As a lactation professional who has worked with adoptive mothers since 1989, I second everything that Alla Gordina has said below.  As a person who has raised a child not mine by birth but mine from the heart, who did NOT breastfeed and as a member of a family who wholeheartedly embraces and adopts across all lines (racial, handicapped, cultural, national), I support this statement.  Absolutely breastfeed if possible, but love comes from the heart first, then flow through the breasts! 

-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Alla Gordina MD, IBCLC, FAAP
Sent: Thursday, April 17, 2014 10:56 PM
Subject: Re: Pregnant and adopting

Ok, I do think it is about time to put on my "pessimistic optimist" hat.

For years I did see my job as an adoption physician not only in preparing families for the successes of their dreams, but also for the gruesome realities of the extremely unfair and unpredictable process we all call /*adoption*/.  (my favorite definition - "pessimist is a well informed optimist").

The question here is not about the possibility of adoptive breastfeeding, and/or tandem breastfeeding, and/or breastfeeding during pregnancy.
We all do agree that all three situations are possible, real and should be addressed as early in the adoption process as humanly conceivable.
The only people who are refusing to discuss it and/or actively opposing it are those "furious officials".

Anyhow - the question here is about an adoptive mother in her mid pregnancy, who just found out that by 34 weeks she will have to travel to another state, stay in somebody's else house while adopting a newborn baby #1, then come back, settle a little bit and then go through the labor with baby#2.

Add to the equation the uncertainties of adoption process (very simple rule that "furious officials" are routinely forgetting to tell adoptive families -  the baby is not yours until everything is finalized), fragility of mother's health and emotional turmoil for everyone. Sounds relaxing and comforting, isn't it (sarcasm intended)?!

So should we create additional stress by talking in such a strict terms about stimulation and SNS, and "no bottles" and those who had established full milk supply while pregnant?
The very last thing we want to do is to have her in a premature labor, or feeling as a failure of something will go wrong with her milk supply, or if (and frequently - when) those "furious officials" will prohibit her to breastfeed even with the SNS?! How this mother will feel then if she would not have any back-up plan and your reassurance that it is OK not to be perfect?!

I'd rather give this mom options of the spectrum, reminding her that whatever she will do will be great and will constitute the incredible success.

At the end of the day (flame away here, be my guest) there is absolutely nothing wrong with a bottle - mother just have to know how to use it. So many mothers on this list were able to breastfeed much older bottle fed babies, not just 2-3 weeks old ones. And so many LC's on this list did help even more mothers to put their kids back to breast.

And (flaming can continue) there is absolutely nothing wrong with the hospital's supplied artificial milks (as hospital can refuse to provide for the baby the donated colostrum, organic formula or anything "non-formulary" else before discharge). Just be ready for that and accept the risks of giving the kid generic non-organic artificial milk on the same level as you are accepting the risks of the kid being exposed to alcohol or drugs during the pregnancy.

We all do agree that we are in uncharted waters here.
So let's tread cautiously and, while hoping for the best, we owe to prepare this mom for the wost realities.
It can happen that the first mother will change her mind and adoption will fell through.
It can happen that adoptive mother would not have an opportunity to hand-express/stimulate because of logistics, medical situation, etc.
It can happen that she will start having contractions (even that may be a old (mid)wives tale).
It can happen that ... a lot of things can happen.

Agree, we should not get in the way of a mother who wants to breastfeed both kids.
But we also have to help this mom to have realistic plans of action. 
Plan A, and plan B, and plan C...

Alla

--
Alla Gordina, MD, IBCLC, FAAP
General Pediatrics
Breastfeeding Medicine
Adoption and Foster Care Medicine

Global Pediatrics and Family Medicine
NJ Breastfeeding Medicine Educational Initiative


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