Grundlegender Text: ABM-Protokolle Induzierte Laktation (englisch)

[Anonymus123]

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.

Newman-Goldfarb Protocols for Induced Lactation® © 2002-2019 Jack Newman, MD FRCPC and Lenore Goldfarb, PhD, CCC, IBCLC, ALC. All rights reserved.
Source: https://www.canadianbreastfeedingfounda ... ocol.shtml

[Anonymus123]

The Protocols for Inducing Lactation and Maximizing Milk Production:
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.

Newman-Goldfarb Protocols for Induced Lactation® © 2002-2019 Jack Newman, MD FRCPC and Lenore Goldfarb, PhD, CCC, IBCLC, ALC. All rights reserved.
Source: https://www.canadianbreastfeedingfounda ... ocol.shtml

[Anonymus123]

Pumping Instructions to Accompany the Protocols for Induced Lactation
We suggest a “baby honeymoon” for the first 48 hours of pumping. Pump every 2 hours by day and every 3 hours by night. Then over the next two weeks, start pumping as follows as often as you can.

8 - 12 times per day:

- Pump for 5-7 minutes on the low or medium setting
- Breast massage, light tickle, jiggle
- 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.

Assisting the Milk Ejection Reflex (Let-Down)

1. Breast Massage
Do as you would for a breast cancer examination. Rotate the flats of your fingertips with gentle but firm pressure in concentric circles starting from the largest portion of the breast and working all around the breast towards the nipple. This will help to empty the alveoli (grapes) into the ducts (branches) and help to drain the breast.

2. Light Tickle
Using the nail side of the fingertips, very gently rake your fingertips from the top of the breast towards the nipple. This helps to move the breastmilk towards the collecting ducts located just behind the nipple and under the areola (colored tissue surrounding the nipple).

3. Jiggle
Lean over and give your breasts a light jiggle. This uses gravity to help move the breastmilk throughout the breast towards the collecting ducts and the nipple.

The entire procedure should take approximately 15 minutes.

- Pump each breast 5-7 minutes. (Use a double pump to save time and get a better result)
- Breast Massage, Light Tickle, Jiggle
- Pump each breast 3-5 minutes.

Newman-Goldfarb Protocols. © Lenore Goldfarb, B.Comm, B.Sc, IBCLC
and Jack Newman, MD FRCPC, November 2002

Newman-Goldfarb Protocols for Induced Lactation® © 2002-2019 Jack Newman, MD FRCPC and Lenore Goldfarb, PhD, CCC, IBCLC, ALC. All rights reserved.

Source: https://www.canadianbreastfeedingfounda ... ions.shtml

[Anonymus123]

The Protocols for Inducing Lactation and Maximizing Milk Production:
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”.

Newman-Goldfarb Protocols for Induced Lactation® © 2002-2019 Jack Newman, MD FRCPC and Lenore Goldfarb, PhD, CCC, IBCLC, ALC. All rights reserved.

Source: https://www.canadianbreastfeedingfounda ... ocol.shtml

[Anonymus123]

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.

Newman-Goldfarb Protocols for Induced Lactation® © 2002-2019 Jack Newman, MD FRCPC and Lenore Goldfarb, PhD, CCC, IBCLC, ALC. All rights reserved.

Source: https://www.canadianbreastfeedingfounda ... nges.shtml

[Anonymus123]

Übersicht auf der Quell-Seite:
https://www.canadianbreastfeedingfoundation.org/induced/induced.shtml

[Fritz]

Der Admin hat den Thread mal dauerhaft oben angepinnt - das sind sehr grundlegende Texte.

Und:

Lenore Goldfarb, PhD, CCC, IBCLC, ALC ist Präsidentin der Canadian Breastfeeding Foundation und sehr bekannte Forscherin zum Thema Stillen. Zusammen mit Dr. Jack Newman hat sie grundlegende Forschungen zu Fragen der Relaktation und Induzierten Milchbildung gemacht - und vor allem klinisch geprüft. Wir hatten die ABM-Texte von oben auch im alten Forum, aber irgendwie war vergessen worden, sie noch einmal ins neue Forum zu setzen.

