Thursday, August 27, 2015

A Lactation Consultation

Just as I hope that my blog may in some way help others, I have been greatly helped by other peoples blogs.  One thing that I found out through another intended mother's blog is that just because you did not give birth to your child, you may still be able to breastfeed him/her.

What did you say?  What sorcery is this?

Not exactly sorcery. It turns out that any woman (with breasts) may be able to breastfeed regardless of whether or not she has given birth, or even has a uterus or ovaries.  Lactation is actually governed by pituitary hormones, not ovarian hormones.  It should be noted that while nearly every woman can do it, it is not necessarily easy or quick, and is generally more successful if you have previously nursed or been pregnant.

When we started in this process, I had been asked by a few people if I intended to breastfeed.  I thought that was a funny question mainly because I had not really considered it.  I guess that I knew that I actually COULD.  I mean, even men can lactate.  But I hadn't really thought that I WOULD.

I think that I just figured that we would bottle feed.  Most adoptive mothers bottle feed.  Millions of children have been bottle fed over the years and virtually all of them have turned out just fine.

I think that I also feared trying to induce lactation since I knew that it was tricky at best.  I thought it would be just another thing that could (and probably would) go wrong.

But as Maybe Baby started to hang in there week after week, and the tests and ultrasounds started to come back OK, some of my fears started to subside and I started thinking that Maybe Baby may actually become a real baby.  Whoa!  This is a new concept.

As I started thinking in terms of an actual vs. theoretical baby, I started thinking about what we would do when the baby comes.  I started reading other IMs blogs about the importance of infant bonding and how it is even more important in an adoption or surrogacy.  Of how important skin to skin contact is, and breastfeeding.  Wait.....breastfeeding.

Breastfeeding is not just about getting nutrients to your baby.  It is also very much about bonding.  I read that it is not important if you make enough milk yourself or if you have to supplement, it is about the time together and the skin to skin contact.  I read blog after blog and story after story of how amazing it was to be able to connect that way with their baby, of how it in some ways made up for the loss of not being able to birth their own child, of how it made them feel more like a mother, and of how it gave them a way to get ready for their babies arrival in the absence of being pregnant.  I read that it was not easy, but that the juice was worth the squeeze.

I decided that it was worth giving it the old college try.

As recommended by everything that I've read, I decided to consult with a professional - a lactation consultant.  I have done a decent amount of research on this, so I was able to jump right into recommendations and protocols with her during our visit.  Since I have a good amount of time before the birth, since it is (arguably) the most successful protocol for induced lactation, since Maybe Baby is essentially the product of a metric crap ton of hormones, medications and other supplements, and taking more hormones, medications and other supplements does not phase me in the least at this point, I am interested in using the Newman-Goldfarb Protocol for inducing lactation.

After talking through my health and pregnancy history and the protocols, my lactation consultant had some good news and some bad news.

The good news:  milk ducts grow rapidly primarily during the first trimester of pregnancy (that is why your boobs get enormous and terribly sore, and why that soreness gets better as you enter the second trimester).  I have been pregnant before, and my second pregnancy almost made it past the first trimester.  I was pregnant long enough for my boobs to get enormous and terribly sore - meaning that I probably went through some milk duct formation, meaning that I will probably be more successful in inducing lactation than someone who has never been pregnant.

The bad news: the magic ingredient in the Newman-Goldfarb protocol is a Domperidone - a drug that is given to relieve nausea and vomiting.  A drug whose major side effect is that it induces lactation because it increases decreases the body's release of dopamine which in turn increases prolactin, which in turn causes lactation.  It is probably used more often for its "off label" use than it is for its primary intent.  Domperidone is not FDA approved - meaning that it is nearly impossible and possibly illegal to get in the US.  There is a legal drug that can also increase lactation called  Metoclopramide, but it has some pretty nasty side effects (much more nasty than Domperidone) and can also be passed through breast milk - making it not really a suitable alternative.  Also, to add insult to serious injury, my insurance may not cover a breast pump since I will not have given birth.  I will need a hospital grade pump for this to work and those are NOT cheap.  Since those cost over $2,000 to buy new, I would need to looking into renting one, or buying a gently used/refurbished model.

I left feeling very defeated and like the visit may have just been a waste of time.

I am now trying to focus on the positives.  While my consultant had heard of using domperidone (and could not and did not recommend it) and the herbs that we discussed (fenugreek, blessed thistle and goat's rue), she had not heard about adding the birth control pill before.  This really intrigued her.  Taking the birth control pill nonstop for a minimum of two months (four or more is even better) essentially tricks the body into thinking that it is pregnant.  The estrogen and progesterone in the birth control pill mimic the levels produced in pregnancy and can help to build milk ducts and breast tissue.  Stopping the birth control pill and then pumping, should cause a rapid decrease in the serum progesterone level while causing an increase in the serum prolactin level. This process attempts to mimic what happens after a normal pregnancy and birth.

My consultant thought that this hormonal "push" may be the key to successfully inducing lactation.  When just beginning to pump, or pump with the addition of herbs, the process can and often does work, it just takes a long time.  She was very interested in pursuing this method and hoped that it could be successful for other patients.  In addition to the BCP, goat's rue is often recommended in the "building" phase as it tends to act like estrogen.  It can be effective taken on its own, but tends to be more effective when taken in conjunction with progesterone.

About 8 weeks before Maybe Baby's due date I should stop the BCP but keep taking the goat's rue and over the nest two weeks begin pumping working up to pumping 8 times per day and 20 minutes each session.  Once I start pumping, I should start taking fenugreek and blessed thistle (alfalfa, fennel, saw palmetto, and shatavari are also recommended, but not as highly as fenugreek and blessed thistle).  I should try to eat oatmeal for breakfast at least 3 times a week - many mothers on the protocols have noticed a significant increase in their milk supplies when they began to add oatmeal to their diets regularly.  I also need to drink at least 6 - 8 glasses of water a day if possible and keep my caffeine to a low level.

I say low level since stopping completely could mean harm to those around me and low levels have not been found to be harmful to babies via breast milk.

When I am ready to start pumping, I will visit my consultant again and she will show me how to use the pump and map out a pumping schedule for me to follow.

After pumping for a while, my milk supply should begin to arrive. It will begin with a few clear drops which become more frequent and more opaque and whiter in color.  These drops will turn into spray which will eventually turn into a steady stream of breast milk. It may take a few days, a week, or two, or more for the milk supply to come in. Everyone responds differently.

I know that this sounds like a huge commitment.  It is.

But, it is a way for me to get ready for Maybe Baby's coming, a way for me to feel like more of a "normal" mother, and most importantly, a very special way for us to enhance our bond.

And that, my friends, will be worth it.

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