Debbie Kali, it looks like you have a logical and considerate plan of care.

Regarding a two-mother couple expecting twins where the gestational mother
has history of breast reduction surgery and concerns about medication, I
would emphasize the importance of the first week. I would encourage them to
think of breastfeeding as therapeutic for the gestational mother's
postpartum recovery and the babies' exposure to colostrum in whatever
quantity the gestational mother produces. They need to understand that in
colostrum volumes, the babies' dose of her medication will be low, but that
any dose of the unique components of colostrum is helpful.

If the gestational mother has trauma history that makes breastfeeding
difficult, then she will be done after a few days, but may have at least
gotten some help with uterine involution and reduction of engorgement. If
oxytocin does its magic and there is more milk transfer than expected, the
opportunity to breastfeed and have a significant milk supply will not have
been diminished.

IMO there is no ethical conflict in fully clarifying the usefulness of all
aspects of breastfeeding to each member of the family. I sense a strong
concern for your client's partner's health, and a need to emphasize that
even if the gestational mother will find breastfeeding difficult in the
long term for reasons of physical and/or mental health, her reproductive
organs will benefit from a gradual rather than abrupt change from the
physiologic game plan. I do not know if I would emphasize introducing herbs
and other galactagogues to the gestational mother's medical regime -- I
would look for the client and her partner's response to their initial
experiences and see if they need more milk and want to pursue that.

Ruth Piatak

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