My Adoptive Breastfeeding Journey

By Teglene Ryan © 2010
Read more from Teglene at The Breastfeeding Mother

I always knew I wanted to breastfeed my children. I couldn’t imagine doing it any differently. I was lucky enough to give birth to two beautiful boys and I enjoyed breastfeeding them both. Not that it was easy or without struggle, but it was what I wanted to do and loved doing it. In fact, I liked it so much, and felt so passionate about breastfeeding that I became a La Leche League Leader, so that I could help other breastfeeding moms. I really took to the idea of “Mothering through breastfeeding”. It wasn’t just a feeding method for me, but a relationship with my child.

My husband and I always talked about adopting a child who needed a family. We thought, if we can’t have kids of our own then we will adopt. Even if we can have kids of our own, maybe we will still adopt. After the birth of our second son it became clear that going through another pregnancy was not going to be good for me or our family. My doctor told me not to risk it, that my health was at stake. But we wanted another child. Well, here was our chance to adopt!

We chose to adopt a child out of foster care. We found an adoption agency that places foster children into adoptive homes. We went through all of the training, the homestudy, and all of the waiting. We were open to adopting one or two children (there are lots of sibling groups needing homes) between the ages of 0-5 years old. I knew that I really wanted to breastfeed another baby. I also knew that it was much more likely that we would get a toddler. There was also the issue of would it be okay to breastfeed a foster child? Would I just not tell anyone and do it anyway?

Either way I spent hours researching adoptive breastfeeding. I joined adoptive breastfeeding discussion boards like Ask Lenore and Four Friends. I read every book on the subject, including Breastfeeding an Adopted Baby and Relactation. I read the article Foster Breastfeeding over and over. I tracked down foster moms who had breastfed their foster babies in California (some successfully, and one who described a baby being taken from her home after the baby’s doctor “turned her in”).

On Monday July 6, 2009, we drove to South Lake Tahoe (about a 2 hour drive) to meet with a social worker. We were one of a few families they were considering placing a newborn girl with. We knew that the baby was a “safe surrender” baby, and that she was born premature. They had already asked if we would be able to go stay in Reno (where she was in the hospital) so that we could have daily visits with her in the NICU until she was ready to come home. It would be a few more weeks until she was ready.

We learned at that meeting that we had been chosen to bring her home if we wanted. Also, the hospital had just called and she was ready to go home! The social worker asked if we could go out to Reno, spend the night in the hospital with the baby, and take her home the next day. Of course we said yes (and I cried, a lot!).

At one point in the meeting the social worker looked at me and asked, “Are you going to breastfeed her?” For a moment I wondered if this was a trick question. My heart skipped a beat. But it wasn’t a trick. “We were so excited to see that you are a La Leche League Leader, and were hoping that you would plan to breastfeed her.” I knew this baby needed to be breastfed and I wasn’t going to have to do it “behind closed doors” as many fost/adopt moms told me they did.

I told them that I would if I was allowed. They couldn’t think of any reason why not, but decided that we would not talk about it any more, or put it in writing anywhere. You just never know how someone might react. People can be weird about breastfeeding.

In that meeting we also learned that this little baby was a bit of a miracle. All of the doctors and nurses at the hospital could not understand why she was alive and doing so well. She was born in a campground in the mountains above Lake Tahoe. Her birth mother did not know she was pregnant. In fact she did not know she was giving birth until she heard the baby cry. The birth mother was taken to a local hospital while the baby was flown to the NICU in Reno. To this day I don’t know if the birth mom ever saw the baby, or even knows if it is a boy or a girl. She gave very little information at the hospital when she surrendered the baby (I won’t get into the paperwork mess that her in one hospital and the baby in another at the time of surrender lead to). She said that she drank alcohol about every other week and smoked a half a pack of cigarettes a day. She told them she did no illegal drugs, however she tested positive for THC (as well as alcohol) at the hospital after the birth.

The baby weighed 3 lbs 2.8 ounces at birth. She was exposed and unreachable by rescuers for 30-45 minutes after the birth. (Even a full term newborn can quickly succumb to hypothermia right after birth, not to mention a 3 lb baby.) At first they expected she whould be in the NICU for about 2 months. She surprised everyone when she needed no help breathing and was quickly eating and gaining weight.

When we went to meet her at the hospital she was 17 days old. The NICU nurses were very nice. They had all “adopted” her temporarily. It was clear that she was a very special baby to all of them. However, she was exclusively bottle-fed formula that whole time and I was wanting to breastfeed her. I was told by the NICU nurses to “just shove it in there” when I held the bottle nipple to her mouth, waiting for her to open like she would for the breast. I was shown the “right” way to hold her and give her the bottle, with her on my lap, away from my body.

She was to be fed on a strict every 3 hours schedule. We were told to not hold her too much. “You can’t hold her so much like that when you get her home. You need to put her down so that she can sleep. She really needs to rest.” I smiled and nodded, knowing that we would be leaving in a matter of hours and that when we got home this baby would not get put down for the next several months.

The NICU doctor told us that we MUST keep her on the special 22 calories per ounce formula until she was 12 months old, no matter what her pediatrician said, no matter how well she was growing. Again I smiled and nodded, knowing full well I was going to do everything in my power to get her off of this formula. I had my own “special formula” in mind for her.

We gave her a name we had picked out for a baby girl years earlier. The next morning when we took her home she weighed 4 lbs. 0.8 ounces.

When we got home I called my LLL co-leader and she drove into town and up the mountain to my house to bring me a hospital grade, Medela Symphony breast pump and a Starter SNS. I needed to get started on bringing in a milk supply! I also went on-line and ordered a Lact-Aid, the at-breast supplementer of choice of adoptive moms. On-line I also ordered domperidone (a prescription that has the side effect of increasing prolactin levels, that is not available in the US) from a pharmacy in New Zealand.

