Preparation for Adoptive Nursing:
As with just about anything, the most important preparation that a woman who wants to nurse an adopted baby can do is educate herself about it. There is not a tremendous amount of written material about adoptive nursing available yet, but there is more and more all the time. Much of this is in the form of personal accounts of individual adoptive mothers. These are very useful and should be taken advantage of! I have also supplied links on this webpage to other resources on the internet.
There is, however, enough written material on breastfeeding in general to keep someone busy for quite some time! An adoptive mom needs to know nearly everything that any nursing mother does. The specific concerns of adoptive nursing are in addition to, not in place of, general breastfeeding information. In general, adoptive nursing is like nursing a bio baby, but with an "external milk duct" (as some women like to think of the nursing supplementer.) About the only thing that bio moms can experience, but adoptive moms cannot, is postpartum engorgement!
Any mother who sets out to try to nurse a baby should own at least one good book on breastfeeding. I have provided a link to ordering information for one of my favorite breastfeeding books, "The Nursing Mother's Companion", by Kathleen Huggins, RN, MS. It is a very thorough, straight forward discussion. The section on adoptive nursing is short, but accurate. Another thing I like about it is that it does not spend as much time talking about pregnancy and birth, which can be upsetting for a woman who has been struggling through infertilty, as some of the other more prominent books.
Seeing mothers nurse is also a very important part of education. For millennia, human mothers nursed their babies just fine, without reading books or going to La Leche League. They knew how to do it because they had grown up seeing it done. Since the breasts have been considered sexual objects, and breastfeeding has been quite rare, for several decades now, this form of education has been lost. Mothers now need to find opportunities to see babies nursing. Photographs are helpful. Videos are quite a bit better than that, but seeing it in person is the best of all.
Contact with La Leche League (an international organization which provides education and support about breastfeeding) is usually helpful. It provides opportunities to see other women nursing babies, but also helps adoptive mothers find friends who will support them and think that what they want to do is wonderful. Whether or not the adoptive mother will find specific council on adoptive nursing depends on the individual leader and other members of the local group. Most women affiliated with La Leche League do not know more than the bare basics of adoptive nursing. LLL does, however, have peer councilors, who are experienced adoptiv nursing mothers, in some areas.
Some women, who have had babies placed for adoption on extremely short notice, have thought that they could not nurse because they had not prepared. It is important to understand that, while some preparation of the breasts is helpful, it can be done without if necessary.
A very simple first step in this is to get used to keeping soap off of the nipples. Warm water is sufficient for cleaning and does not dry out the tissues like soap does.
Before going any farther, a potential adoptive mother should determine whether her nipples are inverted or flat. If they are, it is easier to deal with before the baby comes than after. Having flat or inverted nipples does not mean that someone cannot nurse. Babies throughout the history of mankind have nursed on nipples of all types. However, since most adopted babies have had bottles or pacifiers (which are inserted into the mouth, where nursing requires the baby to open up and latch-on) before their adoptive mothers have a chance to nurse them, it is even more likely that nursing will be difficult if the mother's nipples are flat or inverted. A simple test is described at a link provided below. It is not always easy to tell by looking.
The simplest first step in assisting the nipples to stand out is to wear breast shells designed to put gentle pressure on the area around the nipples. These can be purchased through Medela, La Leche League (both of which links are provided for below) and many other sources. If you find that the shells are not making a difference, or have severely inverted nipples, You might want to try either the Nipplette, sold through Avent UK, or the Evert-It Nipple Enhancer. See links to both below.
Nature provides many changes in the breasts during pregnancy. Besides the changes of the structures inside the breast, there are changes in the nipples and areolas. These enlarge somewhat and the tissue become more elastic, and . There are some things that adoptive moms can do to simulate these effects.
