You would like to breastfeed your adopted baby, or one born with a surrogate or gestational carrier? Wonderful! Not only is it possible, but chances are also 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. See also this article from our website.
There are really two issues in breastfeeding the baby with whom you were not pregnant. The first is getting your baby to breastfeed, that is to latch on to the breast and drink. 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”.
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 fast flow as is typical from a bottle or another method of feeding (cup, finger feeding). So, what can you do?
Speak with the staff at the hospital where the baby will be born and let the head nurse and lactation consultants know you plan to breastfeed the baby. They should be willing to accommodate your desire to have the baby fed by open 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 a lawyer is involved, speak with him or her as well.
Keeping your new baby skin to skin with you as much as practical, 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 the 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 relatively germ free baby (the baby starts to be colonized as he passes through the birth canal) being colonized by the same germs as you. Furthermore, it helps the baby adapt to this new habitat while at the same time encourages him to breastfeed and helping you to make milk.
Some birth mothers are willing to breastfeed the baby for the first few days and even longer. Some will express milk for many days after for you to give to the baby. 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 below). We should emphasize that in the situation where we helped a mother induce lactation, we are not aware of significant difficulties between the birth mother and the mother inducing lactation.
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 “Latching and Feeding Management”).
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, properly screened donor 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?
If you are having trouble getting the baby to take the breast, come to our clinic as soon as possible for help. In fact it would be useful for you to be seen before the baby is born, and you should be followed by a lactation consultant or someone experienced in helping mothers with breastfeeding. Make an appointment at the Newman Breastfeeding Clinic.
As soon as a baby is in sight, contact our breastfeeding clinic and start getting your milk supply ready. Please understand that you may never produce a full supply for your baby, but it is quite possible that 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 well latched on and sucking well. 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. The idea is 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.
1. 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, though we have never been impressed that this is better, and it is a little more complicated. Get information about this protocol from our clinic and also Induced lactation and relactation. We recommend stopping the birth control pill approximately 6 to 8 weeks before the baby is supposed to be born. The reason is to give you time to express your milk and thus build up the reserve of milk and also increase your milk production.
2. Domperidone. See the information sheet “Domperidone”. We recommend a starting dose of 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.
3. Pumping. If you can manage it, rent an electric pump with a double setup. Pumping both breasts at the same time takes 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 Breastmilk”for more information.
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 examination and have your blood pressure checked before starting the protocols and perhaps have a pap smear if you haven’t had one for a while. 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. Furthermore, it is important to maintain contact, in person if possible, with our clinic until the breastfeeding is going as well as possible.
The information presented here is general and not a substitute for personalized treatment from an International Board Certified Lactation Consultant (IBCLC) or other qualified medical professionals.
This information sheet may be copied and distributed without further permission on the condition that you credit International Breastfeeding Centre it is not used in any context that violates the WHO International Code on the Marketing of Breastmilk Substitutes (1981) and subsequent World Health Assembly resolutions. If you don’t know what this means, please email us to ask!
©IBC, 2009, June 2017, 2021
Questions or concerns? Email Dr. Jack Newman (read the page carefully, and answer the listed questions).