Thankyou Barbara for your kind words.
I do think that hormonal factors can play a role in lower milk production in
Western women (related to infertility in some cases though many adoptive
mothers are not infertile and also the body condition stuff we've been
talking about). I think that there are some other minor factors that are
also different from women in developing countries that may be involved but I
don't believe that these are the major reasons.

The major reasons in my view are cultural. A cultural belief that babies
should not be breastfeeding frequently, barriers between mother and child
and socialisation of women to not expect to be good at making milk. I don't
think that it is helpful to blame the victim and to be honest I have not
seen that done. I think that adoptive mothers who wish to breastfeed are as
much the victim of a culture unfriendly to breastfeeding as the average bio
mother, perhaps just more so. One would never suggest to a bio mother that
she will not be able to exclusively breastfeed her baby to 6 months even
though many many do not, without it being their 'fault' in any way. However,
it is extremely common for women who wish to breastfeed an adopted baby for
the first words that come out of their mouth to be "I know I won't make much
milk but I want to breastfeed my baby" That is the shame of health care
professionals and lactation professionals as a whole group. It may be that
Western cultures are not supportive of breastfeeding but I kind of expect
that those whose passion and profession is lactation would not set women up
for failure in this way. I have heard so many experiences from women of
lactation consultants that have treated them as if they were doing something
perverse, or told them it was too difficult, or dismissed them without
support or information or have not looked at the whole picture (like telling
a mother that she had to live with low milk supply because she was an
adoptive mother when another LC found that the baby had a poor latch, latch
fixed milk supply became sufficient) that it's a wonder to me that any woman
ever breastfeeds a baby that she did not give birth to. I know in my own
case that relactating was something that I found extremely difficult to do.
I had belief in the process, knew the research, knew what to do and yet
found it mentally very very difficult. It gave me an appreciation of what it
must be like for fragile women (and many are very fragile by the time they
come to adopting) to be given the sort of "help" they so often are. It is
not unusual for women to really struggle with giving up supplements because
they have been told that they will not be able to.  In recent years Jack
Newman came up with a hormonal protocal to aid in relactation/induced
lactation. It's not really diffierent from the hormonal protocols that have
been around for years but what has happened is that one of the women who
used it has taken it on as her project and is promoting it widely. She tells
women that it will give them a good chance of making a full milk supply and
though I personally don't think that it makes a difference for women who
have been previously pregnant, many women do and they are regularly making
all the milk their babies need. I think that this LC has done adoptive
mothers a favour in this regard in providing the possibility that they can
be good at making milk and they do what they can in order to do this.

Although it may be relatively unusual for a woman in the West to be able
sustain her baby just on breastmilk (ie babies under 6 months, not eating
other food) it is not at all unusual for women to be able to dispense with
milk supplements. The literature (and those who work with breastfeeding
women) do not make a distinction between these two.  We don't have newborn
adoption in Australia and all adopted children are at or close to the age
where they will be starting solid foods so it's irrelevent here. Even
elsewhere I don't believe that the distinction is at all helpful in a
practical sense (others may disagree with me) though it may be in a
scientific sense. My approach is that most women will make all that their
babies need if they breastfeed for long enough. That is provided that the
child is not hooked on the method of supplementation. More and more I think
that you need to be careful with supplementation systems at the breast. Many
mothers assume that you just put the milk it, hook it up and the baby
breastfeeds and will only get milk to top up what is in the breast- not true
of course. Babies also get used to the immediate flow and will not
breastfeed without it. I think the belief that adoptive mothers will aways
need to supplement means that a plan for dispensing with supplementation is
not put in place which is disappointing since it is not unrealistic for
women to expect that they will be able to stop supplementing. Even in the
Auerbach and Avery study which was carried out in the early 70s, hardly the
hey day for breastfeeding, found that 46% of women stopped supplementing at
some stage.
Some publications even suggest that milk is not important for the adoptive
mother (usually the same publications will wax lyrical about the wonderful
properties of human milk) and that also does not sit well with me. I think
it is patronising, trying to protect women from the disappointment/grief if
they are not able to fully breastfeed their baby. I think there are
similarities between this view and the view that used to be held re
infertility and adoption. Many women who adopt in the West are unable to
give birth because of their or their partner's infertility. In times gone by
adoption was seen as a cure for infertility. Now very few people would
suggest this and families are encouraged to grieve the loss of the
biological child they lost to infertility before adopting and the loss of
belief in their body. In much the same way I think that women should be
allowed to grieve the loss of not being able to make enough milk for their
baby, not be told that it is not important.
allow mothers to grieve

Anyway, this is one of my hobby horses so I've gone to town a bit but it's
good to be able to dialogue on this.  I know that among those who work with
adoptive mothers many will not agree with my views but much of what we see
is based on the context within which we work and personal experience.

Re: body condition thankyou for the suggestion to also look at oestrogen
levels.

Karleen Gribble
Australia

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