BMJ 1995; 310 doi: (Published 25 March 1995) Cite this as: BMJ 1995;310:780
  1. Tony Waterston

    A woman is adopting a baby from birth and would like to breast feed. What advice and practical help can she be given? She has no living children and has not breast fed before.

    It is quite possible for a woman who has not been pregnant or not lactated to breast feed, and much experience is available, particularly from the United States. It is easier if the adoptive mother has been pregnant before as may be the case here, but this is by no means essential. To breast feed another mother's baby requires determination, patience, and perseverance, and success is not measured only by milk production.

    The breasts should be prepared in advance by the regular use of a breast pump to stimulate the nipples. The baby should be put to the breast as soon as possible after birth, though this may not be until several weeks in a baby coming for adoption. Artificial teats should be avoided as the baby learns a different technique of suckling. The baby should be put to the breast frequently (two hourly initially) to stimulate lactation.

    Oxytocin nasal spray may promote the let down reflex, but there is only anecdotal experience of its use. The main artificial aid (not strictly a stimulant) is a supply line or Lact-aid, which supplies formula milk through a feeding tube placed beside the nipple. The baby suckles at the breast and also obtains nutrition through the tube from a pack attached to the chest so does not become accustomed to a bottle. This supplementation is gradually reduced as the mother's own supply builds up.

    It is essential that plenty of support is available—both from the partner and relatives and from informal and expert advisers. The La Leche League and National Childbirth Trust can provide advice and documentation (see below). A local breastfeeding counsellor should also be contacted.

    Success is not measured only by the production of an adequate supply of milk. Non-nutritive suckling at night and in the morning can be a pleasurable experience for both mother and baby and is said to increase emotional attachment. In a study of 240 adoptive breastfeeding mothers 35% had never been pregnant and another 23% had never breast fed before.1 Over 80% of the babies were exclusively bottle fed before going to their adoptive home. Three quarters of the babies were willing to nurse by the end of the first week of trying. Most infants were under 2 months. More than three quarters of the mothers felt positive about their experience of induced lactation. The bonding experience of breast feeding was generally felt to be more important than milk production. Measured by requirement for supplementation, 63% needed no more than 480 ml of supplemental fluid a day. Fifty four per cent required supplements as long as the mother nursed. A quarter of mothers who had never been pregnant were able to eliminate supplements before weaning the baby off the breast.

    Doctors tend to be sceptical about the concept of relactation, but it is perfectly possible given perseverance and support.

    Further information is available from the National Childbirth Trust, Alexandra House, Oldham Terrace, London W3 6NH, and La Leche League, Box 3424, London WC1N 3XX.–TONY WATERSTON, consultant community paediatrician, Newcastle upon Tyne


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