There is currently a trend toward using drugs and hormones in induced 
lactation, but I think it is still most important for mothers to be told 
about what I call the "basic method", as the most essential thing, and then 
encouraged to see these other things pretty much as add-ons that can be 
used, if desired.  This is the best way of assuring that the baby will be 
nurtured at the breast, recieving some amount of breast milk, for the 
longest period of time.   One reason for this is that the more medical 
intervention is used, and the more emphasis is placed on being able to 
express milk from the breast,  the greater the chance that the adoptive 
mother will keep pumping and not establish a long-term breastfeeding 
relationship.  IMO, the relationship is even more important for the adopted 
baby than for the baby who remains with the same mother he knows from before 
birth.  Also, although some of the more medical methods may offer greater 
chances for more milk being produced at any one given time, the baby who 
develops a normal breastfeeding relationship with his adoptive mom, using 
supplementation at the breast, as needed, will generally nurse considerably 
longer and benefit more from breastmilk, overall, even if his mother may not 
ever be able to produce the same amount in one day as someone who has taken 
drugs and hormones and spends a great deal of time pumping.

Now, in case that came off sounding like the "basic" method doesn't offer a 
significant milk supply, to anyone, that is not the case at all (it is a bit 
challenging to explain)!  Of mothers who have a Lact-Aid ready to go and 
start nurturing and feeding at the breast, with little or no previous 
preparation, the vast majority will be producing some milk within two weeks 
(but often in a few days) and go on to produce somewhere around half of the 
milk their babies need, while they are still taking only milk, without using 
any kind of galactogogues or pumping.  In most cases, there comes a time, 
usually after the baby is taking other foods, when whatever is coming from 
the breast is sufficient and supplementation no longer needed.  Unlike other 
methods, this basic method is virtually free of the danger of adverse 
effects.  Of course, adding herbs and/or domperidone increases the amounts, 
for some moms more than others.  The most important thing is that, 
regardless of whether the mom chooses to try any "ad-ons" her baby is being 
nurtured at her breast and her breasts are being stimulated to continue to 
produce some amount of milk.

For those who choose to try to get a milk supply going ahead of time, there 
are a couple options.  We haven't seen a whole lot of success with pumping 
except where domperidone is also used (however, some moms have had success 
starting with frequent hand expression).    When domperidone is used, with 
pumping, most moms will be able to be producing ounces within a relatively 
short time, and some will be able to produce all the milk their babies need. 
  There is no way to predict in advance whose body will respond in what way.

The protocol that uses BCPs with domperidone is very useful in some cases.  
However, as with anything else, the more medical intervention is used, the 
more possibility there is for adverse effects.  I feel that it most prudent 
for it to be used in the cases where it is the most likely to be useful, and 
that it should not be presented as a possibility to anyone who has not all 
ready been informed of the other methods.  At one time, there were people 
saying that this was the only way that there was much of a chance of 
producing a significant amount of milk, and the fastest way to start 
producing milk, neither of which is true.  It has also been touted as nearly 
guaranteeing a full milk supply, which has not been the case, either.  IMO, 
the best situations in which to use it are where there are several months in 
which the mom can remain on the BCP phase, before the baby is due, and where 
the arrival of a baby is the surest.  The cases that tend to be the best are 
where a baby is expected through a surrogate.  Adoption is very 
unpredictable, and many women who have gone to great efforts to produce milk 
for a baby they had been told they would be able to adopt have ended up with 
milk and no baby.

In the  case of a mom waiting to adopt a relative's baby, there is something 
else to consider, and that is whether or not there would be any interest in 
adoption, if that one does not work out.  Mothers who have gone to great 
lengths to produce milk for a baby they didn't end up getting, but who keep 
looking for a baby to adopt, at least have a plan for eventually using 
whatever milk they have saved.  I have to say that I haven't heard of very 
many inter-family adoptions working out.  A few do.  I think that, in some 
cases, the fact that an expectant mother expresses an interest in having a 
relative adopt her baby suggests that she does not feel at all certain about 
giving up her baby.  You never know.  It isn't anywhere near easy, but all 
of these things should be taken into consideration in deciding which course 
to take.  Milk production is only one of many things to consider and the 
expected baby is only one of people whose needs should be taken into 
consideration.  The needs of the rest of the family must be taken into 
account, also.  The potential adoptive mother can be counseled, and should 
have as much evidence as possible presented to her, but the ultimate 
decision needs to be made by her, and then supported by those who have the 
opportunity to counsel her.

I don't think the website at www.fourfriends.com/abrw has been provided yet. 
  One of the best things about this site is that there are ladies there who 
have adopted under a wide variety of circumstances, tried a wide variety of 
methods, and had a wide variety of results.

Well, I tried to keep this brief but didn't do a very good job!

Darillyn Starr, adoptive mom of six

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