There’s something very liberating about acknowledging that you don’t have all the answers. Knowing what you don’t know isn’t the least bit concerning, as long as you know where to find the answers.

I count my blessings in that I have acquired, over the years, an amazing group of friends, with an enormous amount of knowledge and experience. So when I am asked a breastfeeding question that I can’t answer, or face a breastfeeding situation that I can’t manage, I simply acknowledge my shortcomings and seek out a “friendly” expert.

Which brings me to the reason for this post. I am thrilled to introduce Elizabeth Hormann, author of Breastfeeding the Adopted Baby and Relactation, lactation consultant extraordinaire, and my friend.

During the past year, baby gooroo has received so many inquires about breastfeeding adopted babies, I thought it best to let someone with far more expertise than me respond. I am so grateful to Elizabeth for saying, “yes” to my plea.

Adoptive Breastfeeding—Fantasyland or Reality Show
By Elizabeth Hormann

Eight-thirty in the morning, the last of the kids has left for school and there’s just enough time for a cup of tea before I head off to work. The phone rings. It’s the Middle School psychologist.

“I’m calling about your son,” she says.

Calling about my son—he, who, by his own admission is “very laid back”, the one who has made it to 7^th grade without ever once getting into trouble? Why would the school psychologist call about him?

“What has he done?” I ask.

“Well he hasn’t actually done anything but he’s said some pretty odd things in class.”

The class turns out to be biology where they are doing a unit on reproduction. Charlie volunteered that he was adopted and that he had been breastfed, the psychologist told me and followed it with a pregnant pause.

“So what are the odd things he has said?” I ask.

There’s another pause, more pregnant than the last.

The psychologist clears her throat—”We were wondering whether he is often given to fantasies.”

“What sort of fantasies did you have in mind?” I ask.

This time a long-suffering sigh comes down the wire. The psychologist is beginning to lose patience with me.

“We’re not quite sure. Is Charlie adopted?”

“Yes” I tell her. This time the sigh is one of relief. “Then that’s clear.”

“And,” I continue before she can move on to her next point, “he was breastfed—for a great many months, just like his sisters and his brother.”

Another exasperated sigh. “But breastfeeding happens after a woman gives birth,” she says.

I agree pleasantly that that is the usual course of events, then explain, using as many one-syllable words as possible, how it can work when there has not been an immediately preceding pregnancy.

The silence when I finish is profound. Is she still breathing? I decide to take pity on her.

“Look,” I say, “I know this is not a familiar practice in Western countries—even many physicians don’t know it’s possible—but it is fairly widespread around the world—and there’s lots of literature available. I’d be happy to share some of it with you and the biology teacher.”

“I’ll have to ask him,” she says doubtfully. “I’ll get back to you.”

Needless to say she never did. She may have gone through life firmly believing that Charlie and I are both prone to fantasies—or perhaps she filed this conversation away and later learned something that made her do a rethink. She was not the first person—nor the last—to be incredulous when she first heard about adoptive breastfeeding.

So what’s the real story about this? Can women breastfeed if they have not recently had a baby—or never had one? The simple answer is “yes”. More complex is the question of how this happens and how well it will work for any individual mother/baby pair.

There’s a considerable body of literature on this subject. A decade ago when the World Health Organization put out a monograph on relactation the references included more than 80 articles that met the standard of scientific respectability. That body of literature has increased considerably since that time. There is data on women in early puberty to post-menopausal who have initiated lactation from scratch or restarted after a gap of a decade or more. This alone tells us that relactation and induced lactation are not isolated practices and—most importantly— that people with breasts can make milk.

This is not something that is readily believed in our culture. How many expectant mothers, for instance, respond to the question: “Are you planning to breastfeed?” with “Yes…if I can.” Despite the weight of the research and the experience in breastfeeding counseling practice, the fact that, with very few exceptions, a woman who can have a baby can also breastfeed, is not yet fully accepted. Small wonder then that there is so much skepticism when it comes to breastfeeding among women who have not been pregnant in some while—or ever.

