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Preparing to Nurse Our Baby;
Learning about Adoptive Nursing
Angel link to Our Adoption Diary II; waiting phase. Click the angel to view
"Our Adoption Diary; waiting phase
Updated January 8, 2000"

Welcome to yet another area where we will share our adoption journey...in this little niche I will tell you about breastfeeding our child through induced lactation...neat huh!? My goal is that the information discussed will serve as a good source for anyone considering this wonderful option and will also be helpful in deciding which interventions are right and will work for them. I should first state that a uterus and/ovaries are not required for induction of lactation...the Pituitary Gland does all the work, well the baby suckling is really the key along w/some help from mom/wet nurse Angel if for Wet Nurses*Yummie, breast milk!!*.

As you decide to prepare to breastfeed your child I HIGHLY recommend that you contact your local La Leche League (LLL) leader and/or a Lactation Consultant that has experience with adoptive nursing induced lactation. It is generally easier to find an experienced certified lactation consultant; LLL leaders are slowly learning and working with women to induce lactation for adoptive nursing. I found a couple of Certified Lactation Consultants; experienced w/induced lactation, by calling hospitals in my area. The LC's that worked at the hospital did not have this experience, but they were able to refer me to someone who did. Of course bulletin boards are great support but there is nothing like having "somebody" physically next to you that will help; unless they don't have experience with induced lactation LOL!! I called LLL in my area but they did not have anybody that was experienced with induced lactation. I was also able to find another LC at Lact Net; a mailing lists solely for lactation consultants. Non-professionals can search the archives but are not allowed to participate in the discussions. The book titled "Breastfeeding the Adopted Baby" by Debra Stewart Peterson; an adoptive breastfeeding mother herself!, was also very helpful. I ordered mine from an online bookstore. Dr. Newman's book, The Ultimate Breastfeeding Book of Answers, also has some excellent information on induced lactation and general breastfeeding issues.


How to's

Here is an outline of the different factors to consider and that are involved with induced lactation;


Preparing to breastfeed our child

When I began nursing school I already knew that I would not be able to give birth to any children and until I reached the Obstertrics/Newborn rotation of the curriculumn I thought I would never be able to share a breastfeeding relationship with my adopted children. During the orientation of the OB/Newborn Nursery unit the Registered Nurse pointed out a room "where women who adopt their babies breastfeed them." Wow! I didn't even know that was possible. I was intrigued to say the least. I asked about it and the only answer I got was, "There are ways."

Well, I am currently preparing to breastfeed our child. We don't know when he will find us, but I do know that I am able to prepare for him or her! The Internet has provided me with the means to learn sooooo much about what a positive experience adoptive nursing can be. I initially found this great site where a woman, Darillyn Starr, shares her personal experience of breastfeeding her six adopted children. In her link section, she has a link to this really cool site, Adoptive Breastfeeding Resources on the Web; where she also has a little corner. I have gathered adoptive nursing links that have been a great source of information for me. I included many of them throughout this discussion, but you can access them from Our Adoption Links.

The first question I had concerned the amount of milk supply that I would be able to provide. I have since learned that the amount varies from situation to situation, but "please understand, you may never produce a full supply for your baby, though it may happen"1 My main objective is the bonding that I will be able to achieve with our baby. I will discuss daddy's role in breastfeeding a bit later. Now, if I wasn't going to be able to produce 100% of milk supply, was I going to have to use a bottle some of the time? Not necessarily. There are special aids to supplement while the baby is at breast. These are called supplemental nursers.

I will now share what I have decided and a bit about why. I have started to pump w/a hospital grade pump; Medela Lactina Select--these pumps are rentals that can be rented from lactation consultants and/or businesses that cater to mothers-to be. Since I don't have a match yet, I only pump about 20 mts for 3-4 times a day. As baby's arrival gets closer I will need to pump every 2-3 hrs; although, only for 10 minutes. This will help simulate the frequency that the baby will need to breastfeed and the increased stimulation will help bring in more milk...if/when lactation does occur. There is no need to wake up during the night but it would not hurt if you pumped at least once. If you should start Domperidone ahead of time, which some moms have done, it is advisable to pump one or twice during the night, as prolactin levels are higher during this time and therefore it would be a greater benefit. Lansinoh (or any other hospital/medical grade Lanolin, but be careful as most others have alcohol as an ingredient, not a good idea due to the its drying effects) makes pumping much more comfortable. I have found Wal-Mart to have the best prices on it. A little goes a long way. Breastfeeding should not hurt, neither should pumping, but some women do experience some soreness for the first couple of weeks at the start of pumping, and perhaps, when you begin breastfeeding your baby.

I also take Fenugreek and Blessed Thissel; two capsules, three times a day. I have started to stock up on Domperidone, but will start taking it only when baby is home or nearly home. Which brings me to a very important issue to consider, inducing lactation and then having the adoption fall through. Judy, an adoptive mother breastfeeding her baby wrote this about her experience
By September, the birthmother changed her mind. I think at that time I had about 4-5 ounces a day and I believe by that point I was finding that I had to pump once in the middle of the night or I would be quite engorged in the morning. We had another remote possibility that was due in December and so with a lot of encouragement from my husband I kept going -- my ultimate goal was to build up a FULL milk supply by the time a baby came (although I knew that this was rare).7

Questions will arise as you start preparing your body to breastfeed your baby. This is when you should take full advantage of the bulletin boards/message boards and the lactation consultant/LLL leaders. There are some wonderful people who will gladly help and support your endevour to induce lactation. I speak from experience, since that is where I have learned a lot of this information.


