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ADOPTION AND BREASTFEEDING INFORMATION AND SUPPORT

Greetings and welcome to my website! I hope that this site will be useful to adoptive moms who want to nurse their babies, as well as others who may work with them in some capacity. As I am a novice at building a webpage, I hope that everyone will bear with me while I figure out the best way to do things! Please watch for frequent updates!

PERSONAL HISTORY

Nursing my six adopted babies has been the most rewarding, wonderful experience of my life! I have been a lifelong breastfeeding enthusiast and believer in the natural apporoach to bearing and raising children. After nine years of unsuccessful attempts at pregnancy, my husband and I finally started our family through adoption.

Our first two children, Stephen Michael and Allan Kimball, were, for various reasons, nursed only for a few months and primarily for comfort. Although this fell short of what I had hoped for, namely a long-term nursing relationship and some sort of milk supply, it was very beneficial and I am thankful for it. Although I suspect that I did produce at least a tiny bit of milk for them, the main benefits were emotional. It helped both of us to establish a strong mother/child bond. It was also very gratifying that, if they were not feeling well for one reason or another, they wanted the comfort of my breast, rather than a bottle. After all those years of infertility, it was nice to feel like there was something important that I could do for a child that no one else could!

Our third child, Thomas Ryan, who had spent the first half hour of life with both lungs collapsed, was the first that I was able to establish a long-term nursing relationship and a milk supply with. Because of the likelihood that he was brain-damaged, I was especially determined that he would be nurtured at the breast and have at least some amount of breastmilk to help his brain develop optimally. Thomas amazed the doctors and nurses who had taken care of him while he was so sick, as well as those whose job was to screen him for signs of developmental problems (which they found none of!). Thomas nursed for a long time. Besides the benefits of nurturing and breast milk, nursing was extremely useful in calming the very extreme tantrums that he had as a toddler. I could either hold him or put him in his room and have him scream and kick for a very long time, or nurse him for 30 seconds and have him calm right down. Thomas is now nine and in the fourth grade. We have seen very little sign of possible brain damage. He does have mood swings and has alot of difficulty with reading, which may or may not have to do with his difficult begininning. Physically, he is extremely strong and agile and excels at any sport he tries. He started competing in power tumbling at the age of five.

Our fourth child, Julia Mazel, came to us as a nine pound, antisocial six month old. She'd been born at term, but with a diaphragmatic hernia. This is a hole in the diaphragm, through which the abdominal organs herniate into the chest. The condition is 100% fatal without surgery, and many children still die of despite having the surgery. Her early life had been hellish. She had spent her first four months in the hospital, having three surgical procedures and being fed through a gastrostomy tube in her side. Her birth parents did not bond with her and, from what we were told about the situation, avoided her, rather than giving her the love and care that she needed. Despite the extreme number of calories that were pumped in through her gastrostomy, she grew very little. At four months, she was very pale, weighed only 7 pounds and was afraid of nearly everyone. If someone tried to speak to her, she would turn her head away from them and, if anyone touched her, she would stiffen up. When she was placed in foster care with a foster mother who held and played with her and fed her solid foods in addition to the formula that was still being pumped through her gastrostomy, she started improving. For the next ten weeks, she did much better than she had in the hospital. She had gained two and a half pounds in that time. Although she was still very small and thin,it was a big improvement, which I am very thankful to the foster mother for. Unfortunately, being, at long last, placed with us for adoption meant having to leave her foster mother, which was another tragedy for her.

Since the story of how I eventually got Julia breastfeeding is posted on the La Leche League website, for which I have provided a link below, I will not relate that here, except to say that Julia nursed from the time she was almost a year old, until she was just over two. The benefits to her, both physiologically and emotionally, were very definite. She is now nearly 8, taller than her older brother, Thomas, and doing well.

Our fifth and sixth children, Joseph Alexander and Joanna "D", came to us at the ages of two weeks and two days. Both were healthy and normal. Although they both had trouble with nipple confusion (which I will write more about later) they nursed for 24 and 20 months respectively and were very healthy and happy. When Joanna weaned, I had been nursing someone, at least occasionally, for eight straight years. I am still missing it a lot!

