You have summed up the problems with breastfeeding research in general, not
just hormones for induced lactation. There are so many confounding factors
and very few ways to devise a proper study of this or many other lactation
issues. This is why we need to continue to share our experiences with these
situations and try to find common threads in them to try to devise
standards of practice that make sense even if there is no good research in
a particular area of interest.

Sharon Knorr, BSMT(ASCP), Breastfeeding USA counselor
Colorado, USA

On Tue, Feb 12, 2019 at 2:52 PM Virginia Thorley <[log in to unmask]>
wrote:

> Carmela, this is a much more complex question than it seems. Doing proper
> studies would need to take into account a number of confounders - not just
> whether artificial hormones had or had not been used. Such factors are:
>
> 1) Culture - a big one (In some societies people are very dependent on
> taking pills for many situations in the hope of a quick fix, and lack
> confidence without them - in other cultures pill-taking isn't common )
> 2) Culture - Some societies have warm networks of extended families for
> support, in others the mother is isolated in varying degrees. However, does
> the family have breastfeeding experience? What support - family,
> professional, peer? How isolated is the mother?
> 3) Method of supplementation - NO bottles vs bottles
> 3A) if no bottles, what is used?
>     - *at-breast feeding* with tube device, including home-made, or
> variations
>     - at-breast feeding with tube device and nipple shield
>     - syringe, cup
> 3B) If the mother is using bottles, a) what type of teat (nipple) and b)
> how is she (or a care-giver) using them? and c) is she combining these with
> alternative supplementation methods?
> 3C) Use of dummy (pacifier, soother). This can reduce time at breast,
> though it can have a limited use in a 'bait  and switch' technique, i.e.
> soothe the child with a dummy and try slipping the breast in when the child
> is calm or sleepy.
> 4) The reason why the woman is seeking to induce lactation is important -
> her medical history, her individual anatomy, etc. If re-establishing a milk
> supply for a child to whom she has given birth, have any child-related
> factors for cessation of breastfeeding been resolved?
>
> For comparison, a prospective study would be needed, in preference to a
> retrospective one. A good study that takes into account  all those factors
> (and more) is all very well, but then the researchers need the numbers for
> statistical power. To control for all the above factors would need larger
> numbers. Induced lactation and relactation aren't situations where large
> numbers are easily available, particularly for a prospective study.
> Multi-centre?
>
> Mothers need to agree to being randomised for such a study - and cultural
> reasons may make them reluctant to be randomised, especially in high-income
> countries, and thus the study doesn't begin.
>
> As Karleen mentioned, there have been case series and case reports where
> mothers brought in milk without recourse to pills, by using stimulation and
> non-pharmaceutical methods. Inducing lactation didn't just come into
> existence with the invention of hormonal pills. In any case, breast
> stimulation (by suckling, expressing massage) provides the relevant
> hormones. Hormones don't necessarily come by pill.
>
> Dr Virginia Thorley, OAM, PhD, IBCLC, FILCA
> IBCLC and medical historian
> Ipswich, QLD, Australia
> Author, Chapter 19 in Core Curriculum for Interdisciplinary Lactation Care
>
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