003: Meet Hope Lien, adoptive breastfeeding mother and CLC

01/26/16 • 29 min

It was great to hear from our show's co-host, Hope, about her inspiring journey to nursing her daughter by adoption. Hope originally learned that breastfeeding in adoption was possible during her doula training. Armed with the knowledge that breastfeeding would be possible for her even though she was unable to conceive, Hope found resources on adoptive breastfeeding to be pretty scarce at first. Fortunately, more information and support continued to emerge. Here are some of the top resources that Hope found:

The asklenore website* got her started with a step-by-step approach for inducing lactation, called the Newman-Goldfarb Protocol. The Newman-Goldfarb Protocol primarily consists of pumping and the use of pharmaceutical medications to induce lactation.
Several months later, Hope discovered additional options for inducing lactation in the newly released book, Breastfeeding Without Birthing. Using some ideas she read about, she choose to enhance the steps in the Newman-Goldfarb protocol by adding some natural techniques, such as herbs and acupuncture
Hope also discovered an amazingly supportive and informative Facebook group called Adoptive Breastfeeding.
Hope consulted with a local International Board Certified Lactation Consultant (IBCLC) to help guide and support her as she induced lactation, and then with nursing once her baby arrived. To find an IBCLC in your area who works with mothers through adoption or surrogacy, see the Find a Lactation Consultant page on the Breastfeeding Without Birthing website.

*Note: Updates to increase the simplicity and safety of the Newman-Goldfarb protocol were published in Breastfeeding Without Birthing. Details regarding these updates can be found on the Breastfeeding Without Birthing blog. SupplementationWhen Hope started the process of inducing lactation, she was hoping to achieve a full milk supply. But, like most mothers who induce lactation, she did produce a significant amount of milk but not a full supply. Knowing how much to supplement can be tricky - not enough supplemental milk or formula means baby won't have enough to eat, but too much supplemental milk or formula can mean less breastfeeding. Looking back, Hope wonders if she supplemented too much too early. Her pediatrician recommended supplementing 3 ounces per feeding within her daughter's first few days of life, but this recommendation was way more milk/formula than a baby needs in total at that age:

At 3 days, normal intake during a feeding is 1 ounce.
At 1 week, normal intake during a feeding is 1.5 ounces.
At 2 weeks, normal intake during a feeding is 2-2.5 ounces.
At 1-6 months, normal intake during a feeding is 3-4 ounces

[Mohrbacher & Kendall-Tackett, 2010]If a mother has induced lactation with pumping before her baby arrives, she will have a pretty good idea how much milk she is producing at a feeding, and can use the difference between her milk production and the normal intake numbers above as a starting point on how much to supplement.

The asklenore website* got her started with a step-by-step approach for inducing lactation, called the Newman-Goldfarb Protocol. The Newman-Goldfarb Protocol primarily consists of pumping and the use of pharmaceutical medications to induce lactation.
Several months later, Hope discovered additional options for inducing lactation in the newly released book, Breastfeeding Without Birthing. Using some ideas she read about, she choose to enhance the steps in the Newman-Goldfarb protocol by adding some natural techniques, such as herbs and acupuncture
Hope also discovered an amazingly supportive and informative Facebook group called Adoptive Breastfeeding.
Hope consulted with a local International Board Certified Lactation Consultant (IBCLC) to help guide and support her as she induced lactation, and then with nursing once her baby arrived. To find an IBCLC in your area who works with mothers through adoption or surrogacy, see the Find a Lactation Consultant page on the Breastfeeding Without Birthing website.

At 3 days, normal intake during a feeding is 1 ounce.
At 1 week, normal intake during a feeding is 1.5 ounces.
At 2 weeks, normal intake during a feeding is 2-2.5 ounces.
At 1-6 months, normal intake during a feeding is 3-4 ounces

