Breastfeeding Your Adopted Baby or Baby Born by Surrogate/Gestational CarrierYou would like to breastfeed your adopted baby, or one born with a
surrogate or gestational carrier? Wonderful! Not only is it possible,
chances are you will produce a significant amount of milk. It is
different, though, than breastfeeding a baby with whom you have been
pregnant for many months. With some determination and perseverance, you
will enjoy the wonderful bond that breastfeeding brings and both you
and baby will benefit from this experience.
Breastfeeding and breastmilk
There are really two issues in breastfeeding the baby with whom you
were not pregnant. The first is getting your baby to breastfeed. The
other is producing breastmilk. It is important to set your expectations
at a reasonable level because only a minority of women will be able to
produce all the milk the baby will need. However, there is more to
breastfeeding than breastmilk and many mothers are happy to be able to
breastfeed without expecting to produce all the milk the baby will
need. It is the special relationship, the special closeness, and the
emotional attachment of breastfeeding that many mothers are looking
for. As one adopting mother said, “I want to breastfeed. If the baby
also gets breastmilk, that’s great”.
Getting the baby to take the breast
Although many people do not believe that the early introduction of
bottles may interfere with breastfeeding, the early introduction of
artificial nipples can indeed interfere. The sooner you can get the
baby to the breast after he is born, the better. The more you can avoid
the baby’s getting bottles before you start breastfeeding, the better.
However, babies need flow from the breast in order to stay latched on
and continue sucking, especially if they have gotten used to getting
flow from a bottle or another method of feeding (cup, finger feeding).
So, what can you do?
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Speak with the staff at the hospital where the baby will be born and
let the head nurse and lactation consultant know you plan to breastfeed
the baby. They should be willing to accommodate your desire to have the
baby fed by cup or finger feeding, if you cannot have the baby to feed immediately after his birth.
In fact, more and more frequently, arrangements have been made where
you will be present at the birth of the baby and will be able to take
the baby immediately to the breast. The earlier you start the better.
This is a situation that should be discussed ahead of time with the
woman giving birth and if there is a lawyer, speak with him or her as
well.
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Keeping your new baby skin to skin with you, you naked from the waist
up and baby naked except for the diaper, is very important at this
time. It helps to establish the necessary exchange of sensory
information between you and your baby and helps the baby stabilize
several physiological and metabolic processes: maintenance of baby’s
blood sugars, heart rate, breathing rate, blood pressure and oxygen
saturation. At the same time, close contact between you and the baby
results in the germ free baby (at birth) being colonized by the same
germs as you. Furthermore, it helps baby to adapt to this new habitat
while at the same time encourages him to breastfeed while helping you
to make milk.
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Some birth mothers are willing to breastfeed the baby for the first few
days. With adoption, there is some concern expressed by social workers
and others that this will result in the biological mother’s changing
her mind. This is possible, and you may not wish to take that risk.
With surrogacy, this may set up some unexpected feeling of resentment
and remorse between the surrogate and the biological mother. This is a
theoretic possibility but it would be helpful if the birth mother did
in fact breastfeed the baby thus helping the baby learn to breastfeed.
It allows the baby to breastfeed, get colostrum, and not receive
artificial feedings at first. Another option is to ask the woman who
gave birth to express her milk for the first few weeks so you have
breastmilk to supplement your own, using a lactation aid at the breast
(see section ‘s’).
- Latching on well is even more important when the mother does
not have a full milk supply as when she does. A good latch usually
means painless feedings. A good latch means the baby will get more of
your milk, whether your milk supply is abundant or minimal. (See the
information sheet When Latching).
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If the baby does need to be supplemented, supplementation should be done with a lactation aid while the baby is on the breast and breastfeeding (See the information sheet Lactation Aid).
Babies learn to breastfeed by breastfeeding, not cup feeding, finger
feeding, or bottle feeding. Of course, you can use your previously
expressed breastmilk to supplement. And if you can manage to get it,
banked breastmilk is the second best supplement after your own milk.
