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Breastfeeding and Adoption & Surrogacy

Breastfeeding and Adoption & Surrogacy


Where to Start

American Academy of Pediatrics Position
Controversy over use of Medications
Herbal Supplements
Books & Articles
Lactation Aids
Breastfeeding FAQ Page

Where to start:

It is indeed possible to breastfeed your adopted child or baby born to a surrogate or gestational carrier. It is usually not easy and often not possible to provide your baby’s full milk supply, but it can be done and can be a rewarding bonding experience for mother and child. In a 1995 study of 240 adopted infants in which 80% were previously bottle-fed, 35% of the mothers had never given birth, and 23% had never previously breastfed found the following:

  • 75% of the babies were willing to nurse by the end of the first week of trying
  • More than 75% of mothers felt positive about their lactation experience.
  • 54% of infants required supplementation for the duration of nursing.
  • 25% of women who had never been pregnant before were able to eliminate supplements completely before weaning off the breast.
  • Mothers reported that the benefit of bonding was more important than milk production.

Dr. Lenore Goldfarb, our adoption and surrogacy breastfeeding expert, said on the Creating a Family show that in a study of 228 women following the Newman-Goldfarb protocol, 31% were able to produce all of their baby’s milk needs without supplementation.

Regardless how much milk you produce, breastfeeding your adopted child or child born to a surrogate can still be a rewarding experience for both mother and baby and a wonderful way to bond. As one mom wrote: “Breastfeeding was so worth it! I not only felt like most of my "broken" pieces weren't so important anymore -- something maternal worked just like for other women -- but being able to nurse in the presence of gestational moms leveled the playing field. It was like I was finally like other "normal" mothers.”

If you are planning to breastfeed an adopted child, please think through the issue of what will happen if the adoption placement falls through because the expectant woman/birthmother decides to parent. I suggest you read posts on several adoptive parenting forums (see list below) to help you decide how soon pre-adoption you want to start trying to induce lactation. For example, this post from a mom who had induced lactation before the expectant woman decided to parent.

Also, it goes without saying, but we'll say it anyway, you should consult with your doctor and your child's doctor before making the decision to breastfeed your adopted child or your child born to a surrogate. The information we present is educational in nature and not intended to replace a careful discussion with your doctors who can evaluate your specific situation.

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American Academy of Pediatrics Position:

  • 2005 Policy Statement on Breastfeeding and the Use of Human Milk (PEDIATRICS Vol. 115 No. 2 February 2005, pp. 496-506). Pediatricians should “provide counsel to adoptive mothers who decide to breastfeed through induced lactation, a process requiring professional support and encouragement.”

  • The press/news release issued to announce the 2005 Policy Statement by the AAP went even further: “Pediatricians should counsel adoptive mothers on the benefits of induced lactation through hormonal therapy or mechanical stimulation.”

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Controversy over use of Medications to Induce Lactation:

Induced lactation requires a specific protocol for almost all women who have not been pregnant. Most protocols suggest starting gradual with gentle massage, nipple stimulation, and pumping a couple of times a day with a high quality electric hospital grade dual attachment breast pump for 3 to 5 minutes. Work up to pumping for 10 minutes 6-8 times per day. Many protocols also recommend the use of prescribed medications called a galactagogue (milk stimulating). One of the most popular and successful protocols to induce lactation without pregnancy, the Newman-Goldfarb protocol, recommends the use of the drug domperidone, a drug not approved by the US Food and Drug Administration. Others suggest the use of the drug metoclopramide (brand name Reglan). Still other woman prefer to use herbal galactagogue to try to stimulate milk production with or without the use of medication. (See resources below on herbs used to induce lactation.)