Wichtig ist auch, dass man die ABM-Protokolle von ihrer Qualität her einem Gynäkologen vorlegen kann, wenn es z.B. darum geht, Yasmin verschrieben zu kommen. Das "Geheimnis" von Yasmin ist der (hohe) Verhältnis-Anteil von Progesteron und (geringe) von Östrogen, das wie in einer Schwangerschaft einen starken Aufbau von Milchdrüsen bewirkt, was man am kräftigen Brustwachstum bemerkt. Das wird ohne zyklische Pillenpause wie beschrieben einige Monate gemacht. Wenn man denn nach dem abrupten Absetzen von Yasmin einige Tage lang wirklich (!!!) oft, also ideal alle 2 Stunden außer nachts mit einer Doppelpumpe 10 Minuten pumpt, dann kommt erheblich mehr Milch, als hätte man diese "Kur" nicht gemacht.
Domperidon hat eine erstaunlich kräftige Wirkung auf die aktuelle Milchgabe, kann alleine aber nicht mehr bewirken, als die vorhandenen Milchdrüsen hergeben. Yasmin bewirkt, diese wachsen zu lassen. - Oder eine Pille ähnlicher Zusammensetzung. Das passiert zwar in jedem Zyklus ebenfalls durch den wachsenden Gelbkörper (außer in der Menopause), aber viel schwächer und bei einigen Frauen nur sehr gering.
Ob man Domperidon kriegt, hängt vom jeweiligen Land ab. Dazu ist in anderen Threads einiges geschrieben worden. Es geht auch ohne Domperidon, vor allem, wenn ein Partner da ist, der mitmacht. Domperidon ist eher eine Art Schrankenöffner. Erstaunlich wirksam, aber durch die richtige Situation, guten Saugreiz und Entspannung ersetzbar. Die Progesteron+Östrogen-Kombination von Yasmin dagegen wirkt essenziell an der Basis. Wenn ich es richtig verstanden habe, ist es vor allem Progesteron, aber der geringe Anteil von Östrogen macht viel aus. (Bei meiner eigenen Frau nur Progesteron, deshalb kann ich da selber nichts sagen und muss noch mal nachlesen,)

Mehr siehe: www.asklenore.info

[Fritz]

Vergleich einiger Pillen, die mit Yasmin verwandt sind:

Yasmin: Drospirenon 3mg & Ethinylestradiol 0,03mg
Petibelle: Drospirenon 3mg & Ethinylestradiol 0,03mg
Yasminelle: Drospirenon 3mg & Ethinylestradiol 0,02mg
Aida: Drospirenon 3mg & Ethinylestradiol 0,02mg
León: Drospirenon 3mg & Ethinylestradiol 0,02mg
Eloine: Drospirenon 3mg (als Betadex-Clathrat) & Ethinylestradiol 0,02mg
Yira: Drospirenon 3mg & Ethinylestradiol 0,03mg
YAZ: Ungeeignet, nur der Name klingt ähnlich

Nachtrag: In Jüngster Zeit wurde in den sozialen Medien sehr viel über ein Brustwachstum bei den Pillen Maxim und Valette berichtet. Obwohl Frauenzeitschriften und Online-Artikel das gerne nur auf ominöse "Wassereinlagerungen" zurückführen, lohnt auch hier ein Blick, ob es nicht die bekannte Kombination Gestagen&Östrogen sein könnte, die ein echtes Drüsenwachstum bewirken können:

Maxim: Dienogest 2 mg & Ethinylestradiol 0,03 mg
Valette: Dienogest 2 mg & Ethinylestradiol 0,03 mg

Dienogest ist wie Drospirenon ein synthetisches Gestagen, allerdings ein sogenanntes "Gestagen der 3. Generation", also nicht genau gleichzusetzen. Die Berichte über Brustwachstum und die offizielle häufige Nebenwirkung "Brustbeschwerden" könnten auf ein Drüsenwachstum hinweisen, müssen aber nicht. Im Netz fand sich dazu leider nichts, daher muss die Frage vorläufig noch offenbleiben, ob Pillen wie Maxim oder Valette, die Dienogest statt Drospirenon enthalten (zusammen mit Ethinylestradiol) gleichermaßen zur Vorbereitung der Brust auf die Milchbildung geeignet ist.

[Fritz]

Ich habe eben noch einen wichtigen Text bekommen (Danke ):

DrJim (Jim Bowman)


The Relationship between Estrogen and Prolactin

For a woman wanting to induce lactation, understanding the relationship between Prolactin and Estrogen is perhaps the most important hormonal thing to know. Inducing lactation is essentially inducing the post partum hormonal state that begins shortly after delivery when her breasts want to produce milk and the woman worries about producing too much rather than too little. The post partum state is a condition where her hormones are balanced differently than in the normal non-pregnant state. This balance is low Estrogen and high Prolactin. Some might say; isn't low Estrogen a bad thing, she will loose her femininity and sexual interest? Not so, granted, there are changes that occur from the low Estrogen including slower vaginal arousal. The high Prolactin however, causes other balancing changes, a greater sensitivity of the breasts to arousal and it brings out the feminine behavior and feelings termed "nesting". The nesting behavior is a very feminine and alluring thing that most men find quite irrestible in a woman. Some husbands might interpret the low Estrogen- slower clitoral arousing condition as a loss of sexual interest and feel as though their wife has lost interest in them. Her preoccupation with nesting with and nursing the infant may make him feel excluded. This does not need to be so. Her hormonal state has caused her to have more interest and sexual arousal through her breasts to make up for the decrease vaginally. This is something for him to explore with her.

When a woman induces lactation at times other than post-partum, she is actually inducing the post-partum hormonal state. This underlying hormonal state is the true condition of lactation. The breasts will surely change, begin lactating and reflect this underlying hormonal state if it occurs. So the focus should be on how to achieve this hormonal state rather than on how to make the breasts lactate when they don't want to. This is why understanding the relationship between Prolactin and Estrogen is important. I also think women find the emotions and feelings that make up the "nesting behavior" to be the thing that they enjoy the most, rather than simply having milk in their breasts.

