have more than 3 months lead time, you can consider The Regular Protocol by Lenore Goldfarb and Jack Newman, MD. If you only have 30 days or less or if your baby has already arrived, you may want to consider The Accelerated Protocol. Basically you need to give yourself about 2 weeks to bring in your milk supply after spending a minimum of 30 days on the protocol. If your baby has already arrived, you can breastfeed with the aid of a supplementary feeding tube device filled with either donor milk or artificial infant milk until your own milk comes in.

My baby will be several days, weeks, or months old when we can finally take him/her home. Can I breastfeed my older baby?

Of course. Generally speaking it is easier to get baby to breast if the baby is less than 3 months old but there are techniques to assist the older baby to the breast. It will take time and patience but it can be done. So far the oldest child that we know of was latched at three years of age. You may find this disconcerting but think about it from the child’s point of view. Perhaps your child was adopted after spending weeks, months, or even years in an institutional setting with little physical contact. Breastfeeding is an ideal way for such a child to be nurtured and bonded with. We highly recommend that you contact an international board certified lactation consultant to assist you with this. You can find one at www.iblce.org

Where can I find more information about induced lactation and breastfeeding?

The breastfeeding section of this Web site contains more information as well as the guide to the Newman-Goldfarb Protocols for Induced Lactation.

Additional information can be found by visiting our message boards or contact Lenore directly at This email address is being protected from spambots. You need JavaScript enabled to view it. and This email address is being protected from spambots. You need JavaScript enabled to view it..

Newman-Goldfarb Protocols for Induced Lactation © 2002-2010 
Jack Newman, MD, FRCPC and Lenore Goldfarb, Ph.D., CCC, IBCLC

Breastfeeding Your Adopted Baby or Baby Born by Surrogate/Gestational Carrier

You would like to breastfeed your adopted baby, or one born with a surrogate or gestational carrier? Wonderful! Not only is it possible, chances are you will produce a significant amount of milk. It is different, though, than breastfeeding a baby with whom you have been pregnant for many months. With some determination and perseverance, you will enjoy the wonderful bond that breastfeeding brings and both you and baby will benefit from this experience.

Breastfeeding and breastmilk

There are really two issues in breastfeeding the baby with whom you were not pregnant. The first is getting your baby to breastfeed. The other is producing breastmilk. It is important to set your expectations at a reasonable level because only a minority of women will be able to produce all the milk the baby will need. However, there is more to breastfeeding than breastmilk and many mothers are happy to be able to breastfeed without expecting to produce all the milk the baby will need. It is the special relationship, the special closeness, and the emotional attachment of breastfeeding that many mothers are looking for. As one adopting mother said, “I want to breastfeed. If the baby also gets breastmilk, that’s great”.

Getting the baby to take the breast

Although many people do not believe that the early introduction of bottles may interfere with breastfeeding, the early introduction of artificial nipples can indeed interfere. The sooner you can get the baby to the breast after he is born, the better. The more you can avoid the baby’s getting bottles before you start breastfeeding, the better. However, babies need flow from the breast in order to stay latched on and continue sucking, especially if they have gotten used to getting flow from a bottle or another method of feeding (cup, finger feeding). So, what can you do?