I took my baby up to my room and lay back on the pillows on my bed. I took off my shirt and put her in only a diaper. I put her warm, tiny little body on my bare chest. She wasted no time. She threw herself down and latched onto my right breast. She started sucking and her body completely relaxed. She was home. She had found her mommy. Now, I just needed to make some milk!

The first few weeks I tried to put formula in the Starter SNS and then the Lact-Aid and feed her at the breast. She could latch on great, but her suck was weak and she could not get any of the formula through the tube. I went ahead and got a full sized SNS to try as, unlike the Lact-Aid, liquid would flow out just with gravity. I bottle fed, and then tried the SNS a couple of times a day. Eventually she could get an ounce from the SNS. Gradually I increased the number of feedings at the breast. Soon she could nurse with the Lact-Aid and get formula from that as well.

After about a month I did all of the daytime feedings with the Lact-Aid. I ordered more parts so that I only needed to wash and prepare the Lact-Aid supplies once a day. Soon I fed with the Lact-Aid around the clock and completely eliminated all bottles. I stopped pumping at this point, as she was nursing very frequently. I encouraged her to nurse for comfort, or for what little milk she could get between formula feedings.

She was such a good little nurser! She would nurse for a while on one breast, then let go and move to the other side. This is what breastfed babies will do naturally after finishing one breast, but I had to move the tube over to the other side so that she could keep eating. She would nurse and nurse for hours, even when she was getting very little milk. We would often take “nursing vacation” days when Papa took her big brothers out for the day. I carefully watched her weight gain to make sure I wasn’t being too stingy with the formula. I wanted to give her the smallest amount she needed so that she would nurse more and get more from me to help stimulate my supply.

Soon I was able to nurse her first thing in the morning and satisfy her. I would just keep nursing her until it became so frequent that it was clear she needed some formula.

I was so excited when I realized I could go from about 3am until 10 am without using formula. Then I could go until 11am, then 1pm, then 3pm! Before I knew it she would get formula at about 2 am and I didn’t need to give more until about 4 in the afternoon. I could go out of the house with her all morning and not need to bring bags of formula! I was exclusively breastfeeding for more than half the day! She soon gave up her pacifier that she came home from the hospital with. Once you have the real thing, no substitutes will do!

When it got to the point that she needed two, 2-4 ounce servings of formula in the evening I stopped using the Lact-Aid. If I had to fill one more bag or clean out the tubing one more time I was going to go crazy!! She was 5 months old when she was only breastfeeding with the exception of two bottles of formula in the evening, getting a total of 4-8 ounces per day. She would nurse both before and after the bottles of formula. I really wanted to breastfeed exclusively, but this was pretty darn good!

At 6 months old I started to offer her solid foods. She LOVED them! She was on WIC and they gave her an obscene amount of jars of fruits and vegetables and boxes of baby cereal. She gobbled it all up. Within a week we had dropped one serving of formula and the next week we dropped the last one. She was now EXCLUSIVELY BREASTFED! (Well, along with some solids, but close enough!) She never had a bottle again. In fact, the one time I left her at 9 months old for a few hours, she would have nothing to do with a bottle.

I thought that when she turned one year I would stop taking the domperidone. As I tried to wean off of it my supply really dropped. Baby got pretty frustrated. So, I did some more research and decided it was safe for me to continue to take the domperidone longer and ordered another 6 month supply. Making More Milk describes a study showing no adverse effects for people taking 120 mg/day for over 10 years, and although for a while I took as much as 160 mg/day, I am down to only 90 mg/day.

At 15 months old she is still going strong. I really enjoy nursing her to sleep at nap time and bedtime. I love cuddling in bed with her early in the morning and hearing her gulp down my milk. I can’t imagine stopping any time soon.

When I breastfed my boys my goal was to nurse them for at least two years, as this is the suggested minimum by the World Health Organization. I learned about so many benefits of breastfeeding well into toddlerhood, that I really wanted to do this. Sadly, I only nursed my boys 14 months each. We ended early for different reasons with each, but both times I was disappointed that I did not make my goal. I still feel like I let them down, even though I know that I did the best I could at the time with the given circumstances. I am hopeful that I can nurse my daughter at least 2 years, and as long as she wants. I got another chance.

~~~~

For further information about nursing your foster or adopted baby and induced lactation see:

The Adoptive Breastfeeding Resource Website

Dr. Jack Newman & Enith Kernerman: Breastfeeding Your Adoptive Baby or Baby Born by Surrogate

Adoption.com's section on breastfeeding

Induced Lactation

Another mother's experience: Breastfeeding My Adopted Child

Dr. Jack Newman Lactation Aid (homemade instructions)

Ask your local La Leche League leaders and/or lactation consultants for names of mothers who have nursed their adopted children.

Books:
Breastfeeding the Adopted Baby, by Debra Peterson
Breastfeeding an Adopted Baby and Relactation by Elizabeth Hormann

Many of the same techniques used to trigger milk supply for working mothers who must be away from their babies all day, every day, are the same gentle parenting measures that will help adoptive moms increase supply as well. For further information on these natural-hormone boosting ideas, see: Balancing Breastfeeding: When Moms Must Work.

For breastmilk donations, look into a variety of resources available.

Additional breastfeeding resources can be found here.

~~~~

Books Fundraiser for Mother and Newly Adopted Daughters from Haiti

A fellow gentle parenting momma needs our help. Three years ago, Jodie (a mother to one child living in Colorado) began the adoption process for two little girls from Haiti. A lot of red tape later, the earthquake that ricocheted Haiti helped to expedite the adoption process of these two orphaned girls, and Jodie was able to bring them home in February of this year.

As happy as their new family is, two extra children brings some added expenses, and in the midst of their adoption, Jodie's husband was laid off from his job. While he has a paycheck through the end of August, come September, they will be in trouble.

To add insult to injury, Jodie's husband was rear-ended last week by an uninsured driver while taking one of their girls to school, and now they have a vehicle that needs repair as well.

