Episode 20 Podcast > Full Transcript
Nicole Witt, Intro:
Although, today's topic goes a little broader than that and appeals as well to people who are a little bit further on in the process. So, I'm really excited about today's topic because it's something that I've discussed with many of my clients over the years: Adoptive Breastfeeding.
Most people don't think that adoptive breastfeeding is possible and they've kind of chalked it up to one of the many losses they've had to come to terms with in cases where they're approaching adoption because they found out that they can't have a biological child. So, it comes as a wonderful surprise to many of my clients to discover that this is an option for them.
With that said, I am no expert on this subject, so I wanted to interview someone with first class qualifications for this topic. Also, for reasons that we'll cover during the show, I wanted to speak with an expert from outside the United States. So, I'm so thrilled that I found just the right person and that she agreed to be my guest. So, please join me in giving a warm and appreciative welcome to Dr. Sharon Silberstein, otherwise known as the breastfeeding doctor, joining us today from London.
Dr. Sharon is a medical doctor, an international board-certified lactation consultant specializing in the field of breastfeeding medicine. She's the owner and director of the Dr. Silberstein Clinic based in London, which is centered around mothers and their babies. She has a team of international board-certified lactation consultants, osteopaths, speech and language therapists and other specialists. Thanks so much for joining us today, Sharon.
Dr. Silberstein:
Hi, Nicole. Thank you so much for having me on your podcast. I'm very excited to speak to you.
Nicole:
We are so happy to have you here. Before we get into some of the nuts and bolts, could you please talk about some of the benefits of adoptive breastfeeding and why this is something people may want to consider?
Dr. Silberstein:
So, I think with adoptive parenting in general, I think it's a bit of a – I think with any parent, really, I think breastfeeding can give us a very special bond with our babies. I think it's not exclusive to breastfeeding – Obviously, bottle feeding can also mean that we can bond with our babies – but I think there is something very intuitive and very – We're all mammals, so it's kind of within us to want to feed our young with our own body the way kind of nature has intended it.
So, I think to make this possible for adoptive parents is something that a lot of them very much value because the bonding doesn't happen, obviously, during pregnancy where other parents who birth their own babies, they have kind of almost like a bit of a head start before they give birth. So, obviously they have nine months to prepare for parenthood by reading and they may go to ultrasounds and see their baby ahead. And adoptive parents might not always get that. Sometimes they do, but it's not always the case. And I think that breastfeeding has a very special value to make up for some of that, for adoptive parents to be able to latch a baby onto your breasts and actually give them nutrition. I think that's a very, very special thing to be able to do.
Nicole:
Absolutely. Absolutely. And we're going to get into some of the logistics a little bit more in depth. But could you start with a high-level overview about how adoptive breastfeeding even works? How is that even possible?
Dr. Silberstein:
So, it depends a little bit what stage we are at, basically. Some parents approach me when they know that their adoptive parent is pregnant and there is a plan in place for the mother to give the baby for adoption. And at that point, obviously, that's kind of a real good benefit if we know early in advance and if the plan is to breastfeed from birth, then we can prepare the parent who is then going to breastfeed the baby for their lactation journey already ahead of the time before they adopt the baby. That's obviously kind of the – Really, it's not very common, but that would be kind of the ideal scenario.
Any parent can breastfeed at any time. So, moms can also decide if they have a baby who is six months old, for example, if they want to breastfeed this baby, they can also breastfeed. I've had parents approach me, at some point, kind of ahead of the time when they started the adoption process and they were given an idea that probably in around six months they will have a baby come to them and then we use those six months to prepare. So, every scenario is really individual. But kind of, yeah, so any parent can breastfeed – any person with a basically with a pair of breasts can induce lactation, so to say.
Nicole:
Okay.
Dr. Silberstein:
So, yeah, every individual needs to kind of present their case and then we can find a solution as to what would make the most sense, basically.
Nicole:
Okay. So, a question that I've heard from clients is, does inducing lactation produce the same breast milk as that of birth mothers or at least breast milk with the same nutritional value?
