QUESTION: I am an adoptive mother eagerly awaiting the birth of my third child. This will be our first newborn and my first attempt at nursing. I have found great resources and support, but there's one question I can't find an answer to and I think it reflect a bias in the adoptive breastfeeding world. My question is why don't most adoptive mothers have a full milk supply?

I know that on the surface this seems like a foolish question, but in the face of the fact that some adoptive mothers here and most in the third world do have full supplies, I wonder what are we doing different. My question is why wouldn't you have a full supply. What differences in the breast does pregnancy create and are there ways of simulating those or do they matter? Does the amount and type of supplementation from supplemental devices have something to do with it?

Lisa,

You ask some very interesting and good questions. Congratulations on this wonderful opportunity and on your desire to breastfeed!! It is also interesting that you ask when we have just received an article on this matter which you can find in the Journal of Human Lactation, volume 15, Number 1, March 1999. Pregnancy prepares our bodies for the birth of a baby. As our babies are growing inside, our breasts are also changing on the inside as well as on the outside. There are two ovarian hormones that prepare the breasts for lactation during pregnancy, estrogen and progesterone. This preparation includes changes that mothers notice throughout their pregnancy and some which take place within the breast. For example, a pregnant woman's areola may become darker and so will her nipple. Some say this change serves as a "bull eye" for the newborn. These hormones also allow for glandular tissue proliferation; the ducts within the breast begin to expand; alveoli also begin to expand. In late pregnancy there is also another hormone, prolactin, that stimulates epithelial growth and which is also responsible for milk production. So as you can see, there are many hormones that are involved in pregnancy.

When we are assisting a mother who wishes to adopt a baby, we emphasize the importance of keeping in mind the importance of the nurturing relationship between her and her baby. I strongly emphasize this relationship as being the most important with a milk supply being a plus and a full supply being a bonus. I have found that the more relaxed a mother is about her "production" and the more focused she is on her baby, the more milk she will have. On the other hand, those mothers who are too worried about their milk production may not have a full supply and may need to supplement. It is important to have a very positive attitude! Keep in mind that in third world countries, mothers often know that they do not have a choice and have more confidence in the importance of breast milk! Could this be a factor? I, would think so. The mind is a very important factor.

It is wonderful on your part to learn as much as you can about breastfeeding before the baby arrives. Remember that really knowing the signs of good breastfeeding is very important, not only in adoptive breastfeeding but also in all aspects of breastfeeding. It is very easy for a new mother to doubt herself when the baby is a reality! I encourage you to find a good lactation consultant in your area to keep in good contact with for those time when you are not so sure. We often recommend that you use a good quality hospital grade electric pump and start pumping 4 to 6 weeks before a mother expects to get her baby and that you use galactogogues to help you induce lactation. Prior to that, you can do breast massage and hand expression so that your breasts receive lots of stimulation.

When you start pumping and get milk, save and freeze every drop that you get because this will add up and you can use it later in a supplementer! I also recommend the book "Breastfeeding the Adoptive Baby" by Debra Stewart Peterson. You can also get lots of information through La Leche League International. Good luck.

Yvonne C. Bannister, B Sc, CBC, LLLL, IBCLC

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