Another peaceful parenting reader (and friend of Jodie's) asked if we would highlight the fundraiser she has put together to help this mom of three. Erin Davey has a very small Usborne Books business and will be donating all profits during the month of August to help Jodie and her family.

Usborne has a wide assortment of wonderful books for babies, children, and teens. There are many fun books, educational books, library sets, books for homeschooling use, books in Spanish, kits and activity books, etc. We all know how much children love to receive a new book - and they make excellent gifts, as well as donations for your local women's, family, or children's shelters. Many kids never have a book of their own, and are not given the opportunity to learn to love reading - so one book purchase can go a l-o-n-g way if you get creative on how it will be used or given away to a child in need. :) If you'd like to purchase a book through Erin this month, you will also be helping another family in the process.

To participate in this book fundraiser for Jodie and her girls, please do not order directly from the Usborne site -- it will randomly pick a consultant and give your order to them, defeating the purpose of the fundraiser. To have your purchase donated to Jodie's family, you will need to select the books you want, and send Erin a message with those you'd like to order.

Erin can be found here on Facebook, and she welcomes any questions you may have.

If you would like to help Jodie's family, but do not wish to make a book purchase, there are other ways to get involved:

Gift certificates for Usborne books will go toward this cause and can be used in the future, or donated to peaceful parenting for the upcoming benefit auction. (As a non-profit organization we provide breastfeeding support, infant sleep resources, intact care, and circumcision information packs, babywearing items, and pregnancy, birth, and newborn care classes to parents who cannot otherwise afford them. Every single family helped here is exclusively supported through donations and we cannot continue without you).

Erin is also happy to pass along any direct gifts to Jodie and her family. You can donate with the PayPal button below and specify in the "Notes" that it is a gift for Jodie and her girls.

No matter what, thank you for being a part of the bigger community of gentle parenting mothers and fathers out there, seeking to make a positive difference for all the children of the world. They need you more now than ever before, so keep your eyes and ears open for ways that you can touch lives. Because every one matters.

If you give a child a book,
s/he is going to start reading.

If a child starts reading,
s/he is going to start thinking.

If a child starts thinking,
s/he is going to imagine.

And if a child experiences the beauty of imagination,
there is no telling how high s/he can soar!

~ International Children's Literature Project

First Time Mom to Adopt & Breastfeed Her Two Babies from Ethiopia

Transcript of News Report by Chasity Mayes

for KSMU Osarks Public Radio
Listen in MP3 format here

Breastfeeding is known around the world for being the healthiest option for babies, and with that comes a well known bonding experience. World Breastfeeding Week wrapped up on August 7th. KSMU’s Chasity Mayes tells us how every mother, including adoptive ones, have a choice when it comes to breastfeeding their child.

There are many benefits to breastfeeding. Everything from the nutrients it provides, to the economical benefits, makes it an easy choice for many mothers. However, as some mothers will tell you, the frustration and pain often put a damper on the experience. That being said, you might find it hard to believe that there are some mothers out there who go through all of the frustration simply for the bonding experience.

“The milk production isn’t necessarily the goal.”

That’s Laura Sarner. She’s the regional director of Lutheran Family Children’s Services in southwest Missouri, an organization that helps families adopting children. She says breastfeeding is more than just feeding your baby. “And that’s what doctors really encourage women to understand. The goal is to build a secure attachment with the baby who is being adopted. And you know, one way to build a strong attachment with an infant is by breastfeeding. And so that’s why a lot of women are attracted to this idea,” says Sarner.

Although some moms choose to breastfeed their adopted children exclusively for the bonding experience, that’s not the goal for all adoptive mothers.

“I mean I figure at the very least I’ll be able to provide nourishment through breast milk which has such an amazing quality to it. It just cannot be artificially recreated.”

That’s Sara Ward, a soon-to-be mom. She’s leaving for Ethiopia on September 23rd and after waiting over a year to complete adoption procedures, she’s excited about being able to give her children breastmilk.

Ward has always wished she could breastfeed her babies, but never considered it as an option until a friend told her it was possible. Since then, Ward has been busy. She researched online how even women who have never been pregnant can actually produce breastmilk through pumping.

Since May, she has pumped every two hours and frozen the milk. She started taking supplements to increase her milk production in December. She says it’s already rewarding.

“It’s so worth it. I mean it’s amazing when you see that you’re able to produce milk and just knowing that you’re going to be able to provide that for your baby is an amazing thing,” says Ward.

Although Ward says she wouldn’t change a thing, she does admit that pumping milk is frustrating and tiresome. She says it’s especially important to surround yourself with support.

“It can also be very exhausting and it’s great to have someone on your side that also believes that it’s significant and will be your cheerleader whenever you get exhausted,” says Ward.

Ward says support isn’t always easy to find when it comes to breastfeeding, especially for adoptive mothers. She says some people are uncomfortable with the idea of adoptive mothers trying to breastfeed, but they don’t understand why it’s being done.

“For adopted children, especially if they’ve lived in a group setting like an orphanage, I mean feeding is done on a mass scale. So out of necessity bottles are propped up. They’re not even able to make eye contact while they’re getting fed. So, feeding becomes for them more about survival than making a connection,” says Ward.

Ward also notes that because breasts are often sexualized in Western Society many people are turned off at the thought of a woman breastfeeding her child. Ward thinks it’s important for all moms to feel comfortable discussing the issues with their doctor. She says something like breastfeeding provides a crucial sense of security for adopted babies.

“If you can breastfeed them whenever they come home to you I think you’re really sending the message that things are different now,” says Ward.

Many women who decide to breastfeed their adopted children take supplements to increase lactation. In the United States many of the FDA approved prescriptions for lactation include uncommon side effects like depression. Ward is using a supplement, but it’s not FDA approved. She chose to use Motilium, which is a lactation supplement from New Zealand because she didn’t want depression to interfere with her parenting.

For Ward, one of her most valued forms of support has been the Mother and Baby Center on National Avenue (Springfield, MO). She says they provide a lactation consultant to any mother at no cost.

