adoptive breastfeeding tutorial

i'm doing it again.  the adoptive breastfeeding thing.  so i thought i'd walk you all through the process and give you a little insight into my pill popping world of late. 

first off, to breastfeed an adopted baby (or baby born via surrogate) you've got to prepare well in advance.  i should have started sooner, but i think i'm still fine.  basically, you can find information on the different ways to prepare to breastfeed on a website called ask lenore, as well as on a website called the adoptive breastfeeding resource website.  both are great places in terms of the information they provide, but both have their own feel to them.  the abrw has moderators that tend to lean toward the natural way of inducing lactation and ask lenore is a little more balanced, in my biased opinion.  both have message boards that are a great place to get your questions answered, but the abrw recently started charging a fee for the use of their boards, and the ask lenore boards are free of charge.  both also have multiple boards dealing with things like infertility, surrogacy, natural and medicated methods of inducing lactation and a host of other topics.  these sites are both good places to begin your research.  and research you must!  but i'll get into that a little more in-depth later. 

to induce lactation last time i used the Newman-Goldfarb protocols for Induced Lactation: The Guide for Maximizing Milk Supply.  i used the accelerated protocol to prepare for z, but this time around i'm using the regular protocol, since i have the time.  in other words - i go the completely medicated route.  i just don't have the persistence to stick with the natural route.  so to do this, here's what i have to do: 

1. take a birth control pill, either yasmin or microgestin continuously for six months.  this prevents me from having a period and makes my breasts prepare in a similar fashion to what happens during pregnancy.  they basically get at least a cup size larger and become painful.  what fun, right? 
2. the same day i start the birth control pill (i'm taking the yasmin) i begin taking 10 mg. of a drug called domperidone four times a day, twenty minutes before i eat.  domperidone is a stomach medication that is not fda approved.  but it's been well-researched in the breastfeeding community.  and the reason it's not approved is because there are other stomach medications out there that the fda feels do what domperidone would do and it is therefore unnecessary to approve dom.  anyhow - it's all bureaucracy.  to obtain domperidone, one must semi-illegally import it through a company called global drug, or get a prescription from your physician (like i did this time) and obtain it through one of the few compounding pharmacies in the u.s.  so it's legal, just not approved - get me?  and domperidone has the amazing side effect of telling your pituitary gland to lactate.  cool stuff, huh? 
3. a week after beginning things, i must up my dosage of domperidone to 10 mg. four times a day. 
4. i continue with everything for six months.
5. once the six months is up (for me, it will be august 7th) i stop the yasmin, continue on the domperidone and should have a period of massive proportions.  it's like what happens in a pregnant woman when the placenta is expelled.  again, fun, huh? 
6. i also start in with the breast pumping.  this stimulates my milk to come in, as if i had a baby breastfeeding at this time.  i've purchased, for a smoking good deal, a used hospital-grade medela lactina breastpump.  don't worry - this one is actually approved for multiple users - and is the exact model that my local lactation clinic uses.  it's hefty duty.  and lovely, don't you think?  you wanna know how many times i have to pump a day?  every three hours and once between the hours of 1:00 a.m. and 5:00 a.m., as my prolactin levels will be highest at that point in the day.  yes, that means that i will be strapped to the blue monster at 8am, 11am, 2pm, 5pm, 8pm, 11pm, 2am, and then i get a break until i wake up again to pump at 8am. 
7. good news, though!  this means that i will begin getting breastmilk that can be stored in my freezer for up to 12 months.  so if nothing else, i will have a massive stock pile built up for coffee when you come visit me! 
8. and i must continue the domperidone throughout breastfeeding. 
9. i can also take herbs like blessed thistle and fenugreek (which makes me smell like curry, yum!) three times a day and eat oatmeal once a day to also help increase my milk supply. 

so - guess what the maximum amount of pills i will have to take per day will be?  just guess.  you'll never guess.  ok.  i must, at one point in this process, take twenty pills a day.  my god.  at this point, my gag reflex gets a little heightened, as i try to down six pills at once. 

in order to be able to logistically pump as much as i'll need it, i need to buy one of these.  or maybe i'll try making my own.  and then i can sit online and blog six times a day for fifteen to twenty minutes a day. 

