Primpo is the successor drug to Premarin.  It is an estrogen compound.
Many adopting mothers are on this medication or on similar ones because
they are in premature menopausal.

It is very difficult to induce lactation when a mother is taking a
hormonal drug such as this one for her menopausal symptoms.  THe
estrogens suppress lactation, just as they do in pregnancy.

I have worked with mothers who go off their medication in order to nurse
a baby they are adopting. Doctors usually don't like this because they
are worried about the long term effects on the mother's health. They
also worry about the baby getting the estrogens in the milk.  Of course,
this has not been studied--makers of drugs for menopausal symtoms have
not anticipated that their drugs could be used by nursing women, so
there is no real information on this.

In several cases, women I have worked with have chosen to use an
estrogen patch (delivers a lower dose) or herbal support during the time
that they nursed.  In at least one case, the woman quickly went back to
her original medication because her menopausal symptoms returned.  Her
doctor would only re-prescibe it under the condition that she would not
nurse.

THe good news is that 1) the estrogens will have delayed the breast
tissue atropy associated with menopause and 2) infantile uterus (to my
knowledge) can occur even though the mother has normal breast tissue
development. (Kind of like the women with an ok uterus that can carry a
baby to term but have little or no breast development.  I understand
that in both cases it typically has to do with the target organ not
being sensitive to estrogen, rather than the body not making enough
estrogen. SOmetimes a mother with a weird uterus is a DES daughter, in
which case breast development is usually normal. (DES caused infantile
and biforcated and twin uteruses and other unusal formations in some
daughters)

The caution: even without the medication and the infantile uterine, it
is highly unlikely that a nullipara woman will produce enough milk to
feed twins.  This doesn't mean she shouldn't nurse, but that she should
be doing it to bond and because this is how babies are supposed to eat.
However, if she is expecting a big milk supply, she will undoubtedly be
disappointed. Unless she is the rare exception, she doesn't have enough
ductal tissue to produce anywhere near enough milk for both her babies.
You will be doing her a big favor if you emphasize your enthusiasm for
the breastfeeding process and de-emphasize your enthusiasm for
breastmilk.  When some women hear that they are unlikely to get a full
supply, they decide not to adoptive nurse.  It may surprise you that
most go ahead because what they really want is the breastfeeding
relationship and they view the milk that they do get as a side benefit.
I have worked with several womoen who got very little milk but view
adoptive nursing as one of the highlights of their lives.

Warmly--
Judy Gelman, IBCLC
Washington, DC
(Mother of Aviva, 14, Ezra, 11, and Josh, 7, all of whom were adopted
and breastfed for a LONG time)

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html