All nursing involves a couple but we will be talking about a woman breastfeeding a man, rather than a baby. This might be because the couple thinks nursing might be enjoyable or for another reason, such as preparation for adopting a baby. We’ll cover how to make the “machinery” work, what nursing demands from and gives to a relationship and some of the special issues of couples nursing. No short article can include everything you need to know about breastfeeding so we also recommend a book and some web sites and other resources.
The first question everyone asks is “Can I (my wife/girlfriend) make milk?” The answer is almost always “Yes”, but the job takes so much time and work that very few succeed.
Nearly any woman of child bearing years can produce breast milk. If she is already nursing a baby, couples nursing is simple; it can be started with the man taking ‘leftovers’ and then replacing the baby as it is weaned. Bringing in milk when the woman hasn’t just had a baby is also possible; this is called ‘inducing lactation.’ A woman who isn’t nursing now but has before probably can bring in milk again (‘relactate’) in two or three months. A woman who has not nursed can still induce but she may not get as much and it may take longer.
Since shifting from a nursing baby to an adult partner usually is simple, we’ll talk mostly about how to induce lactation. This is a lot of work; in fact it is so much work that if the woman works away from home or does not have a full-time partner it is often not practical.
How much work is ‘a lot’? Something like 20-30 minutes each session for at least eight sessions a day for two or three months. After that, five or more 20-minute sessions a day may be needed if she wants to keep a full supply. The schedule doesn’t have to be rigid but it must be regular (no sleeping through the night, no “let’s just skip today”) both to bring in milk and to maintain the supply. And for as long as nursing continues, missing two or more sessions in a row may require either squeezing some milk out by hand or pumping in order to keep her comfortable; missing most of a day may mean some loss of supply even if she pumps.
Not only is there a very demanding schedule, there will be ‘how to’ and ‘oops’ problems to be solved. The woman’s breasts must be stimulated and her milk removed; the man could do these jobs every time, or let her do it all or most of the time. How will you work this out? Like anything complicated you do together, nursing puts some strain on a relationship and many couples may not feel that it’s worth it. After you get started there will be at least a couple of hundred dollars of expense.
On the other hand, lactation and nursing is a skill; the woman has to learn to use new parts of her body as well as other tools and many women find this very satisfying. (As the old book title says, it really is “the womanly art of breastfeeding”!) Most of the work and learning can be shared by the man and this sharing can be fun, even wonderful. Breastfeeding is probably the single most important thing she can do after birth to give a baby a good start and the woman who knows how to nurse an adult partner is likely to find a baby a cinch. And many nursing couples can’t imagine giving it up. If you want to try, the best approach is to think of it as a shared experiment, an adventure to be taken and enjoyed together, wherever it may lead.
Concerns About Breastfeeding
If couples nursing is a new idea, some concerns are natural.
Her concern: Her breasts will suddenly burst out of all her clothing making people stare.
The facts: Breast size increase happens over several weeks and is never ‘amazing’; the amount of increase depends on how much milk she makes and will nearly always be in line with other common changes such as her monthly cycle or starting to take birth control pills. With full lactation the increase will be one or two cup sizes but large breasts will increase less than small ones.
(We will use the term ‘full lactation’ to mean roughly a quart of milk a day which is about the requirement for a six-month old baby right before starting solid foods. This is about as much as any partner is likely to want.)
Her concern: What if she should leak milk while at work or visiting her mother?
The facts: Leaking milk sometimes happens after a woman has a baby because of the flood of milk triggered by the birth process. It is very rare after the first few weeks because the breasts adjust and don’t make so much milk. We have only heard of one woman who induced lactation who had this happen, although a few do have leakage during the night if they sleep through.
His concern: There may be less sex, maybe even a lot less.
The facts: This is possible but it may be much better sex. You’ll have to talk about it and work it out.
His concern: He’ll be more ‘tied down’, will lose his independence, she’ll be using him just as a milking machine to empty her breasts.
