Surrogacy and Breastfeeding: Inducing Lactation

 

Kalaimathy A. and Vidhya K.

Asst. Professors in OBG Department, PSG College of Nursing, Coimbatore-4

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INTRODUCTION:

For intended mothers whose baby is born by surrogacy as well as adoptive mothers, inducing lactation offers an opportunity to experience the physical and emotional bond of breastfeeding with her newborn.

 

MEANING:

Inducing lactation is a process by which a women who has not been pregnant and who is not currently breastfeeding, intends to breast feed the surrogate or adoptive baby.

 

Adoptive feeding is the ability for women to breast feed without going through a pregnancy.

 

PHYSIOLOGY OF LACTATION:

Lactation involves two hormones. Prolactin is considered the milk-making hormone while oxytocin is the hormone responsible for releasing breast milk. Both of these hormones are controlled by the pituitary gland and are therefore not ovarian hormone. This means that even a woman who has undergone a hysterectomy can induce lactation.

 

METHODS OF INDUCING LACTATION:

Non-Pharmacological Methods:

While manual stimulation alone should be sufficient in inducing lactation. Inducing lactation can take 5 days to 4 months to prepare for lactation, so expecting mothers often begin to induce lactation during the third trimester of a surrogate pregnancy.

 

Nipple Stimulation:

It seems to be most frequently used technique for non puerperal breast. Hand is gently squeezing the breast by placing the thumb and forefingers 2 to 3cm behind the nipple and press inward towards the chest. Repeatedly change the finger position around the areola. It should be started at least 6 weeks before the arrival of adopted infant and should practice several times a day for about 5mts in each breast.

 

Breast Massage:

In Breast massage, the hands are used to cup and support the breasts. Breasts are gently pushed together and hands gently rotate around the breasts for 1 to 2 minutes.

 

Sucking by baby and Electric breast pump method:

Women were encouraged to suckle their adopted infants or electric pump for at least 10 minutes on each breast 10 times per day. In approximately 13 to 18 days, all of the women were able to progress to partial breast feeding, which become exclusive breastfeeding after 21 to 28 days.

 

PHARMACOLOGICAL METHODS:

Domperidone:  It is an anti-emetic drug which crosses Blood Brain Barrier minimally. Not a hormone but it has side effects those results in an increase in prolactin levels. It should be start 6 months before the arrival of the adopted infant. It’s safe for both mother and infant. Orally, 10-20mg 4 times a day for one week. Best results to take 30mts before the meal and1 hr before pumping or breastfeeding.

 

Metoclopramide (Reglan): It is a Dopamine antagonist which cross the Blood Brain Barrier. It can be taken orally , 10-15mg ,3 times per day

 

Chlorpromazine:  Central nervous system tranquilizer. The dose is 25mg, oral, 4 times per day. It’s not recommended because of its adverse effects.

 

HERBS:

Fenugreek seed- 3 capsules (580-610 mg each) 3 times a day with food.

Blessed Thistle herb  3 capsules (325-390mg) 3 times a day with food.

 

HORMONAL REPLACEMENT:

Yasmin – Common pills (3mg of Progesterone) is used. Birth Control (BC) pill must contain at least 1mg of Progesterone (2-3mg is better) and not more than 0.035mg of estrogen. Birth control pill must be taken nonstop. The combination of birth control pill with domperidone will give best results and start from 6-9 months before the baby arrival. Drug can be stopped when the mother started to pump breast milk

 

PROTOCOL FOR INDUCING LACTATION:

Ψ  6 months: BC pill each day + 10mg domperidone 4 times per day for a week, then increase the dosage to 20mg after the breast changes.

Ψ  5 months: BC pill each day + 20mg domperidone 4 times per day.

Ψ  4 months:  BC pill each day + 20mg domperidone 4 times per day.

Ψ  6 weeks: Stop BC pill. Continue 20mg domperidone 4 times per day + pump for 5-7 mts for every 3 hrs+ Fenugreek 610mg with Blessed thistle herb 390mg 3 times a day with meal.

Ψ  Once the baby arrives, put the baby to her breast as soon as possible + continue domperidone 20 mg and herbs till to wean the baby.

 

Arrival of milk supply begins with clear drops, which become more opaque and white in color. Drops will appear, followed by milk spray, then a steady stream of breast milk.

 

MENOPAUSAL PROTOCOL:

Ψ  Stop the hormonal replacement therapy.

Ψ  Combination of birth control pills and Domperidone 10mg should be started then increase the dose to 20mg.

Ψ  60 days to experience breast changes like increased breast size (1 cup), feel full, heavy, painful.

Ψ  Same protocol as per others.

 

CONCLUSION:

A gender of women is enough to breast feed the baby when the breast and Pituitary gland is in normal function irrespective of age.

 

REFERENCES:

1.        http.mamadearest.ca/induced lactation

2.        http.dreamhawk.com

3.        www.asklenore.info

4.        www.drmomma.com

 

 

 

 

Received on 15.07.2011                                   Modified on 16.08.2011

Accepted on 19.10.2011                         © A&V Publication all right reserved

Asian J. Nur. Edu. and Research 1(3): July-Sept. 2011; Page 94-95