Breastfeeding an Adopted Baby

You’re adopting a baby. Congratulations! It’s an exciting time in the life of your family.  

Throughout this process, you’ve undoubtedly navigated a lot of new information and questions. We find that soon-to-be adopting mamas are typically most curious about the specifics of breastfeeding their little one(s) and how to induce lactation when they haven’t carried or delivered the baby. 

Because breastfeeding is an amazing way to provide your newborn with vital nutrients and bolster their little immune systems, we applaud your desire to learn about your options! The good news? It’s completely possible. You can breastfeed an adopted baby with a little help, education, and preparation. 

Here’s what you need to know.

Some adoptive parents believe it's impossible to breastfeed their newborn if they aren't their birth mother, but that is not true! It is a surprise to many, but it is completely possible to breastfeed a baby without having been pregnant. This process is called induced lactation.

Adoptive breastfeeding through induced lactation is a wonderful way for adoptive mothers to bond with their new child and provide them with nutritional and immunological benefits similar to those provided by traditional breastfeeding. 

It may be difficult to achieve, and most adoptive moms (unless they have previously birthed children whom they breastfed) will struggle to have a full milk supply. It requires a lot of effort, but it is possible through a combination of physical stimulation of the breasts and hormonal therapy that mimics the hormonal profile of pregnancy. The goal is to trick the body into producing milk.

The methods below can be used by an adoptive mother (or both adoptive parents, if applicable), mothers with babies born by surrogacy, and female partners of birth mothers.

Beyond the wonderful benefits of bonding with your baby, breast milk’s chemical makeup is designed to help infants grow and thrive. 

Breast milk is rich in antibodies and immune-boosting substances that help protect your baby from infections and illnesses. It contains the perfect balance of nutrients that a baby needs for healthy growth and development. Breastfed babies are at a lower risk of developing health complications, including asthma, type 1 diabetes, sudden infant death syndrome (SIDS), and more. Breast milk also helps preterm infants gain weight and continue their body and brain development in the NICU.

Adoptive breastfeeding has been proven to have many positive effects on mama, too, including regulating your heart rate and attachment development with your baby from the skin-to-skin contact that breastfeeding allows.

If you are planning to exclusively or occasionally pump, bottle feeding your baby will still provide your little one with the benefits of breastmilk, while allowing a non-breastfeeding support partner to bond with your newest family member.

When deciding to breastfeed a baby that you did not carry, it is important that you explore your options.If your goal is to exclusively breastfeed your adopted child, it’s good to understand how developing a milk supply typically works so that you can manage your expectations. 

Establishing a steady supply of breast milk takes time, and you may need to supplement with an alternative occasionally. That’s okay! This process looks different for everyone, and it’s important to remind yourself that however you keep your baby happy and fed is whatever is right for you and your baby!

To help you establish some lactation goals, we recommend that you:

• Research and talk to your doctor about the use of galactagogues, which are herbs or prescription medications that increase breast milk production.
• Talk to your healthcare provider about the Goldfarb-Newman Protocol (more on this later!). This method involves taking birth control pills to stimulate pregnancy hormone changes and then both expressing the breasts and taking medication to increase hormone levels.
• Use herbal remedies such as fenugreek, which is available over the counter.
• Stimulate your breasts by hand or pump for several weeks or months before your baby arrives (more on this below). 

The amount of milk you will be able to produce varies from mother to mother just as much as the ability to feed varies from baby to baby. There is no way to know ahead of time how much milk you will produce.

This process is full of trial and error, as is the case with many breastfeeding journeys. It’s something that you and your baby are experiencing together, and that is a beautiful thing! Rather than worrying about how much milk your baby is getting, try to keep your focus on the breastfeeding relationship that you have. One of the many benefits of breastfeeding is the physical connection and skin contact for both you and your baby, which can promote your bonding, connection, and special closeness.

