Breastfeeding

The International Adoption Clinic at the University of Minnesota encourages any mother who wishes to breastfeed her adopted child to do so. This viewpoint is supported by the American Academy of Pediatrics in its position paper entitled "Breastfeeding and the Use of Human Milk", and by the American Academy of Family Physicians. The health benefits of human breast milk for infants are many, including protection against a variety of infections (e.g., otitis media, bacterial meningitis, and respiratory tract infections) as well as conditions later in life (e.g., childhood obesity and diabetes). The emotional benefits are similarly compelling, particularly enhanced bonding between a mother and her child.
Many adoptive mothers are physically capable of producing milk. This is true even if they have never been pregnant or have had a hysterectomy. The process of stimulating milk production in women is called “induced lactation”. It demands significant desire, understanding, and time on the part of the adoptive mother in the weeks (and perhaps months) prior to the adoption of her child.  If she has this level of commitment to breastfeeding, it can be a rewarding phase as she anticipates the day of adoption.  Many adoptive mothers who have breastfed have enjoyed the experience even if their milk production never fully satisfied the nutritional needs of their children. 
 
The earlier a woman starts the process of lactation induction, the greater the likelihood that she will succeed in producing milk by the time she adopts her child. But the production of human milk is a complex weaving of multiple systems in the body, and so patience and persistence, as well as supportive family/friends, are vital ingredients.
 
What can a woman do to produce milk?

    * Do breast massage and nipple stimulation
    * Take a prescribed medication called a “galactologue”
    * Take prescribed hormones

If you wish to breastfeed your adopted infant, how should you begin this process?

    * Contact a lactation specialist
    * Contact your personal physician

What will a lactation specialist provide?
Nipple and breast stimulation is the key to any program for inducing lactation. In fact a woman can produce milk using nipple stimulation without taking any medications at all (though this route is likely to take longer and be more time-intensive). A lactation consultant can teach you how to stimulate your breasts by hand or by electric pump, depending on your preference. You will need to do this for at least 4-6 weeks prior to the time when you wish to start breastfeeding, and on a schedule much like that of a breastfeeding infant -- every 2-4 hours. Using double breast pumps can save you time, particularly if you are working. 
 
Most mothers who breastfeed their adopted children still need to supplement their milk supply with formula. A lactation consultant can teach you to use a supplemental feeding device (one brand is called Lact Aid, for example). This device consists of a pouch containing formula that hangs around your neck and has a tiny outlet tube that travels from the pouch, along your breast, and to the nipple. Your child is still cradled in your arms and can suck on both nipple and tube simultaneously. Even if you don’t produce any milk this can be a wonderful way to have the skin-to-skin contact, warmth, comfort, and bonding that goes with breastfeeding.
 
What will my personal physician provide?
He/she will review your health history to ensure that you can safely take two prescribed medications:

    * a galactologue
    * hormones (a combination of estrogen and progesterone). 

What is a galactologue?
Galactologues are a class of drugs that increase the level of prolactin in your body. Prolactin is a hormone that causes milk to be produced. At the time of this writing (2009), two galactologues are commonly used:

    * Metaclopromide (also called Reglan) is the most commonly prescribed medication to induce milk production.  This medication is taken four times per day for about two weeks, and then a gradual “tapering off” over an additional couple of weeks. Metaclopromide can cause some side effects such as fatigue and diarrhea. It can also cause central nervous system effects such as headache, confusion, anxiety, and depression.   So it is important to stay in touch with your physician while taking this medication in case you experience any of these symptoms.
    * Domperidone has several uses and is approved and used widely in other parts of the world. However in the United States the FDA issued a warning in 2004 about its use based on safety concerns when it was given intravenously to very ill patients in a hospital. It has been difficult to find this drug in most U.S. pharmacies ever since. Nonetheless some physicians continue to prescribe oral domperidone because it has fewer side effects in general and specifically fewer central nervous system side effects when used for lactation induction. It also is not as likely as metaclopromide to cross over into breast milk.

What role do hormones play?
Hormones (progesterone and estrogen) prepare the structures of the breast necessary for milk production – for example, expanding the milk ducts and changing the color of the areola and nipple. Your physician may decide to prescribe hormones in the form of a combination birth control pill for several months before your adoption. You would stop taking this pill a few weeks prior to the time when you plan to start breastfeeding, since these hormones actually block milk production. Once the hormones have prepared the inner “workings” of the breasts, you have the ongoing job of stimulating/pumping your breasts so that secreted milk is emptied, which in turn continually stimulates the production of more milk.
 
It is important to note that both galactologues and hormones – like all medications - have potential side effects. The galactologues in particular have not been exhaustively studied in women who take them to induce lactation.
 
One final thought: breastfeeding is obviously an intimate experience. An infant/child who has lived any portion of life in an institutional setting, or has lost a familiar caregiver in the process of adoption, may not immediately be capable of engaging in the trust and attachment necessary to breastfeed.  You may have to invest some months simply laying the foundation for this closeness. Holding your child, massaging, frequent skin-to-skin time, bathing together – all of these (and more!) aspects of mothering will help.  But if your child rejects this closeness initially, keep several truths in mind:

    * there are many stresses in the early weeks after an adoption; once life settles into some routines, breastfeeding success may come more easily
    * gentle loving persistence over time is likely to yield dividends
    * ultimately it is your child’s decision; he/she should not be forced to breastfeed.

REFERENCES
 
American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics. 2005; 115: 496-506.
 
American Academy of Family Physicians. Family physicians supporting breastfeeding (position paper). <http:www.aafp.org.>
 
Gribble, K.D. Mental health, attachment, and breastfeeding: implications for adopted children and their mothers. International Breastfeeding Journal 2006; 1:5
 
La Leche League: The womanly art of breastfeeding. 7th edition. New York. Plume. 2004.