For the last five months, I’ve been feeding my adopted son Jasper at my breast, something that surprises many people, and which even still surprises me occasionally. But the experience has been one of the most rewarding of my life, and I would like to share what I’ve learned with others who might be contemplating the possibility, or who might contemplate it after reading this! I am so, so glad I did it; I would really strongly recommend adoptive breastfeeding to any adopting mother.
In this article, I will describe what we did and are doing. I don’t endorse our particular path for anyone else–it was pretty haphazard–but the end result has been very rewarding. We did make some trial-and-error discoveries which I’ll describe as I go along. At the end I reflect a bit on why I find it so wonderful, despite the effort required.
I came to adoptive breastfeeding very gradually. I thought it sounded pretty crazy the first few times I heard about it. A colleague at work had done it. I thought, how strange! My sister-in-law showed me the adoptive breastfeeding section in “The Nursing Mother’s Companion”. I thought, seems like a lot of trouble! At our match meeting, our IAC counselor Crystal asked if I planned to breastfeed. I said no. But the idea must have taken root somewhere. A month before our son was due, my sister-in-law handed me a Medela Supplemental Nursing System she had bought but didn’t need for her (biological) son, and I thought, why not give it a try?
I was 43 years old, and had a month before Jasper’s due date to prepare, once I made the decision. To prepare the breast tissue to produce milk, it is recommended that an adoptive breastfeeder take a birth control pill to simulate pregnancy for four to five months before her child’s arrival, if possible. I had spent about a decade on the pill in my 20s, but my body had never gone through even the early stages of an actual pregnancy. Since I decided to try only a month before Jasper got here, I couldn’t do the pill part. What I could do was start nipple stimulation with regular breast pumping. Nipple stimulation is one way to increase the amount of prolactin circulating in your bloodstream, which is the hormone that leads to milk production.
I bought the cheapest double breast pump I could find — a Playtex model — and started pumping for ten to fifteen minutes every three hours, even at night. I got pretty adept at waking up to my alarm, hooking up half-asleep, setting the timer for ten minutes, and going back to sleep. The first two or three times I used the pump, a few clear drops of liquid came out, and I was pretty excited, but then I was dry as a bone after that. After a day or two I was able to use the pump on its highest setting, gritting my teeth a bit. I got some nipple cracking, turned it down, and then gradually back up again. Still no more drops, though. I also started taking fenugreek, which is supposed to promote milk supply–four pills, four times a day. That’s higher than the usual dose, but one breastfeeding woman on the internet said she didn’t see any effect until she got her dose up to where she could smell the maple-syrup aroma in her sweat, so I did the same. I also started watching YouTube videos of babies while pumping—being around babies is supposed to help too. And I ordered a drug recommended in the adoptive breastfeeding protocols — Domperidone — from a pharmacy website, which would take some weeks to arrive.
I thought I’d have a month to prepare, but life’s funny like that; Jasper’s birthmom went into labor two weeks early. We raced to the hospital from a thousand miles away in time to see him come out, and there I was with my supplementer and a hungry newborn and some bottles of formula. I hadn’t ever even tried to set the thing up! I put a couple of ounces in the bottle, taped the thin rubber tube to my right breast according to instructions, and tried to get my distressed baby latched, holding my breast and tube with my right hand, and Jasper with my left in a ‘cross-cradle’ position. Formula was dripping everywhere, but, totally amazingly, he did it. He drank about an ounce and fell asleep. I just sat there and held him in a total daze.
Subsequent feeds were more difficult; the flow would come too fast and Jasper would choke; the tube would get pinched or wouldn’t get in his mouth properly and he wouldn’t get any formula at all; he couldn’t latch onto my flabbier left breast very well; I would get a crick somewhere after holding an unnatural position for five minutes–it was all very tricky. The one great thing was that newborn Jasper was totally game; he had a big mouth and big cheeks and would latch like a champion if given half a chance. The lactation consultants at the hospital were very helpful (and very interested in our unusual situation). But after a day or two we got a system down that worked for the first couple of months, and has subsequently evolved into what we’re doing now. I’ll break things down into FAQ-like sections below so you can find information about a specific question easily.
Now, four or five months in, I am generally pumping three to four ounces of milk in the morning, after four to five hours of uninterrupted sleep (1-2 oz from each breast), and two to three ounces in the afternoon and evening (0.5-1 oz or so from each breast). He also is getting some milk when nursing with the supplementer. So I’m providing somewhere between 6-12 ounces of human milk to him on most days.
