Notes from “Induced Lactation and Adoptive Nursing”

August 25, 2011. Posted in: Adoptive BF/ Relactation,Got Milk?

These are notes that I took during a LLLI conference session presented by Sharon Larsen, RN and Kerry Yancy Dolan, MD (July 4, 1999)

Reasons for adoptive breastfeeding

  • Standard reasons for breastfeeding
  • Benefits for adoptive relationship
    • Enhancement of bond between mother and child
    • Breastfeeding as a reflection of femininity
    • Mother and child don’t lose breastfeeding experience (in addition to pregnancy and birth)
    • Much more than nutrition

Physiology

Hormones

  • Estrogen: The increase in estrogen during pregnancy stimulates the ductile system to grow and become specific. Estrogen levels drop at delivery and remain low for the first several months of breastfeeding.
  • Progesterone: The increase in progesterone during pregnancy influences the increase in size of alveoli and lobes.
  • Prolactin: The increase in prolactin and other hormones contributes to the accelerated growth of the breast tissue during pregnancy. Prolactin levels rise with nipple stimulation during feedings. Baby’s sucking (pressure & release pattern) stimulates the brain to release prolactin into mom’s bloodstream. Alveolar cells make milk in response to the release of prolactin when baby sucks at breast. Has been referred to as the “mothering” hormone. Together with oxytocin, it may be responsible in part for the intense feeling of needing to be with baby that many mothers experience.
  • Oxytocin: Oxytocin contracts the smooth muscle of the uterus during childbirth and after birth. After birth, oxytocin contracts the muscle layer surrounding the alveoli to squeeze the newly produced milk into the duct system (releases hindmilk). Oxytocin is necessary for a let-down, or milk ejection, reflex to occur.

What’s normal for adoptive mothers who are nursing

  • Tingling at milk ejection reflex is common. Leaking is rare.
  • Mense irregularities occur
  • Milk supply is more variable with menstrual cycle (than in non-adoptive moms)
  • Greatly increased appetite as supply is established
  • Weight gain as supply is established (due to more food eaten, fluid retention from increased oxytocin) or weight loss

Issues

Uncertainty of adoption

  • When will adoption go through?
  • Will baby accept me?

Use of breastpump prior to adoption/placement

  • controversial – don’t push it
  • can increase glandular/ductal tissue
  • prepares breasts
  • may begin to stimulate supply
  • strict schedule is hard to follow
  • adds physical aspect to emotional cost of failed adoption
  • milk supply, etc. is about the same around a month after baby, whether or not mom pumps
  • may suggest hand expression instead of pumping

Medications

  • Estrogen and Progesterone therapy – works, but can be risky
  • Prolactin – not available
  • Oxytocin
    • nasal spray not readily available now
    • IV works, but there is a rebound effect
  • Thorazine – very risky
  • Reglan
    • elevates prolactin levels
    • Risks:
      • temporary depression/moodiness
      • drowsiness
    • more info on Reglan

Herbs

  • Fenugreek
    • elevates prolactin levels
    • generally regard as safe in usual amounts
    • one person has had good results with recommending that moms take one capsule at each nursing
    • standard dosage is 2-4 capsules, 3 times a day
    • a research study is now in progress studying fenugreek and milk supply
    • more info on fenugreek

     

  • Red Raspberry Leaf
    • aids milk ejection reflex by increasing oxytocin
    • generally regarded as safe
    • more info on red raspberry leaf

     

  • Chasteberry
    • conflicting reports
    • generally regarded as safe
    • more info on chasteberry

     

  • Fennel
    • estrogenic effects
    • increases milk supply
    • more info on fennel

     

  • Mother’s Milk Tea
    • many/varied ingredients
    • increases milk supply
    • more info on mother’s milk tea

     

  • More info on herbal galactagogues

Useful Publications

  • “Nursing Your Adopted Baby” (LLL Publication #55)
  • Lactation Consultant Series I, Unit I – “Relactation and Inducted Lactation” by Ann Sutherland, BA, and Kathleen G. Auerbach, PhD (LLL Publication #288-1)
  • “The Womanly Art of Breastfeeding” (LLL Publication #297)
  • “Breastfeeding the Adopted Baby” by Debra Stewart Peterson (LLL Publication #355)
  • Lay press articles
  • Medical Journals: Journal of Human Lactation 15(1), 1999 is a good recent article

Mentors

  • La Leche League Leaders
  • Lactation Consultants
  • LLLI referral line (1-800-LA LECHE) to moms with experience in breastfeeding an adopted baby

Seeing someone or talking to someone who has nursed an adopted baby can make a world of difference, particularly seeing the supplementer used.

