Jack Newman, MD., FRCPC:
I understand that there has been some controversy about approaches to breastfeeding the adopted baby on this website, in particular with regard to protocols for inducing lactation which were written by Lenore Goldfarb, with suggestions and changes from me. I would like to make clear my position on the question of breastfeeding the adopted baby so that no one misunderstands that position. I am speaking only for myself.
1. I believe that an adopting mother should be given all the help she needs to be able to breastfeed her adopted baby. I believe this because it is good for the baby to be breastfed, and it is good for the mother to breastfeed.
2. Breastfeeding is more than breastmilk, and more than just another way of getting nutrition to the baby, though I would not want to suggest that breastmilk itself is not important. This approach I learned from the first adopting mother who came to see me when I was just starting helping mothers breastfeed. I admit I didn't know very much about breastfeeding in general, never mind induced lactation. When I told her that I didn't think it likely she would produce much milk, she said, as I remember it, "I want to breastfeed. If the baby also gets breastmilk, that will be a bonus". I believe this is a good principle to work with. Indeed, it is the same principle I work with when biological mothers come to see me for "not enough milk".
3. Domperidone, without any doubt, will make the process of milk production easier for most adopting mothers. Breastmilk will be produced more quickly, and in larger quantities when the mother takes domperidone.
4. I believe that if the we can "simulate" a pregnancy during the time that an adopting mother is waiting for the baby, this will also increase her ultimate milk production. There is no proof for this, but it makes sense. Breast changes which occur during pregnancy prepare the breast for milk production. There is no reason that this should not be true for using hormones. I will admit that many things in medicine which "make sense" ultimately turn out to be untrue. I also understand that some mothers will be taking drugs for no reason, when the adoption falls through, as it sometimes does. I believe I can understand, at least somewhat, the terrible disappointment this causes. But I'm not sure this is a reason not to prepare in advance for breastfeeding.
5. If a mother is reluctant to use medication, it is not my practice to push her to use it. I explain that it is likely she will produce more milk, but again point out that this may not be the ultimate goal. I should point out however, that if a woman does contact me, it is usually because she wants to go the medication route, so most adopting mothers I have seen use the medication. Otherwise, they don't need a physician to counsel them, though I am happy to do that.
6. Not to put too fine a point on it, there is not a single medication out there that has not killed someone. Aspirin has killed many, yet few people are reluctant to take aspirin. There is always a risk of taking medication. Or as one of my teachers once said "A drug is a poison with beneficial side effects". Some women will say that taking medication to increase the milk supply is not worth any risk. I respect that. Others will want to produce as much milk as they can. Some women will not want to breastfeed at all. If they make an informed choice, that's their prerogative.
7. On the other hand, we should not use scare tactics to dissuade women wanting to use medication to increase their milk production from taking them. They should make an informed choice. The side effects of domperidone are very mild, and in fact, most women do not have any. But aspirin was around for 100 years before we learned it could cause Reye's Syndrome, and domperidone has not been around for 100 years, far from it. The side effects of the hormones are the same as the side effects of pregnancy. These can be serious, and can include deep vein thrombosis and pulmonary embolus, which can be fatal. For this reason, any mother inducing lactation with medication, even if only with domperidone, must be followed by her family doctor. Under no circumstances should the family doctor be unaware of what she is doing.
8. I believe that formula should be considered a drug. To be used only if necessary. I say this advisedly, because I know that many on this website have required formula for their babies. If formula is required, it's required and should be used, just as someone with bacterial pneumonia should get drugs as well if it decreases the length of their illness or possibly saves them from death. But the antibiotics the person with pneumonia gets may cause diarrhea, abdominal pain, yeast infections, and sometimes much more serious effects, sometimes even death. But we weigh the risks against the benefits. Formulas are better than they used to be, but they are still not breastmilk. So is it worth taking a drug or drugs to increase the amount of breastmilk a baby will get? Not for me to say.
9. There has been, apparently, some concern about "numbers" on the website. My opinion is that obsession with numbers is killing breastfeeding. We have to go back to making breastfeeding simple. Rules like 20 minutes on each side make no sense, none at all. Waking the baby to feed every three hours also makes no sense. Statements such as "if the baby gets 15% of his milk as breastmilk is not worth it" are similarly absurd (I'm not saying anyone made such a statement).
I hope this is clear.
Jack Newman, MD, FRCPC