“You come in with your baby and they will assist you right there with helping them latch on. And they can talk with you about the various products that you can use to help your baby become comfortable with it. And they’ll even weigh your baby for you to make sure they’re getting the proper nutrition. It’s really amazing,” says Ward.

In September, when Ward is Ethiopia bound, she’ll be bringing home not one, but two new faces to Springfield. One child will be five months and the other will be one year old.

For more information on breastfeeding, see Breastfeeding Resources

For more information on the science of attachment, and building a secure attachment, see many of the excellent books linked here.

~~~~

Induced Lactation

The following is an excerpt from the excellent resource book, The Breastfeeding Mother's Guide to Making More Milk, by Diana West, IBCLC, and Lisa Marasco, M.A., IBCLC. If you work with new mothers and/or breastfeeding women, or if you are a nursing mom concerned about your supply now or in the future, pick up a copy of Making More Milk today.


Induced lactation is the process of creating a milk supply for a child you have not birthed. With a long historical tradition in native societies, it is becoming more common as women learn that it is possible. (1, 2) For both adoptive mothers and mothers of surrogate babies, breastfeeding is about more than the milk-it's a way to connect at a deeper level with your new baby and contribute to his growth beyond the pregnancy. Although it will require time, motivation, perseverance, tenacity, and patience, breastfeeding your baby can be tremendously rewarding.

As with relactation, the younger the baby, the more likely he is to latch onto the breast easily. A baby older than three months is liable to have more difficulty learning what to do than a newborn. All babies nurse more willingly when there is more milk, so it helps to do all you can to maximize your production. Achieving a full supply may be possible provided there aren't underlying problems such as hormonal dysfunctions or underdeveloped breast tissue. If you struggled with infertility in particular, there may be a hormonal problem that could limit your milk-making capability. However, most mothers can make at least some milk, and the total amount of milk need not interfere with a satisfying breastfeeding relationship. While you won't produce true colostrum, the milk you make will be the same quality as a birth mother's mature milk. (3)

If you're currently nursing but want to breastfeed a new baby you did not birth, you may not be able to increase milk production enough to meet the new baby's needs fully because you are in the autumn season of lactation now. But it's always worth trying because your new baby will benefit from whatever extra you can make.

Methods of Inducing Milk Production

In traditional cultures, women have successfully stimulated milk production just by putting the baby to the breast very frequently. Our Western approach relies more often on breast pump technology, but pumping is an imperfect way to induce milk production because it is cold, mechanical, and vacuum-centered only. Plus, it takes time to become comfortable and proficient at pumping. Even birth mothers with excellent milk production aren't always able to pump effectively, especially in the beginning. A nursing baby adds a positive emotional element; not only does suckling stimulate milk ejection, but the psychological effect of baby's smell, sight, and sounds triggers additional oxytocin releases that a pump can not. If possible, combining pumping with nursing baby using an at-breast supplementer can provide the best of both worlds. Adding galactogogue medications and/or herbs can result in significantly higher milk production.


Basic Pumping Protocol for Induced Lactation

1. Two to four weeks (or more) prior to the baby's arrival, begin manual massage of nipples and breasts for ten minutes eight to ten times per day for two weeks.

2. After two weeks, begin double pumping with a hospital grade pump for ten to fifteen minutes eight to ten times per day. If you find pumping without a flow of milk to be uncomfortable, try putting a bit of breastfeeding-grade lanolin on your nipples or lubricate the funnel with a bit of vegetable or olive oil before pumping.

3. When baby arrives, use an at-breast supplementer to provide feedings at the breast (pictured above). [Note: Commonly used at-breast supplementers include the Lact-Aid (preferred by most mothers interviewed by DrMomma.org) and the Supplemental Nursing System. Find human milk donations to use in the supplementer through a variety of resources.] Pump after feedings or several times per day, as time permits (this is also called "Power Pumping"). Keep a close watch on baby's weight gain to ensure that he is getting enough nutrition.

4. As your breasts begin to feel full, heavy, and slightly tender, see if baby will nurse at the· breast without supplementation for the first few minutes of the feeding ifhe is willing. Continue to watch diapers or track weight gain.

5. As long as hunger cues aren't frantic and weight gain is sufficient, gradually decrease either the amount of milk in the supplementer or the length of time the milk is allowed to flow from the supplementer during the feeding. Eventually, you may reach a point where you can no longer decrease the amount of supplement you offer without leaving baby hungry. That is the amount that will be needed for now, and maybe for the long term.

In the beginning, you have only your standby skeletal crew of lactocytes to start up milk production. Be patient. Induced lactation really is more like building a milk factory by hand from bricks and mortar instead of having the construction company, pregnancy, do it with all their specialized parts and equipment. Not as fancy and takes longer, but sooner or later new workers and assembly lines will slowly start to kick in, and your production will pick up.

Hormonal Simulation

Hormonal protocols for inducing lactation attempt to artificially simulate a pregnancy in order to build a milk factory. The amount of hormones used is less than what is normally produced during pregnancy. A birth control pill containing estrogen and progesterone is taken for a specific amount of time in order to stimulate the growth of more milk-making breast tissue. Then a prolactin-stimulating medication is introduced. Finally, pumping is begun to remove milk and further stimulate milk production.

In most cases, hormonal protocols result in more milk production than simple pumping. The more time you spend in the pregnancy-mimicking phase, the more milk-making tissue will be created. Starting at least four months before baby is expected to arrive produces the best results. You can initiate a protocol even after your baby arrives, but the shorter the lead time, the less you should expect to produce.