Her concern: He’ll only be interested in her as a cow. She’ll become dependent on him both for nursing itself and for help with the other work and problems; then maybe he won’t be available when she needs him.
The facts: Breastfeeding does mean greater dependence of each partner on the other. You need to talk frankly about this, not once but regularly. Often an ongoing discussion like this is the beginning of a better relationship.
Her concern: Her breasts are too small to make any milk. (Or, her breasts are so large she’ll be gushing all over the place.)
The facts: Most of the breast is fat which pads and protects the milk making glands but does not actually do anything. Women with very small breasts and those with large ones have different amounts of fat in their breasts but the ‘machinery’ is nearly the same. Both can (nearly always) make enough milk and neither is likely to gush.
Her concern: What if she has to go to the doctor? Won’t he/she notice?
The facts: A doctor is very unlikely to examine her breasts unless she’s there for a physical exam or breast problem. Even if he does it’s no big deal — you will nurse or express before going and finding a little milk in a woman’s breasts isn’t uncommon.
His concern: He might gain weight.
The facts: Weight gain is possible; if it does happen it will be slow and he can adjust his diet and exercise.
Milk is produced in hundreds of tiny sacs called “alveoli” inside the breast. These sacs are connected by tiny tubes (ductules) which join to make 10-25 larger tubes (ducts) each ending in a tiny hole in the nipple. There are bulges in the ducts just below and behind the nipple area; these are called “sinuses” and are about 1/4″ in diameter.
Both boys and girls are born with the beginnings of this system. As a girl becomes a woman, becomes pregnant, and carries her baby, the breast machinery develops from these beginnings until she is able to nurse right away after delivery. When the baby is weaned, the machinery turns off and is mostly removed but even years later some of it will still be there. With the right stimulation a full milk supply generally will come back.
Through the months a baby is being nursed, the amount of milk adjusts to its needs. A baby who is always hungry because he has outgrown the milk supply will nurse longer and probably be put to the breast more often than one who is getting plenty. The stimulation of the nipples caused by the alternate squeezing and sucking of the baby’s mouth signals a part of the woman’s brain to make prolactin, a chemical which tells the alveoli to make milk; longer and more frequent nursing means more chemical signals to make milk.
It is this system that lets a woman who does not have milk start production without having a baby. If she applies lots of nipple stimulation to signal a need for ‘more milk’ then over a few weeks or months production will increase from nothing to tiny drops to as much as she wants. A woman who has not been pregnant may not be able to bring in a full supply (the experts don’t agree on this) but probably can make enough to satisfy most couples.
A feeding begins with most of the milk in the alveoli, which have been making it since the last feeding. When the woman gets a cue she connects with nursing (such as thinking of her partner nursing), an automatic response called ‘letdown’ pushes her milk out of the alveoli and through the duct system to the sinuses. Letdown is often felt as a tingling or prickling sensation behind the nipple as the sinuses fill. After letdown, the pressure of the partner’s mouth and tongue on the sinuses pushes the milk out of the openings in the nipple into his mouth. If the feeding is much overdue and the woman has a lot of milk, letdown may not only fill the sinuses but make milk dribble or even squirt from the nipple.
Because letdown is also partly triggered by milk pressure, it won’t happen when production is just starting. You’ll probably have to massage the breast to bring down those very first drops.
You don’t have to read this section to induce lactation but if you are interested, it will help you understand some of the trickier things about how lactation and nursing works.
‘Endocrinology’ is the study of glands which make chemical signals that circulate in the blood to control body functions. Chemicals that do this are called ‘hormones.’ There are many hundreds of hormones but just four of them do most of the control of the breasts.
Estrogen is made mostly in the woman’s ovaries but some is also made in fat cells throughout the body. It is the basic ‘I am a woman’ hormone and causes most of the difference in body shape between men and women. Its effect on the breasts is to tell them to enlarge and build the foundations for the milk-making equipment but it also tells the breasts not to make milk now.
