JP wrote:
"As a mother of an adopted breastfed three year old and soon to be
breastfeeding another adopted child, I have been on dom for about 3 1/2
years collectively.  I personally never experienced any depression that I
associated with the dom and I moderate an adoptive breastfeeding web
group - (if your client would like to join, she can go to yahoo groups
and look for [log in to unmask])  I have not had anyone relate
such an experience however, I have had moms with depressive symptoms from
breastfeeding, and the losses that may come back with breastfeeding or
any experience with the baby that the mom feels that she lost in not
having a biological child.  Also lack of libido can result just from
breastfeeding itself.  I also believe the fluctuation of hormones,
perhaps less prolactin etc could easily upend her mood especially if she
is prone to depression or just has unresolved issues surrounding the
infertility.  I counsel a mom that is a biological mother that associates
her depression with breastfeeding, as it lasts until weaning, and she
takes a mild anti depressant.  I think where hormones are involved, any
mood changes is easily attribituted to this.  Also from an adoptive
mothers perspective, they almost always imagine having a full supply, no
supplementation.  This is not always possible as I have seen myself
unable to produce more than half my first adopted childs needs.  This
despite having a biological child and no supply issues.  It took a long
time to come to term with this and as I aproach the time when I will be
doing this again I find myself once again, hoping to eventually supply
the babies full needs.  This can sometimes seem like an added failure
when the body has already disappointed by not being able to produce a
child.  I think listening and counseling is the best bet unless
depression is severe or lasts beyond a few weeks.  If she wishes to talk
to others in the same situation, the above group would be a good forum to
start.
JP"

This is an excellent post, that I hope everyone who works with any adoptive
mothers will read and take to heart.  Mothers who have the desire to go to
the extra effort of breastfeeding an adopted baby are usually women who have
a much greater than average amount of, for lack of a better word, "maternal
instinct".  We are women to whom pregnancy and birth are seen as a wonderful
privilege, and having
to do without that represents a tremendous loss.  Because of this, each
adoption brings not only joy, but pain.  Many times, such mothers are afraid
to voice their feelings (or even to admit them to themselves) for fear of
being considered ungrateful for the wonderful opportunity of adopting the
baby.

The topic of milk production can be quite precarious.  It may sound old
fashioned in a time when medications have become so widely used, but it is
still true that an adoptive mother's expectations about milk supply have
alot to do with how she views her success at breastfeeding.  While
domperidone and other medication use has made it possible for more American
mothers to provide for all of their babies' nutritional needs at their
breast, it is still true that, in western civilization, most require some
amount of supplementation. More than not require supplementation at least
until their babies are taking other foods, and many continue to supplement
beyond that.  Keeping sight of the benefits of nurturing at the breast, and
whatever breast milk a mother is producing, whether that is 75% of the
baby's calories, or 15%, can be difficult.  Even at this late date, I have
to admit that I feel a pang of grief and insecurity, every time I hear of
someone whose body is responding with alot more breast milk for her adopted
baby than the average of 10-12 ounces (sometimes more, sometimes less) a day
that I worked so hard for.  I did not have domperidone, which would probably
have given several more ounces a day, but the fact that I feel the need to
specify that is telling, isn't it?  It actually takes alot of courage to
admit that I never even made it to half of my babies' total nutritional
needs.  I do this because I know that there are many moms out there like me,
and they need to know that their responses are in the average range.  Since
those who produce the most milk are the ones who tend to publicize it the
most (and whose experience is related by others the most) an adoptive mom
whose body's responds in volume of milk more modestly can easily feel like
her body is, once again, letting her down.  The saddest thing is when a
baby, who is actually recieving tremendous benefits from nurturing at the
breast and some amount of breast milk, has this cut short because his mother
feels inadequate.

As for the domperidone possibly causing depression, I HAVE heard from a
couple of adoptive mothers who felt certain that domperidone made them more
depressed and/or anxious.  It seems to be quite rare for this to happen, but
possible.  I would guess that the incidence is in the neighborhood of 5-10%,
compared to 85-90% with metoclopramide.  There have also been times that
someone who was feeling miserable on the Newman protocol has wondered if the
domperidone was causing it, but I believe it is birth control pills that are
to blame in most of those cases.  Many such moms have felt much better after
they discontinued the BCPs, but were still on domperidone.

I would encourage a mother who felt that domperidone was creating depression
and anxiety to back off of it gradually and see what happens.  I believe a
baby benefits more from having a mother who is happy and fulfilled, and
enjoying him, than from a few more ounces a day of breast milk.  Of course,
the amount of help the domperidone is providing needs to be considered too.
An adoptive mom who produces all the milk her baby needs, on domperidone,
versus very little without it (which has been the experience of a few moms),
might be more inclined to put up with side effects, versus someone who feels
that it only gives her a little more than she would produce without it.
Also, there are moms who benefit as much from fenugreek or other herbs as
they do from domperidone.

Another long rambling post, but I hope the adoptive mom in question will
soon find the combination that best provides for the needs of her baby,
herself, and the rest of her family.

aloha,
Darillyn

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