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Building Milk Supply in Adoptive Mothers

Karleen Gribble
Niagara Park NSW Australia
From: LEAVEN, Vol. 40 No. 5, October-November 2004, pp. 103-104.

Human milk is the standard food for babies (Wiessinger 1996) and breastfeeding is part of normal mothering, promoting child-mother attachment, and providing pleasure and comfort to the baby (Blass 1994).

The breast is ordinarily prepared for lactation during pregnancy under the influence of estrogen, progesterone, prolactin, and other hormones. The ductal system proliferates and differentiates and the lobes, lobules, and alveoli increase in size (Riordan 2004). Without pregnancy, the same breast changes can be achieved through nipple stimulation, which causes the secretion of prolactin (Kolodny et al.), growth of secretory alveoli, and production of milk (WHO 1998).

Once milk secretion begins, removing milk causes more milk to be made (WHO 1998). It is a normal, natural process for the breast to produce milk in response to a baby suckling. Thus, weaning need not be permanent and babies unable to be cared for by their biological mother can be breastfed by their adoptive mother.

Adoptive Breastfeeding in Developing Countries

The possibility of adoptive mothers being able to produce sufficient milk for their babies has been routinely discounted in countries including the US, Canada, and Australia. Researchers in Western societies have found that women are generally not successful in providing enough milk to solely nourish their children (Gribble 2004). However, in developing countries, most adoptive mothers are successful milk producers (Gribble 2004). Why is this the case? What can we learn from the experiences of women in developing countries? What follows is the results of a study (Gribble 2004) of the influence of context on milk production in adoptive mothers.

An examination of adoptive breastfeeding in developing countries and in Western countries reveals differences in breastfeeding practices. Having observed breastfeeding from a young age, mothers in developing countries are generally knowledgeable about the process (Jelliffe and Jelliffe 1972). This results in increased confidence in breastfeeding and fewer breastfeeding problems (Hill and Aldag 1991; McCarter-Spaulding 2001). Women in developing countries are also likely to have beliefs about child care that optimize breastfeeding. They allow unrestricted breastfeeding and keep their babies in close physical contact, day and night (Quandt 1995; Lozoff and Brittenham 1979). This maximizes prolactin secretion and breast emptying, thus accelerating breast development (WHO 1998) and increasing milk production (Daly et al. 1996).

Suggestions for Leaders

Adoptive mothers in Western countries can be encouraged to maximize their milk supply by educating themselves about breastfeeding, developing a strong breastfeeding support network, and emulating the mothering styles of women in developing countries. Mothers can be encouraged to seek information about breastfeeding, both of a general nature and that specific to adoptive breastfeeding, as early as possible in the adoption process. Building a network of knowledgeable breastfeeding contacts, including other adoptive mothers who can provide the support and encouragement to persist with breastfeeding is also helpful (Gribble 2001). In addition, prearrangement of practical support for the post placement period will help women to concentrate on developing the mother-child relationship and initiating breastfeeding (Raphael and Davis 1985).

To emulate the mothering style of women in developing countries, mothers can be encouraged to maximize physical contact with their children, breastfeed as frequently as possible, and use the breast as a source of comfort (Quandt 1986; Vis and Hennart 1978). Since providing unrestricted breastfeeding and close contact is contrary to mainstream Western beliefs (Quandt 1986), it is imperative that women obtain support. This will assist them in becoming comfortable with this style of parenting and in dealing with unsupportive contacts (Ladas 1972). Such support, of course, may be found in La Leche League Groups. Knowledge of and support for breastfeeding are important factors in maximizing milk production in adoptive mothers.

Leaders can also encourage women in their ability to lactate with the understanding that while it is impossible to tell how much milk an individual mother might make, there is much that can be done to maximize milk production. Mothers can be told that although they may need to supplement their milk initially, it may be possible that eventually this will be unnecessary if they breastfeed for long enough (Riordan 2004). It is important that mothers also be aided in devising a plan for the transition to breastfeeding, including making sure the baby is getting enough, safely reducing supplements and minimizing the likelihood that the baby will become too attached to the method of supplementation. The support of those knowledgeable about breastfeeding is vital for adoptive mothers in the West given the breastfeeding unfriendly culture (Raj and Pilchta 1998).

