Ok, I do think it is about time to put on my "pessimistic optimist" hat.
For years I did see my job as an adoption physician not only in
preparing families for the successes of their dreams, but also for the
gruesome realities of the extremely unfair and unpredictable process we
all call /*adoption*/. (my favorite definition - "pessimist is a well
informed optimist").
The question here is not about the possibility of adoptive
breastfeeding, and/or tandem breastfeeding, and/or breastfeeding during
pregnancy.
We all do agree that all three situations are possible, real and should
be addressed as early in the adoption process as humanly conceivable.
The only people who are refusing to discuss it and/or actively opposing
it are those "furious officials".
Anyhow - the question here is about an adoptive mother in her mid
pregnancy, who just found out that by 34 weeks she will have to travel
to another state, stay in somebody's else house while adopting a newborn
baby #1, then come back, settle a little bit and then go through the
labor with baby#2.
Add to the equation the uncertainties of adoption process (very simple
rule that "furious officials" are routinely forgetting to tell adoptive
families - the baby is not yours until everything is finalized),
fragility of mother's health and emotional turmoil for everyone. Sounds
relaxing and comforting, isn't it (sarcasm intended)?!
So should we create additional stress by talking in such a strict terms
about stimulation and SNS, and "no bottles" and those who had
established full milk supply while pregnant?
The very last thing we want to do is to have her in a premature labor,
or feeling as a failure of something will go wrong with her milk supply,
or if (and frequently - when) those "furious officials" will prohibit
her to breastfeed even with the SNS?! How this mother will feel then if
she would not have any back-up plan and your reassurance that it is OK
not to be perfect?!
I'd rather give this mom options of the spectrum, reminding her that
whatever she will do will be great and will constitute the incredible
success.
At the end of the day (flame away here, be my guest) there is absolutely
nothing wrong with a bottle - mother just have to know how to use it. So
many mothers on this list were able to breastfeed much older bottle fed
babies, not just 2-3 weeks old ones. And so many LC's on this list did
help even more mothers to put their kids back to breast.
And (flaming can continue) there is absolutely nothing wrong with the
hospital's supplied artificial milks (as hospital can refuse to provide
for the baby the donated colostrum, organic formula or anything
"non-formulary" else before discharge). Just be ready for that and
accept the risks of giving the kid generic non-organic artificial milk
on the same level as you are accepting the risks of the kid being
exposed to alcohol or drugs during the pregnancy.
We all do agree that we are in uncharted waters here.
So let's tread cautiously and, while hoping for the best, we owe to
prepare this mom for the wost realities.
It can happen that the first mother will change her mind and adoption
will fell through.
It can happen that adoptive mother would not have an opportunity to
hand-express/stimulate because of logistics, medical situation, etc.
It can happen that she will start having contractions (even that may be
a old (mid)wives tale).
It can happen that ... a lot of things can happen.
Agree, we should not get in the way of a mother who wants to breastfeed
both kids.
But we also have to help this mom to have realistic plans of action.
Plan A, and plan B, and plan C...
Alla
--
Alla Gordina, MD, IBCLC, FAAP
General Pediatrics
Breastfeeding Medicine
Adoption and Foster Care Medicine
Global Pediatrics and Family Medicine
NJ Breastfeeding Medicine Educational Initiative
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