Getting lactation started without the benefit of a recent pregnancy is difficult, in that it requires your actively stimulating and “expressing” your breasts for ten to fifteen minutes each, at least every 3-4 hours, throughout the 24-hour day. If your work schedule keeps you from finding the time to express your breasts during the day, your breasts will be slower in responding and it will require a longer time to lactate.

 A method that shows some promise is the use of a TENS Unit, which stands for Transcutaneous Electrical Nerve Stimulation (which basically means the unit stimulates your breast and nipple nerves through the skin of your breasts). It is a medical device that produces a very low electrical current that flows from one electrode of each channel to the other electrode of the same channel. Some TENS Units have only two electrodes (single channel) while others may have four electrodes (two pairs – two channels). The latter would be a better choice because it could be applied to both breasts and used simultaneously. These electrodes are placed a small distance apart on your breast. The TENS unit relies on the surface of your skin as the conductor of that electrical current, to complete the circuit. You often cannot feel that electrical current… you can only feel your nerves reacting to it.  

 The original purpose of using the TENS Unit is to stimulate the nerves in your body to “hide” pain such as lower back pain, etc. In this case, it is used to stimulate the nerves of your breast... mostly nerves in your nipple area, which promote the release of Prolactin by your Pituitary Gland (in your brain). That induces lactation.

 Everyone should be concerned about the effects that any electrical device has on their heart. If you are wearing a pacemaker, you should not use a TENS Unit without discussing it with your doctor first. The following is what DrJim says about the safe use of a TENS Unit on your breasts:

 “ The amperage of the current is what is critical in triggering heart arrhythmias. TENS units have an extremely small micro amperage current and it would be very unlikely for one to trigger an arrhythmia. Some of them can run for a week on a watch battery. TENS units generate a high frequency alternating waveform. It tends to be very non-penetrating, running superficially in the skin and it disperses in the tissues rapidly. It is quite effective in triggering nerve endings. Depolarizing the heart would not be very likely with this high frequency. Defibrillators use either a direct current or a low frequency alternating sine wave current. They are of course, very effective at depolarizing the heart. If you have an implanted pacemaker or defibrillator do not use a TENS unit in this fashion. Each channel of a TENS unit connects to two pads. The current travels between these pads. It would be best to use 2 pads (one channel) on each breast rather than having one pad on each breast with the current traveling through the chest between the breasts. Using two channels should be very safe. “

 The idea is for the pads to be attached to your breasts before you get dressed. They can be used inside your bra (if you wear one) or simply worn under your outer clothing. The control unit can slip into your bra between your breasts, hang from a cord around your neck, clip to your belt or slip into your pocket. It makes no vibrations or noise, and can be running while you are working at your desk or having lunch with your friends. You merely turn it on when you want it to function and turn it off when you are finished with it.

 The intent of using this unit is not to replace your partner’s oral expression or your manual expression of your breasts, but to substitute in their place when you are not able to take time away from work to suckle or express.

Purchasing a TENS Unit can be done over the internet, without a prescription, or you can go through your health care provider to get a unit. You will be concerned about the unit’s size, as you will be hiding it on your body while you are at work or shopping. Some units come with a tiny watch battery in them that will last for weeks, and they are more easily hidden on your body. Larger units contain a nine-volt battery that lasts longer and is more easily replaced. You can buy either single or dual channel units. If you have two breasts, obviously the dual channel unit might be a better choice. DrJim has suggested one internet URL that has some available, and there are many others that you might find to be more to your liking.

When you place the electrodes on your breasts, use the two wires from one channel on each breast. The electrodes will be marked in some way, indicating that one electrode is a "+" electrode and the other is a "-" electrode. Do not intermix the channel wires… be certain that each channel goes to a single breast. DrJim has suggested another URL where you will find some specialized pads (electrodes) that will fit onto your areola, with an opening in the center for your nipple:

If you are using individual pads on the ends of each wire, they should be placed about 2 ” to 2½” apart, one on each side of each nipple. Looking in the mirror, the four pads and your two nipples should all be lined up in a single row: + Pad __ nipple __- Pad __ Cleavage __ - Pad __ nipple __+ Pad. This image show what this is like:

Your TENS unit may have several settings that you can adjust Some typical adjustments and suggestions might be:

1. Wave Form: I think that I would chose "Symmetrical Bi-phasic rectangular" simply because breast stimulation is best when it is done symmetrically.

2. Amplitude: This basically means the volume or the current. I would adjust this to give you a pleasant "tingling" in your nipples or areolae. Don't make it uncomfortable, but it needs to be effective. Hopefully with time and others' experiences we will eventually find what Amplitude settings will be best.

3. Pulse Width: This basically means how long each pulse lasts. Considering the 'pulse' of a baby's suction is possibly half a second, I think I would try the longest pulse, or 250 to 500 micro-seconds.

4. Frequency: This should be the same as a baby that is sucking. I would say that setting it at about 70 per minute would be reasonable.

Turn on the TENS Unit for about fifteen minutes for each scheduled breast expression time that you cannot perform because you are at work or out to dinner. Excessive or constant stimulation will not be effective because your body “ignores” excessive stimuli. Your nerves need to 'rest' before your next expression session for your breasts to be effectively stimulated.

You do need to continue the oral or manual expressing of your breasts whenever you can. Use the TENS unit only when you are not able to suckle, manually express, or pump. Once you start producing milk, a TENS unit has no means of capturing your milk, and if your milk is not removed from your breasts, your body assumes that you do not need the milk and your breasts start to become “weaned”… you will actually work backwards and lose what you have built up if you have lapses in your scheduled sessions of breast expression (whether it be by mouth, by hand, by pump, or by TENS).

 After a few days or weeks (or months) you may begin to see your breasts and nipples swelling; they may feel larger and feel sore and under pressure. These are all normal indications that new acini (milk-producing glandular tissues) are developing inside your breasts. That is necessary before you will be able to produce milk.

I hope that this helps you to make a decision on what you want to try. If you do use a TENS Unit, please consider keeping me informed on your progress. Your experience will be very helpful for others that are waiting to hear your results.

 Do not hesitate to contact me if you have any questions.

Ken L. Smith
Breast Health Facilitator for the American Cancer Society
www.BreastNotes.com
BreastCare@comcast.net