Some Leaders may feel that they have inadequate knowledge to assist mothers. However, it is extremely important to recognize that even without specialized knowledge of adoptive breastfeeding, Leaders have a vital role to play as supporters for the adoptive mother, perhaps being the only people in her life who believe in what she is doing.

Assisting adoptive mothers to maximize their milk supply does not minimize the emotional impact of breastfeeding. Many adopted children have histories that leave them emotionally vulnerable (Drury-Hudson 1994) and the act of breastfeeding has been observed to assist children in healing past hurts (Gribble 2003). In addition, the promotion of close physical contact between mother and child will not only benefit the milk supply of an adoptive mother but will also assist development of a positive attachment relationship (Anisfeld 1990; Gribble 2003) which will have long-term benefits for the child (Drury-Hudson 1994; Bowlby 1969).

References

Anisfeld, E. et al. Does infant carrying promote attachment? An experimental study of the effects of increased physical contact on the development of attachment. Child Dev 1990; 61:1617-27.
Blass, E.M. Behavioral and physiological consequences of suckling in rat and human newborns. Acta Paediatr Suppl 1994; 397:71.
Bowlby, J. Attachment and Loss, Vol 1: Attachment. London, England: Hogarth Press, 1969.
Daly, S.E. et al. Frequency and degree of milk removal and the short-term control of human milk synthesis. Exp Physiol 1996; 81: 861-75.
Drury-Hudson, J. Some effects of attachment disturbance on child behaviour. Children Australia 1994; 19:17-22.
Gribble, K. Mother-to-mother support via the Internet: A new method for an old model. Breastfeed Rev 2001; 9:13-19.
Gribble, K. Mother comfort: The breastfeeding of older adopted children. International Lactation Consultants Association Conference 1-3 August, 2003, Sydney, Australia.
Gribble, K. The influence of context on the success of adoptive breastfeeding: Developing countries and the west. Breastfeed Rev 2004; 5-13.
Hill, P. and Aldag, J. Potential indicators of insufficient milk supply syndrome. Res Nurs Health 1991; 14:1-19.
Jelliffe, D.B. and Jelliffe, E.F.P. Non-puerperal induced lactation. Pediatrics 1972; 50:170-71.
Kolodny, R.C. et al. Mammary stimulation causes prolactin secretion in non-lactating women. Nature 1972; 238:284-86.
Ladas, A. Breastfeeding: The less available option. J Trop Pediatr Environ Child Health 1972; 18:318- 46.
Lozoff, B.M. and Brittenham, G. Infant care: Cache or carry. Pediatrics 1979; 95:478-83.
Quandt, S.A. Patterns of variation in breast-feeding behaviors. Soc Sci Med 1986; 23:445-53.
Quandt, S.A. "Sociocultural Aspects of the Lactation Process," in Breastfeeding: Biocultural Perspectives, (New York: Adline de Gruyter, 1995) 127-43.
Raj, V.K. and Plichta, S.B. The role of social support in breastfeeding promotion: A literature review. J Hum Lact 1998; 14:41-45.
Raphael, D. and Davis, F. Only Mothers Know: Patterns of Infant Feeding in Traditional Cultures. London, England: Greenwood Press, 1985.
Riordan, J. Breastfeeding and Human Lactation, 3rd edition. Sudbury, Massachusetts: Jones and Bartlet, 2004.
Vis, H.S. and Hennart, P.H. Decline in breastfeeding: about some of its causes. Acta Paediatr Belg 1978; 31:195-206.
Wiessinger, D. Watch your language. J Hum Lact 1996; 12:1-4.
Relactation: Review of Experience and Recommendations for Practice. Geneva: World Health Organization, 1998.

Karleen Gribble is an Australian Breastfeeding Association Community Educator and Adjunct Research Fellow in the School of Nursing, Family and Community Health at the University of Western Sydney. Her research interests focus on adoptive breastfeeding (particularly on breastfeeding of older children and the contribution of breastfeeding to the development of secure attachment in adopted children) and the non-nutritional impact of breastfeeding (including breastfeeding of older children). She is mother to two children, one biological and one adopted from China, both breastfed. The Contributing Editor for "Keeping Up-to-Date" is Norma Ritter.

Last updated 12/29/06 by jlm.
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