As with any breastfeeding journey, there are some complications every mama should look out for. These may include:

• Clogged Milk Ducts: It sucks, but it happens. When your milk glands get clogged, it can be pretty painful. And when left untreated, clogged milk ducts can lead to swelling, redness, or infection. If you notice any of these symptoms, reach out to your doctor!
• Nipple Sensitivity: Your nipples may get dry, cracked, or raw while breastfeeding. This is normal! Saliva and improper latch may be to blame. A lactation consultant can help you determine the cause and work on your baby's latch, but in the meantime, lanolin can provide your nipples with some much-needed relief.
• Low Milk Supply: Low milk supply can be due to a variety of factors, and can be especially common in adoptive parents trying to induce lactation. Working with a lactation consultant can help! These professionals are trained to support you in setting and achieving your lactation goals.

If you’re an adoptive mother or a mother who brought your baby into the world through a surrogate pregnancy, the time to begin working on your milk supply is before the little one is born—if possible. Studies show that mothers are more successful if they begin the induction process prenatally, instead of after the baby is born. Once the baby is born, we recommend direct-breastfeeding (nursing the baby at the breast instead of using pumped milk) as much as possible, in addition to pumping frequently and having a strong support system.

If a mom has previously breastfed another baby, the process of rebuilding her milk supply is called relactation. Often, some of the same techniques are used for inducing lactation and relactating. It is very common for moms experiencing relactation to produce more milk than moms who are trying to produce milk for the first time.

There are many kinds of lactation induction methods. Whether you use medications or not, consistent milk removal is necessary to elevate your lactation hormones and induce lactation. Stimulating and massaging your breasts can also have benefits, so lactation induction methods often include both of these approaches for full effect.

Here is an example of an induction protocol without medication:

• Around 2 to 4 weeks before your baby’s arrival, gently massage your nipples and breasts for 10 minutes with your hands. Do this 8 to 10 times per day for 2 weeks. If you don’t have weeks to prepare for your baby’s arrival, it is perfectly fine to start a manual massage as soon as you can. Massage your breast starting at the top, using circular pressure. After a few seconds, lift your fingers to move to the next area on the breast. Spiral around your breast with a circular pressure while moving towards the areola and nipple. Use the same gentle pressure that a newborn baby’s hands might put on your breast while feeding to simulate this same action.
• After 2 weeks, use a hospital-grade electric breast pump to pump while doing a small amount of massaging for 10 to 15 minutes, 8 to 10 times per day. If pumping is uncomfortable, add coconut or olive oil to the funnel. The discomfort may be caused by less elastic nipple tissue, as pregnancy hormones increase nipple elasticity.
• After your baby arrives, at the beginning of each feeding, have your baby suckle at the breast. Suckling helps to stimulate the letdown reflex, and a hormone called oxytocin helps release the milk from the milk ducts. Smelling, seeing, and hearing your baby will trigger additional oxytocin to be released. Generally, having a baby feed directly from the breast with a good latch will bring greater oxytocin surges and overall milk volume than the pump.
• Pump as time permits, ideally after each feeding. The goal is to get productive milk removal by your baby your breast pump, or a little of each, at least 8 to 10 times per day. 
• In the early days as you are building your supply, use a supplemental nursing system (SNS) to provide expressed milk feedings at the breast through a small feeding tube. Cut back on the length of time you use the SNS as your supply builds. Monitor the number of dirty and wet diapers and your baby’s weight gain to help confirm that the combination of your supply and the supplemental milk amount is sufficient. Some new mamas will eventually be able to completely stop using the SNS, while other moms may need to use the SNS supplemental milk long-term.

It is highly recommended that you work with an IBCLC (International Board Certified Lactation Consultant) during this process to meet your breastfeeding goals as well as to ensure your baby is getting enough milk and gaining weight. 

Using hormones as a lactation aid for adoptive breastfeeding is common, as it can simulate the milk-making breast tissue growth (e.g., milk ducts and alveoli) that happens in pregnancy. Starting hormone supplementation at least 2½ to 5 months before your baby’s arrival will have the best likelihood of producing the strongest milk supply, but any amount of preparation will help!