Dr. Silberstein:
Yes, absolutely. Yes, that's absolutely the case 100%. The difference that we can see is that the colostrum is not always present. So, we don't always get the kind of the thick, yellowy substance that birth mothers will develop from about 20 weeks of pregnancy. We don't always get that with inducing lactation. But that doesn't mean that the breast milk that does develop then is of any less value. And colostrum is anyway designed for the very newborn babies. So, it may not be relevant anyway for an adoptive parent, depending on what age they take in their adoptive child.
Nicole:
Okay. So, you talked about how it's ideal if they come to you, kind of very early on as far in advance as possible. So, how long does it take for lactation to start? How far in advance should someone start preparing? And then what do they do to prepare? What's the protocol?
Dr. Silberstein:
It varies. I've had mothers who, within four weeks of us starting the induced lactation protocol, they were able to produce very good amounts of breast milk; four weeks in. And there have been others where it took a few months. Generally, the more time we have in advance, the better we can prepare the glandular tissue in the breast to make the milk that we need.
And again, it obviously again depends on how old the baby is, how much of the baby's nutritional needs you can meet with the milk you make. So, if you have, let's say, six weeks in advance, you may not make the full amount just yet. So, there may be a little lag. But if you have six months in advance and you receive a newborn baby, then obviously it's very possible that you may meet the full demands of that newborn baby. So, obviously, an older child obviously has greater nutritional needs than a very newborn baby. But on the whole, the earlier we start the process, the more success we have because we have more time for the body to prepare the breast and for the glandular tissue to develop.
And the protocol: I use Dr. Jack Newman's protocol. There is a protocol they call the Newman Goldfarb Protocol. It's available online. Anyone can read about this. Dr. Jack Newman is a pediatrician based in Toronto. He's the Founder of the International Breastfeeding Center, and he's very, very highly regarded within the breastfeeding medicine world. He's pretty much the trailblazer in this kind of – who made it very accessible for people to read the protocol that he has tried and tested for decades, really. So, I'm not much of a – I just kind of took the protocol and ran with it. It's not my invention at all. I just use what I've been given, so to say. So, it's not my credit.
Nicole:
Well, and so what is the protocol look like? What's involved with the process?
Dr. Silberstein:
There is a link to the website where you can see a flowchart which the clinician can read that guides the couple through the induced lactation, where you can decide whether you should take the accelerated protocol or the normal protocol. So, the accelerated protocol we use if we only have six weeks or so before a baby is due to come into the family and the normal protocol is based on however long. So, if we have three, four or five, six months. So, the normal protocol gives us a little bit more time. So, you can decide on which kind of path to take. So, the accelerated protocol works as well, but it may not work as well as the normal protocol where we have months’ time to prepare.
So, the way we work is obviously I always have a medical consultation, sometimes remotely, but sometimes also in person, in advance. And I go through the medical history of the adoptive parent to make sure that obviously the hormones and the medication that I usually prescribe that are part of the protocol are suitable. We particularly look for if there is any medication that could interact with the medication that I prescribe, we used to look at any cardiac history, anything that I need to know that may mean that they can't go that kind of normal protocol route.
But generally, on the whole, if the women are kind of young and healthy and they haven't got any particular medical history that would mean that they can't take the medication, that I would prescribe a combined oral contraceptive pill, which then kind of makes your body believe that you're pregnant. It will obviously stop the cycles.
And then about six weeks before we know that the baby is due to arrive, we then start with a pumping protocol. And throughout that time, I also prescribe a medication called Domperidone. It is a medication licensed for nausea. And the side effect of this medication, we're using it for our benefit, which what it does is it increases the prolactin levels. And prolactin is the hormone that's responsible for increasing the milk supply and for developing the glandular tissue in the breast. So, the Domperidone gets taken throughout and the contraceptive pill until about six weeks beforehand, then we stop the pill and at which point then we start pumping.
We usually start with a with a kind of slow, a few times a day, maybe some hand expressing, and then we ramp that up to eight times a day. And we usually use a hospital grade double pump, which guarantees the best breast stimulation. And initially, it obviously quite can be quite disheartening because obviously the first pumps may not result in any breast milk at all. So, it means kind of dry pumping for a few weeks even. But that shouldn't put anyone off because in most cases it's possible to produce breast milk. And then during those weeks, usually the amounts increase.