Functionally and very simply, the hormones Estrogen and Prolactin oppose each other. When one is high it suppresses the other. These two hormones are like a Seesaw, one goes up, the other goes down. Not only this, the Seesaw prefers to have one or the other end down rather than to be balanced in the middle with both hormones equal. In the normal non-pregnant state the Seesaw is balanced with high Estrogen and low Prolactin. To get this Seesaw to tip the opposite way requires much nipple stimulation. Once it is tipped the other way it usually requires less effort to keep it tipped toward Prolactin because the breasts increase their sensitivity and response to stimulation and put out much more Prolactin with stimulation. The greatest sign that the Seesaw is tipped fully toward Prolactin is when the woman stops menstruating. When this occurs it means the ovaries are quiet and not putting out Estrogen in the normal monthly cyclic pattern.

The post-partum state begins when the woman delivers the baby and placenta. The placenta is the source of all the high hormone levels during pregnancy. The ovaries are quiet because the FSH (follicle stimulating hormone) that turns them on has been absent. As she enters this low Estrogen state the sensitivity for Prolactin release is turned on. Her Seesaw is tipped fully toward Prolactin. If she breastfeeds frequently enough, the FSH signal will be suppressed, Estrogen will stay low, she will not menstruate and her breasts will produce copious amounts of milk. This condition can last for as little as a month or so to a year or more. When the breastfeeding frequency and nipple stimulation decreases, typically when the infant is being weaned, her menstrual cycle will return and she becomes fertile again. This indicates that FSH suppression is not complete because the interval between breastfeeding events has increased to the point that the FSH signal is escaping and intermittently stimulating the ovaries. When the FSH signal becomes strong and regular enough, her Estrogen level will rise enough to cause her breasts to dry up. The Seesaw has tipped back toward high Estrogen.

Many women are able to continue to lactate partially and be fertile and have their menstrual cycle at the same time. This is a condition where the Seesaw is balanced in the middle. It can be a very long lasting state actually, but usually requires regular nipple stimulation to maintain it. When inducing lactation, I believe most women can find this balance only by first getting the Seesaw tipped toward the high Prolactin side for some minimal time then letting it balance back toward the middle.

When beginning to induce lactation most women find that even though they stimulate the nipples a lot there is no milk, even if the breasts have the alveoli and are ready to produce it. This is because of their high Estrogen state. Their hormonal condition has to be tipped toward Prolactin through nipple stimulation for a while before any actual milk will be produced. Again, it is important to remember that the breasts in their size, shape, development and readiness simply reflect the underlying hormonal balance or state of the woman.

During pregnancy a woman's breasts are hormonally stimulated to grow lots of alveoli and be ready for lactation when the post partum state comes. This hormonal induction is not necessary for women to go through when they are younger and their breasts are in a fairly ready state. They can usually have good success by inducing through nipple stimulation alone. When women are nearer menopause their low hormonal state may cause their breasts to loose most of their alveoli. For them they may have better success by mimicking the pregnancy to post partum sequence, which is hormonal stimulation followed by nipple stimulation. I believe there are two most common causes of failure to produce any significant amount of milk after a reasonable length of time spent stimulating the nipples, they are; 1. Persistent high Estrogen state keeping the Seesaw tipped away from Prolactin (most common in younger women). 2. Not very many alveoli present to respond to the stimulation (most common in older women)

Now for those who want to know the actual hormonal pathways involved in this Seesaw. Notice how Estrogen reinforces itself and inhibits Prolactin while Prolactin reinforces itself and inhibits Estrogen; Nipple stimulation sends a signal to the Pituitary to cause it to release Prolactin. Over time Prolactin causes the breasts to change and develop leading to lactation. The nipples and areola respond to this stimulation by enlarging and becoming more prominent and developing more nerve endings. The nipples become more sensitive to suckling so that more Prolactin is released with the activity. The signal to the Pituitary satisfies it in place of Estrogen so that it turns off its FSH (Follicle stimulating hormone) signal for a short time (with repeated stimulation this signal can stay off). This inhibits the ovaries in their production of Estrogen. Estrogen released by the ovaries is associated with the development of follicles that ovulate and release an egg at mid month. This process is inhibited when FSH is inhibited. The other side; Estrogen feeds back to the Pituitary and elevates a hormone called PIF (Prolactin inhibitory factor). This hormone causes the Pituitary to be less sensitive to nipple stimulation and the release of Prolactin

Domeperidome increases the sensitivity of the Pituitary to nipple stimulation so that more Prolactin is released. There are other ways to increase Prolactin release, primarily through efforts to lower Estrogen levels. Lowering Estrogen as well as raising Prolactin is what a woman is attempting to do when inducing lactation through nipple stimulation. This is what the Seesaw is about. Progesterone is another hormone, which functionally inhibits Estrogen and can help tip the Seesaw over into the high Prolactin state. Progesterone also causes more alveoli to develop in the breasts. Progesterone supplementation, if considered, can help bring on lactation in young and older women.

DrJim

[milchling]

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