THE INCREASED IMPORTANCE OF NURTURING FOR THE ADOPTED INFANT

Human newborns are much more emotionally and psychologically developed than they are often given credit for! Research has shown that an infant recognizes the mother who has given birth to him, through her scent, voice, and heartbeat. It is, therefore reasonable to believe that an infant also notices when his birth mother is not there. There is a theory called the "Primal Wound", which holds that children who are placed for adoption have a very difficult time ever learning to trust again, or overcome fears of being rejected or abandoned. While I think the severity and lack of potential for this to be overcome is often exaggerated, I do believe that something to that order exists and that, therefore, it is especially important for an infant who is placed for adoption to be with the adoptive parents as soon as possible and that adoptive parents should take very seriously the need for to do everything in their power to quickly assure the baby that, although the mother he has known is no longer there, she has provided him with someone else on whom he can depend for the love and care that he needs.

There are many things adoptive parents can do to facillitate this process. Spending lots of time holding, rocking and singing to the baby, carrying him in a sling or pack, infant massage, etc., are among the things that are helpful.

Nurturing the baby at the breast can help develop trust and security in a baby in an especially timely manner. There have been moms and babies who have nursed without any breastmilk production and been totally delighted by the experience, including a woman who'd had a double mastectomy and breast reconstruction! With an understanding and appreciation of the nurturing benefits of adoptive nursing, there simply is no room for failure!

MILK PRODUCTION

If you look hard enough, you will find claims that most adoptive mothers who are dedicated will have full milk supplies, claims that very few adoptive mothers produce any milk at all, and everything in between. The truth is, a few adoptive mothers produce no milk and a few produce a full milk supply (defined as enough breastmilk to keep a baby contented and growing normally with no other foods or liquids). The vast majority are somewhere in between. There are so many variables that there is no way to predict what one mom's experience will be. Adoptive moms who have nursed more than one adopted baby even find that their milk production can vary from one child to another.

This can be quite a bone of contention. There are people who insist that if someone thinks they can produce lots of milk they will be able to. Those of us who insist on cautioning against such expectations have been accused of having a bad attitude. This is both puzzling and frustrating. It is EXPERIENCE which has proven, over and over again, that there is alot more going on than just a woman's expectations, or how hard she works at it. There isn't a one of us who wouldn't have loved to have a full milk supply. Many adoptive moms have gone to a phenomenal amount of effort and been as dedicated as they could possibly have been, but the majority have still had only partial milk supplies. Many become very disappointed over this, if they have been led to believe that a full milk supply, or even a nearly-full milk supply, is likely. Some feel guilty. Many feel that they are failures. In my correspondence with many other adoptive moms, I have seen, over and over again, the harmful effects of women being told that if they are dedicated they can have full milk supplies. There are also some who decide not to try it after being told that it is unlikely that they will have any milk at all. But, at least, of those who decide to go for it anyway, the vast majority are happy with the experience. Most produce some breastmilk too.

Take as an example, two hypothetical adoptive mothers (who are composites of actual women I have been in contact with) One is told that nurturing at the breast alone is worthwhile, given accounts of other adoptive mothers who have nursed with a partial milk supply, or even no milk, and told that even a small amount of breastmilk would be very beneficial for her baby. The other is counciled about the benefits of giving a baby only breastmilk, told only about adoptive mothers who claimed full milk supplies and told that, if she works hard, she can probably have a full milk supply too. Both women spend the next month nursing their babies with the Lact-Aid. At the end of this time, the babies are still taking quite a bit of formula, but they are not taking any more formula than when they started nursing, despite the fact that they have gained weight. Some of their soiled diapers show evidence of breastmilk. Both moms can express large drops and an occasional stream of milk.