once the baby is home, he will do most of the work of the breast pump (thank god) and i'll be able to significantly reduce my pumping time.  and all that saved-up frozen milk?  well - if you won't accept it in your coffee or tea - someone will have to use it.  so i guess it will be the baby.  and the way we'll use it is with one of these handy dandy thingys.  i put the milk in the bag, strap the tube to my breast, and plop my breast in the baby's mouth.  and ta da!  we have milk from the bag, milk from me, and the baby stimulating my milk supply to increase. 

with these protocols, it is expected that i'll be able to produce most of my child's milk needs.  the rest will come through the lact-aid from my frozen milk and if necessary, i'll supplement with an organic formula.  i know that sounds doubtful, but my friend certainly did it.  she was like a one-woman dairy farm on the regular protocol.  last time, i managed to pump quite a bit of milk, but because of multiple factors, z and i had to give up the breastfeeding just a few short months after we began.  this time, those factors won't get in our way, and i hope to breastfeed my son as long as he damn well pleases.  but no, he will not be allowed to as for my 'nu nus' or 'ta tas' or 'nuk nuks' or even 'bubbies'.  they are breasts.  when he wants to nurse, he'll have to ask to nurse.  or breastfeed.  or maybe he'll wean early.  who knows. 

now - how many of you are asking, 'why on earth is she doing this?'

Comments

[Jenny]

Actually, I have been really struggling with whether to do this myself! I am considering it quite seriously, but the concept weirds out my husband. :) (Did you have that issue at all?) We are not hooked up with a birthmom yet, but when we are, I may start the protocol -- either accelerated or regular, depending on how things go. But I have to say, I really, really can't see pumping every three hours, especially at work! I just can't imagine explaining it to my co-workers, even though they know I'm adopting -- the concept is so foreign to most people. So, I don't know if that means I'm not committed enough, or what. :) Anyhow, thanks for all of the info! I had another friend who tried it, but was unfortunately unsucessful. So, it's nice to hear that you have had this work out, at least for awhile.

[Cityslicker mom]

Oy. all that pumping talk is bringing back so many memories! let me just say I never want to pump again!! good luck:)

[Ann]

Oh, how I hated to pump. You are amazing to do this...what a great thing for your new baby-to-bed.

[Kohana]

so.much.work.
can't.comprehend.
go for it!

[mamamarta]

okay, i have to admit that i now wish we had a little pet name for nursing, because my almost three year old all-too-often yells, at the top of his lungs, in very public places, "i wanna nurse! i waaaannnnnaaaa nuuuuurrrssseee!!" and while i'm all about nursing in public, am a big old lactavist, and all of that, i have to admit that sometimes i'd like to be able to be a little bit more discrete about it with the hulking, 35 lbs of walking, talking (in paragraphs, much less complete sentences) boy!

[shannon]

I looked into it last time, but it seemed like SOOO much work for only a partial ability to feed the baby.

So my question is: How much do you produce and what %age of her dietary needs can you fill this way?

I guess because I'm mulling it over again for baby #2.

Oh and how long did you breastfeed Zade?

[stellarma]

i'm so impressed and proud of you! you are so very inspiring :)

[Marisa]

This is great. I really want to do it, too, but I've been worrying about taking a drug and breastfeeding - even if it's a drug that makes it possible to breastfeed in the first place. Do you know about any research on it? I'd like to do it naturally, but, as you said, it might be a hella long time of preparation for a few drops.

[Brooklyn Mama]

Awesome!
Very best of luck!

[Suki]

I'm a new reader, and have to say--Awesome! What a beautiful gift to your child. Stay positive, don't give up. BFing my baby was the most difficult and rewarding things I've done in my entire life, as I'm sure you can relate with Zade.

[kim.kim]

I find the idea of an adoptive mother breastfeeding offensive.

[Lilian]

*Fascinating* stuff! The link to the home made contraption for "handless" pumping? -- hilarious, but it seems to be effective, and cheaper than the store bought one.

I had to pump when my son wouldn't latch on and I used the Medela SNS for the feedings - so I know perfectly well how the other contraption you linked to works.

Well, I hope this time breastfeeding lasts longer. I was actually wondering for how long Z. had nursed.

kim.kim I know where you're coming from. Your comment really made me try to think about this from the birthmother's perspective. Of course I haven't thought long enough, but my reaction right now would be - Afrindie is still going to be the baby's mother (albeit the "second" one), and if she can give him the best nutrition (breast milk), that's a good idea...

