Breastfeeding Outside the Box

We are proud to present a series of podcasts for parents Breastfeeding Outside the Box, where we aim to support the nourishing and nurturing of babies in exceptional families - families who historically have not received the help and support they need and deserve. Our exceptional families include adoptive, intended, and foster families; gender and sexual minorities; families with special needs babies; parents who have had breast surgery; mothers with IGT or low milk production for other reasons; exclusively pumping mothers; and more.
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Breastfeeding Outside the Box





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Feb 10, 2019


Cathy, like so many other non-birthing parents wanting to induce lactation or relactate, is trying to unravel all of the varying information she has received.  So she emailed us for help.  When I suggested we might share her email on the podcast so that we could help others in her shoes, Cathy agreed.  This podcast episode is devoted to addressing Cathy's questions, concerns, and confusion around the basics of how to induce lactation/relactate -- and you might find it addresses some of yours as well!  Below is the email that is the inspiration for today's episode:

I am 38 and have an almost 3-year-old son whom I nursed from birth-22 months. We are in the process of adoption.  We are in process of our homestudy and imagine we'll be bringing an infant home within 9-12 months.  I am eager to relactate for this baby.  I have spoken with two of our local IBCLC's.  One suggested the Newman-Goldfarb protocol, and the second suggested I contact you.  My GP suggested I talk to my ob/gyn for the prescriptions and my ob/gyn said the only way to relactate is via pumping.  As you can imagine, I am a bit frustrated.
Dec 28, 2016

We have interviewed several adoptive mothers on the podcast, but Courtney is the first to have actually produced a surplus of milk.  Whereas most mothers who induce lactation need to supplement their milk production, Courtney was able to donate 3000 ounces of the milk she produced by inducing lactation to anther adoptive mom!  Breastfeeding has been such a positive and healing experience for Courtney that she is spreading information and support for adoptive breastfeeding through her new website.  You'll hear more about Courtney's personal experience and her brand new website in this episode.

Dec 14, 2016

Sally is an adoptive mom gone lactation consultant, and she uses her personal experiences to guide her professional role with abundant wisdom and compassion.  In this interview, Sally does a beautiful job helping adoptive parents and the professionals who support them to navigate through the particular emotional and logistical challenges adoptive parents may face with breastfeeding. 

Nov 30, 2016

Last time we talked with Kristin on the podcast, she briefly mentioned a condition called "insulin resistance" that could cause low milk production.  This was new to us!  We wanted to learn more, and thought you would, too.  On this week's podcast episode we ask Kristin a ton of tough questions about IR. It is a pretty complex topic, with still so many unknowns, but Kristin does an amazing job breaking it down for us.  Once again, we are so thankful for Kristin's lactation expertise, as well as her caring, sensitive approach to new families.

Oct 26, 2016

"Calm Down. It's about relationship"

That is what Amber Duncan ultimately learned about breastfeeding.  Breastfeeding isn't only about feeding a baby - it is also about the connection nursing facilitates between parent and baby.  This glass-half-full (or breast/bottle-half-full in this case!) attitude allowed Amber to look beyond her own ability to produce milk and find that using a combination of her own milk and donor milk could lead her and her baby to a successful long-term breastfeeding relationship.
Oct 12, 2016

"They say to marry your best friend, but what about your breast friend? Our story of laughter, tears, and endless pumping proves that that a couple who breeds together can feed together!" - Bethy Annsa

Interested in learning more about trans feminine nursing or co-nursing? We are delighted to share Sparrow and Bethy's beautiful story with you.  

Sep 14, 2016

This podcast episode is so absolutely rich with information and ideas, no matter what your breastfeeding outside the box situation, you won't want to pass this one up.  Starting with her own "lactastrophe", Kristen shares with us how to find help, causes of low milk production such as insufficient glandular tissue (IGT) and insulin resistance, herbs and medications that can help increase milk production, sources of milk donations, LGBTQ breastfeeding, and more.