The mother who was counciled about the benefits of nurturing at the breast and the value of any amount of milk is very happy! She feels confident about her ability to mother her child and takes great pleasure in nursing her little one, knowing that she is doing the best she possibly can for him. Her adopted baby is likely to continue to be nurtured at the breast, and receive enough breastmilk to help keep him healthy, for a long while. The mother who was told mainly of the benefits of complete breastmilk feeding, and that if she worked hard she could probably have a full milk supply, is depressed and feels like a failure. She is likely to decide that it is "not working" and her baby will quite likely end up being totally bottle fed.

Breast milk is SO good that even a small amount in addition to formula can make a tremendous difference in a baby's health. Many babies have come to their adoptive families having already had chronic health problems, which they have found relief from as soon as they started recieving a few ounces of breast milk a day. Such problems include ear infections, chronic constipation or diarrhea and different skin disorders. An adoptive mom who is providing her child with some amount of "liquid gold" has no reason to feel inadequate!

PREPARATION FOR ADOPTIVE NURSING

Educational Preparation:

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! I have also supplied links on this webpage to other resources on the internet.

There is, however, enough written material on breastfeeding in general to keep someone busy for quite some time! 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!

Any mother who sets out to try to nurse a baby should own at least one good book on breastfeeding. I have provided a link to ordering information for one of my favorite breastfeeding books, "The Nursing Mother's Companion", by Kathleen Huggins, RN, MS. It is a very thorough, straight forward discussion. The section on adoptive nursing is short, but accurate. Another thing I like about it is that it does not spend as much time talking about pregnancy and birth, which can be upsetting for a woman who has been struggling through infertilty, as some of the other more prominent books.

Seeing mothers nurse is also a very important part of education. For millenia, human mothers nursed their babies just fine, without reading books or going to La Leche League. They knew how to do it because they had grown up seeing it done. Since the breasts have been considered sexual objects, and breastfeeding has been quite rare, for several decades now, this form of education has been 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.

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 adoptiv 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.

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.

Before going any farther, 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. These can be purchased through Medela, La Leche League (both of which links are provided for below) and many other sources. If you find that the shells are not making a difference, or have severely inverted nipples, You might want to try either the Nipplette, sold through Avent UK, or the Evert-It Nipple Enhancer. See links to both below.

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. These enlarge somewhat and the tissue become more elastic, and . 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. For a good description of this, see link below.

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 nealy as effective, without the financial investment. No cylinder or bicycle-horn pumps should be used. Some very good hand pumps and small electric pumps include those from Medela, Ameda Egnell and White River. Of those that can be purchased in grocery stores or department stores, I would recommend first, the Avent Isis breastpump, and then the Gentle Expressions pump. 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 last thing I will say about this right now is to caution women against being sold expensive things that they do not need. Far too many times, I have had women tell me that they have gone to visit someone who claimed to know about adoptive nursing and said they could help, only to be told that they "have to" pump, and sold an expensive electric pump (or expensive double pumping kit and rental on a full-sized pump). With the high price of adoption these days, they last thing an adoptive mother needs is a bill for $300 for a pump that she will not use, or at least that will not be any more useful to her than a pump in the $50-75 range.

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.

There are some other things that can be done to maximize milk production, (which I will discuss further later) but the most important thing is having the baby nursing well at the breast, the more frequently, the better!

NURSING 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 be 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. Medela's Starter SNS was designed for short term use and will not hold up to the repeated use required for adoptive nursing. In my experience, it does not work very well even when it does stay together. If someone needs to get by for a while with a device available in a hospital, the Medela Finger Feeder would be far more useful than the Starter SNS. (Note: The Nursing Mothers' Association of Australia offers a supplemental device called "Supply Line". It is difficult to obtain directly, however. It is generally only offered to someone who is the client of a lactation consultant.)

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.

Many adoptive moms get their information from La Leche League and, since LLL sells the Medela SNS, are told about it (and sold one) without having a chance to see the Lact-Aid. Some moms make it with the SNS, but many more find nursing to be too much of an ordeal with it. Many adoptive nursing situations have been preserved by a last minute switch to the Lact-Aid.