[kim.kim]

I have nothing against Afrindie, she's a really cool person. It's just adoptive breast feeding is something that is highly un-natural. The best nutrition for a baby is his own mother's milk, not milk induced by a series of drugs. I don't want to get into a debate about this and I really don't want to offend Afriendie.
I know you are good people and mean well.And I wish that this didn't disgust me but it does. If I thought that my daughter's adoptive mother had breastfed my daughter I would be horrified.
Anyway, I know this will come out more offensive than it is meant, please just try to see it from different perspectives and if you still disagree well I can't force anyone to change can I.

[Amanda/Mayhem Mama]

I'm very impressed! Good luck to you, and thanks for all the info.

I contemplated adoptive breastfeeding, but when I started reading about it I got overwhelmed and didn't really try.

You've broken it down to the basics, and I'm sure other adoptive moms will find it helpful.

[afrindiemum]

kim.kim
i do understand where you're coming from. honestly i thought that way at first, too. i was all - whaaaaa? that's weird! but after feeding z formula, i'm even more convinced that this is the right thing to do.

our baby's bio mom will know that i plan to do this prior to placing with us - i want to make sure she's on board with this.

but as for being unnatural - well - i don't know what to say to that. i do feel that my breastmilk is better and more natural for any child than formula is - but that's just my opinion. and as for the medications, they do not pass the blood-brain barrier, so there is no worry about it affecting the baby. the breastmilk is just as nutritious as a first mother's.

you may think it unnatural, but it is just another way to do the best thing possible in a not so ideal situation. i hope you can also see it from my point of view.

[kim.kim]

No I can't see it from your point of view at all. I wish I did, really I do but I don't. What is natural about taking twenty pills a day? The baby's mother will have perfectly good and naturally produced breast milk. I die my hair, it's not naturally this colour, that's not being rude about my hair it's just a fact. Natural means not forced, not chemically induced and produced by nature.
It's not that I think it's un-natural, it is un-natural. That's not me saying you are a bad parent or a bad person because I am not. You will do what you do and the world will keep turning. We can't all agree on everything.

[Kristen Jean]

Okay, I can't see how taking anything that is not FDA approved is safe regardless of what the breastfeeding communities are saying. You could be putting the child at risks that are unknown to you and those communities. Next, hormonal birth control methods, the FDA does not know what affects that those forms of birth control have on breastfeeding. It's another risk that you are taking. Women who give birth are off of birth control for at least a year. When I spoke with my Obgyn she told me when I was ready to have children that first I would have to be off of birth control for a year maybe more. Second that I was advised not to go back on birth control until after I was completely done breastfeeding becasue I do intend to do that. And no I will not read into adoptive mother breastfeeding sites, that is not the place to get the best information about hte drugs you have been putting into you body. Any chemical means of anything is not natural.

Next, the baby can smell the difference between your breast milk and his/her first mother's breast milk . Whether you breast feed or not the infant with subconsciously know that something is different that something is "not right" because no matter what you do you milk is different.

Now I wouldn't have much of a problem if there were no chemicals involved. But if you look at the delicate balance in diet that women need while pregnant and that certain foods affect the child differently ( In this instance, I am thinking abotu red meat, if you eat a whole lot of read meat durring pregnancy and have a daughter she will get her period much early than a child who's mother did not eat alot of red meat during the pregnancy). The hormones and chemicals in foods can cause bad effects for life in a child.

If by some chance the FDA comes out with new studies that show that this unapproved drug or that hormonal birth control is not good for breastfeeding and can harm your child, then what will you do? the damage is already done. I think thats really unfair.

As an adoptee, I would be horribly angry if my adoptive mom tried to do this claiming that it was better for me. Weighing the options, either get her/him natural breastmilk or give him/her formula.

I have also heard of men who if they are around a crying baby enough can and do also begin to lactate. Why not do the natural route. If you can't get pregnant you just cant and if you cant naturally breastfeed I don't think you should. Maybe thats just me.

[m]

I really admire that you're going to all this work to provide breastmilk to your baby. I thought about doing this myself since my wife will be carrying our first baby, but have decided instead to go the route of a supplementer. Of course, we'll already have a supply of fresh breast milk in the house. Good for you!

[Jen (yup, another one)]

Good for you! It sounds like it will be a tough road but I know you had success already with Z, so best wishes.