Aug 31, 2016

​It was a shock for Rosalie when it was determined postpartum that she had a condition called Insufficient Glandular Tissue, more commonly referred to as IGT.  IGT is a breast condition that makes it difficult - and in most cases impossible - for a nursing parent to produce enough milk to meet all her baby's feeding requirements. Rosalie understands firsthand how difficult this diagnosis can be.  She also understands that it doesn't mean the end of breastfeeding.  Today, as a lactation consultant working with nursing parents with IGT, Rosalie focuses on developing a plan for long-term breastfeeding success, which she believes (and we agree!) is very possible for parents with IGT.  In this week's podcast, Rosalie shares with us about IGT with the heart of someone who has been there and the wisdom of her professional experience.  

Jul 18, 2016

What?! How can you have a "breastfeeding" podcast episode on bottle-feeding?  Well pretty easily as it turns out.  We at Breastfeeding Outside the Box understand that breastfeeding cannot always look like exclusive breastfeeding, and there are many situations in which nursing parents may need to use a bottle to feed their baby.  Through her groundbreaking (and frankly, courageous) efforts, Dee Kassing has developed a method of bottle-feeding that not only doesn't cause the dreaded nipple confusion, flow confusion or flow preference, but actually helps babies with nursing.  Some parents have even called it "therapeutic".  Dee honors us once again with her expertise and wisdom on this week's podcast episode.

Jul 13, 2016

How wonderful when a family includes a breastfeeding mother! Well how about if a family includes two of them?  For same-sex female couples, both mothers can share in the nursing of their baby.  This is called co-nursing.  Co-nursing can be such a gift for families, but it also has its challenges.  Rachel is a lactation consultant with personal experience with co-nursing.  She shares her amazing wisdom and insights with us on this podcast episode!

Jun 22, 2016

Chrissy is an intended mother, in other words she became a mother via surrogacy.  She tells us of her inspirational journey to nursing her son, from the surprising way she discovered induced lactation to her current breastfeeding relationship with her now 9-week old son.  

Jun 8, 2016

In this podcast, we catch up with Alyssa Schnell, co-host of the Breastfeeding Outside the Box podcast and author of Breastfeeding Without Birthing.  We heard a bit about Alyssa's personal story in episode #2.  Now we connect with Alyssa professionally as she shares some of her expertise on breastfeeding-without-birthing ... or breastfeeding in situations of adoption, surrogacy, foster care, co-nursing, relactation, and more.

May 25, 2016

Some babies seem to be born knowing exactly what to do at the breast.  And for some others...well, latching comfortably and getting milk from the breast isn't so easy.  Lots of times, mothers feel that they have done something wrong when this happens, when in fact their babies are born with some extra challenges.  That was certainly the case with Becca's baby.  But Becca was resourceful and determined, and with the help of some amazing local professionals she gradually and lovingly transitioned her baby from exclusive bottle-feeding to breastfeeding.  We are so grateful that Becca has shared her amazing journey with us!

Apr 13, 2016

If there was a queen of breast pump flanges it would be Dee Kassing.  I'm serious.  Dee knows A LOT about breast pumps and their flanges. What is a breast pump flange?  The flange is the clear plastic funnel-like piece that a mother places on her breasts to draw in the nipple and some of the areola in order to extract and collect milk.  But why does using the right flange matter very much?  Dee explains that using the right flange for you results in the most comfort and milk output.  If you are regularly using a breast pump to provide milk for your baby, this podcast episode is a must!

Mar 23, 2016

Hearing from Bridget and her husband Shawn will blow you away.  This incredible couple shares their touching journey through a cancer diagnosis during pregnancy, cancer treatments that did not allow mom to breastfeed, and a baby who would not accept his wet nurses or a bottle, Together this mother, father and baby discovered a solution that helped heal them all. Finger-feeding ended up not only being a way for this couple to nourish their baby, but a way to nurse their baby when traditional nursing was not available.  No milk production required.  No breasts required.  Just a finger, a feeding device, and love.

Mar 9, 2016

We are so thrilled to have the wonderful Diana West on Breastfeeding Outside the Box.  Through her writing, speaking, and individual work with breastfeeding families, Diana has opened the doors to breastfeeding for so many parents, starting with mothers breastfeeding after breast reduction surgery.  Her influence then grew to supporting mothers with low milk production for various reasons.  And she is now expanding the understanding and support for breastfeeding/chestfeeding for the transgender community.  