Of the two, the Lact-Aid is by far preferred by adoptive mothers over the Medela SNS, by mothers who have had a reasonable amount of experience with both (yours truly included!). Among the features which make the Lact-Aid more convenient for adoptive mothers, most of whom must use it many times a day for many months, are that the Lact-Aid is:

-- much easier and faster to put on and get set up to nurse (which is important when there is a baby screaming to be fed!)

--much easier to conceal under clothing and use discretely in front of others

--more comfortable to wear

--easier to adequately clean

--easier to use lying down or slumped down in a recliner

--much easier to use without tape, which can cause a great amount of skin damage

--more conducive to proper suckling.

The tube is softer and more flexible and durable. Some babies who refuse the SNS tube will take the Lact-Aid tube. (They feel about the same to an adult's fingers, but not to a baby's mouth). Another problem with the SNS tube is that a baby will sometimes learn to suck in such a manner as to extract milk from the tube, and not be properly expressing the breast. Some of these problems may be helped by using the smallest SNS tube, rather the medium, as is recommended. However, it is much easier to just start out with the Lact-Aid.

Cost wise, the two are similar. A double Lact-Aid kit costs only slightly more than one SNS. Additional disposable bags must be purchased for the Lact-Aid, if it is to be used very long, but, almost invariably, additional units of tubing must purchased for the SNS because they break. Because the Lact-Aid tubing is more durable and flexible, it is very rare for it to break.

Ideally, the adoptive mother should own enough units that she only needs to wash and fill supplementers once or twice a day. She may be able to get by with one, but it is best to have a spare of every piece that is required. Some adoptive mothers have been caught without one of the tiny pieces required to put the unit together, which is not a good discovery to make when there is a baby who needs to be fed!

STIMULATING BREASTMILK 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 our adopted babies have had before we get them, 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 counciled 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, my feeling is that 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,my concern with cup feeding is that it 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.

If however, you don't have the option of making requests about how you want the baby to be fed, don't worry! Most of us do not have that option. Some babies will still latch on and suck just fine. Few have so much trouble that you cannot overcome it with a little patience and creativity. It is often helpful to consult a La Leche League leader or certified lactation consultant, especially if you are a first-time mother.

My most challenging child to get latched on was my fifth baby, Joseph. He came to me after 15 days on the little pointed bottle nipples that most hospital nurseries use and a little pointed pacifier. He wanted to nurse, but when I touched his lips, he would pucker up like he was waiting for those pointed things to be inserted into it.

One benefit to challenges is that they make us more resourceful! After weeks of trial and error and sore nipples, I finally figured out a way to get Joseph latched on. I would line up his upper lip with the spot on my areola that it should be on in order for him to be latched on properly. Then, I would try to get him to open up as wide as he would (which wasn't very wide). Then, I would quickly flip my nipple, with the Lact-Aid tube, as far into his mouth as I could and then immediately push down on his chin and pull his lower lip out, if necessary, to get him suck more of the breast in. Since this took more effort, and was more likely to cause soreness if I couldn't get his chin down and lip out before he started sucking hard, I didn't do alot of switching from breast to breast. I usually tried to have him nurse from both breasts at a feeding, but if I was having an especially hard time getting him latched on, or was only half-awake, like in the middle of the night, once I got him well latched on to one side, I would usually just leave him there.

POSITIONING FOR NURSING

We usually think of holding babies in the "cradle hold" position for nursing. However, there are many positions that can be used. With a baby who has nipple confusion or other difficulty, or just while mother and baby are both learning to nurse, it can be very helpful to hold the baby in an upright "football hold", or clutch position. It is good to be wearing a bra that supports the breast well, so that you can easily see what is going on. Very large breasted women sometimes find that placing a rolled up towel or baby blanket under the breast is helpful to support it. The baby should be essentially sitting up and facing the breast directly. It is useful to have pillows to help support the baby, so that mom can use her hands to get him latched on. Most good breastfeeding books contain photos of different nursing positions. As you and your baby get more comfortable with nursing, you can experiment to find the most comfortable positions to nurse in. This is especially important at night. With practice, it is possible to rest or even sleep while nursing, either in bed, or in a recliner. It not only helps keep mom from being a worn- out wreck (speaking from personal experience) and is also likely to help her milk production.