1. Speak with the staff at the hospital where the baby will be born and let the head nurse and lactation consultant know you plan to breastfeed the baby. They should be willing to accommodate your desire to have the baby fed by cup or finger feeding, if you cannot have the baby to feed immediately after his birth. In fact, more and more frequently, arrangements have been made where you will be present at the birth of the baby and will be able to take the baby immediately to the breast. The earlier you start the better. This is a situation that should be discussed ahead of time with the woman giving birth and if there is a lawyer, speak with him or her as well.
2. Keeping your new baby skin to skin with you, you naked from the waist up and baby naked except for the diaper, is very important at this time. It helps to establish the necessary exchange of sensory information between you and your baby and helps the baby stabilize several physiological and metabolic processes: maintenance of baby’s blood sugars, heart rate, breathing rate, blood pressure and oxygen saturation. At the same time, close contact between you and the baby results in the germ free baby (at birth) being colonized by the same germs as you. Furthermore, it helps baby to adapt to this new habitat while at the same time encourages him to breastfeed while helping you to make milk.
3. Some birth mothers are willing to breastfeed the baby for the first few days. With adoption, there is some concern expressed by social workers and others that this will result in the biological mother’s changing her mind. This is possible, and you may not wish to take that risk. With surrogacy, this may set up some unexpected feeling of resentment and remorse between the surrogate and the biological mother. This is a theoretic possibility but it would be helpful if the birth mother did in fact breastfeed the baby thus helping the baby learn to breastfeed. It allows the baby to breastfeed, get colostrum, and not receive artificial feedings at first. Another option is to ask the woman who gave birth to express her milk for the first few weeks so you have breastmilk to supplement your own, using a lactation aid at the breast (see section ‘s’).
4. Latching on well is even more important when the mother does not have a full milk supply as when she does. A good latch usually means painless feedings. A good latch means the baby will get more of your milk, whether your milk supply is abundant or minimal. (see the information sheet When Latching).
5. If the baby does need to be supplemented, supplementation should be done with a lactation aid while the baby is on the breast and breastfeeding (see the information sheet Lactation Aid). Babies learn to breastfeed by breastfeeding, not cup feeding, finger feeding, or bottle feeding. Of course, you can use your previously expressed breastmilk to supplement. And if you can manage to get it, banked breastmilk is the second best supplement after your own milk. With a lactation aid used at the breast, the baby is still breastfeeding even while being supplemented; after all, isn’tbreastfeeding what you wanted for your baby?
6. If you are having trouble getting the baby to take the breast, come to the clinic as soon as possible for help. In fact you should be followed by a lactation consultant or someone experienced in helping mothers with breastfeeding.

Producing Breastmilk

As soon as a baby is in sight, contact a breastfeeding clinic and start getting your milk supply ready. Please understand that you may never produce a full supply for your baby, though you may. You should not be discouraged by what you may be pumping before the baby is born, because a pump is never as good at extracting milk as a baby who is sucking well and well latched on. The main purpose of pumping before the baby is born is to draw milk out of your breast so that you will produce yet more milk, not only to build up a reserve of milk before the baby is born, though this is good if you can do it.

Using the medications discussed below in A. and B., helps to prepare your breasts to make milk. We are trying to make your body think you are pregnant. The medications are not an absolute requirement for you to produce milk, but they do help you make more.

A. Hormones

Oestrogen and Progesterone. If you know far enough in advance, say at least 3 or 4 months, treatment with a combination of oestrogen and progesterone will help prepare your breasts to produce milk. A birth control pill is one way of taking these hormones, but you skip the placebos (sugar pills for one week out of every four weeks) and go right to the next package; another way is to use oestrogen patches on the breast plus oral progesterone. Get information about this protocol from the clinic and see the Newman-Goldfarb Protocols for Induced Lactation at www.asklenore.info). We encourage you to take the hormones until about 6 weeks before the baby is to be born.

B. Domperidone

See the information sheets Domperidone, Getting Started andDomperidone, Stopping. The starting dose is 30 mg three times a day, but we have gone as high as 40 mg 4 times a day. The domperidone is continued when the hormones are stopped. Usually it is necessary to continue it for several months after you start breastfeeding. Check the information sheets for more information. Ask at the clinic.

C. Pumping

If you can manage it, rent an electric pump with a double setup. Pumping both breasts at the same time takes half the time, obviously, and also results in better milk production. Start pumping when you stop the birth control pill. Do what is possible. If twice a day is possible at first, do it twice a day. If once a day during the week, but 6 times during the weekend can be done, fine. Partners can help with nipple stimulation as well (see the information sheet Expressing Milk)

But will I produce all the milk the baby needs?

Maybe, maybe not. If you do not, breastfeed your baby anyhow, and allow yourself and him to enjoy the special relationship that it brings. In any case, some breastmilk is better than none.

Very Important: If you decide to take the medications (the hormones and/or the domperidone), your family doctor must be aware of what you are taking and why. It is very important to have a physical and have your blood pressure checked before starting the protocols. Significant side effects have been rare, but that does not mean they cannot happen. Your doctor needs to be following you, and once the baby is with you, your baby’s doctor needs to know that you are breastfeeding him and needs to follow the baby’s progress just as s/he would any other baby.

Breastfeeding Your Adopted Baby or Baby Born by Surrogate, 2009© 
Written and revised (under other names) by Jack Newman, MD, FRCPC, © 1995-2016 
Revised by Jack Newman MD, FRCPC, IBCLC and Edith Kernerman IBCLC, 2008, 2009©

This handout may be copied and distributed without further permission, on the condition that it is not used in any context in which the WHO code on the marketing of breastmilk substitutes is violated.