Just had to bring this up, re Kathy's mom who ended up weaning to get rid of
severe mastitis, but was devastated about not being able to breastfeed.
Being one to whom breastfeeding was important enough to go to great lengths
to nurture and produce a partial milk supply for my adopted babies, I can
really feel for this mom, and anyone else who has a such a strong desire to
breastfeed.  What I would suggest, in cases like this, or others that really
require undesired weaning or not nursing in the first place (such as a lady
I am in contact with who must undergo chemo for breast cancer as soon as her
baby is born) is to plan on a return to the breast when it is safe to do so,
even if that will be after many months.  This would bear several
similarities to situations where an adoptive mom wants to nurse a baby who
is adopted beyond the newborn period.

What I would recommend is that the mother who wants to return to
breastfeeding first get started nursing the baby with the Lact-Aid (the SNS
may be easier to use in clinical settings, but the Lact-Aid is easier for a
mother to get set up to nurse with, many times a day, with no assistance
from anyone else).  Many moms feel much better just from being able to
nurture their babies at their breast.  Once a nursing relationship is
established, the mom can just let her milk supply build as it may, from her
baby's suckling alone, using the Lact-Aid as needed, or choose to do
domperidone, herbs, etc..  I would be cautious with adding pumping to the
mix, especially where a baby is willing to nurse.  I believe in putting the
emphasis on baby at the breast, rather than ounces of milk.  For this
reason, I also discourage the practice of putting off attempts to get baby
to the breast, in order to try to get milk going beforehand.  Although I
believe that virtually any baby can be taught to accept comfort and food
from the breast, with enough patience and creativity, it definitely tends to
be easier, the younger the baby is, not to mention the fact that delays in
getting baby to breast means letting precious time go by without the
benefits of the nurturing (and usually some amount of breast milk), for both
mom and baby.

In a case where relactation can be planned in advance, I suggest taking
steps to preserve breastfeeding behaviors, such as not inserting the bottle
nipple into the mouth, but making baby open up first, switching arms in the
middle of a feeding, skin to skin, etc..  With older adopted babies, the
biggest hurdle is often to get the baby to accept being in a position facing
right into the breast, so it is good to avoid having the baby become
uncomfortable in this position in the first place.  Bottlefeeding in as
close to nursing position as possible is good, but can only come so close,
unless mother has a hole in her chest for the bottle to go into.  Other
options are finger feeding, holding the finger in front of the breast, or
feeding from a wide-based bottle nipple, which has a supplementer tube
threaded through, sticking just barely through the hole.  If the latter
thing is done with a nipple that will hold its shape when baby sucks,
without being attached to a bottle, and has only one hole, which is small
and tight, the tube can be threaded through so that the baby will not suck
air around it, but just get the supplement from the SNS or Lact-Aid.  This
way, mom can hold baby facing right into the breast.  She can even lift up
her shirt and expose her breast, positioning the bottle nipple right over
her nipple.  This is a trick I came up with to help get my daughter, Julia,
converted from bottle to breast, which has since benefited many other
adoptive moms with babies whom they adopted at an older age.

I would hope that any mom who had a strong desire to nurse her baby, but was
faced with a health problem that really required weaning would be informed
that relactating is a very good option.  Often, the bigger the challenge is,
the more the mother and baby have to gain from nurturing at the breast, and
whatever amount of breastmilk she is able to provide.

Aloha,
Darillyn

"We had a mother with a similar scenario. Milk culture showed MRSA
(methicillin resistant staph aureus). She was hospitalized for at least 10
days and was in severe pain, unable to even hold baby near her chest. Much
as
she wanted to breastfeed, she asked us finally to help her wean. Infectious
disease specialists were afraid of any milk stasis so we very slowly, over
several weeks, decreased pumping unitl she finally dried up. We felt if she
did wean it was important to do it while she was still on antibiotics. She
left the hospital, as I remember, on an oral vancomycin preparation. Of
course she developed yeast also. She was never pain free until she had
totally dried up. She was on antibiotics for weeks. We saw her every couple
of days to support her through this and to help with the very slow weaning
plan.  She was devastated about not breastfeeding, but was not able to get
on
top of the mastitis while she was producing milk and couldn't even hold her
baby. She had had several bouts of less severe mastitis before she was
hospitalized with MRSA. She was probably receiving the wrong antibx until
she
was cultured in the Lactation Center.

Kathy Boggs, RN,IBCLC"


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