Previous Episode

002: Meet Alyssa Schnell IBCLC and author of Breastfeeding Without Birthing

Alyssa shared with Hope the breastfeeding story that inspired Breastfeeding Without Birthing. It has been 10 years since Alyssa became an adoptive parent who nursed her baby, and she has been working hard ever since to grow information and support around breastfeeding without pregnancy and birth. Alyssa's passion for breastfeeding grew out of her experience nursing her first two (biological) children. When she and her husband planned to adopt, she knew that breastfeeding would be a very important part of that plan. Building a Full Milk Supply when Inducing LactationWhile many mothers who induce lactation hope to build a fully supply, few of them do. Alyssa was one of the fortunate ones. Why are some mothers able to produce a full supply and others much less? We really don't have all the answers, just as we don't have all the answers why some mothers by birth cannot produce a full supply. But we do have some inclinations:

Mothers who've birthed and breastfed before tend to make more milk.
Mothers who work with an International Board Certified Lactation Consultant (IBCLC) tend to make more milk.
Mothers who effectively and frequently empty their breasts make more milk, usually either by pumping with a hospital-grade breast pump or by breastfeeding with an at-breast supplementer.
Mothers who take the medication domperidone tend to make more milk.
Mothers who have experienced infertility due to hormonal reasons tend to make less milk.

Alyssa emphasized that nursing very frequently (up to 14 times per day) was a challenge, yet she believes it was an important factor in why she was able to breastfeed her adopted daughter without supplementation. She explained that frequently nursing her baby allowed her to get enough milk over the course of the day, even though her breasts probably didn't produce very much milk at each feeding. Producing a small amount of milk each time the breasts are emptied is referred to as "small breast storage capacity" and is typical of mothers whose bodies haven't just undergone pregnancy.

Next Episode

004: Dr. Frank Nice on Domperidone

Domperidone is a pharmaceutical medication that can help increase milk production. In this interview, Frank Nice gives us the scoop on "dom". He tells us who might benefit from domperidone and who shouldn't take it. He tells us about common - and some not-so-common side effects. We learn what dosage is ecommended, and how to safely and effectively discontinue using domperidone when the time comes. And of course we discuss the big controversy around domperidone - why it is not currently FDA approved and where we are in the process of getting it approved. Listen to Dr. Nice's interview: Here are a few highlights from our interview:

General dosage of domperidone is 10-20mg 4 times per day or 30mg 3 times per day. Increasing the dosage can further increase milk supply, but dosages greater than 120mg per day rarely result in additional milk production (although a few mothers have found dosages up to 240mg per day are effective).
Although most mothers who will get a boost in milk production from domperidone notice a difference within a few days, it can take up to 4 weeks for domperidone to have an effect on milk production for some mothers.
Although risk of cardiac arrythmia is stated by the FDA as a reason they have not approved domperidone, metoclopromide (aka Reglan) has the same very low level of risk and it is FDA approved.
While domperidone is currently in orphan drug status in route to becoming FDA approved as a medication for breastfeeding mothers, there is also a push for FDA approval for domperidone as a treatment for gastroparesis and this may happen even sooner. Right now, we can expect to wait another 3-4 years before domperidone is FDA approved.

Not only is he a wealth of knowledge, Dr. Nice lives up to his name with a huge heart for mamas and babies. We are thrilled to add this amazing interview to our podcast stream. Find out more about Dr. Nice and his work at www.nicebreastfeeding.com About Dr. NiceDr. Frank J. Nice has practiced as a consultant, lecturer, and author on medications and breastfeeding for 40 years. He holds a Bachelor’s Degree in Pharmacy, a Masters Degree in Pharmacy Administration, Masters and Doctorate Degrees in Public Administration, and Certification in Public Health Pharmacy. He retired from the US Public Health Service after 30 years of distinguished service. Dr. Nice practiced at the NIH and served as a Project Manager at the FDA. He recently retired after 43 years of government service and currently is self-employed as a consultant and President, Nice Breastfeeding LLC (www.nicebreastfeeding.com).Dr. Nice has published Nonprescription Drugs for the Breastfeeding Mother, 2nd Edition and The Galactogogue Recipe Book. Dr. Nice has also authored over four dozen peer-reviewed articles on the use of prescription medications, Over-the-Counter (OTC) products, and herbals during breastfeeding, in addition to articles and book chapters on the use of power, epilepsy, and work characteristics of health care professionals. He has organized and participated in over 50 medical missions to the country of Haiti. Dr. Nice continues to provide consultations, lectures, and presentations to the breastfeeding community and to serve the poor of Haiti.