Milk does not come in until the pumping phase and first appears as clear drops that eventually become more opaque and white in color. As the milk volume increases, you may begin to see small sprays that eventually become streams of milk. The amount of time it takes to reach the streaming phase varies from mother to mother and depends on the type of protocol that she follows. It may take days, weeks, or months for milk production to begin. You'll know your body is gearing up to make milk when your breasts increase at least one bra cup size and feel full, heavy, and slightly tender. If you don't experience at least some tenderness within fifteen days, it may be necessary to increase your progesterone intake.

Because hormonal protocols entail the use of prescription drugs, it is essential to consult a physician. Present the entire protocol and explain that the birth control pill is not being used as a contraceptive but rather to develop lactation tissue. The medication can be started at any point in the menstrual cycle because the purpose is to simulate a pregnancy rather than prevent one.

Mothers who have blood clotting problems (a history of thrombosis), heart conditions, or severe blood pressure problems (hypertension) should not use hormonal protocols. Nor should mothers who wish to tandem nurse, because the existing milk supply will be reduced initially.

The Newman-Goldfarb protocols were developed by Lenore Goldfarb, B.Comm., B.Sc., IBCLC, in consultation with Dr. Jack Newman, as a result of her personal experience and subsequent work with other mothers, and are still evolving. They represent a new strategy that has not been formally tested in clinical trials but has been described theoretically by Dr. Peter Hartmann and his research group in Australia. (4) Many mothers have found the protocols to be effective. Similar but more limited protocols using medications to stimulate lactation hormones have been tested and found to be effective as well. (5, 6, 7, 8)

There are several versions of the Newman-Goldfarb protocol to accommodate the varying amounts of time available before baby arrives and the mother's hormonal situation. Mothers who prepare for six months or more by following the "regular protocol" are more likely to induce a full milk supply, while mothers who do so for fewer than six months and follow the "accelerated protocol" are often able to induce a 50% supply. Mothers who follow the "menopause protocol" may produce a 25% or less milk supply." Since these protocols are still evolving, visit the Ask Lenore website for specific details and more information.


For further information about induced lactation:

The Adoptive Breastfeeding Resource Website

Dr. Jack Newman & Enith Kernerman: Breastfeeding Your Adoptive Baby or Baby Born by Surrogate

Adoption.com's section on breastfeeding

One woman's experience: Breastfeeding My Adopted Child

Dr. Jack Newman Lactation Aid (homemade instructions)

Ask your local La Leche League leaders and/or lactation consultants for names of mothers who have nursed their adopted children.

Check out the book, Breastfeeding the Adopted Baby, by Debra Peterson.

Many of the same techniques used to trigger milk supply for working mothers who must be away from their babies all day, every day, are the same gentle parenting measures that will help adoptive moms increase supply as well. For further information on these natural-hormone boosting ideas, see: Balancing Breastfeeding: When Moms Must Work.

For breastmilk donations, look into a variety of resources available.

Additional breastfeeding resources can be found here.

References

1) Jelliffe, D & Jelliffe, E. Non-puerperal induced lactation. Pediatrics. 1972; 50(1):170-1.

2) Auerbach, K & Avery, J. Induced Lactation: A study of adoptive nursing by 240 women. Am J Dis Child. 1981; 135(4):340-3.

3) Kulski, J., Hartmann, P., Saint, W., Giles, P., Gutteridge, D. Changes in the milk composition of nonpuerperal women. Am J Obstet Gynecol. 1981;139(5):597-604.

4) Hartmann, P., Atwood, C., Cox, D., Daly, S. Endocrine and autocrine strategies for the control of lactation in women and sows. In: Hannah Research Institute Conference on Intercellular Signaling in the Mammary Gland. New York: Plenum Press; 1994:203-25.

5) Bryant C. Nursing the adopted infant. J Am Board Fam Med. 2006;19(4):374-9.

6) Biervliet, F., Maguiness, S., Hay, D., Killick, S., Atkin, S. Induction of lactation in the intended mother of a surrogate pregnancy: case report. Hum Reprod. 2001;16(3):581-3.

7) Petraglia, F., De Leo, V., Sardelli, S., Pieroni, M., D'Antona, N., Genazzani, A. Domperidone in defective and insufficient lactation. Eur J Obstet Gynecol Reprod Biol. 1985;19(5):281-7.

8) Nemba, K. Induced lactation: a study of 37 non-puerperal mothers. J Trop Pediatr. 1994;40(4):240-2.

Breastfeeding My Adopted Child

By Julie Bouchet Horwitz
Photos by Dyana Van Campen


Note: The author of this article used a Supplemental Nursing System (SNS) made by Medela. However, all of the adoptive, breastfeeding mothers I have met with have much preferred the Lact-Aid System made by Lact-Aid International and found it worked better for them. If you are thinking of adopting in the future, or need help nursing your baby now, you may wish to look into both systems to see which would best suit your needs.




It was Christmas Eve. The fireplace, ablaze with warmth and light, was hung with four stockings: one for my husband, Bill, one for me, one for our nine-year-old daughter, Margot, and one nameless stocking for the adopted daughter whose arrival our family had been anxiously awaiting for months. Although Margot was born shortly before our first anniversary, after eight years Bill and I were still longing for another baby. When we made the decision to adopt, we decided to seek a child from China because we were assured we could adopt a young and healthy infant there.

I had my heart set on something special: I wanted to breastfeed my adopted child. I had breastfed Margot and enjoyed the bonding and nurturing so much that I wanted to share this same closeness with our new baby. I had heard of women nursing adopted babies and hoped this would be possible for me. But how, without a pregnancy, was I to do this?

To induce lactation, the milk ducts of the breasts must be stimulated. This is accomplished ordinarily through the baby's sucking. Stimulation releases prolactin, a hormone that relaxes the mother. As the prolactin builds up in the bloodstream, the body begins to produce milk. Most adoptive mothers do not get a full milk supply, but almost all produce some milk. It is more than likely that a mother who chooses to nurse her adopted baby will need to supplement her milk supply.

An adoptive mother may choose to have some breastmilk already established by pumping her breasts before the baby arrives, as I did. I used a double-electric model, pumping every two to three hours on both breasts for ten to fifteen minutes during the day and once during the night, when possible. Within a few weeks, some milk appeared.

It isn't necessary, however, to pump beforehand to induce lactation; simply putting the baby to the breast every two or three hours will achieve the same results. I had been pumping for two weeks when we received the medical records and a picture of our new daughter, who was three months old and lived in an orphanage in a small city about 400 miles west of Shanghai. It would take at least a month before we were able to make the necessary logistic and legal arrangements to pick her up. This meant that I faced the challenge of breastfeeding a baby who had been institutionalized and bottle-fed for the first four months of her life, but I was not deterred. We named the baby Olivia. She was healthy and beautiful and would soon be in our arms.

