Dr. Jack Newman is a Toronto pediatrician who has practiced medicine since 1970. In 1984 he established the first hospital-based breastfeeding clinic in Canada, at Toronto’s Hospital for Sick Children. He now holds breastfeeding clinics in several hospitals in the Toronto area.
Here he shares some practical tips on how to get the baby on the breast:
Getting the baby to take the breast
Although many people do not believe that the early introduction of bottles may interfere with breastfeeding, the early introduction of artificial nipples can indeed interfere. The sooner you can get the baby to the breast after he is born, the better. However, babies need flow from the breast in order to stay latched on and continue sucking, especially if they have gotten used to getting flow from a bottle or another method of feeding (cup, finger feeding). So, what can you do?
1. Speak with the staff at the hospital where the baby will be born and let the head nurse and lactation consultant know your plan to breastfeed the baby. They should be willing to accommodate your desire to have the baby fed by cup or finger feeding, if you cannot have the baby to feed immediately after his birth. In fact, more and more frequently, arrangements have been made where the adopting mother is present at the birth of the baby and takes the baby immediately to nurse. The earlier you start, the better.
2. Some biological mothers are willing to nurse the baby for the first few days. There is some concern expressed amongst social workers and others that this will result in the biological mothers’ changing her mind. This is possible, and you may not wish to take that risk. However, this has been done, and it allows the baby to breastfeed, get colostrum, and not receive artificial feedings at first.
3. Latching on well is even more important when the mother does not have a full milk supply as when she does. A good latch means painless feedings. A good latch means the baby will get more of your milk, whether your milk supply is abundant or minimal.
4. If the baby does need to be supplemented, this should be done with a lactation aid with the supplement being given while the baby is breastfeeding . Take a look at the Medela Supplemental Nursing System. Babies learn to breastfeed by breastfeeding, not cup feeding or finger feeding or bottle feeding. Of course, you can use your previously expressed milk to supplement. And if you can manage to get it, banked breastmilk is the second best supplement after your own milk. With a lactation aid, the baby is still breastfeeding even while being supplemented, and isn’t it breastfeeding you wanted for your baby?
5. If you are having trouble getting the baby to take the breast, come to the clinic as soon as possible for help.
As soon as a baby is in sight, contact a breastfeeding clinic and start getting your milk supply ready. Please understand, you may never produce a full supply for your baby, though it may happen. You should not be discouraged by what you may be pumping before the baby is born, because a pump is never as good at extracting milk as a baby who is sucking well and well latched on. The main purpose of pumping before the baby is born is to draw milk out of your breast so that you will produce yet more milk, not to build up a reserve of milk before the baby is born, though this is good if you can do it.
If you know far enough in advance, say at least 3 or 4 months, treatment with a combination of oestrogen and progesterone (as in the birth control pill, but without a break, or oestrogen patches on the breast plus oral progesterone) plus domperidone will simulate the hormonal milieu of pregnancy somewhat, and may allow you to produce more milk. Get information about this protocol from the clinic.
a. Pumping. If you can manage it, rent an electric pump with a double setup. Pumping both breasts at the same time takes half the time, obviously, but also results in better milk production. Start pumping as soon as the baby is in sight, even if this means you will be pumping for 4 months. You do not have to pump frequently on a schedule. Do what is possible. If twice a day is possible at first, do it twice a day. If once a day during the week, but 6 times during the weekend can be done, fine. Partners can help with nipple stimulation as well.
b. Domperidone. This drug can help you produce more milk. It is not necessary for you to use in order to breastfeed an adopted baby, but it will help you develop a more abundant milk supply faster. There is no such thing as a 100% safe drug. If you do decide to take it, the starting dose is 30 mg three times a day, but we have gone as high as 40 mg 4 times a day. Using pumping and domperidone, most adopting mothers have started to produce drops of milk after two to four weeks.
But will I produce all the milk the baby needs?
Maybe, but don’t count on it. But if you do not, breastfeed your baby anyhow, and allow yourself and him to enjoy the special relationship that it brings. In any case, some breastmilk is better than none.
Please note: If you decide to take the medications (the hormones and/or the domperidone), your family doctor must be aware of what you are taking and why. Significant side effects have been rare, but that does not mean they cannot happen. Your doctor needs to be following you, and once the baby is with you, your baby’s doctor needs to know that you are nursing him and needs to follow the baby’s progress just as s/he would any other baby.
Always consult your health care professional and ensure your baby is gaining weight accordingly.