Behind the bones at the back of the inside of your nose and up under your brain is the pituitary gland. It is connected by nerves to the nipples and gets signals when they are stimulated as they would be by a baby sucking. When this happens it makes two hormones:
Prolactin causes milk-making cells in the breasts to go to work. Combined with estrogen it tells the breasts to make more milk cells.
Oxytocin tells the breasts to push the milk toward the nipples — the ‘letdown’ effect. It also causes muscles to contract in other places. The uterus is one and oxytocin causes the contractions of orgasm and also those which push a baby out. Many women feel the pleasant contractions caused by suckling of their nipples. The digestive system is also affected by oxytocin; a ‘growling stomach’ is a good sign that stimulation of the woman’s nipples is working.
The last hormone we need to know about is dopamine. Dopamine does many things; one of them is to tell the pituitary “Don’t make so much
prolactin.” Drugs that reduce the amount of dopamine mean more prolactin and can be used to make lactation easier. Two common ‘dopamine antagonist’ drugs are metoclopramide and domperidone; they are discussed later.
“We now return to our regular programming.”
How to Bring in Her Milk.
Lactation requires some things that are natural and automatic; it also requires knowing how to operate parts of the woman’s body and use some other tools. When lactation happens after a baby, nature does most of the work, but inducing requires a lot more knowledge and skill and you will have to do a lot of work. At the start it takes more time than nursing a baby.
To induce lactation you must do two things: first, you must frequently and effectively stimulate the nipples to tell the brain “There is a hungry baby here”, and second, you must at every session completely remove any milk which is produced so the breast doesn’t get the idea that there’s plenty and shut off. Any stimulation method that does both these things without hurting the breast will bring in milk; any method that does not, will fail.
The best nipple stimulation is the suckling of a partner. This is not the flicking or teasing of the nipple which is often part of sex, but actual squeezing of the nipple and the dark area around the nipple called the ‘areola.’ Suckling is what a baby does and of course it also removes the milk.A few women can suckle their own breasts. Those who can may find this almost as effective as a partner at the start. Once her milk comes in it isn’t as good because bending the breast closes off some ducts meaning that the breast can’t be completely emptied. Also many women find this uncomfortable and others don’t like the idea or don’t like the taste of their milk.
Second best for stimulation is the woman’s hand (‘hand stimulation’), rolling and squeezing the nipples themselves. Although this must be done gently it can be tiring; she may get cramps and sore muscles in her hand at first if she uses it a lot. Hand stimulation, however, is a very effective method, the equipment costs nothing, and it is always with you so it is convenient if you aren’t always at home. We know of women who use this method every time they go to the john at work and even one who does it in her cubical. The hand cramps and other problems will go away with practice. Once the milk comes in you can also gently squeeze and massage the breast to remove the milk as you stimulate the nipple; this is called ‘hand expression.’
Knowing how to hand stimulate and express milk is very useful. It may take time to learn but it is worth it.Third and much worse are breast pumps. None of the ones we’ve tested gave good nipple stimulation. However breast pumps can be helpful for removing milk when you have a lot because the milk goes in a bottle rather than squirting out as with hand expression.
More About Breast Pumps.
The inexpensive electric pumps found in most stores (Gerber and Evenflo are two brands) are useless for inducing because they don’t give strong enough stimulation and can’t completely empty a breast. Also they are hard to work because you must turn the suction on and off by hand.
The ‘hospital’, ‘rental’ or ‘professional’ grade electric pumps made by companies like Medela and Ameda Egnell all have ‘automatic cycling’ and can get more milk from a breast but they’re much more expensive to buy — $150 and up, some are over $250. They can, however, be rented from medical supply or larger drugstores in most towns if you want to try one for a month. (You will have to buy a kit of parts that touch the milk so rental isn’t as cheap as it may sound.) These pumps don’t give nearly as effective stimulation as a partner’s mouth and they can hurt your breast; if you try one, be careful.
