Breastfeeding & Adoption

Adoptive breastfeeding is possible with good planning and preparation, and more and more frequently, mothers planning on infant adoption are considering this option as a way to promote attachment. This is a highly personal issue, and not without controversy.

Many adoptive mothers choose to breastfeed their adopted children because of the widely-touted benefits of breastfeeding. These benefits include extra nutrients, protection against disease, easier digestion, and customized nutrition.

Preparation

Education

As with just about anything, the most important preparation that a woman who wants to nurse an adopted baby can do is educate herself about it. There is not a tremendous amount of written material about adoptive nursing available yet, but there is more and more all the time. Much of this is in the form of personal accounts of individual adoptive mothers. These are very useful and should be taken advantage of.

There is, however, enough written material on breastfeeding in general. An adoptive mom needs to know nearly everything that any nursing mother does. The specific concerns of adoptive nursing are in addition to, not in place of, general breastfeeding information. In general, adoptive nursing is like nursing a bio baby, but with an "external milk duct" (as some women like to think of the nursing supplementer.) About the only thing that bio moms can experience, but adoptive moms cannot, is postpartum engorgement!

Seeing mothers nurse is also a very important part of education. For millenia, human mothers nursed their babies without reading books or going to La Leche League. They knew how to do it because they had grown up seeing it done. Since then breasts have come to be considered sexual objects, and this form of education has been largely lost. Mothers now need to find opportunities to see babies nursing. Photographs are helpful. Videos are quite a bit better than that, but seeing it in person is the best of all.

Support Organizations

Contact with La Leche League (an international organization which provides education and support about breastfeeding) is usually helpful. It provides opportunities to see other women nursing babies, but also helps adoptive mothers find friends who will support them and think that what they want to do is wonderful. Whether or not the adoptive mother will find specific council on adoptive nursing depends on the individual leader and other members of the local group. Most women affiliated with La Leche League do not know more than the bare basics of adoptive nursing. LLL does, however, have peer councilors, who are experienced adoptive nursing mothers, in some areas.

Physiological Preparation

Some women, who have had babies placed for adoption on extremely short notice have thought that they could not nurse because they had not prepared. It is important to understand that, while some preparation of the breasts is helpful, it can be done without, if necessary (Citation Needed).

A very simple first step in this is to get used to keeping soap off of the nipples. Warm water is sufficient for cleaning and does not dry out the tissues like soap does.

A potential adoptive mother should determine whether her nipples are inverted or flat. If they are, it is easier to deal with before the baby comes than after. Having flat or inverted nipples does not mean that someone cannot nurse. Babies throughout the history of mankind have nursed on nipples of all types. However, since most adopted babies have had bottles or pacifiers (which are inserted into the mouth, where nursing requires the baby to open up and latch on) before their adoptive mothers have a chance to nurse them, it is even more likely that nursing will be difficult if the mother's nipples are flat or inverted. A simple test is described at a link provided below. It is not always easy to tell by looking.

The simplest first step in assisting the nipples to stand out is to wear breast shells designed to put gentle pressure on the area around the nipples.

Nature provides many changes in the breasts during pregnancy. Besides the changes of the structures inside the breast, there are changes in the nipples and areolas. There are some things that adoptive moms can do to simulate these effects.

It is a myth that a nursing mother needs for her nipples to be "toughened up". Tactile stimulation of the nipple and areola is essential in getting the message to the brain that there is a baby nursing who needs milk. However, since the invention of the bra, many women in industrialized countries have developed a nipple sensitivity that it more extreme than nature intended it to be. Bras made of artificial fibers, especially, can produce a less than optimal situation. For women who spend most of their waking hours in a bra, it can be helpful to go braless or wear a nursing bra with the flaps down. This is only to promote air circulation and provide a small amount of tactile stimulation. The clothing worn over the breasts should be soft and, preferably, cotton.

Pumping of the breasts is very often found to be helpful in preparing the nipple area for nursing. This helps mainly by increasing the elasticity of the tissues and, possibly, enlarge the areola to some extent. Some try to do this with nipple "rolling" or other manipulations of the nipple. The problem with these is that they tend to stress the base of the nipple, which is prone to cracking. A good pump, which fits the breast well, disperses the suction over the nipple and areola, avoiding stressing one spot.