With a lactation aid used at the breast, the baby is still
breastfeeding even while being supplemented; after all, isn’t breastfeeding what you wanted for your baby?
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If you are having trouble getting the baby to take the breast, come to
the clinic as soon as possible for help. In fact you should be followed
by a lactation consultant or someone experienced in helping mothers
with breastfeeding.
Producing Breastmilk As soon as a baby is in sight,
contact a breastfeeding clinic and start getting your milk supply
ready. Please understand that you may never produce a full supply for
your baby, though you may. You should not be discouraged by what you
may be pumping before the baby is born, because a pump is never as good
at extracting milk as a baby who is sucking well and well latched on.
The main purpose of pumping before the baby is born is to draw milk out
of your breast so that you will produce yet more milk, not only to
build up a reserve of milk before the baby is born, though this is good
if you can do it.
Using the medications discussed below in A. and B., helps to prepare
your breasts to make milk. We are trying to make your body think you
are pregnant. The medications are not an absolute requirement for you
to produce milk, but they do help you make more.
A. Hormones—Oestrogen and Progesterone. If
you know far enough in advance, say at least 3 or 4 months, treatment
with a combination of oestrogen and progesterone will help prepare your
breasts to produce milk. A birth control pill is one way of taking
these hormones, but you skip the placebos (sugar pills for one week out
of every four weeks) and go right to the next package; another way is
to use oestrogen patches on the breast plus oral progesterone. Get
information about this protocol from the clinic and see the
Newman-Goldfarb Protocols for Induced Lactation at www.asklenore.info).
We encourage you to take the hormones until about 6 weeks before the
baby is to be born.
B. Domperidone. See the information sheets Domperidone, Getting Started and Domperidone, Stopping.
The starting dose is 30 mg three times a day, but we have gone as high
as 40 mg 4 times a day. The domperidone is continued when the hormones
are stopped. Usually it is necessary to continue it for several months
after you start breastfeeding. Check the information sheets for more
information. Ask at the clinic.
C. Pumping. If you can
manage it, rent an electric pump with a double setup. Pumping both
breasts at the same timetakes half the time, obviously, and also
results in better milk production. Start pumping when you stop the
birth control pill. Do what is possible. If twice a day is possible at
first, do it twice a day. If once a day during the week, but 6 times
during the weekend can be done, fine. Partners can help with nipple
stimulation as well (See the information sheet Expressing Milk)
But will I produce all the milk the baby needs?
Maybe, maybe not. If you do not, breastfeed your baby anyhow, and allow
yourself and him to enjoy the special relationship that it brings. In
any case, some breastmilk is better than none.
Very Important: If you decide to take the medications (the hormones and/or the domperidone), your family doctor must
be aware of what you are taking and why. It is very important to have a
physical and have your blood pressure checked before starting the
protocols. Significant side effects have been rare, but that does not
mean they cannot happen. Your doctor needs to be following you, and
once the baby is with you, your baby’s doctor needs to know that you
are breastfeeding him and needs to follow the baby’s progress just as
s/he would any other baby.
Questions? First look at the website nbci.ca or drjacknewman.com. If the information you need is not there, go to Contact Us and give us the information listed there in your email. Information is also available in Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA); and/or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding (available in French or with subtitles in Spanish, Portuguese and Italian); and/or The Latch Book and Other Keys to Breastfeeding Success; and/or L-eat Latch and Transfer Tool; and/or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.
To make an appointment online with our clinic please visit www.nbci.ca. If you do not have easy access to email or internet, you may phone (416) 498-0002.
Breastfeeding Your Adopted Baby or Baby Born by Surrogate, 2009©
Written and revised (under other names) by Jack Newman, MD, FRCPC, 1995-2005©
Revised by Jack Newman MD, FRCPC, IBCLC and Edith Kernerman IBCLC, 2008, 2009©
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