A company called White River Concepts claims that their pump produces nipple stimulation as good as that from the sucking of a baby and tests have been done that seem to show this, but when we tried one we couldn’t get it to work any better than the others. Also their electric pumps are very expensive and because of the special soft cup design we thought they were hard to use. In the spring of 2000 the company was hard to contact and not helpful in finding a dealer from whom to buy their products.
This situation doesn’t make sense. Cows use breast pumps all the time: they are called milking machines and they are very effective for stimulation as well as removal. As we finished this revision Whittlestone Inc. had started selling a new type of electric breast pump based on the same theory as the milking machine and said to be less likely to hurt the breast than other electrics. A while back they also said it was more effective at stimulating the nipples but that claim seems to have been dropped in favor of talk about how comfortable it is to use. It sells for about $320. We have tested one and we know another woman who is lactating who has tried one. The idea sounded great, it is quiet and certainly comfortable, but it produced a lot less milk than the little hand pump we talk about below. In our opinion this pump is a waste of money for inducing lactation.
All the other more powerful electric pumps we know about are noisy — way too loud to use where there’s someone on the other side of your door.
In our opinion no high-price pump available now is worth buying to induce. You should keep your money and the woman should work with her partner and her hands. Nearly every woman — maybe 95% or more — can successfully induce this way. Until there’s something better on the market, pumps are only for removing milk.
For good milk removal at a reasonable price we recommend the Avent Isis hand pump at about $40. Unlike most electric pumps this is silent — you can use it in your bedroom, office or the john without anyone hearing it. You can work it with one hand and it’s small enough to carry in a large purse. After a little practice most women find it easy to use though there are a lot of parts to put together. The Isis is available on the web and in some of the better stores. Try it both with and without the soft silicon rubber insert in the cup; some women like it better one way, some the other.
No matter what method or equipment you use, don’t do anything that hurts. Sore nipples and bruised breasts are a lot easier to prevent than cure.
How To Tell If Your Pump Is Working.
To see how well a pump is emptying the breast, the partner should try to suck right after pumping. If he gets more than a taste, the pump isn’t getting all the milk.
To know if your pump is stimulating the nipples at all, compare how the woman feels when using it to how she feels when the partner nurses. If she gets uterine contractions from suckling and doesn’t get them from a pump, it’s not stimulating her nipples enough and all it is doing for her is removing any milk she has. We don’t know of any pump that works well for stimulating nipples.
Suckling should be as a baby does it: get a 2″ circle of breast with the nipple just above the center (the end of the nipple will be near the middle of the tongue) and suck and squeeze at the same time while pressing upward with the tongue. Release immediately but hold the lips against the breast. Suck-Squeeze – release – wait/suck-squeeze – release – wait/suck-squeeze… This should be done about 3 or 4 times every 5 seconds or 35-50 times a minute. Try to keep the teeth mostly off the breast, don’t slide the lips but stay ‘latched’ in place, as a baby would. This is easiest if his lips are just damp rather than wet.
The ‘sucking’ part of this action should be gentle; it has less effect on milk removal and nipple stimulation than does the squeezing, and too-hard sucking will cause sore (stretched) nipples and perhaps other problems. If he is able to hold on to the breast while squeezing, he’s sucking hard enough. When he first starts to get some milk, he may be tempted to suck too hard; try to avoid this as sore nipples will be a definite setback.To give the best stimulation (and get the most milk!), suckling should squeeze the sinuses under the areola. When things are working right, this will feel like chewing soft clay. If the end of the breast is firm, let go and latch again or switch to the other breast for a while. If that doesn’t work (it often won’t when you’re starting) then just press gently on the firm area. Because the man, the woman, and the woman’s breasts are all learning and changing at once it takes a while to get the hang of this but in a couple of months it will be completely natural.
Women who have nursed a baby will remember how that feels. Those who have not should expect contractions of the uterus similar to those of orgasm (but usually gentler; only a few women have orgasms when nursing) and should coach the partner until they get these feelings. However, don’t worry about getting the sucking exactly right. In the beginning all that matters is plenty of gentle squeezing of the end of the breasts; later, when there is milk, he will naturally adjust his technique so he gets the most milk.