And then it's very difficult to say how large those volumes will be. There is a chance that we don't meet the complete needs for the baby. Obviously, again, depending on age of the baby, there is a chance that it's not going to be a full breast milk supply. And most parents, I will always talk about this, it's all about obviously managing expectations at that stage. We can't work miracles. But I think the fact that an adoptive parent that hasn't given birth is able to breastfeed their baby is already quite miraculous on its own. So, I always try and say to them, “There is a chance that it may mean combination feeding. We may have to supplement the breastfeeding with either donor milk or formula milk.” And a lot of parents are in touch with donor milk banks, some have a very good friend. Obviously, I don't can't encourage that, from a medical point of view. But there are some mothers that I have met that their best friend was just breastfeeding their six months old and they're able to share some of their surplus milk. You know, that's obviously amazing.
Nicole:
Yeah, I know, that's a great overview. Thank you. And I think you may have answered this next question already, which I was going to ask you about any complexities that are added, given that you don't know when you might match with an expected mom and(or) when the baby will arrive. So, besides choosing between the regular protocol versus the accelerated protocol, is there anything else timing wise related to adoptive breastfeeding that comes into play with the approach?
Nicole:
I mean, I think if we're ahead of the game, then great. There's always the option of freezing milk. It doesn't really go out of date for – If we deep freeze breast milk, we can deep freeze it for a year.
Nicole:
Okay.
Dr. Silberstein:
So, if we're already inducing milk and we're still waiting for the baby to arrive, it's not the end of the world. It just means it gives us more chance basically, to develop the breast milk supply for longer, really.
Nicole:
Okay.
Dr. Silberstein:
So, I think it's not a disadvantage.
Nicole:
Okay, great. And so, you talked about some of the medications. Are there also supplements that people take, like herbs and that kind of thing? Where does that fit in?
Dr. Silberstein:
Yeah. In America, actually, the market is way ahead of what we have here in the UK. In fact, I was just seeing now I'm just exploring the option of trying to develop something here in the UK which matches the American offering.
There are a few companies. So, there is, for example, Legendary Milk and Mother Love; those are just two of the companies that kind of come up quite a lot. And we often order them across from America. It seems a bit silly because really, they are herbs that have been used for centuries to increase breast milk supply. Some of the ones that are mostly used is maybe the fenugreek and blessed thistle, but those are not the only ones. There's a whole host of different – There's brewer's yeast, there is shatavari, moringa, alfalfa; probably for some of them now, but those are kind of the most common ones.
So, Legendary Milk, for example, has, I believe, it's four different products that are slightly fine-tuned to different needs basically. So, they, they worked out which herbs work best for which type of patient. For example, there's one that's more catered towards mums with, for example, PCOS. So, polycystic ovaries, who have maybe a low supply due to their endocrine issues.
So, herbs can very much support lactation. Black seed oil is another one. So, there's a there's a whole host of different herbs that have been used for centuries. We don't have good scientific evidence, but that doesn't mean that there isn't enough anecdotal evidence. And sometimes it's a bit about playing around with different options and seeing which one works for which women. I don't think it's a one-fit-all situation with herbs. And unfortunately, there aren't too many people that – I think that knowledge got a little bit lost because we kind of lost when we use our chemical drugs rather, over the herbal options.
Nicole:
Right. Yeah. And regardless, I mean, people should definitely be working with a medical professional to figure out what herbs might make sense for them. But like I mentioned in the introduction, that's definitely why I wanted to speak to somebody outside the US, because a lot of the doctors here are not as focused on the herbal side of things. And I think that's certainly an option that people should have to factor into their protocol.
Dr. Silberstein:
Definitely.
Nicole:
So, you mentioned that some people are able to produce enough milk for all of the baby's needs and some people aren't. What are some realistic expectations people should have? Like how successful do they tend to be? What are some of the key factors that might impact whether or not they're able to produce a completely adequate milk supply or if they might need to supplement with other options?
Dr. Silberstein:
The one thing is I think that we need to always optimize the breast stimulation. And I think that's where a lot of moms struggle because obviously it's hard; inducing lactation is hard work. And I will always say it as well, “You have to be prepared to, eight times a day, double pump with an electric pump. And it's time consuming, it's expensive, it's tiring.”
