Induced Lactation for Adoptive Breastfeeding Dyads

Abstract

IntroductionBreastfeeding has many benefits for both mother and baby, but not all mothers can have their own babies. Here we used an induced lactation protocol to breastfeed adopted babies.Materials and MethodWe implement and describe an induced lactation protocol for adoptive breastfeeding dyads at Kemang Medical Care (KMC) Women and Children Hospital and Permata Depok Hospital, Greater Jakarta, Indonesia. Participants included 32 of 48 breastfeeding dyads or subjects undergoing induced lactation protocols and fulfilling the inclusion criteria. The induced lactation protocol included the Praborini Method (hospitalization for nipple confusion) to promote latching, pharmacologically induced lactation, and at-breast supplementation.ResultsNineteen babies (59.4%) were aged <1 month and nine (28.1%) were aged 1–3 months at protocol initiation. Almost all (31 babies, 96.8%) were adopted after birth. At first examination, 20 babies (62.5%) could not latch, but all dyads could breastfeed after hospitalization for <1–2 days. Breast milk was induced after one cycle of Yasmin in 24 cases (75%). All mothers took domperidone and no side-effects were reported. Average breastfeeding duration was 8.5 months, with weaning at 2–25 months of age, with working mothers weaning at ≤4 months. At-breast supplementation was used until weaning.ConclusionsAdopted babies can achieve long-term breastfeeding through this multimodal protocol. Further prospective studies are warranted.

The Three Step Framework for Inducing LactationTM

“…Step 3 Feeding baby and making more milk Praborini et al, 2019;Wilson et al, 2015;unspecified in Szucs et al, 2010), medroxy progesterone (depo provera 3-month injection in Nemba, 1994; oral provera discussed in Thearle et al, 1984); micronized progesterone (200 mg increased to 400 mg for a transwoman in Reisman and Goldstein, 2018). Step 2) Baby is arriving very soon or has already arrived.…”

“…In the case when a dosage of 80 mg per day was safely used, the participant initiated use of metoclopramide at 20 mg per day for 1 week with no adverse effects (Shiva et al, 2010). When domperidone was used in Steps 2 or 3, dosages of 80 mg per day (20 mg QID) or 90 mg per day (30mg TID) were used in research (Praborini et al, 2019;Reisman & Goldstein, 2018;Schnell, 2022;Szucs et al, 2010). Intranasal oxytocin several times per day, while not commonly used, can increase oxytocin prior to milk removal (Auerbach & Avery, 1981;Cheales-Siebenaler, 1999).…”

“… Note. a Forms of estrogen: estradiol in an oral contraceptive pill (0.035 mg ethinyl estradiol in Schnell, 2022; 0.03 mg ethinyl estradiol in Praborini et al, 2019; Wilson et al, 2015; unspecified in Szucs et al, 2010), oral estradiol (8 mg increased to 12 mg for transwoman in Reisman and Goldstein, 2018), oral conjugated estrogen (1.25 mg, LeCain et al, 2020), topical estrogen patch (100 mg twice weekly, LeCain et al, 2020). b Forms of progesterone: progestin in an oral contraceptive pill (1 mg norethindrone in Schnell, 2022; 3 mg drospirenone in Praborini et al, 2019; Wilson et al, 2015; unspecified in Szucs et al, 2010), medroxy progesterone (depo provera 3-month injection in Nemba, 1994; oral provera discussed in Thearle et al, 1984); micronized progesterone (200 mg increased to 400 mg for a transwoman in Reisman and Goldstein, 2018).…”

“…Although there are no known medications to increase placental lactogen, the other hormones may be elevated with medications. Elevating pregnancy hormones for about 8–9 months most closely simulates a pregnancy, but previously it has been reported that study participants have taken these medications between 3 weeks (Praborini et al, 2019; Zingler et al, 2017) and 9 months (LeCain et al, 2020), with most study participants taking pregnancy hormone elevating medications for 2–3 months (McGuire, 2019; Nemba, 1994; Reisman & Goldstein, 2018; Szucs et al, 2010; Wilson et al, 2015).…”

“…When domperidone was used in Step 1, dosages of 30–80 mg per day were reported in the research. Although domperidone was initiated at dosages of 30 mg or 40 mg per day for a period of 1–4 weeks in some studies, a dose of 80 mg per day (20 mg QID) was most common (McGuire, 2019; Praborini et al, 2019; Reisman & Goldstein, 2018; Schnell, 2022; Szucs et al, 2010; Zingler et al, 2017). This is a much higher dosage than suggested by ABM Protocol (Brodribb & ABM, 2018).…”