adoptive breastfeeding revisited, pt.2

For part one, click here.

Aside from the challenges I knew I’d encounter in trying to induce lactation, I was concerned about the potential risks to me and to the baby of taking the medications. (Note this issue was also raised by a commenter on the last post, which prompted me to elaborate on my decision-making process here.)

As someone who goes out of her way to avoid foods treated with chemicals and hormones, I know I am a walking contradiction to have injected numerous hormones into my body in my quest for a child. Yet the thought of passing any risky medication through breast milk to affect the baby was another issue altogether. I was very concerned about potential effects on the baby, and I did a lot of research before beginning the protocol. Ultimately I was satisfied that there would not be a real risk of harm. Here’s why.

First, the birth control pill you take and stop more than a month before the baby comes. When you begin pumping, it is to increase demand and not supply, so any milk produced is not ingested and those drugs clear your system. The other drug, domperidone, is more controversial because it is not approved by the U.S. FDA for the purpose of inducing lactation. For years it has been used by women with poor milk supply to increase production. But its prescribed usage was to treat GI tract problems in infants and children (with lactation being an unfortunate side effect). Any trace amounts that could pass through breast milk would be much less than the regular dosage prescribed for a baby who was spitting up and losing weight.

The controversy stems from a warning issued by the FDA in 2004 against use of domperidone to increase milk production, citing an old study which found risks of heart problems with high dosage intravenous use. No significant risks have been found with short-term oral use. Unlike other drugs to increase production (e.g., Reglan), it does not pass the blood-brain barrier and has few side effects. Finally, the American Association of Pediatrics lists domperidone as “compatible with breastfeeding” with no sign of effects in infants. (Quite possibly the FDA was upset that women were ordering the drug online from Canada and the UK.)

After speaking with several health professions (who were admittedly biased in favor of breastfeeding), ultimately I decided that the potential benefits outweighed the potential risks (though someone else could reach a different conclusion, of course). As a precaution, I planned to taper down the dose once I had a supply and rely instead on the herbal and pump protocol.

Once I began the protocol, however, I found it very challenging to comply. I didn’t have enough time on the meds to produce anywhere near an adequate supply. I didn’t like taking the drugs. I was working long days and couldn’t maintain the pumping schedule. K, the expectant mother with whom we were matched, was due to give birth in less than a month. After more than six years, we were busy actually planning for a real live baby. On top of everything, keeping up with the protocol was nearly impossible.

Yet I stuck with it. I tried to prioritize it. I did what I could. That was my mantra: Do what you can.

A few days into the protocol, when I noticed the first drops of milk coming in, I was astonished. I was encouraged to stick with it and became even more dedicated. Yet as I excited as I got, as relieved as I was (it was working!), I never produced much milk, even with all the herbs and pumping for weeks and months.

Still, the very first time Baby J suckled at my breast soon after she was born, my heart filled up and overflowed, tears came streaming down my face, and I felt a serene sense of joy like I have never known.  For that moment alone, it was all worth it.

Then that first night was really hard. I was not producing enough. I had no colostrum (though Baby J did get some from K, which was expressed by the midwives). I had to supplement my weak supply with formula, so we bought the best organic one we could find. I used one of those annoying supplemental feeding contraptions around my neck and down my boob so the baby could feed while stimulating the nipple to produce more milk. It was hard work for all of us. Everyone was frustrated. It was really, really challenging.

By day three, Baby J had begun to lose so much weight that our pediatrician — a strong breastfeeding advocate with a lactation consultant on staff — suggested that we switch to a bottle from the annoying supplemental feeder. Any breast milk she gets is a bonus, he said. But she needs to eat. More. Now.

Our plan had been to try to stick with our system for three weeks to establish a good latch, then add the bottle. But once we saw she needed more, that plan changed. That night, we introduced the bottle and the baby was happy and full and slept well. It made a world of difference.

Once she realized she could get more faster from the bottle, it was harder to nurse of course. In those first weeks, I tried to nurse her and hooked up the supplemental feeder several times a day. But when she was really hungry, she wanted the bottle and I gave it to her. There’s nothing good about an unhappy insatiable baby.

Many of the women I know breastfed exclusively for the first year and continued to nurse until after age two. Some had difficulties, and they dealt with them however they had to. My main fear before Baby J was born was that I would not be able to feed her. I was not worried about loving our daughter; I was worried about feeding her. Anyone who knows me, anyone who comes to my house, gets fed. Food is part of my DNA. I tried not to feel entirely inadequate when I couldn’t produce enough to feed our baby. I tried to remember that it was amazing I could produce anything at all.

On a side note, K and I acknowledged the irony when she was trying to dry up her supply while I was working so hard to increase my own. K’s midwives advised her on the protocol she would follow, and I commiserated with her about how awful it was. Having had full, painful, leaky breasts with no baby to feed, even though our situations were obviously different, I supported K as best as I could. Though there I was, trying to feed our daughter with my own limited supply. What was usually the most natural thing after the birth of a baby was not so normal or ordinary for us at all.

K spent a lot of time with us during the first two months or so of Baby J’s life. When she’d visit in those early days, she’d hold the baby and feed her a bottle while her breasts would leak. I’d get her some ice or cold cabbage or sage tea, doing whatever I could to make her more comfortable, my heart breaking a little each time. Yet K said that as hard as it was, it was healing to be with us, to hold and feed her beautiful baby, to be with us as a new family, all of us.

Meanwhile, if it was hard to pump before the baby was born, it was next to impossible afterward. Who had the time? Plus now we had to deal with cleaning the pump, the feeder and bottles too. Things are so much simpler when you can just feed your child anywhere with no worries, nothing to clean except maybe a bit of spit-up. Seriously. Easier, simpler, and cheaper.

I continued to nurse at night, when preparing a bottle with a wailing newborn was an ordeal, and in the morning when she was sleepy. Sometimes I was able to nurse her for comfort when she cried, though if it was a hunger cry, the boob would not satiate her. I was only releasing a couple of ounces a day from both sides total. Still, every ounce was like a small victory.

Eventually Baby J weaned herself completely by about three months old. I continued to pump until she was about five months old. But by that point I was only able to produce enough milk for about 1-2 bottles per week. It did not seem worth the tremendous effort for such little output. When I finally returned the pump rental, I was relieved. But to be honest, I still miss those moments, that intimacy.

So it was a lot of work for not much milk, but I think the end result was absolutely worth it. We had an incredible opportunity for some early bonding, and she did get some added nutrients. I still wish I could have done more. I wish it could have lasted longer. I wish I could have sustained her. It still gets me when I see how easily breastfeeding comes to others. I know it doesn’t work for everyone. Some of us have to work harder. Some of us never get there. At least we had a taste of what it was all about, she and I.

At the time, my lactation consultant said that I should view “success” in terms of what I could do, rather than what I could not. That made so much sense. I am grateful for those moments we shared, for that opportunity, and I’m still astounded that it worked at all.

~ by luna on April 18, 2010.