Breast massage, or compression, is also sometimes found to be useful in preparing the breasts, and also in helping make what milk is in the breasts more easily available to the baby.

Some moms use a full-sized, double electric pump, but a good hand pump, or small electric model, used a few times a day for a few minutes at a time, may be nearly as effective, without the financial investment. No cylinder or bicycle-horn pumps should be used. This pumping should be done slowly and carefully. Hurting the breasts is not the object! Sometimes, moistening the breast with an unscented, hypoallergenic moisturizer, or even warm water, is useful in avoiding irritation.

Taking on a rigorous schedule of pumping, in an attempt to bring in milk in advance, is sometimes recommended. However, although a few women are able to eventually pump a few ounces, the VAST majority see no more than drops, or even droplets, for their efforts. This has discouraged some women so much that they have given up before they even got their babies. Experience with a pump is not a dependable way to predict what the experience will be with a baby. Pumps do not express the breast in the same way that a baby does, and they don't elicit the same emotional response that triggers the production of lactation hormones. Some bio moms have a very hard time getting much milk out with a pump, even those who have thriving, totally breastfed babies. The increased anxiety that many prospective adoptive moms are experiencing can greatly inhibit the emotional/physiological responses to breast stimulation.

Anyone considering such a pumping routine should take many things into consideration. One difficult, but real, fact is that many prospective birth mothers decide that they cannot go through with placement, once the baby is born. While this is their right, and I am in no way criticizing mothers who do this, it is a very painful thing for a prospective adoptive mother to deal with. Some mothers who have been pumping around the clock for weeks or months beforehand, have said that they thought that fact made it even more difficult for them to deal with the loss of the potential baby.

Other moms decide to pump and then find that it produces too much anxiety for them. They need to know that they can quit at any time without reducing their chances of success once a baby is placed with them.

The time required for the first droplets to appear varies from a few days to several weeks, but does not appear to be a very good way to predict what the mom will be producing when her production reaches its peak, which occurs after about 12 weeks of nursing. The amount of milk that an adoptive mother gets from pumping alone is usually not a bit accurate in predicting how much milk is there or how much may eventually be produced.

Supplementers

Nearly all adoptive mothers need to supplement their milk supplies AT LEAST until their babies are taking solids and other liquids by cup or bottle. Many use a supplemental device the entire time they are nursing. Some use it well beyond the time that the child actually needs the supplement from it, because the child is accustomed to having it their and will not nurse well without it.

Use of a nursing supplementer is strongly encouraged over other means of supplementing, such as bottles, eye-droppers or syringes. It is important to make sure that the baby is being adequately fed, that nursing is a pleasant experience for both mother and baby, rather than an ordeal, that as much sucking as possible is done at the breast, and that the device employed not pose a threat to the baby in any way. The only devices that meet all of these criteria are nursing supplementers.

There are two two nursing supplementers available in the USA, which are intended for use by adoptive mothers, the Lact-Aid Nursing Trainer and the Medela Supplemental Nursing System.

In a pinch, a temporary supplementer can be made by inserting a length of tubing through the hole of a bottle nipple. The tubing should be long enough that one end will hang down to the bottom of the bottle and the other will reach the mother's nipple. If one of the tall, narrow, plastic bottles from ready to feed formula is used, the mother may be able to just tuck it into her bra. Some moms who use the SNS have found themselves in need because the the tubing to the device has broken off. This tube would be fine for inserting through a bottle. A gavage feeding tube can be used for this, if it is the only thing available, but it would be obvious to the baby and probably rub a a raw spot on the breast quite quickly. Anyone using this would want to find a Lact-Aid or SNS as soon as possible.

Milk Production

The primary method of inducing milk production in a woman who has not given birth is to have the baby positioned and sucking well at the breast. Adoptive mothers often need to pay especially close attention to the positioning and latch of the baby. Bottle nipples, which most of adopted babies have become accustomed to before adoption, do not require the baby to take an active part in getting them into his mouth. Nor do they require the same type of sucking that nursing at the breast does. Some are worse than others. In general, the smaller, more pointed, bottle nipples are the worst for a baby whose adoptive mother want to nurse him. They, in effect, "confuse" the baby about what he needs to do for food. Nursing can, of course, still be done, although it may take a bit more patience and creativity, but it is much easier to prevent the problems they cause.