It took a long while to get to that amount, though. I was at least three weeks on the Domperidone (20 mg, four times a day) before I was able to pump a measurable amount of milk, and it was a very very small measurable amount — like a quarter of an ounce from each breast. We treasured every drop like it was liquid gold, though, and I do believe that he got some immune factor support from even that amount.
After the first month, production kept increasing very slowly but steadily. Three weeks later, it occasionally was up to an ounce. Then just when I was ready to throw in the towel, three weeks later, I could sometimes get two ounces. Things seem to have topped out at my current level, but you never know; there were and are lots of fluctuations in the amount I produce, some days more, some days a lot less, and it could still be going up. Some friends and relations recommend throwing caution to the winds and the supplementer out the door and just nursing solidly for three days, to see if my production will rise to match the demand, but I’m too unsure to try it. I do just nurse him without a supplementer sometimes, especially in the morning–I can tell when he’s getting milk by the little swallows and ‘cuh’ noises–but he gets frustrated sometimes with the slower flow and time it takes for let-down to occur, and I like the reassurance the supplementer gives me of knowing how much he’s getting.
In retrospect, my Playtex pump was a mistake. I tried a Medela Symphony unit about three months in, and my breasts could be emptied of all milk in 15 minutes, as opposed to the thirty or more it took with the Playtex unit. The Symphony pump is too expensive to buy, but can be rented from a pharmacy, and that’s what I do now. It likely would have been better for nipple stimulation early on, too, I imagine, and might have meant that my production ramped up faster.
Supplemental Nursing Systems
I started with the full-size Medela unit at the hospital, but the flow was too fast, and the bottle hanging between my breasts would bang on Jasper’s head and face and generally get in the way of our breastfeeding comfort. We switched to the thinner tubes, which helped with the flow rate, but it still wasn’t great.
The lactation consultants offered us the Medela ‘Starter SNS’, a smaller supplementer that attaches to a small two-ounce bottle you can clip off to one side. We took home two of those from the hospital, and bought two more, and used mostly those for the first three months. They were ok–I could clip them to my shirt fairly low down, and thus controlled the flow by making him suck against gravity. But they would often leak around the cap, and they looked like an IV drip–very medical–and the bottle still got in the way of my cuddling or burping him on the side it was clipped to.
After talking to my adoptive breastfeeding colleague and visiting a La Leche League meeting, I bought the Lact-Aid system, and now we use that exclusively. It’s very fiddly to set up, but the actual breastfeeding part is much more natural-feeling. I wear a homemade pouch on a string my colleague gave me, with the string across my chest so the bag hangs under my armpit. The tube is taped to my breast from that side, and Jasper can lay comfortably across my body with no hard bottles in the way. Although buying it involves a bit of sticker shock, and then learning to set up the bags is another bit of a shock, it’s by far the best system we have tried. I recommend buying the four-pack of feeders, a big supply of the bags, and having a rack of four at a time ready in the fridge; then you’re good for quite a while and can respond quicker to a hungry baby than if you have to fill a bag on demand. There’s still leaks, but fewer of them; there’s still a waiting crying baby while you get the bag out of the fridge and the tube taped to your breast, but it’s no slower than getting a bottle ready and the feeding experience is super-natural and lovely.
A note on taping: The illustrations show tape arranged crossways to the tube, but it works better (and you can use less tape) if you tape parallel with the tube, along its length. The paper tape doesn’t seem to grip your skin at first but smooth it down a few times and it gets fused on there pretty tight. Don’t get tape on your areola–it’s already no fun pulling it off of your regular breast skin afterwards, let alone your areola. Another advantage of the Lactaid system is that the tube isn’t as long as on the starter SNS, and requires less tape; also Jasper’s less likely to grab it and accidentally rip it off.
Drugs, supplements and galactogenic foods
(Editors note: It’s extremely important to consult with your doctor before taking any medication.)
The goal of nipple stimulation and the Domperidone is to increase the levels of circulating prolactin. Reglan is another drug with the same effect as Domperidone. Neither are designed to stimulate milk production (they are targeted to improve gastric motility and prevent nausea), but both increase circulating prolactin as a side-effect. They increase prolactin because they block dopamine receptors in the pituitary gland, which is one of the prolactin-producing parts of the body.