After traveling halfway around the world, Bill, Margot, and I arrived at our hotel, ready to meet Olivia. Three days later we received a call saying that our new daughter was, at that very moment, in the conference room on the second floor of our hotel. Rushing downstairs, we first saw little Olivia peeking out from layers of Chinese clothing. She was handed to Margot, whom we had promised would be the first to hold the new baby. We tried to establish eye contact, but Olivia looked away. I stared at her long enough to get a fleeting smile.

We returned to our room to feed our new daughter. In the orphanage she had been fed four times a day, between 6 a.m. and 6 p.m. There were no feedings at night. At four months of age she weighed only 9 pounds. I decided to nurse Olivia immediately to see if she would even accept the breast. Babies have a desire to suck that is just as important as their need for nourishment. To my great relief, when I offered her the breast, she sucked readily.

In most cases, an adoptive mother will not produce enough breastmilk to meet the baby's nutritional needs and will need to supplement her milk supply. To avoid nipple confusion (babies suck differently on a bottle than they do on the breast), the mother can use a breastfeeding aid that provides a supplement while allowing the baby to still suck at the breast. I used a commercial product called the Supplemental Nursing System (SNS). With the SNS, the mother wears a special light plastic bottle around her neck. A thin tube attached to the bottle is taped to the mother's nipple. The baby sucks at the breast and simultaneously receives a supplement from the bottle. The more breastmilk the mother produces, the less supplement the baby takes in from the SNS. An adopted baby will nurse with a SNS even if no breastmilk at all is produced.

When nursing an adopted baby, the mother will need to make use of a SNS for every feeding. In between feedings, one can nurse without a supplement. I offered Olivia a supplement every two hours. Of course, this schedule requires sitting down and nursing many hours a day, but it replicates the normal postpartum period: mothers resting, eating healthy and nutritious food, drinking fluids, and nursing around the clock.

The first time that Olivia nursed with the SNS was a bit confusing. It took some time and experience to coordinate the tubes and flow of milk. After consuming 4 ounces of formula, she vomited. Her caregivers from the orphanage had already warned me that she regularly vomited her feedings. I tried feeding her less formula at each feeding, and this solved the problem.

Eventually, Olivia and I mastered the SNS. She was nursing frequently but, because she had been bottle-fed, used her tongue improperly. Besides causing terribly sore nipples, improper usage of the tongue does not stimulate the milk ducts. The tongue must protrude over the lower gum to milk the ducts of the breast, but Olivia's tongue was curled at the back of her throat. To my distress, my body stopped making milk. A lactation consultant showed me how to use finger-sucking exercises to teach Olivia the correct way to nurse. We continued to use the SNS at each feeding, and, in time, my milk returned.

Just how much milk my body produced is difficult to estimate. Judging from the amount of supplement Olivia consumed, I probably provided about a quarter of her nourishment. Although I had initially hoped to be one of those rare women who produce a full milk supply, I was delighted to be nursing my baby in any way possible. Word spread in our community that I was nursing an adopted baby and needed to supplement. Nine mothers came forth, and over the course of a year donated breastmilk to Olivia. It was a gift of love as well as nourishment. No words can express the gratitude I felt.

Having already nursed a baby, I knew how much babies love to suck. But Olivia was sucking only for nourishment. I wanted her to nurse for pleasure, too, without the SNS. If babies accept and love pacifiers, I asked myself, why wouldn't Olivia suck for pleasure on a warm, soft malleable nipple that emits a drop of sweet milk every now arid then? When she became sleepy after nursing, I would gently pull the tube out of her mouth. She continued to nurse. I would cradle her in the Baby Bundler, a sling that allows skin-to-skin contact, and walk her to sleep, all the while offering her my breast. Gradually she began to accept the breast for comfort alone.

There were other hurdles to overcome. Conditioned to institutional care, Olivia was somewhat aloof and distant. Often, if I held her against my chest, she would arch her back and struggle to get out of my arms. She was so accustomed to being swaddled and left alone to sleep that the rocking, singing, and holding that we used to induce sleep did not work. Bill and I wanted to sleep with our baby, and I felt very frustrated that my mothering style did not suit her.

We struggled to come up with solutions. Bill encouraged Olivia to accept us by lying next to her in bed and gently stroking her arms. I learned to carry her curled up in the side of my arm until she felt comfortable being held against my chest. Eventually she became sensitized to our touch, our rhythm, and our voices. She began to fall asleep at the breast more often, until she came to enjoy it. Gradually the distance she maintained melted away, and she blended more completely into our family.

By the time Olivia was a toddler, she ate solids, drank from a cup, and continued to nurse often. Much to my disappointment, however, she still wanted warm milk from the SNS. I wanted her to wean from the SNS so that I would be free from bottles and tubes altogether. One day I inadvertently put donor milk that had a high content of colostrum in the bottle. Olivia tasted it and frowned. This gave me a little idea. I pulled out the tube and gently encouraged her to accept the breast without the bottled milk. "Nurse Momma instead." Within 24 hours she was weaned from the SNS.

Today, Olivia is a bright, affectionate, and loving child with a remarkable zest for life. Despite the problems we had to overcome, it was more than worth it. Because our nursing relationship was lengthy, Olivia has memories of breastfeeding that I hope will carry her through when she processes her experience of being abandoned as an infant. When I hold her in my arms and cover her with kisses, I am amazed to think of what we accomplished. We have a closeness I shall always treasure.


Julie Bouchet Horwitz is an internationally board-certified lactation consultant, childbirth educator, labor doula, and La Leche League leader.

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For further information about nursing your foster or adopted baby and induced lactation see:

The Adoptive Breastfeeding Resource Website

Dr. Jack Newman and Enith Kernerman: Breastfeeding Your Adoptive Baby or Baby Born by Surrogate

Adoption.com's section on breastfeeding

Induced Lactation

Another mother's experience: My Adoptive Breastfeeding Journey