There are things that can be done to help avoid nipple confusion. Prospective adoptive mothers are often counseled to arrange to be present at the baby's birth and start nursing immediately thereafter, if possible. This is often not physically possible. Even in cases where it is, the wishes of the prospective birth mother should be considered first. If she expresses a desire to have the adoptive mother there and nursing immediately, which is occasionally the case, that is what should be done. However, it is generally better to allow her to to have that time to herself and the baby. Remember that she cannot, and should not have to, make a final decision until after the baby is born. As difficult as that may be for a hopeful adoptive mother to have to think about, it is only right.

So, in most cases, our babies will be fed in some manner before their adoptive mothers have a chance to nurse them. Sometimes adoptive parents do not even learn about their babies until after they are born. In that case, there is nothing that can be done to avoid the baby being fed with whatever bottle nipple the hospital nursery is using. If, however, the situation is such that the potential adoptive mother can make requests about how the baby will be fed until she takes custody of him, there are a few things that would be helpful.

The type of nipple that is used can make a difference. The best choices are either orthodontically shaped nipples or Avent bottles and nipples. Feeding the baby with a feeding tube attached to a finger is another option. So is cup feeding, which is often used in third-world countries, to`help avoid nipple confusion in babies who are temporarily unable to breastfeed. However, cup feeding does not meet the baby's sucking needs. This is very important to the well-being of a baby. A baby being cup-fed could be given a pacifier too, but it should be an orthodontically shaped pacifier or an Avent pacifier.

Whatever method is used, the baby's lips should be tickled and he should be encouraged to open his mouth and take the bottle nipple, finger or pacifier into it, rather than it being inserted into his mouth. This may help preserve the "rooting" reflexes that babies are born with, which are there to help them find the breast and start nursing.

Many of adoptive parents don't have the option of making requests about how you want the baby to be fed. Adoptive parents shouldn't become over-concerned in such instances. Some babies will still latch on and suck just fine. Others have minor difficulties at first but ultimately become good breastfeeders. A few have so much trouble that you cannot overcome it with a little patience and creativity.

There are some other things that can be done to maximize milk production, but the most important thing is having the baby nursing well at the breast. The more frequently, the better.

Pharmaceuticals

Drugs In brief, the two drugs which have been shown to be the most effective at increasing milk production are metoclopramide, AKA Reglan, and domperidone.

Metoclopramide has proven to be a very hazardous drug, because of the very high potential for side effects such as depression and/or anxiety. These symptoms can appear immediately after starting it, after it has been taken for awhile, or only after the drug is discontinued. The effects can be quite severe and also take several weeks or months to subside after the drug is discontinued. The modest increase in milk production that it is known to produce is not worth the risk of these side effects. Some moms have become so depressed that they wished they hadn't adopted their babies, felt totally unfit to be mothers, or even had suicidal thoughts. There does not appear to be any way to predict who will have severe effects and who will not. The vast majority of adoptive moms who have tried this have experienced them to some degree. Most have stopped taking the drug soon after noticing the effects, which may have prevented severe symptoms. (Citation Needed)

Domperodone has been used to successfully augment milk production in adoptive moms, without the side-effects of metoclopramide. The recommended dosage is 20mg., four times daily. Remember that this only helps with milk production. It does not take the place of time spent nursing the baby, nor does it guarantee a large milk supply.

Herbal Supplementation

Many herbs have been used to improve lactation. The most common of these is fenugreek seed. I have provided a link to an article about the use of this herb. It can be taken whole, washed down like small pills, made into teas, taken in capsule form, or in infusion form.

Among the other more popular herbs for this purpose are blessed thistle, fennel, nettle, marshmallow, red clover and red raspberry. Taking both the fenugreek and one other, or a combination of them, may be the wisest course to take. Some prepared forms of these are available, including Mother's Milk tea, which is widely available in grocery stores, and More Milk, offered by the Motherlove herbal company.

Sources

Breastfeeding Manual. Originally written for adoption.com by Darrillyn Starr.