To those of you who disagree vehemently with Afrindie, are you also opposed to mothers with supply problems taking drugs (the same exact ones she's talking about) to increase their supply? Do you find breast milk banking offensive? These are medically supported practices (for adoptive and NON-adoptive families) because when at all possible, breast milk is better for babies.

[afrindiemum]

hey all -
the non-fda approved thing isn't anything more than just the fda. this medication is approved in many other countries for breastfeeding purposes. it's what they give to natural mothers that have trouble producing a full-supply of milk for their children. it doesn't pass the blood-brain barrier, therefore it does NO HARM to the baby. it HAS been studied and approved for use - just not in the US. it's even prescribed here in the U.S. I have a physician following me closely and she prescribed all of the medications i'll be taking. so it is approved - it's not dangerous.

and this breastmilk is better for a baby than formula - there have been studies done on it.

lastly - the birth control pill isn't something that is taken during the time the baby is breastfeeding. so there is no way that it will affect the baby whatsoever. as for needing to be off the pill for at least a year before getting pregnant - as i understand it - it's purely because your body must take time to regulate it's cycles again and you're not likely to get pregnant until that happens. it's nothing to do with endangering the baby. no - you don't want to be on the pill when you're pregnant - but many, many women do get pregnant on the pill and the babies are just fine. this will be the same type of thing.

and - my body will lactate on it's own. if i put a baby to my breast, it would stimulate my pituitary gland to create milk for the baby. many women have done this in times of emergency. in fact - the world health organization even has guidelines on how to breastfeed during an emergency situation when you're not a lactating woman. the medication - what it does - is ups the amount of milk i'll produce.

this, like everything else, is something that must be resarched well before a decision is made. and i've done my research. i'm well versed on both the pros and cons of ab. and the cons? well, they're few - and they only affect me.

[Mary]

Leaving aside the "drugs or no drugs" issue, I think it's important to point out that back before there was such a thing as formula, it was common for babies to be nursed by women who weren't their mothers. If a woman died in childbirth, another woman would have to feed the baby--otherwise it would die soon after its mother. Rich women who survived childbirth would have a wet nurse as part of the household staff.

Not that I'm favoring a return to the middle ages, I'm just saying there's a very long tradition of women nursing babies they didn't give birth to, and it was never considered unnatural in the past.

"Thou wast the prettiest babe that o’er I nursed"--Nurse to Juliet (William Shakespeare, Romeo and Juliet)

[Amy]

I'm wondering if those who are against adoptive breastfeeding would be against any mother using medication to induce or support lactation. My sister used domperidone, fenugreek and pumping to help support her in breastfeeding her twins since she had a very traumatic delivery (she was in the ICU for 3 weeks afterwards) and her milk supply was severly impacted. It never got her to the point where she could breastfeed exclusively but it helped a lot. It certainly doesn't seem any more unnatural than formula.

And while from an anti-adoption standpoint I can see where you are coming from the idea of children being breastfed by someone other than their mother is nothing new. Wet nurses have been around for as long as babies have. My grandmother lived with my aunt who was her wet nurse because her milk never came in. I'm not trying to pick on you guys I am really just curious if you see that differently and if this is really an adoption issue rather than an "unnatural" issue.

[mamamarta]

according to the world health organization, the best way of feeding an infant is breastmilk from his biological mother's breast. second best is his biological mother's expressed milk fed through some other means than the biomom's breast. third best is another woman's breastmilk. fourth best is formula. (sorry, i can't find the citation quickly, but i'll find it if anyone wants it.)

the breastmilk of women who have induced lactation is exactly the same in composition and nutrients as the breastmilk of woman who has been pregnant and given birth, after the first few weeks (no colostrum is produced when a woman induces lactation). (this is according to studies conducted by lenore goldfarb, who developed the newman-goldfarb protocol with dr. jack newman. she induced lactation for her two children who were carried by a gestational surrogate. she is now an international board certified lactation consultant and pursuing a ph.d. in human lactation.)