Because hormone therapy protocols require prescription medications, it is important to work with a trusted and knowledgeable healthcare provider who is familiar with inducing lactation. Since oral contraceptive pills are typically the hormones used to develop milk-making tissue, and these pills have certain health risks, it is important to talk with your healthcare provider about your medical history. Risk factors may include heart conditions, blood clotting concerns, high blood pressure, and more. 

Here is a summary of the hormone therapy protocol called the Newman-Goldfarb Protocols for Lactation. It builds on the above stimulation and pumping protocol by layering in the medication. Please note that the medication will not work on its own to induce lactation—physical stimulation is an important part of inducing lactation. 

• Around 2½ to 5 months before your baby’s arrival, at any time in your cycle, take a daily oral contraceptive pill to increase the breast tissue that produces milk. Your doctor who is familiar with Newman-Goldfarb will know the correct levels of estrogen and progesterone needed. Only certain brands have the right levels and ratio of these hormones.
• At the same time, introduce a prolactin-stimulating hormone medication that is safe for long-term use. Prolactin is the hormone involved in milk volume. The medications often used are Metoclopramide and Domperidone. Domperidone tends to have fewer side effects than Metoclopramide, but it is not approved by the Food and Drug Administration in the
• United States for use to increase lactation. Some side effects of Metoclopramide are drowsiness, depression, and tardive dyskinesia, a neurological disorder characterized by involuntary movements of the face and jaw. Talk with a trusted healthcare provider about your options.
  While taking the different medications, use the nipple stimulation and pumping protocol described above to assist in the milk production process.

Herbal supplements with a galactagogue effect (a food or drug that promotes or increases the flow of human milk) are sometimes used in combination with nipple and breast stimulation and/or hormone treatments as a lactation aid, but they are not necessary for the protocols to work. Common herbal supplements used as galactagogues include fenugreek, milk thistle, blessed thistle, alfalfa, and cinnamon tea.

For more on galactagogues, read our blog.

Please talk with your healthcare provider, breastfeeding clinic, or a lactation consultant when establishing your breastfeeding goals and before starting any herbal supplements to ensure there are no health complications, such as interactions with other medications or other contraindications.

Information provided in blogs should not be used as a substitute for medical care or consultation.

References

• https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/expert-answers/induced-lactation/faq-20058403

• https://www.cdc.gov/nccdphp/dnpao/features/breastfeeding-benefits/index.html#:~:text=Breastfed%20babies%20have%20a%20lower,the%20mother%20with%20her%20baby

• https://www.cdc.gov/nccdphp/dnpao/features/breastfeeding-benefits/index.html#:~:text=Breastfed%20babies%20have%20a%20lower,the%20mother%20with%20her%20baby

• https://jps.biomedcentral.com/articles/10.1186/s12576-023-00860-w#:~:text=We%20found%20that%20during%20breastfeeding,higher%20parasympathetic%20activity%20during%20breastfeeding

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8167187/#:~:text=Mothers%20who%20breastfeed%20their%20infants%20between%20from%202%20to%2012,Maternal%20Attachment%20Inventory%20(MAI)

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631302/#:~:text=The%20release%20of%20oxytocin%2C%20often,the%20mother%20and%20her%20baby

• https://pubmed.ncbi.nlm.nih.gov/32926655/

• https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/supporting-families-with-relactation.html#:~:text=What%20is%20relactation%3F,time%20(weeks%20or%20months)

• https://www.ncbi.nlm.nih.gov/books/NBK148970/

• https://www.medela.com/en/breastfeeding-pumping/products/special-feeding-needs/supplemental-nursing-system-sns?productId=1015

• https://pubmed.ncbi.nlm.nih.gov/32926655/

• https://www.canadianbreastfeedingfoundation.org/induced/regular_protocol.shtml

• https://www.ncbi.nlm.nih.gov/books/NBK519517/#:~:text=Metoclopramide%20is%20a%20dopamine%20receptor,and%20vomiting%20in%20chemotherapy%20patients

• https://www.ncbi.nlm.nih.gov/books/NBK501371/

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4165197/#:~:text=Galactogogues%20are%20synthetic%20or%20plants,such%20as%20prolactin%20(PRL)