Even ample evidence in the form of breast secretion in these women may be dismissed out of hand. Just after I published my first booklet on adoptive breastfeeding—more than 35 years ago—the late Ann Landers published an exchange on this topic concluding that her “authorities”, the top obstetricians and gynecologists in the country, had unanimously declared the documentation (on adoptive breastfeeding) to be balderdash.” These spokespeople told her that “abnormal breasts” (male and female) may secrete a liquid called colostrum but this is NOT milk and has no nutritional value. The problem is—apart from the patently incorrect information on the nature of colostrum—that the-then top-obstetrician and president of ACOG was actually very interested in adoptive breastfeeding. He had been quite helpful as I was preparing my booklet—which he communicated to one of the experts (a dermatologist) who called him in the middle of the night to demand a comment on the storm raging in Landers’ column.

A few years later the Journal of Pediatrics published an article based on laboratory studies of the milk expressed by five adopting mothers—three of whom had never been pregnant—and concluded that the “values obtained from milk collected…during the first five days of relactation show that concentrations of certain whey proteins and total protein are similar in amount to values obtained from transitional milk and mature milk collected after the firth day post-partum from biologic mothers.” In other words these women produced human milk.

So how is it done?
For some mothers it is as easy as putting the baby to breast, letting him suckle as much as he wants and supplementing as needed until the milk supply is adequate (or he starts on solid foods) For most women, especially in industrialized countries, it is not quite that simple. There are lots of reasons—mostly cultural—for the different experience that they have compared to many women in developing countries. But for all relactating and adoptive mothers the main essentials are close and near-constant skin contact (to stimulate the release of the hormones needed to make milk and make it available to the baby) and very frequent suckling.

Skin contact not only stimulates milk production but—and this is even more critical—promotes bonding between the mother and her baby. When mother and baby are quite literally “in touch” for much of the time, it encourages their relationship in a way that a more distant mothering style does not. So whatever happens with respect to milk supply, the adoptive/relactating mother and her baby are in a “win-win” situation.

That’s not to say that it is always easy. Some babies—even very small ones—aren’t enthusiastic about going to breast, especially if it is not producing a lot of milk. A lot of patience, persistence and skilled support may be necessary before a reluctant baby can be persuaded to try out this new way of feeding.

Many mothers need to supplement, often over a long period of time. Ideally this is done while the baby is suckling to give the breast the best stimulation—but this also involves getting acquainted with some type of nursing supplementer device. Which is different from the experience mothers have after giving birth.

Galactogogues—plants, foods or medications to encourage milk production—are common in many cultures. Their effect can be both biologically-based and psychological. A number of protocols involving a period of taking hormones to simulate pregnancy and/or a prolactin-stimulator to get the milk production going have been tried around the world. They have a certain appeal but there are down-sides as well. The possible risks involved in taking hormones—especially without interruption for a long(ish) period are well documented. Chemical galactagogues are also not risk-free. Chlorpromazine—a powerful tranquilizer, for instance, was commonly used for many years to stimulate milk flow. Now we know that the effects it has on the central nervous system—including Parkinson-like symptoms—can be long-lasting or even irreversible. The newer drugs used to stimulate prolactin—metoclopramide and domperidone—appear to have fewer side-effects but the evidence is not all in.

So, tempting as it may be to try to encourage the process with medication, not every mother wants to run the potential risk. It’s a balancing act. I’ve seen a couple of women in Germany, where I live, who have taken domperidone for a while and have been encouraged by the early appearance of some milk. Interestingly, they both decided not to continue with the medication once they saw that their breasts were capable of making milk.

Is it worth the effort?
A great many women—and I am one of them—think it is worth the effort to relactate and breastfeed an adopted baby. Just as with breastfeeding a home-made baby, breastfeeding an adopted baby is not only—or even mainly—about the milk, but about the kind of relationship that it is possible to build when mother and baby are in close physical proximity for a large part of the day (and night). And while the milk is not unimportant, the relationship will still be active when breastfeeding is a distant memory. So, by all means, put your adopted baby to breast, see how he likes it, make reasonable efforts to produce milk— nearly every mother with a suckling baby will have some—but remember to keep your eye on building that relationship that will last a lifetime.

© Elizabeth Hormann, 2008

References
Ask Ann Landers. Chicago Sun-Times, Thurs, Aug. 17, 1972.

Guóth-Gumberger, Márta. Breastfeeding with the Supplementary Nursing System Parent-INFO, 2006.

Kleinman, Ronald, Jacobson, Linda, Hormann, Elizabeth and Walker, W. Allan. Protein values of milk samples from mothers without biologic pregnancies. The Journal of Pediatrics, October 1980, 612-615.