Dr. Jack Newman Lactation Aid (homemade instructions)

Ask your local La Leche League leaders and/or lactation consultants for names of mothers who have nursed their adopted children.

Books:

Breastfeeding the Adopted Baby, by Debra Peterson

Breastfeeding an Adopted Baby and Relactation by Elizabeth Hormann

Many of the same techniques used to trigger milk supply for working mothers who must be away from their babies all day, every day, are the same gentle parenting measures that will help adoptive moms increase supply as well. For further information on these natural-hormone boosting ideas, see: Balancing Breastfeeding: When Moms Must Work.

For breastmilk donations, look into a variety of resources available.

Additional breastfeeding resources can be found here.

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Sleeping with Your Baby

by Peggy O'Mara
Published in Mothering, Issue 141

One of the biggest crises of confidence that new mothers face has to do with sleep. Mothers feel responsible for their babies' sleep. Others ask mothers if their babies are sleeping through the night, as if this is something the mothers can control. Mothers lie to one another about whether or not their infants sleep through the night. And everyone lies about not bringing their babies into bed with them.

We lie because our society has unrealistic expectations of babies, and therefore we have unrealistic expectations of ourselves as mothers. Our expectations for babies' sleep simply do not coincide with babies' actual capabilities, or with the normal behavior of our species.

It is normal for human beings to wake during the night. We each awake several times a night, but don't remember that we have. It is normal for human infants, especially, to wake at night. During their early weeks, they sleep during the day and are awake for periods during the night. It takes about two months for their day-night cycle to regulate itself. From two to four months, infant sleep is more predictable, with longer stretches of night sleep. Parents are tempted during this time to say that their babies sleep through the night, and they fully expect that they should be. This is often false hope.

New brain activities—manifested in sitting up, standing, creeping, and crawling, as well as in the eruption of new teeth—conspire to make the period from five to nine months a time of increased night-waking. Baby becomes more aware of others during this time, and may have separation anxiety and nighttime fears.

The pattern of increased brain activity, new growth and stimulation, eruption of baby teeth, and the maturation of the immune system is mostly complete by two years of age. While many parents with one-year-olds who are not sleeping through the night think that their baby has a sleep problem, it is actually not until between two and three years of age that a child regularly sleeps through the night. This does not mean that the two-year-old wakes as much as the newborn, but only that sleep is a process as well as a state.

There is nothing we can do to change this, nothing we can do to make our babies sleep through the night. We sometimes think that introducing solid food will help our babies sleep, but starting solids too early can hurt them. One study found that feeding babies rice cereal before four months was a risk factor for the development of diabetes. The American Academy of Pediatrics recommends not starting solids before six months; the World Health Organization suggests waiting even longer.

Even if we wait to start solids, it is not a good idea to start with rice cereal, although it is very popular. Rice cereal doesn't make babies sleep through the night. In fact, it has a high glycemic index and may raise the baby's levels of blood sugar and insulin. It is not as rich in nutrients or flavor as other foods, such as vegetables and fruits. If food actually did make babies sleep, rice cereal would not be a good choice; as a starch, it is digested quickly. The cereal became popular decades ago to complement formula feeding because it could be more easily fortified with iron.

While we cannot make our babies sleep, we can provide them with regular bedtime routines. I always nursed my babies to sleep in a rocking chair. Baths, quiet time, reading stories, soft light, and a slow pace help prepare children—and adults, for that matter—for sleep. These routines help us to relax.

It is also important that older children have time during the day to run and play, as a lack of exercise can make them wakeful. On the other hand, children who are overstimulated can also take time getting to sleep. We all need a period of unwinding from a busy day, and the transition from waking to sleep requires sensitive pacing.

Most of us, though, can figure out the baths and the bedtime stories. It's the night waking when our children are babies that drives us wild. It drives us wild because we're up in the night and don't want to be. It also drives us wild because it's a dark secret to admit that our babies wake at night.

Over 30 years ago, I sat in a room with a bunch of other new moms and bemoaned the fact that my baby was waking up during the night. I thought I was weird. All of a sudden, it occurred to me to ask the other mothers how many of their babies were waking at night. Nearly all of them raised their hands. We all breathed a great collective sigh of relief. It was not our fault. It is just the way babies are.

After observing my four babies, it is clear to me that teething is a major culprit in night waking. My babies' night waking dramatically decreased after their two-year molars came in, often at about 18 months. There can be other reasons for night waking, and it's always helpful to try to figure out if there is anything out of the ordinary in the baby's life that might contribute to wakefulness. If not, one simply has to live with it.

We have set a cruelly unrealistic standard for infant sleep. We expect babies to conform to our adult world, and we justify coercing them when they don't.

I know it's been a long time since my children were babies, and I no longer feel in my bones the ache of missed sleep, but I found it easier to handle sleep interruptions once I came to accept night waking as normal. I recently received an e-mail advertising the services of a doctor who specializes in sleep training. "Sleep training" implies that we can, and therefore probably should, control our babies' sleep habits. But is sleep a "habit"? Good sleeping habits are one thing, and they do indeed help children sleep better—but sleep itself is a need, and therefore out of our control.

Yet we parents are not only expected to control our children's sleep, we are told where our babies are to sleep. Defying centuries of ancestral wisdom and common practice, today's medical experts raise doubts in young parents about the safety of sleeping with their babies. This advice flies in the face of the fact that most of the world's parents sleep with their babies and always have. It's the way of our species. The assumption that one needs a separate room and a separate bed to safely raise a baby is elitist. There's nothing inherently wrong with these things, but they don't have a monopoly on safe sleep.