It is a myth that a nursing mother needs for her nipples to be "toughened up". Tactile stimulation of the nipple and areola is essential in getting the message to the brain that there is a baby nursing who needs milk. However, since the invention of the bra, many women in industrialized countries have developed a nipple sensitivity that it more extreme than nature intended it to be. Bras made of artificial fibers, especially, can produce a less than optimal situation. For women who spend most of their waking hours in a bra, it can be helpful to go braless or wear a nursing bra with the flaps down. This is only to promote air circulation and provide a small amount of tactile stimulation. The clothing worn over the breasts should be soft and, preferably, cotton.
Pumping of the breasts is very often found to be helpful in preparing the nipple area for nursing. This helps mainly by increasing the elasticity of the tissues and, possibly, enlarge the areola to some extent. Some try to do this with nipple "rolling" or other manipulations of the nipple. The problem with these is that they tend to stress the base of the nipple, which is prone to cracking. A good pump, which fits the breast well, disperses the suction over the nipple and areola, avoiding stressing one spot.
Breast massage, or compression, is also sometimes found to be useful in preparing the breasts, and also in helping make what milk is in the breasts more easily available to the baby. For a good description of this, see link below.
Some moms use a full-sized, double electric pump, but a good hand pump, or small electric model, used a few times a day for a few minutes at a time, may be nearly as effective, without the financial investment. No cylinder or bicycle-horn pumps should be used. Some very good hand pumps and small electric pumps include those from Medela, Ameda Egnell and White River. Of those that can be purchased in grocery stores or department stores, I would recommend first, the Avent Isis breastpump, and then the Gentle Expressions pump. This pumping should be done slowly and carefully. Hurting the breasts is not the object! Sometimes, moistening the breast with an unscented, hypoallergenic, moisturizer, or even warm water, is useful in avoiding irritation.
Taking on a rigorous schedule of pumping, in an attempt to bring in milk in advance, is sometimes recommended. However, although a few women are able to eventually pump a few ounces, the VAST majority see no more than drops, or even droplets, for their efforts. This has discouraged some women so much that they have given up before they even got their babies. Experience with a pump is not a dependable way to predict what the experience will be with a baby. Pumps do not express the breast in the same way that a baby does, and they don't elicit the same emotional response that triggers the production of lactation hormones. Some bio moms have a very hard time getting much milk out with a pump, even those who have thriving, totally breastfed babies. The increased anxiety that many prospective adoptive moms are experiencing can greatly inhibit the emotional/physiological responses to breast stimulation.
Anyone considering such a pumping routine should take many things into consideration. One difficult, but real, fact is that many prospective birth mothers decide that they cannot go through with placement, once the baby is born. While this is their right, and I am in no way criticizing mothers who do this, it is a very painful thing for a prospective adoptive mother to deal with. Some mothers who have been pumping around the clock for weeks or months beforehand, have said that they thought that fact made it even more difficult for them to deal with the loss of the potential baby.
Other moms decide to pump and then find that it produces too much anxiety for them. They need to know that they can quit at any time without reducing their chances of success once a baby is placed with them.
The last thing I will say about this right now is to caution women against being sold expensive things that they do not need. Far too many times, I have had women tell me that they have gone to visit someone who claimed to know about adoptive nursing and said they could help, only to be told that they "have to" pump, and sold an expensive electric pump (or expensive double pumping kit and rental on a full-sized pump). With the high price of adoption these days, they last thing an adoptive mother needs is a bill for $300 for a pump that she will not use, or at least that will not be any more useful to her than a pump in the $50-75 range.
The time required for the first droplets to appear varies from a few days to several weeks, but does not appear to be a very good way to predict what the mom will be producing when her production reaches its peak, which occurs after about 12 weeks of nursing. The amount of milk that an adoptive mother gets from pumping alone is usually not a bit accurate in predicting how much milk is there or how much may eventually be produced.
There are some other things that can be done to maximize milk production, (which I will discuss further later) but the most important thing is having the baby nursing well at the breast, the more frequently, the better!
Text Copyright © 2005 Darrillyn Starr. All rights reserved. Reproduction in whole or in part without permission is prohibited