Breastfeeding an Adopted Baby/Induced Lactation

Breastfeeding an Adopted BabyIt is indeed possible to breastfeed your adopted child (or baby born to a surrogate, gestational carrier, or same sex partner). It is usually not easy and often not possible to provide your baby’s full milk supply, but it can be done and can be a rewarding bonding experience for mother and child.

Adoptive breastfeeding is a great tool for bonding. As one adoptive mom wrote in an email:

Breastfeeding was so worth it! I not only felt like most of my “broken” pieces weren’t so important anymore — something maternal worked just like for other women — but being able to nurse in the presence of gestational moms leveled the playing field. It was like I was finally like other “normal” mothers.

In addition to the many resources on breastfeeding an adopted baby that we list below, Dr. Lenore Goldfarb, Board Certified Lactation Consultant, President of the Canadian Breastfeeding Foundation, and co-author of  the Newman-Goldfarb Protocols for Induced Lactation answers questions on our Adoptive Breastfeeding FAQ Page.

Inducing lactation for adoptive breastfeeding take planning and preparation in advance. If you are planning to breastfeed an adopted child, please think through what will happen if the adoption placement falls through because the expectant woman/birthmother decides to parent.

You should consult with your doctor and your child’s pediatrician before making the decision to breastfeed your adopted child or your child born to a surrogate. The information we present is educational in nature and not intended to replace a careful discussion with your doctors who can evaluate your specific situation.

+ How Successful is Adoptive Breastfeeding?
Success in adoptive breastfeeding depends heavily on:

  • How old the child is at adoption
  • Whether the child has been breastfed in the past
  • How motivated the mother

Most women find that they need to start pumping a few months before the child arrives to induce lactation, and need to supplement breastfeeding with formula. It is possible and preferable to supplement through a specialized feeding device designed for this purpose.

Adoptive breastfeeding can provide many benefits to both mothers and babies beyond providing nutrition; however, when people ask if adoptive breastfeeding “works” they are usually asking if adopted babies will nurse and if adoptive mothers can induce enough milk to provide the sole nutrition for their infant.

In a 1995 study of 240 adopted infants in which 80% were previously bottle-fed, 35% of the mothers had never given birth, and 23% had never previously breastfed found the following:

  • 75% of the babies were willing to nurse by the end of the first week of trying
  • More than 75% of mothers felt positive about their lactation experience.
  • 54% of infants required supplementation for the duration of nursing.
  • 25% of women who had never been pregnant before were able to eliminate supplements completely before weaning off the breast.
  • Mothers reported that the benefit of bonding was more important than milk production.

Dr. Lenore Goldfarb, our adoption and surrogacy breastfeeding expert, said on a Creating a Family show that in a study of 228 women following the Newman-Goldfarb protocol, 31% were able to produce all of their baby’s milk needs without supplementation.

+ American Academy of Pediatrics Position on Adoptive Breastfeeding

  • 2005 Policy Statement on Breastfeeding and the Use of Human Milk (PEDIATRICS Vol. 115 No. 2 February 2005, pp. 496-506). Pediatricians should “provide counsel to adoptive mothers who decide to breastfeed through induced lactation, a process requiring professional support and encouragement.”
  • The press/news release issued to announce the 2005 Policy Statement by the AAP went even further: “Pediatricians should counsel adoptive mothers on the benefits of induced lactation through hormonal therapy or mechanical stimulation.”
  • The American Academy of Pediatrics revised their Policy Statement on Breastfeeding and the Use of Human Milk in 2012 and did not mention adoptive breastfeeding or induced lactation at all.
  • American Academy of Family Physicians’ position on Adoptive Breastfeeding states “The physician should discuss with the adoptive mother the option to breastfeed her child. A knowledgeable physician or lactation consultant may help the mother develop a milk supply before or after an adoption. …Many adoptive mothers are physiologically capable of producing milk, to a greater or lesser extent. …Although the adoptive mother may not develop a full milk supply, with induced lactation techniques and the use of galactagogues [herbs and foods that increase milk supply], it is often possible to provide a significant amount of mother’s milk. … In many cases, the opportunity to emotionally bond during nursing is the primary benefit of breastfeeding for adoptive mothers and babies.”

+ How To Induce Lactation Without Pregnancy
Induced lactation requires a specific protocol for almost all women who have not been pregnant. Most protocols suggest starting gradually with gentle massage, nipple stimulation, and pumping a couple of times a day with a high quality electric hospital grade dual attachment breast pump for 3-5 minutes.  The woman works up to pumping for 10 minutes 6-8 times per day.