We are not medical doctors and we strongly recommend that you discuss this option with both your gynecologist and your child’s pediatrician. The following information may help you make this decision:
  • Domperidone (brand name is Motilium) is a gastric motility agent widely used in Canada, New Zealand, Germany, Australia, Mexico, and South Africa to treat gastric reflux and nausea. It is not approved for use in the United States. Domperidone may also increases prolactin production (galactagogue), and thus is often recommended for lactation induction. Domperidone is not approved for lactation induction in any country, but is being used off label for this purpose.
  • The US Federal Drug Administration warned in June 2004: "The agency is concerned with the potential public health risks associated with domperidone. There have been several published reports and case studies of cardiac arrhythmias, cardiac arrest, and sudden death in patients receiving an intravenous form of domperidone that has been withdrawn from marketing in a number of countries. In several countries where the oral form of domperidone continues to be marketed, labels for the product contain specific warnings against use of domperidone by breastfeeding women and note that the drug is excreted in breast milk that could expose a breastfeeding infant to unknown risks. Because of the possibility of serious adverse effects, FDA recommends that breastfeeding women not use domperidone to increase milk production."
  • American Academy of Pediatrics (2001). “The transfer of drugs and other chemicals into human milk: Policy statement.” See specifically Table 6
  • Dr. Lenore Goldfarb was our guest on the Creating a Family radio show where she discussed the use and safety of domeridone. On the show she mentioned the following: “Tom Hale, Ph.D. stated in his book Medications and Mother’s Milk (2008) that no pediatric concerns have been reported following the use of domperidone, that following a dose of 10 mg three times daily, only 2.6 ug/L was found in the breast milk when tested, and that domperidone is “considered to be the ideal galactogogue” (p. 302). It is noteworthy to point out that there is a theoretic pediatric dose of domperidone of 0.18 ug/kg/day used to treat infants who suffer from reflux and vomiting (Hale, 2008).” Note, that Dr. Golfarb is not a medical doctor and she lives and works in Canada where domperidone is an approved drug for use for gastric problems.
  • Article by Dr. Jack Newman discussing the safety and use of domperidone. It is not written specifically for adoptive mothers or mothers whose child was born to a surrogate or gestational carrier. Note, that Dr. Newman practices in Canada where domperidone is approved for use for gastric problems.
  • Dr. Dena Goffman and Dr. Peter Bernstein discuss the use of metoclopramide (brand name Reglan) and domperidone.

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Herbal Supplements that May Increase Milk Production:

Some people prefer to stay about from prescribed medication for inducing milk supply. The following herbs have been reported to have the effect of increasing milk supply for nursing mothers. Remember that herbs are not benign. If they were, you would not be considering them. You hope they will have the effect of increasing your breast milk supply. But remember, they can also have negative side effects for both mother and child. Check with your gynecologist and pediatrician before you take anything.

  • Fenugreek (Trigonella foenumgraecum)

  • Blessed thistle (Cnicus benedictus)

  • Alfalfa (Medicago sativa)

  • Goat's Rue (Galegas officinalis)

  • Shatavari (Asparagus racemosus)

  • Milk thistle (Silybum marianum)

  • Oatmeal (not an herb, but …)

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Resources on Using Herbs to Induce Lactation:

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Books & Articles:

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Lactation Aids:

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  • I Am Not the Babysitter- Great blog of a mom who adopted a son from Ethiopia and chose to breastfeed him. She interviews other adoptive mom who breastfeed and includes these interviews on her blog. Great resource.
  • Preparing to Nurse our Baby - A little outdated, but good blog by a mom preparing to breastfeed her adopted child.

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  • Adoptive Breastfeeding is a Yahoo group of moms committed to breastfeeding their adopted children. This list goes through periods of inactivity, but if you have a question or want support it is definitely worth posting and seeing if you will get a response. Most people tell me that they do.

  • 1ABSupportGroup is an active Yahoo group that provides support for adoptive breastfeeding mothers and mothers to be.

  • Ask Lenore - One of the best forums. Very Active.

  • - Adoptive moms, moms through gestational carrier, fairly active and moderated so you’re likely to get a response.

  • Medela, the makers of breast pumps, lactation aids, & breast shields has a nursing forum on their site. Although it is not specific to non-gestational mothers, it is an active forum that welcomes questions by adoptive moms and moms through surrogacy.

  • Adoptive Breastfeeding Resource Website - support and information forum.

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Image Credit: Shannon Miller Lifestyle

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