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You are about to adopt a baby and you want to breastfeed? Wonderful! Not
only is it possible, it is fairly easy and chances are you will
produce a significant amount of milk.
It is different, though, than breastfeeding a baby with
whom you have been pregnant for many months.
Breastfeeding
and breastmilk
There are really two issues in nursing an adopted baby.
One is getting your baby to breastfeed.
The other is producing breastmilk.
It is important to set your expectations at a reasonable
level. Since there is more to breastfeeding than breastmilk, many
mothers are happy to be able to breastfeed without expecting to
produce all the milk the baby will need.
It is the special relationship, the special closeness,
and the biological attachment of breastfeeding that many mothers
are looking for. As one adopting mother said, “I want to breastfeed.
If the baby also gets breastmilk, that’s great”.
Getting
the baby to take the breast
Although many people do not believe that the early
introduction of bottles may interfere with breastfeeding, the
early introduction of artificial nipples can indeed interfere.
The sooner you can get the baby to the breast after he is
born, the better. However,
babies need flow from the breast in order to stay latched on and
continue sucking, especially if they have gotten used to getting
flow from a bottle or another method of feeding (cup,
finger
feeding). So, what
can you do?
1.
Speak with the staff at the hospital where the baby will be born
and let the head nurse and lactation consultant know you plan to
breastfeed the baby. They
should be willing to accommodate your desire to have the baby
fed by cup or finger feeding, if you cannot have the baby to feed immediately after his birth. In
fact, more and more frequently, arrangements have been made
where the adoptive mother is present at the birth of the baby
and takes the baby immediately to nurse. The earlier you start, the better.
2.
Some biological mothers are willing to nurse the baby for the
first few days. There
is some concern expressed by social workers and others that this
will result in the biological mothers’ changing her mind.
This is possible, and you may not wish to take that risk.
However, this has been done, and it allows the baby to
breastfeed, get colostrum, and not receive artificial feedings
at first.
3.
Latching on well is even more important when the mother does not
have a full milk supply as when she does.
A good latch means painless feedings.
A good latch means the baby will get more of your milk,
whether your milk supply is abundant or minimal.
(Handout A: When
Latching).
4.
If the baby does need to be supplemented, this should be done
with a lactation aid with the supplement being given while
the baby is breastfeeding (Handout #5, Using
a Lactation Aid). Babies
learn to breastfeed by breastfeeding, not cup feeding, finger
feeding or bottle feeding.
Of course, you can use your previously expressed milk to
supplement. And if you can manage to get it, banked breastmilk
is the second best supplement after your own milk.
With a lactation
aid, the baby is still breastfeeding
even while being supplemented, and isn’t breastfeeding what
you wanted for your baby?
5.
If you are having trouble getting the baby to take the breast,
come to the clinic as soon as possible for help.
Producing
breastmilk
As soon as a baby is in sight, contact a breastfeeding
clinic and start getting your milk supply ready.
Please understand that you may never
produce a full supply for your baby, though that may happen.
You should not be discouraged by what you may be pumping
before the baby is born, because a pump is never as good at
extracting milk as a baby who is sucking well and well latched
on. The main
purpose of pumping before the baby is born is to draw milk out
of your breast so that you will produce yet more milk, not to
build up a reserve of milk before the baby is born, though this
is good if you can do it.
If you know far enough in advance, say at least 3 or 4
months, treatment with a combination of oestrogen and
progesterone (similar to the birth control pill, but without a
break, or oestrogen patches on the breast plus oral
progesterone) plus domperidone will simulate the hormonal milieu
of pregnancy somewhat and may allow you to produce more milk.
Get information about this protocol from the clinic.
a.
Pumping. If you can manage it, rent an electric pump with a double
setup. Pumping both
breasts at the same time takes half the time, obviously, and
also results in better milk production.
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 it twice a day.
If once a day during the week, but 6 times during the
weekend can be done, fine.
Partners can help with nipple stimulation as well.
b.
Domperidone. (Handout #19a and 19b, Domperidone
1 and Domperidone
2). This
drug can help you produce more milk. It is not necessary for you
to use it in order to breastfeed an adopted baby, but it will
help you develop a more abundant milk supply faster. There is no
such thing as a 100% safe drug. If you do decide to take it, the starting dose is 30 mg three
times a day, but we have gone as high as 40 mg 4 times a day.
Check the handout for more information.
Ask at the clinic. Using pumping and domperidone, most
adopting mothers have started to produce drops of milk after two
to four weeks.
But
will I produce all the milk the baby needs?
Maybe,
but don’t count on it. But
if you do not, breastfeed your baby anyhow, and allow yourself
and him to enjoy the special relationship that it brings.
In any case, some breastmilk is better than none.
Please
note: If
you decide to take the medications (the hormones and/or the
domperidone), your family doctor must be aware of what you are
taking and why. Significant
side effects have been rare, but that does not mean they cannot
happen. Your doctor
needs to be following you, and once the baby is with you, your
baby’s doctor needs to know that you are nursing him and needs
to follow the baby’s progress just as s/he would any other
baby.
Questions?
(416)
813-5757 (option 3) or
drjacknewman@sympatico.ca or
my book Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate
Breastfeeding Book of Answers in
the USA)
Handout
#23 Breastfeeding your
Adopted Baby. January 2005
Written by Jack Newman, MD, FRCPC. © 2005
This
handout may be copied and distributed without further
permission,
on the condition that it
is not used in any context in which the WHO code on the
marketing of breastmilk substitutes is violated.
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