Nursing Supplementer

A nursing supplementer consists of a container for the supplement (either a bag or a bottle), which hangs on a cord around mom’s neck and rests between her breasts. Thin tubing, leading from the container, is taped to the mother’s breast, extending about 1/4 inch past the nipple. You usually see the tubing going directly from the bottle (between the breasts) to the nipple. You can also wrap the tubing down & around the breast before bringing it up to the nipple.

Why it’s useful

  • baby receives formula as he nurses
  • nursing stimulates milk production
  • formula satisfies baby, so he continues to nurse

General suggestions

  • Speakers suggest buying both a Lact-Aid and a SNS (Medela), rather than renting a pump. They both felt this was a better use of money.
  • Expect a learning curve of a couple of weeks.
  • Can use well-mixed powered formula (buying premixed formula is not necessary).
  • Taping tube so that it’s 1/4 inch past end of nipple is not that necessary – if baby objects to this method, the supplementer will still work.

Comparison of Lact-Aid and Medela SNS

  • May be best to use both supplementers in different situations.
  • Lact-Aid
    • Uses a bag to dispense supplement
    • Allows you to nurse lying down
    • Easier for breastfeeding in public
    • Harder to learn to use than SNS
    • Type of container & size: 4.5-ounce (135 ml) disposable plastic bag
    • Easy to assemble? No, the mother may need help at first
    • Obvious under clothing? No, lies flat and hides under clothing
    • Tubing – One tubing size. Only one tube fits on the unit at a time.
    • Includes cleaning syringe and instructions for adjusting rate of flow

     

  • Medela SNS
    • Uses a rigid plastic bottle to dispense supplement
    • Uses gravity feed – can’t nurse lying down
    • Top must snap closed (unlike Lact-Aid) or bottle will leak
    • Once baby is nursing, you need to unclamp the tube on the other side so the milk will flow (not necessary on Lact-Aid).
    • Easier to transport (rigid), but Lact-Aid does make a carrier now (or you can set the Lact-Aid bag in a cup).
    • Makes a “gurgling” sound. The Lact-Aid does not.
    • Type of container & size: 5-ounce (150 ml) rectangular bottle
    • Easy to assemble? Yes
    • Obvious under clothing? Yes, bulky and visible
    • Tubing – Three tubing sizes for variety of flow regulation. Two tubes fit into the unit at once, so mom can switch sides without moving tubing.
    • Unit cleaned by squeezing the bottle.

Challenges

  • more complex than breastfeeding or bottle-feeding
  • formula prep
  • care of supplementer
  • leakage of supplementer
  • tape sensitivity
  • skill required to nurse in public
    • logistics of using the supplementer
    • nursing clothes don’t work so well with a supplementer

Realistic Expectations

Few adoptive moms produce 100% of the milk that baby needs. 25%-75% supply is a realistic goal. Some moms get no milk. The mother-infant bond from breastfeeding is the true measure of a successful breastfeeding experience.

Infertility Issues

  • psychological toll of infertility treatment
  • fear of failure of breastfeeding

Other Issues

  • Age of baby at placement – older babies can learn to nurse
  • Nipple confusion
  • Different race of mom & baby can be an issue (what will people think, etc.)
  • Reactions of others – family, friends, adoption professionals
  • Don’t talk about amount of mother’s milk when counseling – they hear it everywhere. Dwell on baby, etc.
  • Everyone asks mom how.

Sources of Support

  • Husband, family, friends
  • La Leche League (Leaders, 1-800 line referrals, meetings)

Remember: No Preparation is Required!!!
All you need is a method for supplementation.

Sources and Additional Information

“Induced Lactation and Adoptive Nursing” by Sharon Larsen, RN and Kerry Yancy Dolan, MD, as presented at the La Leche League International Conference, July 4, 1999.

The Breastfeeding Answer Book (La Leche League, 1997) by Nancy Mohrbacher, IBCLC and Julie Stock, BA, IBCLC

Adoptive Nursing @

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