Milk production is also supposedly promoted by a variety of herbs and foods, including most famously fenugreek and blessed thistle, both of which I take religiously. The foods that reportedly promote lactation (‘galactogogues’) include oats, barley, carrots, dark beer, and seaweed; I like all of those so I’ve been eating them too, but who knows if they’re having an effect. The state of research into dietary influences on milk production is pretty dismal–it seems that it’s mostly based on anecdotal evidence–but I figured if I liked something on the various lists of galactogogues out there, I might as well eat it!
You can get more information about these and other supplements from your doctor, or La Leche League.
The main trick with feeding using the supplementer is getting the tube positioned correctly. It’s got to end just about where your nipple does, but the flexing of my breast as Jasper latches often means that it pokes out too far and he’s not comfortable. But if it’s too short, positioned before the nipple, the suction of his palate won’t get to it and he doesn’t get anything. You also have to be sure that it doesn’t flex to one side or the other as it’s going in his mouth; it has to go straight in so as to sit over the tongue in the palate. I usually have to use the near-side hand to hold the breast and keep my thumb on the tube as he latches. The tape keeps it from moving around too much. (The colleague I mentioned also found that it’s also possible to just pin the tube in place without using tape by tucking it under the edge of a bra lifted up over the nipple, but I didn’t find that as comfortable. On the other hand, I have to peel tape off every time.)
Because my near-side hand is occupied with holding the breast and tube, I need to use the opposite side hand to steady Jasper, and have a couple of pillows to support his head at the right height to reach my breast. This is the cross-cradle position that I think a lot of nursing mothers use at first and then are able to give up with practice, but because of the tube I still need to use it. As Jasper gets more able to hold his head in place, and aware of what’s going on, I might be able to be more flexible in positioning. I read a number of breastfeeding books, and the advice in ‘Bestfeeding’ concerning positioning was the most helpful to me, though other books have better details on other topics.
Because of the hassle of getting my pouch and tape in place, I typically only feed on one side at a time, alternating sides between feeds. Jasper needs small, frequent feedings, because of reflux, so neither breast goes too long without stimulation, but if he fed in larger amounts and went longer between feeds, I might feel the need to pump the unused breast after each feed so they would be evenly drained.
My husband Art usually does a couple of feedings per day so I can sleep. To prevent any possibility of nipple confusion, he finger-fed Jasper for the first month, holding the tube of the supplementer against his pinky finger and letting Jasper suck on that. (He mentions that the skin-to-skin contact this required, and the tactile feedback about Jasper’s feeding, was a bonding experience for him as well.) I don’t know if the finger-feeding was really necessary or not, but we switched him to a bottle without a problem after a month; he showed no disinclination to latch at the breast during any of it. The milk that I pump usually gets bottle-fed to Jasper, and we breast- or bottle-feed as it is convenient. I pump if I have to go more than four or five hours without nipple stimulation.
One thing worth noting is that we have found that Jasper doesn’t care a bit if the formula is cold or warm. From very early on we gave it to him straight out of the fridge. It’s even helpful in a way, in that I can feel the cool formula trickling over my nipple and into his mouth. I know if I don’t feel it then there is some problem with the tube positioning or other kink in the system that is preventing him from getting his food.
Why do it?
All of the above may seem like a lot of hassle, and it is. But, as I have said to many people over the past five months, I am very glad I did it, and I would be equally glad even if I never made a drop of my own milk. It is a really natural and beautiful way to get formula into a baby. They are built to expect to latch onto a breast, and the way his little body and face relaxed blissfully the first time he felt the food start to go in made it clear to me that it had to be a good thing to do. When we bottle feed him, he usually stays awake through the process, looking into your eyes or around the room, holding the bottle: he never relaxes completely. In contrast, when he breastfeeds, he often relaxes, and closes his eyes. If he’s tired, he’ll fall asleep at the breast, though he seldom falls asleep at the bottle. (Of course, other times he’s very active while nursing, swinging his arms around and whacking me on the jaw, grabbing the pouch string, looking distractedly away periodically–but that’s true on the bottle too.) The closeness and face-to-breast contact that I get with him every day because of it just can’t be had any other way. I feel like our connection is stronger, and my mothering role more secure, because of our feeding relationship.
Coming to open adoption was quite a journey for me and us, and so was coming to adoptive breastfeeding. Both have been beyond wonderful. I also want to say I could not have breastfed without the constant support and encouragement of my husband, and also the positive support of our extended family, many friends and relations, the lactation consultants at the hospital, the La Leche League chapter near us, and others. I was ready to quit several times in frustration–I threw a starter SNS system across the room, once–but they all helped me persevere, and I am very, very grateful.