Feb 24, 2016

We are thrilled to have had the opportunity to interview Jo Lockhart, nursing mother, doula, and creator/moderator of the Supply Line Breastfeeding Awareness Project Facebook page.  In this interview, Jo shares her early struggles with breastfeeding and how using a supply line (a.k.a. at-breast supplementer) has been a key element in her successful nursing relationships with her two youngest children.  Jo is now a pioneer for supply line feeding for mothers with low milk production all over the world.   Cry and celebrate along with Jo as she shares her inspirational journey in this monumental podcast episode.   

Feb 10, 2016
Domperidone is a pharmaceutical medication that can help increase milk production.  In this interview, Frank Nice gives us the scoop on "dom".  He tells us who might benefit from domperidone and who shouldn't take it.  He tells us about common - and some not-so-common side effects.  We learn what dosage is ecommended, and how to safely and effectively discontinue using domperidone when the time comes.  And of course we discuss the big controversy around domperidone - why it is not currently FDA approved and where we are in the process of getting  it approved.  β€‹

Listen to Dr. Nice's interview:

Here are a few highlights from our interview:
  • General dosage of domperidone is 10-20mg 4 times per day or 30mg 3 times per day.  Increasing the dosage can further increase milk supply, but dosages greater than 120mg per day rarely result in additional milk production (although a few mothers have found dosages up to 240mg per day are effective). 
  • Although most mothers who will get a boost in milk production from domperidone notice a difference within a few days, it can take up to 4 weeks for domperidone to have an effect on milk production for some mothers.
  • Although risk of cardiac arrythmia is stated by the FDA as a reason they have not approved domperidone, metoclopromide (aka Reglan) has the same very low level of risk and it is FDA approved.
  • While domperidone is currently in orphan drug status in route to becoming FDA approved as a medication for breastfeeding mothers, there is also a push for FDA approval for domperidone as a treatment for gastroparesis and this may happen even sooner. Right now, we can expect to wait another 3-4 years before domperidone is FDA approved. β€‹
Not only is he a wealth of knowledge, Dr. Nice lives up to his name with a huge heart for mamas and babies.  We are thrilled to add this amazing interview to our podcast stream.  Find out more about Dr. Nice and his work at 

About Dr. Nice

Dr. Frank J. Nice has practiced as a consultant, lecturer, and author on medications and breastfeeding for 40 years.  He holds a Bachelor’s Degree in Pharmacy, a Masters Degree in Pharmacy Administration, Masters and Doctorate Degrees in Public Administration, and Certification in Public Health Pharmacy.  He retired from the US Public Health Service after 30 years of distinguished service. Dr. Nice practiced at the NIH and served as a Project Manager at the FDA.  He recently retired after 43 years of government service and currently is self-employed as a consultant and President, Nice Breastfeeding LLC (

Dr. Nice has published Nonprescription Drugs for the Breastfeeding Mother, 2nd Edition and The Galactogogue Recipe Book. Dr. Nice has also authored over four dozen peer-reviewed articles on the use of prescription medications, Over-the-Counter (OTC) products, and herbals during breastfeeding, in addition to articles and book chapters on the use of power, epilepsy, and work characteristics of health care professionals. He has organized and participated in over 50 medical missions to the country of Haiti. Dr. Nice continues to provide consultations, lectures, and presentations to the breastfeeding community and to serve the poor of Haiti.
Jan 26, 2016
It was great to hear from our show's co-host, Hope, about her inspiring journey to nursing her daughter by adoption.  Hope originally learned that breastfeeding in adoption was possible during her doula training.  Armed with the knowledge that breastfeeding would be possible for her even though she