When her milk first starts to come in there’ll be a few drops of milk with each suck at the start of a feeding, then quickly less until there seems to be none. You can get more by massaging the breast with a cupped hand. Either partner can do this, but it is easier for the man. He should use his hand to roll or sweep milk toward the nipple just before the suck-squeeze part of the suckling pattern.
Suckling one breast helps the other let down, so nurse each side at least twice at each feeding. Be sure to empty both breasts completely. Because the second breast nursed will be the most fully emptied, he should nurse one side first during one session and the other first the next time. A good pattern for a session is:
Left breast, right breast, left with massage, right with massage, left with massage again.
When you next nurse, reverse left and right so the pattern is:
Right, left, right with massage, left with massage, right with massage again.
If you don’t switch the side you start with, one breast will have much less milk than the other and there may be other problems.
Once her milk starts to come in, he will be tempted to take all the milk in a few minutes and stop. Don’t do that — the breasts need just as much time to give the brain signals as they did when there wasn’t any milk. If things are going well, this will only be a problem during the second and into the third month; after that she’ll have enough milk to last 20 minutes or more.
Be gentle, especially at first. Hard sucking and massaging will not bring milk much sooner and may cause sore nipples or bruise the breast. If you want faster results nurse more often (up to 20 minutes every hour and a half if you have time and nothing hurts), or use other methods we’ll discuss later; don’t use more force. After a couple of weeks you can gradually start sucking or massaging a little harder as long as it feels good to the woman and doesn’t leave the breast sore or bruised.Suckling much longer than about 30 minutes doesn’t give any more ‘make milk’ signals. You must stop for an hour or so before the signal can be given again.
Using Your Hands
When no partner is available, the woman should use her hands. For hand stimulation of the nipples you squeeze and release the nipple and areola to imitate a baby’s mouth. You can use two fingers and a thumb, the base of your thumb and first first finger, curl your ‘pinky’ around the nipple, or squeeze against your palm with any two fingers. If one motion makes your hand tired you can switch to another. You can use both hands at once and get double the effect! Start with five minutes on a side and increase gradually to at least ten minutes as long as nothing is sore.
Hand expression of milk is different. To do this you work further back on the breast with both hands. Use a rolling motion rather than sliding skin on skin to avoid trouble with chafing. Breastfeeding books like the one mentioned below have more details on hand expression; you can also look up ‘Marmet technique’.
When you start inducing you only need to stimulate the nipples. Once she gets sips of milk, each session should end with enough hand expression or pumping to remove all her milk. Of course if her partner is suckling he does the whole job at one time.
Because inducing lactation is at first more work for the nipples and breasts than nursing a baby, they need extra good care. You should be super careful to keep the breast area clean and dry. Wear a clean bra every day; going braless when at home is a good idea if you have enough privacy and it’s comfortable. Don’t wash bras with dirty items, do use a bit of ‘safe’ bleach and do be sure bras get completely dry before putting them on.
Don’t cover the breast after a session or shower until it and especially the nipple area is completely dry. Don’t put anything (such as cream or lotion) on the end of the nipple; if bacteria get into the ducts you can get a nasty breast infection.
Breast or other creams aren’t necessary but if dryness or chapping occurs you can use a breast cream such as Lansinoh (great but expensive), Udderly Smooth or any hand lotion that works. “Works” means it feels good, tastes okay, doesn’t sting when you put it on, and doesn’t make the nipple so slippery that the partner can’t latch. Once you have some milk, a drop or two rubbed around the nipple and areola and allowed to dry is better (it is an antibiotic!) and it’s both free and 100% natural.
If soreness is a problem it’s probably due to stretching of the skin around the nipple. The nursing partner should be careful not to suck too hard. This is also the answer if he has soreness of the lips or elsewhere in his mouth.