+ Controversy Over Use of Medications to Induce Lactation
Many protocols also recommend the use of prescribed medications called a galactagogue (a milk stimulant). One of the most popular and successful protocols to induce lactation without pregnancy, the Newman-Goldfarb protocol, recommends the use of domperidone, a drug not approved by the US Food and Drug Administration. Others suggest the use of metoclopramide (brand name Reglan). Still other woman prefer to use herbal galactagogue to try to stimulate milk production with or without the use of medication. (See resources below on herbs used to induce lactation.)

We are not medical doctors and we strongly recommend that you discuss this option with both your gynecologist and your child’s pediatrician. The following information may help you make this decision:

  • Domperidone (brand name Motilium) is a gastric motility agent widely used in Canada, New Zealand, Germany, Australia, Mexico, and South Africa to treat gastric reflux and nausea. It is not approved for use in the United States. Domperidone may also increases prolactin production (galactagogue), and thus is often recommended for lactation induction. Domperidone is not approved for lactation induction in any country, but is being used off label for this purpose.
  • The US Federal Drug Administration warned in June 2004: “The agency is concerned with the potential public health risks associated with domperidone. There have been several published reports and case studies of cardiac arrhythmias, cardiac arrest, and sudden death in patients receiving an intravenous form of domperidone that has been withdrawn from marketing in a number of countries. In several countries where the oral form of domperidone continues to be marketed, labels for the product contain specific warnings against use of domperidone by breastfeeding women and note that the drug is excreted in breast milk that could expose a breastfeeding infant to unknown risks. Because of the possibility of serious adverse effects, FDA recommends that breastfeeding women not use domperidone to increase milk production.”
  • The Transfer of Drugs and Other Chemicals into Human Milk: Policy Statement (PEDIATRICS Vol. 108 No. 3 September 1, 2001, pp. 776 -789). See specifically Table 6.
  • Dr. Lenore Goldfarb was our guest on the Creating a Family radio show where she discussed the use and safety of domeridone. On the show she mentioned the following: “Tom Hale, Ph.D. stated in his book Medications and Mother’s Milk (2008) that no pediatric concerns have been reported following the use of domperidone, that following a dose of 10 mg three times daily, only 2.6 ug/L was found in the breast milk when tested, and that domperidone is “considered to be the ideal galactogogue” (p. 302) and “It is noteworthy to point out that there is a theoretic pediatric dose of domperidone of 0.18 ug/kg/day used to treat infants who suffer from reflux and vomiting (Hale, 2008).” Note, that Dr. Golfarb is not a medical doctor and she lives and works in Canada where domperidone is an approved drug for use for gastric problems.
  • Article by Dr. Jack Newman discussing the safety and use of domperidone. It is not written specifically for adoptive mothers or mothers whose child was born to a surrogate or gestational carrier. Note that Dr. Newman practices in Canada where domperidone is approved for use for gastric problems.
  • Dr. Dena Goffman and Dr. Peter Bernstein discuss the use of metoclopramide (brand name Reglan) and domperidone.

+ Herbal Supplements that May Increase Milk Production
Some people prefer to stay away from prescribed medication for inducing milk supply. The following herbs have been reported to have the effect of increasing milk supply for nursing mothers. Remember that herbs are not benign. If they were, you would not be considering them. You hope they will have the effect of increasing your breast milk supply, but remember they can also have negative side effects for both mother and child. Check with your gynecologist and pediatrician before you take anything.

  • Fenugreek (Trigonella foenumgraecum)
  • Blessed thistle (Cnicus benedictus)
  • Alfalfa (Medicago sativa)
  • Goat’s Rue (Galegas officinalis)
  • Shatavari (Asparagus racemosus)
  • Milk thistle (Silybum marianum)
  • Oatmeal (not an herb, but …)

Creating a Family has many resources on breastfeeding an adopted baby. A few we think you will find particularly helpful are:

Many more Creating a Family radio interviews with experts, videos, blogs, fact sheets, and Q and A’s with Experts on adoptive breastfeeding can be found at the icons below.

 

Sources: Creating a Family resources listed below, www.aap.org, www.asklenore.info


Additional Resources

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Creating a Family Radio Shows on Breastfeeding

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Creating a Family Blogs on Breastfeeding

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Creating a Family Factsheets, Tips on Breastfeeding

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Creating a Family Videos on Breastfeeding

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Q and A's with Experts on Breastfeeding

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