On 5/11/2013 2:47 AM, Barb Glare wrote:
> I don't agree Karleen with you.
>
> I think many mums adoptive mums do not make enough milk to supply all their baby's nutrition,  even if they keep feeding for long enough, and I doubt many would make enough for a newborn.  If it takes them 6 mnths then they are not really making a full milk supply (but they don't need to by then either)  I don't think that it is very helpful to tell adoptive mothers that they could have made a full milk supply but they didn't try hard enough or long enough when there are underlying problems to begin with, any more than it helps to tell any mother that they would make enough milk if they just tried harder.    I don't think that means they can't breastfeed successfully.  Yes, maximise breastfeeding and milk supply will be maximised.  but for some mothers they still won't produce much milk and will need to supplement - no drama there, just that it's a different experience.  I have worked with many adoptive mums who are highly motivated to breastfeed.  But I haven't yet seen many who have made a full supply, and not for lack of trying.  Often they feel that what they do produce, or the experience itself is not worthy of being called breastfeeding.  The cases where women do make a good milk supply are celebrated in case studies, because we really WANT it to be so for all women, but I don't think it's the reality for most

Barb is asking very important questions that do not have a simple 
cookie-cut answer.

Those who know me, know that I do like to start with a story...
So, many-many moons ago, in the previous Millennium, when I was a 
pediatric resident in NJ, we did have a resident who in his previous 
life in Moscow was a pediatric anesthesiologist. And as a such, he did 
not know, simply said - he hated talking with parents. His family prep 
for the spinal tap (and we were tapping every other infant at that time) 
did sound like that - "We have to take your baby for a spinal tap 
because of XYZ. Spinal tap does hurt a lot, your baby will be 
uncomfortable, and will be crying. Here are the possible 
complications:.... . You have to give me your baby and sign the consent 
form". He was giving the appropriate information, but the way how it was 
done, was.... not extremely comforting to say the least. Needless to say 
- parents were were ... not happy.

I do remember this story every time people are discussing the adoptive 
breastfeeding the way Barb is addressing it. The facts are all there - 
we have to provide info, most of induced/re-lactated moms would not 
reach the exclusive breastfeeding goal and so on and so forth.

But adoptive breastfeeding is not that much about the milk production. 
It is not even about lactation per se. It is about providing the baby 
with the goodness of promoting development, trust, and attachment. 
Adoptive breastfeeding is not a binary "yes and no" process, it is a 
continuum that ranges from a simple skin-to-skin contact (those dealing 
with children hurt by abuse and neglect know how hard it is to make a 
kid to accept not s2s, but a simple hug), to latching on, to accepting 
mother's milk - and anything in between. any step of the process is a 
success.

For many adoptive breastfeeding, with the presumed (IMHO - wrongfully 
presumed) assumption of complete induced lactation, is intimidating 
enough to stop any thoughts about moving forward.

I, personally prefer the therm "adaptive nursing", as that empowers the 
adoptive mother to set her own goals and to celebrate small steps toward 
the goal of adoptive breastfeeding - whatever she and her child would mean.

Below is the story of one adoptive mother, who had the wisdom and 
courage to STOP her lactation in order to continue her daughter's 
version of the extremely successful adoptive breastfeeding.

"Our daughter was placed with us from foster care last summer just weeks 
before her 2nd birthday (actually foster to adopt).  She has no apparent 
developmental delays and is meeting all milestones.  I introduced her to 
breastfeeding through books, friends who breastfeed, talking about 
nursing her baby dolls and giving her child sized slings for her babies. 
  She attended LLL meetings with me and had an opportunity to see 
mothers nurse regularly. If she asked to nurse I offered (this began 
about a month after placement though we had been transitioning her into 
our home for 2 months before that even).  She latched for just mere 
seconds but it seemed to please her. I was quite surprised that her 
latch was pretty good .  Four months after placement I began taking 
Domperidone and pumping. I produced a some milk.  She was latching maybe 
a couple times a week at bedtime for just the few seconds.  When my milk 
came in some she began refusing to latch and was quite put off by the 
milk and even became a little uncertain of our regular cuddle routine. 
  After only a month I stopped the pumping and taking Domperidone 
knowing that for her and I the latching was far more important than the 
milk (I have not pumped for 5 months).  If the milk was putting her off 
then we didn't need it.  She was equally put off by an SNS system.  It 
seemed to breach her comfort level.  After a number of weeks she began 
asking once or twice to 'nurse' and would latch for seconds.  This has 
continued up until now with her asking anywhere from 1-5 times each 
week.  She has been increasingly unsettled at bedtime recently and last 
night through her crying she asked to nurse.  To my delight she remained 
latched for almost 10 minutes."

Enjoy, and happy Mother's Day
Alla
Alla Gordina, MD, IBCLC, FAAP


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