Maximizing Milk Production

Since Tripod is evidentally not working right today and just lost three and a half hours worth of text that I had written on this topic, I am writing a very abbreviated version for now. I will concentrate on what I believe is most effective, but without alot of discussion. My apologies!

First of all, remember that the most effective way of stimulating milk production is to have a baby sucking at the breast both often and long. Also, remember that the things that I am about to discuss are options, not a necessities. Nursing full time and preparing formula and supplementers alone requires a great deal of commitment. Each adoptive mom must weigh ALL of the needs of her baby, herself, and the rest of her family, in decisions of how much to do in order to help produce as much breast milk as possible. No one who chooses not to take on any of these other things should ever feel that she is being negligent. Remember that nursing is supposed to be a wonderful, enjoyable, emotionally rewarding experience, not an ordeal. The adoptive mother should avoid things that interfere with her ability to enjoy her baby. Babies enjoy being enjoyed! In fact, they will not thrive without it!

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. I do not recommend that adoptive moms take this drug.

Domperidone has been used to successfully augment milk production in adoptive moms, without the side-effects of metoclopramide. It is not currently available in the USA. However, it can be obtained through a pharmacyies in Mexico, which can be contacted by phone at 011 526 654-1834. 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 quarantee a large milk supply.

Herbs

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.

The only side-effect of fenugreek that I know of is increased perspiration which has a maple syrup scent to it. No cases of toxicity are known to me. A government commission appointed to review several topics in the use of medicinal herbs, which are in common use in Germany, reported no cases of toxicity.

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 (see below for link).

Pumping

Pumping in addition to nursing is sometimes recommended. However, trying to spend time sitting pumping in addition to all of the time spent nursing is not often reasonable. The most effective use of a pump appears to be for use on one breast while the baby is nursing on the other. This should only be done with a gentle pump that is easy to operate with one hand. The Avent Isis pump would be a good choice for this. Again, this should only be undertaken if it can be done without turning the experience into an ordeal.

Breast compression is also found to be helpful by some moms. A link to a good discussion on this is provided below.

HOW FRIENDS AND FAMILY MEMBERS CAN HELP THE ADOPTIVE FAMILY

The following advice comes from not only my own experiences adopting babies, but from my experience in trying to support other adoptive parents, usually the mother, through a quest to adopt, which may take years to accomplish. There are many issues that are not well understood by most people, but which are very important to the new adoptive family. Some of this has to do specifically with supporting an adoptive mother who wants to start nursing her new baby, but much of it applies to any adoptive situation. This is "motherly" advice, which I hope will reach the eyes and ears of people who have someone close to them adopting.

Many people, mistakenly believe that, since the adoptive mother has not given birth, she has been through no ordeal and needs no extra help or consideration. As anyone familiar with adoption knows, adopting a baby is generally an extremely stressful event. There have often been years of attempts at parenthood prior to the adoption. In many cases, where a couple has been chosen by a potential birth mother before the birth, there has been concern about whether the placement would go through and/or,depending on the laws governing the particular situation, whether the baby will be allowed to stay, or whether the baby will be reclaimed after, days, weeks, or even months.

In some cases, most often with international adoption, the potential adoptive mother has known about a baby who was already born and has been given a time frame in which to expect to be able to bring the baby home, only to have the time extended over and over again.

The adoptive mother may also be feeling badly for the birth mother, and even feel guilty about being happy, knowing that another woman is grieving. This is much like the "survivor guilt" that often occurs in people who have survived accidents or other catastrophies where others have been killed.

Worry, long distance travel (in many cases) and concerns about how to finance the adoption (which can run as high as $30,000 or more), can leave a new adoptive mother feeling like she has been through a battle. She is exhausted, physically and emotionally, and she may have stress induced illness, or a worsening of any recurring illness that she may already have had, such as migraine headaches.

It may sound like I am dramatizing, but I am not! People close to a new adoptive family can be of tremendous service, by volunteering to have meals brought in, helping with housework or the care of any other children in the family, offering to pick up necessities at the grocery store, etc.. Because of the financial burden that adoption usually brings with it, others can often help by choosing practical gifts, like diapers, strollers, carseats, etc..