So, I think that it's a big obstacle for a lot of women. So, I think optimizing the breast stimulation and milk removal is the basic thing for any lactation, but also for just any mum that has just given birth. So, that's where a lot of moms struggle. So, kind of ticking those right boxes for sure is difficult. So, if we only pump four times a day, then your supply will always match that demand. So, that can be an issue. And I think that if your body hasn't given birth, there may be a hormonal kind of a limitation to what your body can do.
But if it is slightly shortfall in the supply, what I usually suggest is using what we call the supplementing nursing system, which there is either the homemade version, which would just be a small nasogastric tube, which is very thin little tube that we can connect the baby's mouth with a little bottle of formula. And whilst they are feeding on the breast, they almost use it like a straw and they suck the supplement through the bottle into their mouths whilst they're feeding. So, that could be a really good way of making sure that the mum can exclusively breastfeed, which means that as in they feed all of the feeds on the breast, but not all of the milk is produced by the mum. Does that make sense?
Nicole:
Yeah, absolutely.
Dr. Silberstein:
So, the brand, Medela, makes a bottle that hangs around the neck, which is called the Supplementing Nursing System and there's another one called the Lact-Aid, which is just another system. So, there is that option.
And if there is a shortfall, and I think it's very, very unpredictable. When I start inducing lactation with parents, I will always say to them, “I absolutely cannot tell you how far we can push this. There will most likely be a form of lactation.” So, I haven't had a parent yet where we didn't induce lactation. They've all been successful in some form, but not all of them have been able to produce a full supply and that could be limited by just the way their breasts are structured, whether the glandular tissue isn't quite developed, or it could be to do with their own endocrine problems. For example, the reason why they got to that stage where they have to think about adoption may have to do with certain limitations in some conditions they have. So, that might be something.
Nicole:
Right.
Dr. Silberstein:
So, it's impossible to predict basically how far we can go with inducing lactation, basically.
Nicole:
Okay. You know, you've answered, I think, all the other questions I have in terms of other options with the supplemental tubes, how to really get some of those other benefits of breastfeeding, even if you're not able to produce a complete supply. And I know you also talked a little bit earlier that it's even possible if the baby is not a newborn, which is something I wanted to ask you about as well.
Dr. Silberstein:
Yeah, totally.
Nicole:
Yeah, we'll put links in the show notes to a lot of the brands and companies that you've mentioned, as well as to the protocol. So, if people want to explore things further, I think those are some great places to start. I really want to just thank you so much for being here, Sharon, and for sharing your expertise on this topic.
Dr. Silberstein:
Sorry to interrupt.
Nicole:
No, please.
Dr. Silberstein:
I don't know if you're familiar with the book by Allyssa Schnell called Breastfeeding Without Birthing. It's a very nice book.
Nicole:
Okay.
Dr. Silberstein:
And it might be something to link up as well for your parents as well, because it's a very lovely written book all about, obviously, breastfeeding without having – So, it's all made for adoptive parents or parents who have having birth their own babies.
Nicole:
Wonderful. And yeah, is there anything else before we wrap up today that you wanted to add?
Dr. Silberstein:
Yeah, just to say, also just thinking what you just touched on about not only thinking about breastfeeding in the early stages of newborn babies. I think that we also need to open our minds to be able to breastfeed older children; I'm talking about babies who maybe even approach their first birthday. It's still something that could be explored at that stage or their second birthday.
Nicole:
Okay, wonderful.
Dr. Silberstein:
Some people call it extended breastfeeding, but really, it's not. It's just really natural term breastfeeding. So, it could be something that's relevant for slightly older children, too.
Nicole:
Okay, great. That's really good to know. That is something I was not aware of, so I really appreciate you sharing that information.
Again, listeners, my guest today has been Dr. Sharon Silberstein, the Breastfeeding Doctor, MD and international board-certified lactation consultant specializing in the field of breastfeeding medicine, as well as the owner and director of the Dr. Silberstein Clinic in London. The best way to reach her is via email at admin@breastfeedingdoctor.co.uk or on Instagram (@breastfeedingdoctor.uk).
But of course, listeners, most of all, I'd like to thank you for tuning in. I hope you've heard something today that has given you encouragement and(or) has given you something to think about that perhaps you hadn't considered before. Take care and I'll catch you next time.