Hi Cindy,
I'd really recommend that you dowload the WHO booklet on relactation and
give it to the Dr. It is an excellent publication and while it's a few years
old it is still by far the best. You can download it at
http://www.who.int/child-adolescent-health/New_Publications/NUTRITION/WHO_CHS_CAH_98_14.pdf
Unfortunately the information that is contained within the major texts when
it comes to relactation or adoptive breastfeeding ranges from bad to awful
IMO! Particularly when it comes to the issue of "counselling" the mother on
how much milk she might make (to say that most adoptive mums will not make
enough milk is not only discouraging and can become a self fulfilling
prophecy it is not true if you check out the research in this area!) My
attitude is that mothers need encouragement and that it is perfectly
reasonable to tell mothers that while they may need to supplement for a time
they have every likelihood of dispensing with supplements if they breastfeed
for long enough. IMO the LC has an important role in providing information
to the mother that will help her maximise her milk supply (just as is
applicable in non-adoptive breastfeeding situation where the mum has low
supply). You might find an article I wrote for Leaven helpful,
http://www.lalecheleague.org/llleaderweb/LV/LVOctNov04p103.html This is a
summary of a paper that I wrote for Breastfeeding Review Gribble, K. The
influence of context on the success of adoptive breastfeeding: Developing
countries and the west. Breastfeed Rev 2004; 5-13.

Anyway to answer your questions.
1. As others have mentioned ovaries are not necessary for lactation.
However, HRT will have a negative impact on milk production so sorting out
what to do with this is important. Sometimes exogenous hormones are used to
assist with relactation/induced lactation. There are various protocols
available, some are at www.asklenore.com but be aware that there are
sometimes nasty side effects associated with use and more drugs does not =
more milk.
> 1) what levels of estrogen and progesterone would be appropriate for
> giving mother to help enhance her possibility to lactate?

> 2) how can she help increase the mother's prolactin?
Breast stimulation results in the secretion of prolactin so
suckling/pumping/hand expression will result in prolactin release. If she
does pre-placement preparation via pumping then aiming for 6-8x a day for
20-30 mins is in my experience a good thing to aim for (no research here!)
In addition there are a number of drugs that inxcrease prolactin
secretion...Domperidone being the most used currently.

Good luck to you, Dr and the mum-to-be. She's lucky to have supportive
professionals to help her.

Karleen Gribble
Australia

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