Ask the Expert- Adoptive/Surrogacy Breastfeeding
Our expert, Lenore Goldfarb, Ph.D., IBCLC is a lactation educator, International Board Certified Lactation Consultant (IBCLC), researcher, and co-
founder of the Goldfarb Breastfeeding Clinic and Program located at the Jewish General Hospital in Montreal, Quebec, Canada. She is the co-author of the Newman-Goldfarb protocols for Induced Lactation: The Guide for Maximizing Milk Supply with Dr. Jack Newman. Dr. Goldfarb is married with two sons born via gestational surrogacy and breastfed via The Newman – Goldfarb Protocols for Induced Lactation.
Keep in mind, that all information presented here is for educational purposes. Consult your physician regarding the advisability of any opinions or recommendations with respect to your individual situation.
E-mail your breastfeeding and induced lactation questions to firstname.lastname@example.org
The medications recommended by Dr. Jack Newman and the doctors at our breastfeeding clinic [in 2011] are Ortho 1/35 (once daily, only active pills, no sugar pills, no periods) and domperidone (10 mg 4 times per day for the first week and then increase to 20 mg 4 times per day) and continue until about 6 weeks before your baby is due to arrive. You must check with your doctor about the advisability of using these medications for you.
NOTE: If you are over the age of 35 you would need to replace the Ortho 1/35 with either Provera 2.5 OR prometrium 100 mg, or comparable medications being used now. There are health risks associated with the use of the combination birth control pill over the age of 35 that you need to discuss with your doctor. And this is why we replace the bcp in our regular protocols with Provera 2.5 OR prometrium 100 mg for the regular protocol for women over 35.
Since you would be taking the Ortho 1/35 OR the Provera OR the prometrium to develop the milk making structures of your breasts and not for contraception, you can start the protocols at any time with your doctor’s knowledge and support. The sooner you can begin the bcp/domperidone combination, the more breastmilk you can expect. The starting dose of domperidone that our doctors recommend is 10 mg 4 times per day for the first week and then increase to 20 mg 4 times per day. Again, check with your doctor.
Kindly stop the birth control pills approximately 6 – 8 weeks before your baby is due to arrive, maintain the domperidone, add the herbs and begin pumping with a good electric breast pump. Hand pumps are not up to the job. The double electric pump fools your body into thinking you have a really hungry set of twins at the breast and is the fastest way to increase your milk supply. You’ll need to pump every 3 hours (a minimum of 8 times in 24 hours for 20 – 30 minutes each session).
Once you’ve started pumping you can add the herbs Blessed Thistle herb (approx 390 mg per capsule) and Fenugreek seed (approx 610 mg per capsule). Most mothers take 3 capsules of each 3 times a day with their meals and their domperidone ½ hour before meals for best absorption.
They also try to eat oatmeal for breakfast at least 3 times a week and drink 6 glasses of water a day but it’s important that you don’t overdo the water. Just drink water when you’re thirsty.
You can expect clear drops, which become more opaque. Then spray, then stream. It may take a few days, a week, or two, or more for you milk supply to come in. Everyone is different.
If your baby arrives before you have completely built your milk supply, you simply maintain the domperidone/herbs, and put your baby to the breast with the help of a supplemental feeding tube device filled with either donor breast milk or formula. It helps to pump for about 10 minutes after most feeds to further build your milk supply.
Before you begin any protocol please check with your doctor to be sure there is nothing preventing you from following a protocol to induce lactation and to be monitored while following it.
Inducing lactation is one aspect of the process the other aspect is getting baby to the breast. Whether breastfeeding an adopted newborn or older child, most mothers find it helpful to obtain the services of a lactation professional who is familiar with adoptive breastfeeding. The International Board Certified Lactation Consultant (IBCLC) is the gold standard in lactation consulting as they are clinically trained to assist mothers with a variety of lactation issues. Another source of support is La Leche League International which has support groups that mothers can attend to share experiences and offer peer support. Most cities have local chapters.
Check with your doctor to see if this is advisable for you. It’s also important that the mother be monitored by her doctor. Not all mothers can take these hormones and there are risks associated with all medications. Also, there is more to our protocols than use of just the birth control pill. The mother would require a galactagogue as well.
In your particular case, without knowing all the facts, I can tell you that according to the available research just about any mother can induce lactation if she has breasts and a functioning pituitary. Because you are over the age of 35 we would suggest a protocol that involves the use of progesterone (Provera 2.5 or Prometrium 100mg) together with domperidone for a minimum of 60 days (longer is better) and then stopping the progesterone approximately 6 weeks before your baby is due to arrive. At that time you would add the herbs fenugreek and blessed thistle and begin pumping with an excellent dual electric breastpump that can pump both breasts at the same time. You will need to pump 8 times in 24 hours, 20-30 minutes per session. Before you begin any protocol please check with your doctor to be sure there is nothing preventing you from following a protocol to induce lactation and to be monitored while following it. [This answer was given in 2011 and preferred medications may be different now. Check with your doctor.]
It is important that you be completely free and clear of any chemotherapy prior to breastfeeding because this is one of the few times when a medication is not compatible with breastfeeding. Chemotherapy medications are designed to go after bad proliferating cells and so could go after the good cells of babies which proliferate at an extraordinary rate (so baby can grow), because the medication cannot determine the difference.
If you are considering a protocol to induce lactation, it is important for you to check with your doctor prior to beginning any protocol. Many mothers with a history of breast cancer have followed a non-estrogen protocol that replaces the combination birth control pill in our protocols (Ortho 1/35 or Yasmin) with a progesterone-only medication (Provera 2.5 or prometrium 100 mg) together with domperidone for a period of time, followed by pumping. The amount of time on the progesterone/domperidone combination is dependent upon when your baby is due to arrive. We recommend a minimum of 30 days but longer is better until about 6 weeks before your baby is due. At that time you would add the herbs fenugreek and blessed thistle and begin pumping with an excellent dual electric breastpump that can pump both breasts at the same time. You will need to pump 8 times in 24 hours, 20-30 minutes per session. Again, before you begin any protocol please check with your doctor to be sure there is nothing preventing you from following a protocol to induce lactation and to be monitored while following it.