Nipple soreness can also happen when a tooth rubs the nipple or areola. As much as possible the partner should squeeze with his lips rather than his jaw muscles and keep his lips over his teeth.
Nipples should be checked after every session at first for any signs of blisters or rubbed areas; if you see a problem or she starts to feel pain, figure the problem out now as it will get much worse in a hurry.
Also watch out for any whitish or greenish ‘crud’ around or on the nipples as this could be a fungus. Treat fungal infections immediately by keeping the area extra dry and using both a yeast cream (as for vaginal yeast problems) and one for athlete’s foot; these should be wiped off before nursing. If it doesn’t start to get better within a few days, stop nursing and see a doctor.
The only rubbing that’s normal is between the end of the nipple and the back of his tongue and roof of his mouth and even this may leave him with a sore tongue. Switching from suckling to manual stimulation can be soothing when her nipples or his mouth are sore.
You’ll work out your own, but to help you think about it here is an example of what can work. This is an easy situation because the woman is home most of every day:
07:00 AM — Nurse partner who goes to work
10:00 AM — Hand stimulate
01:00 PM — Hand stimulate or nurse partner if he can come home for lunch.
04:00 PM — Hand stimulate
07:00 PM — Nurse partner
10:00 PM — Nurse partner, go to bed.
01:00 AM — Nurse partner
04:00 AM — Nurse partner
This is 8 sessions a day. The exact times can of course be adjusted to fit other things the woman does but should stay in the range 2-4 hours apart most of the time. If the length of each session is a bit over 20 minutes then the total time is three hours. This couple is almost certain to succeed. Once she starts to get milk she can express it by hand or add a few minutes to the session and use a pump when he’s not available.
It may seem strange right now, but once you get started, the time the woman spends actually nursing her partner can be used to read, watch videos or TV, even to snack. During the night she’ll mostly sleep through feedings. She can even nurse while taking those long boring phone calls from her aunt or college girlfriend! (We have a hand signal to say “Let’s nurse” silently). One of the nice things about nursing is it mostly isn’t an exciting big deal — just something you love doing together.
If the woman works, then her daytime sessions will have to be done at work. Use the john (disgusting maybe, but …), use your office, go out to your car at lunch, stimulate on breaks — whatever it takes. Almost every woman can, but those who aren’t mostly at home who do, will have worked very hard for their success.
When we talk to people who are having trouble inducing the reason is nearly always ‘not enough time’ — usually when we count up the time it’s less than two hours a day and often only an hour. A woman with so little time will probably never get beyond a few drops and may never see any milk at all.
Are You Getting Anywhere?
If there is enough stimulation (at least 8 sessions, total three hours a day or more, no big gaps in the schedule) the woman will notice within a week or so that her breasts are getting larger; very likely her nipples and areolas will darken. She can expect drops of milk in two weeks to a month, a sip or squirt in one to two months and a pint or more per day in two to four months.
If a month goes by without definite progress you need to change something. If there is no progress in a month there may never be any unless you change your routine.
Different women start in different ways. Some will have a few drops of milk on the first day, then nothing for a week or more while others will have nothing at the start. Next may come some clear salty tasting fluid, then drops of salty milk; this may be whitish or brownish in color. All of these are normal and show that the breasts are starting to make milk; the salt is caused by direct leakage from the blood into the alveoli and will stop within a few days of continued stimulation. The brown is a few red blood cells coming along.
Once she has some milk you will probably notice that production will decrease slightly in the last five days or so before her period starts. Do not nurse less when this happens — instead you should nurse more if possible. Even though her milk supply doesn’t show it, her breasts are growing inside and by the second day of her period you will see more milk, maybe even a lot more!
As you get close to what you want you can cut the number of daily feedings by one a week until you find how many it takes to keep her supply; however milk production may gradually stop if you don’t keep at least one middle-of-the-night feeding. Experts differ but various sources say “at least one (or two or three) feedings per day” and “at least 90 minutes per day” are needed to keep a supply of milk.
“to find your true abf partner you must have patience and persistence, but the rewards are there”