Pumping

Pumping is not mandatory. Adoptive mothers have had a positive nursing relationship without having used a breast pump ahead of time. But, if you decide to pump it is recommended that you use a hospital grade electric pump with a double pumping kit. The double pumping action helps increase the release of prolactin, the hormone that is a precursor for milk production. I have found the Lactina Select, by Medela to be a very comfortable.

Like a lot of issues about induced lactation, recommendations on how far ahead to start pumping vary, but in an article Dr. Jack Newman recommends to "start pumping as soon as the baby is in sight, even if this means you will be pumping for 4 months. You do not have to pump frequently on a schedule. Do what is possible. If twice a day is possible at first, do twice a day. If once a day during the week, but 6 times during the weekend can be done, fine."

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Supplementers

"A nursing supplementer consists of a container for the supplement (either a bag or a bottle), which hangs on a cord around mom's neck and rests between her breasts. Thin tubing, leading from the container, is taped to the mother's breast, extending about 1/4 inch past the nipple. You usually see the tubing going directly from the bottle (between the breasts) to the nipple. You can also wrap the tubing down & around the breast before bringing it up to the nipple."2

The baby can be supplemented with formula, expressed breast milk, donated/banked breast milk, or a combination of these. There are strict guidelines to obtaining banked breast milk, the most important is the requirement of a doctor's prescription for dispensing from the Milk Bank. Rarely a surplus supply is available this would make it possible to obtain banked milk for using with the supplementer.

There are three brands, although the third brand is only accessible in Australia; Lact-Aid, Medela's SNS, and Supply Line (Supply Line Developed and produced by NMAA. This kit enables additional nutrition (EBM or formula) to be fed via a fine silastic tube, to a baby suckling at the breast. Stimulates lactation and avoids confusing the baby with a bottle teat. For use in special circumstances; supplied only on the recommendation of a health professional or through a NMAA Counsellor. Supply line usage does require initial supervision, and follow-up consultations.)3

Lact-aid

Lact-Aid
Medela's SNS
Medela's SNS
NMAA does not
release pictures of
their Supply Line

Each has its own advantages and disadvantages. From now on I will only be referring to the Lact-aid and SNS, since the Suppply Line is not accessible in the States. I already have the Lact-aid. Its size was a major plus and deciding factor for me but there were other considerations. It uses disposable bags and the tubing that is placed on the breast as baby suckles is made of a softer and pliable silicone base.

The best comparison that I have found is from Kelly's Attachment Parenting Page from the LLLI conference session presented by Sharon Larsen, RN and Kerry Yancy Dolan, MD (July 4, 1999)...you can link to the page here but I posted the info below.

Comparison of Lact-Aid and Medela SNS

Challenges

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Milk Supply

Pumping in advance not only helps to condition breast tissue, but it stimulates the production of prolactin, is responsible for lactation and therefore will bring in breastmilk. There are several options that will help increase milk supply. These include herbal remedies and medicines. The most important factor is having baby at the breast frequently.

Herbal remedies are effective for most women; mothers breastfeeding their biological children can also benefit from these herbs at times when their supply is low. One of the best articles on this that I have found on the Internet is titled Herbal Remedies to Increase Milk Supply. It does a very good job of explaining not only the different herbal remedies, but also lists the recommended dosages. Taking a combination of these herbs produces better results, as some herbs work by increasing the actual amount of milk and others work by helping with let down; the action of releasing the milk.

About the most effective and widely used herb is Fenugreek. "Rima Jensen, MD, suggests that fenugreek may affect milk production because the breast is a modified sweat gland, and the herb is known to stimulate sweat production."4 Fenugreek has been taken by women with low supply intermittenly; on an as needed basis, during their nursing. Other women have to take it during their entire nursing experience, as is the case with most women who induce lactation to breastfeed their adopted child.

As there are herbs that help with milk supply there are others that hinder it. These include5

Induced lactation can been seen as a side effect to a variety of medications. "Domperidone (Motiliumô) works for the mother trying to develop a full milk supply while nursing an adopted baby,"6 but it's effects are less dramatical than when being used by a mother breastfeeding her biological baby. Although all medications have side effects and their risks should be weighed to it's benefits (as you should discuss with your physician), Domperidone's undesireable side effects are fewer and less dangerous. At this time it can only be obtained from pharmacies in Canada (prescription required), Mexico (no prescription required) and through the internet (no prescription required). It was taken off the market in the US because a more effective drug in its class (drugs for enhancing digestion) was developed. There are some sources for obtaining it from Mexico at the ABRW site.

Another medication prescribed for inducing lactation, although it is not approved for this use, is Reglan...BAD, BAD, BAD, DRUG!. I have gathered some sources that discuss Reglan here if you are interested in researching more specifics. Generally though, It can't be used safely for extended periods of time, as is necessary for adoptive nursing, without significant risks. There are some populations who should not be given this medication, i.e., those with a history of depression.

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Dr. Newman's Protocol

Since I started this page there has been a new development by Dr. Newman (I am updating on June 28, 2001). You can learn from the protocol at this site. You can also follow a virtual testament of the effectiveness of this protocol at this link.

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