domperidone is an L2 category drug according to dr. hale, whose "Medications in Mother's Milk: A Manual of Lactational Pharmacology" is the most comprehensive study of the effects of various medications on breastfeeding and the breastfed infant. an L2 category drug is generally considered "safer" for breastfeeding women: "Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant. And/or, the evidence of a demonstrated risk which is likely to follow use of this medication in breastfeeding woman is remote." this is in comparison to an L1 category of drug, which is considered "safest"; an L3, which is "moderately safe"; an L4, which is "possibly hasardous"; and an L5, which is "contraindicated." many many other L2 and even L3 drugs are routinely used by bfeeding women under their doctor's supervision. the american academy of pediatrics approves of the use of domperidone in breastfeeding moms, and it is routinely used around the world for mothers -- both biological and adoptive -- who have supply issues. in most of the developed world, domperidone is an over-the-counter medication; it has not been fda approved entirely for commercial and political reasons.

the levels of progesterone and estrogen in the the birth control pills used in the newman-goldfarb protocol closely mimic the levels of those hormones during pregnancy, which is why, in combination with prolactin (which domperidone produces), they stimulate the breasts to prepare for lactation.

there are potentially risks -- currently unknown -- associated with the use of these medications for inducing lactation (as there are with any medication, herb, homeopathic remedy, etc. used during lactation), although all of the current understanding of their effects suggests that they outweigh the actual and known detriments of artifical infant food, which, according to the american academy of pediatrics include but is not limited to an increased incidence of various infectious diseases; type 1 and 2 diabetes; lymphoma; leukemia; hodgkin disease; overweight and obesity; hypercholesterolemia; asthma; and a 21% increased postneonatal infant mortality rate. (see Breastfeeding and the Use of Human Milk, Section on Breastfeeding, Pediatrics 2005; 115; 496)

my son's mother does not know that i breastfed him, because she did not want to know anything about us. before our son was placed with us, we were matched with a pregnant woman who ultimately decided to parent. i told her that i was planning to breastfeed, and she was very very happy and supportive of that. i personally would never accept a placement of a child whose mother actively disapproved of my breastfeeding our baby. i feel very very strongly that adoptive moms *must* communicate that information to the first mothers of their children before placement; i know that many don't, precisely because they are afraid of a reaction like kimkim's, but i think that's just wrong wrong wrong.

i know that afrindiemum agrees with me on this one.

my son is almost three and still an avid nurser.

[mamamarta]

errata and disclaimers: i should have written above (and thought i had) "...although all of the current understanding of their effects suggests that they outweigh the actual and known detriments ASSOCIATED WITH [rather than OF] artifical infant food..." i do not know whether or not there is a documented causal relationship between any of these risks and artifical infant food, although there is certainly a well-documented correlation between the two. and, just to ward off the inevitable anecdotes about everyone's cousin, husband, daughter, etc. who was formula fed and is a perfectly healthy rocket scientist, let me also say that the detrimental correlation between artifical infant food and various risks (including, yes, a lower iq, if you care about those sorts of things, which i don't) can be seen clearly from a public health perspective, i.e. when populations are observed as a whole, rather than any particular individual. and no, i don't think it's terrible to feed your baby formula, and no, i don't think you are a bad mom or dad if you do. many wonderful parents have fed formula to many healthy, happy, well-adjusted children, including me and julie. and our parents, for that matter. so please don't take the data personally, okay?

[kim.kim]

What happens if the mother decides not to go ahead with the adoption and keeps her baby. I also worry about the assumption that the mother will not change her mind. Doesn't that put more pressure on her, isn't that coercive? Should potential adopters assume they are going to get the baby or should they take the stance of letting the mother see her child, have some time without pressure and then decide? Having yourself all set up to breastfeed would be another element of pressure on the mother. I think it's better to let the mother know that you support her choice not to part with her baby and that you would respect that. I am going to be honest here, it makes me really angry. I really resent people who call pregant women birthmothers or biomothers, she's a mother, she's not a potential mother and she will never be an ex-mother. I think you should take a step back from a pregnant woman and not be hovering with your bassinets and your breasts full of chemically induced milk. Your baby rooms all beautifully furnished waiting for another woman's baby. I think you should be gracious and tell her that you are not assuming you will get her baby. Be honest and say you hope to be a parent but see it for what it is. To get another mother's child is to destroy her life so before you go in and do that, step the fuck away and give her the space to see if that's what she really wants to do. SOrry about the intensity, I am premenstrual but I am also a mother who had a lot of pressure when her daughter was born. 22 years later I am still dealing with the aftermarth of that so I feel very protective of other mothers like me.