I couldn't agree more with the comments from Jan Ridler and Karleen Gribble and, earliere, Pam Morrison. Hormonal help and sudden withdrawal can give a kickstart, but breast stimulation and expressing (or a baby at breast) have been used effectively, too, and after milk appears, no method works to maintain milk flow without ongoing, frequent milk removal.

Back in the 1970s, a Sydney professor developed a protocol using high doses of oestrogen and progestogen, followed  by withdrawal, but as time went on some of us became concerned about the doses, especially as women who were adopting babies tended to be older, and potentially more at risk of deep vein thrombosis (DVT). Karleen adds the point about long-haul flights overseas and DVT. For years, mothers and their GPs would contact me asking for contact details for the particular hormonal protocol - but it was hard to get across the need for frequent enough expressing as some expected a magic pill that would do the work. At least by talking to me first, they could decide whether they could commit to the time involved. Even today, "frequent" means different intervals to different people.

The great thing today is that in Western countries there is increasingly more support and acceptance of mothers bringing in a milk supply for an adopted of foster baby, whatever methods they use at the start. Support and frequent milk removal are of course key, and lack of support - and consequent lack of confidence - was a reason why many women have given up or struggled. A breastfeeding culture (not their geographic location) makes a difference, and now mothers can also go online to get the support of a micro culture of others doing the same.

I shall be going "no mail" later today and so any replies need to be copied to me privately.

Virginia Thorley
Brisbane, QLD, Australia

Karleen Gribble wrote:
 
> I think that the difference in use of hormonal protocols is more in terms of the rate of the milk is production initially. If using a hormonal protocol with an abrupt withdrawal of oestrogen and progesterone women see milk start to be produced in significant amounts with a few days. With the more traditional relactation/induced lactation based on suckling of a baby or breast pumping the milk supply is built much more gradually. So that's the kick start. In the long term it's the frequency and degree of milk removal that builds the milk supply and it matters not which drugs have or have not been used. More drugs does not equal more milk. It is important for health providers and women considering the use of hormones to consider the potential side effects because they can be serious (and I get nervous about older mums to be doing long haul flights for adoption or surrogacy taking drugs that increase the risk of deep vein thrombosis).   
Ditto on the importance of knowledge and support Jean!
Karleen Gribble
Australia


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