They can also help by timing their visits well. Most adoptive parents are delighted with others'interest in the baby, but care should be taken to visit at a convenient time and the adoptive mother should not be expected to entertain company. Another thing that visitors can do is to help provide the new adoptive mom with opportunities to relax and feed the baby. Whether breast or bottle feeding is chosen, it is important for a newly adopted baby to be fed by his new adoptive mother (or father, if bottle feeding) as near always as possible. Feeding is a very emotionally important experience for a baby, which acquaints him with the adoptive mother and helps him bond with her. A baby can easily become confused about who his new parent(s) is/are, if many different people are feeding him.

If the new adoptive mother is trying to breastfeed, it is important for her to be surrounded by only people who are supportive of, or at least tolerant of, her efforts. Those around her can help by freeing her up to spend more time with the baby and by refraining from volunteering to give the baby a bottle, or any other gestures or comments that would tend to question her ability to adequately feed the baby at her breast. Anyone who cannot be supportive, even grandmas, may need to keep their visits brief. Some of the doubters, however, may be concerned more from a lack of understanding of the process than anything else, and may feel much more capable of being supportive after reading up on the topic.

Another issue that is helpful for friends and family to be aware of is that adoptive parents may have even more concerns about having the baby exposed to many people, than parents who have given birth would have. An adopted baby's maternal stores of antibodies are usually specific to a different area than his adoptive home, making him more susceptible to illness. For this reason, new adoptive parents may feel even more of a need to limit the new baby's exposure to others for a while. Our last adoption is a case in point. While waiting for clearance to travel home with our youngest daughter, Joanna, there was a hurricane developing, which was headed straight for Miami, where she was born. When we were told that all beach front hotels, including the one we were staying in, were being evacuated. I was in a panic! I was actually not nearly as afraid of the hurricane as I was the thought of being in a shelter with my five day old daughter being exposed to hundreds of people from all over the USA and several other countries! Fortunately, some kind soul got on the phone and found us another hotel room in an area that was not being evacuated!


Breastfeeding and/or Adoption Links

Lact-Aid International: Information on breastfeeding with the original, and most highly recommended, device available for providing formula supplement to a baby at the breast.
La Leche League International: Five articles written by adoptive mothers for LLLI's journal for nursing mothers, "New Beginnings".
The Nursing Mothers' Association of Australia: A good resource for breastfeeding information and support, and related equippment.
The Adoptive Breastfeeding Resource Website: This site provides helpful links, discussion, and a bulletin board for dialog about adoptive nursing.
Adoption and Nursing Bulletin Board on ParentsPlace.com : A general discussion of the topic. Be sure to look through the archives!
Ordering information for The Nursing Mother's Companion, by Kathleen Huggins, R.N., M.S.: An excellent general breastfeeding book.
Fenugreek: One Remedy For Low Milk Production, by Kathleen Huggins, R.N, M.S.: A good article on the use of the herb, fenugreek, for improving milk production
Information about inverted nipples: Describes a test to take to determine whether nipples will protrude for nursing.
Avent UK: Information about the Nipplette, a device for everting severely inverted nipples.
Evert-It Nipple Enhancer: Ordering information for the Evert-It, a "mini breastpump" designed to help pull out inverted or flat nipples.
Medela Breastfeeding Products: A source of excellent pumps, breast shells, nursing bras, the SNS, and other nursing aids. Also contains a small amount of information on adoptive nursing.
Mother to Mother Nursing Wear: A good source of nursing clothing that is handy for nursing with a supplementer
Motherlove Herbal Company: Offers fenugreek seeds and infusion, an herbal combination called "More Milk" and a good natural nipple cream that does not need to be washed off.
BabyTrekker: A good, versatile baby pack which can be used for nursing in.
Mothers Against Circumcision: Provides information and support for those who decide to keep their babies' penises intact, as well as factual information on care of the intact penis throughout infancy and childhood.

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