was unable to conceive, Hope found resources on adoptive breastfeeding to be pretty scarce at first.  Fortunately, more information and support continued to emerge.  Here are some of the top resources that Hope found:
  • The asklenore website* got her started with a step-by-step approach for inducing lactation, called the Newman-Goldfarb Protocol.  The Newman-Goldfarb Protocol primarily consists of pumping and the use of pharmaceutical medications to induce lactation.
  • Several months later, Hope discovered additional options for inducing lactation in the newly released book, Breastfeeding Without Birthing.  Using some ideas she read about, she choose to enhance the steps in the Newman-Goldfarb protocol by adding some natural techniques, such as herbs and acupuncture
  • Hope also discovered an amazingly supportive and informative Facebook group called Adoptive Breastfeeding.
  • Hope consulted with a local International Board Certified Lactation Consultant (IBCLC) to help guide and support her as she induced lactation, and then with nursing once her baby arrived.  To find an IBCLC in your area who works with mothers through adoption or surrogacy, see the Find a Lactation Consultant page on the Breastfeeding Without Birthing website.
*Note: Updates to increase the simplicity and safety of the Newman-Goldfarb protocol were published in Breastfeeding Without Birthing. Details regarding these updates can be found on the Breastfeeding Without Birthing blog.

When Hope started the process of inducing lactation, she was hoping to achieve a full milk supply.  But, like most mothers who induce lactation, she did produce a significant amount of milk but not a full supply.  

Knowing how much to supplement can be tricky - not enough supplemental milk or formula means baby won't have enough to eat, but too much supplemental milk or formula can mean less breastfeeding.  Looking back, Hope wonders if she supplemented too much too early.  Her pediatrician recommended supplementing 3 ounces per feeding within her daughter's first few days of life, but this recommendation was way more milk/formula than a baby needs in total at that age:
  • At 3 days, normal intake during a feeding is 1 ounce.
  • At 1 week, normal  intake during a feeding is 1.5 ounces.
  • At 2 weeks, normal intake during a feeding is 2-2.5 ounces.
  • At 1-6 months, normal intake during a feeding is 3-4 ounces
[Mohrbacher & Kendall-Tackett, 2010]

If a mother has induced lactation with pumping before her baby arrives, she will have a pretty good idea how much milk she is producing at a feeding, and can use the difference between her milk production and the normal intake numbers above as a starting point on how much to supplement.  
Jan 26, 2016
Alyssa shared with Hope the breastfeeding story that inspired Breastfeeding Without Birthing.  It has been 10 years since Alyssa became an adoptive parent who nursed her baby, and she has been working hard ever since to grow information and support around breastfeeding without pregnancy and birth.  

Alyssa's passion for breastfeeding grew out of her experience nursing her first two (biological) children.  When she and her husband planned to adopt, she knew that breastfeeding would be a very important part of that plan.
Building a Full Milk Supply when Inducing Lactation

While many mothers who induce lactation hope to build a fully supply, few of them do.  Alyssa was one of the fortunate ones.  Why are some mothers able to produce a full supply and others much less?  We really don't have all the answers, just as we don't have all the answers why some mothers by birth cannot produce a full supply.  But we do have some inclinations:

  • Mothers who've birthed and breastfed before tend to make more milk.
  • Mothers who work with an International Board Certified Lactation Consultant (IBCLC) tend to make more milk.
  • Mothers who effectively and frequently empty their breasts make more milk, usually either by pumping with a hospital-grade breast pump or by breastfeeding with an at-breast supplementer.
  • Mothers who take the medication domperidone tend to make more milk.
  • Mothers who have experienced infertility due to hormonal reasons tend to make less milk.

Alyssa emphasized that nursing very frequently (up to 14 times per day) was a challenge, yet she believes it was an important factor in why she was able to breastfeed her adopted daughter without supplementation. She explained that frequently nursing her baby allowed her to get enough milk over the course of the day, even though her breasts probably didn't produce very much milk at each feeding.  Producing a small amount of milk each time the breasts are emptied is referred to as "small breast storage capacity" and is typical of mothers whose bodies haven't just undergone pregnancy. 

Jan 26, 2016

Alyssa and Hope are hard at work preparing to serve you with some inspiring and hugely informative podcasts to guide you along your journey to feed and care for your precious little one.  We will be talking with experts in the field - both lactation professionals and parents who've nursed their babies outside typical definitions of breastfeeding.  We will cover topics such as helping a non-latching baby, inducing lactation, exclusively pumping, bottle-feeding and bottle-nursing, nipple shields, at-breast supplementers, chestfeeding, co-nursing, relactation, IGT, tongue-tie, herbs and medications for increasing milk production, and more.