Human babies are born helpless and have the longest period of dependency of any species. We are not comfortable with this because our culture equates dependency with weakness. It is, in fact, a healthy dependency that guarantees independence. I don't think I am the only mother who has observed that her most dependent babies turned into her most independent children. As with sleep, independence is not something we can teach our children. It is something they develop.

But what is a parent to do with all of the mixed messages regarding sleep and babies? One doctor recommends swaddling babies all night long. And yet, observation of babies self-attaching to the breast shows them using their arms to locate the breast and to move toward it. Babies also move their arms to lower their body temperature, which is important—overheating can be a contributing factor in SIDS.

Another doctor recommends that parents refuse to comfort a baby who wakes at night. He suggests standing outside the door of the baby's room to listen to her cry it out. I can't imagine any other circumstances in which one would be so deliberately unresponsive to a loved one's suffering. When the baby finally falls asleep out of exhaustion, it is not because she has learned how to sleep. It is because she has given up on others.

Convincing international research supports a parent's instinct to sleep with her baby. Cosleeping seems to have a corrective effect on the infant's respiration. The baby breathes more regularly when in skin contact with the mother. For this reason, too, cosleeping is protective against SIDS. One researcher even found that cosleeping was not only safe, it was twice as safe as not cosleeping.

And yet, the gold standard for infant sleep is an approved crib. According to controversial research conducted by the Consumer Product Safety Commission, each year 60 babies die in adult beds—but most of these babies are alone. On the other hand, 900 babies die each year in cribs, and in the last 25 years there have been 36 recalls of cribs. Does this mean that cribs are unsafe? No. It means that babies sometimes die at night.

It is cruel to suggest to parents that they could be lethal to their own children, and that the only solution is to buy a new crib, which many parents can't even afford. In fact, new products are recalled just as often as old ones. The fact that a product is new does not mean that it has been safety tested, because safety testing is not required. It may mean that it meets current mandatory standards, but if it is a new type of product, there may be no standards yet set for it. This is true even in the juvenile products market.

Common sense tells us that night waking is not a pathological abnormality but a temporary disturbance. It decreases as baby teeth come in and the immune system matures. Here are some ideas that can help:

• Accept night waking as normal.
• Sleep when the baby sleeps.
• Don't turn on the light or change diapers when the baby wake at night to nurse.
• Don't count how many times you're awake at night.
• Don't look at the clock in the middle of the night.
• Nap on weekends, or whenever you can get help with the baby.
• Carry on.

Peggy O’Mara is the mother of four grown children. She has gained international celebrity as publisher, editor and owner of Mothering Magazine. She is also the author of four books: Having a Baby Naturally: The Mothering Magazine Guide to Pregnancy and Childbirth, Natural Family Living: The Mothering Magazine Guide to Parenting, The Way Back Home: Essays on Life and Family, and A Quiet Place: Essays on Life and Family, all of which can be purchased in the Mothering Shop [1]. A dynamic speaker, she has lectured and conducted workshops in conjunction with organizations such as the Omega Institute, Esalen, La Leche International, and Bioneers. She has appeared on numerous television and radio programs and has been featured in national publications including The Wall Street Journal, USA Today, The Washington Post, Chicago Tribune, Mother Earth News, and Utne Reader.

Read Peggy O’Mara’s editorials for philosophical information and practical advice about Natural Family Living

How the Stats Really Stack Up: Cosleeping Is Twice As Safe

By Tina Kimmel © 2002
Originally published in Mothering, Issue 114

The Consumer Product Safety Commission (CPSC) and the Juvenile Product Manufacturers Association (JPMA, the crib manufacturers' lobby) recently launched a campaign to discourage parents from placing infants in adult beds or sleeping with them, based on data showing that infants have a very small risk of dying in adult beds. (1, 2) The CPSC implies that infants in adult beds are at greater risk than infants in cribs, but as we know, and as they know, babies also die in cribs.

What we need to do is calculate the relative riskiness of an infant sleeping in an adult bed versus a crib. We can do that by dividing a measure of danger for each situation by the prevalence, or frequency, of that situation, and then comparing them. (Oddly, the CPSC never presents relative risks.) Using government figures, we can perform a rough calculation to show that infants are more than twice as safe in adult beds as in cribs. This is aside from the many other advantages of cosleeping or bedsharing, such as increased breastfeeding and physiological regulation, the experience of having slept well, parents' feeling of assurance that their child is well and happy, the enhanced security of psychological attachment and family togetherness, and family enjoyment. (3)

Let's begin by looking closely at the CPSC data. The anti-cosleeping campaign is based on a dataset that contains the 2,178 cases of unintentional mechanical suffocation of US infants under 13 months old for the period 1980 to 1997. CPSC-authored articles about these data reflect only the small portion of deaths that occurred in adult beds. (4) However, these data also have been published with summaries of the cause-of-death codes on all 2,178 cases. (5)

Of these 2,178 infant suffocation deaths, we are certain of only 139 occurring in an adult bed. For 102 of these, we know that a larger person (presumably a sleeping adult) was present, because the cause-of-death code is "overlain in a bed." That does not tell us exactly what caused the death-that is, whether the baby died and then was lain on, or died as a result of being lain on. We can assume that the 37 deaths involving waterbeds occurred in adult beds, since few child waterbeds exist. That gives us a total of 139 infant suffocation deaths known to have occurred in adult beds in these 18 years.

The same data show that 428 infants died due to being in a crib. It is likely that there were preventable risk factors (such as using a crib in need of repair) involved in these crib-related deaths. But that doesn't change our calculations, because the deaths did occur. Similarly, our calculations do not change due to the preventable risk factors (such as intoxication) involved in adult-bed deaths (and other overlying). Note that advocates are raising public awareness to increase the safety of both these sleeping arrangements, with the hope that all these deaths will decrease.

We can't use the other 739 bed- or bedding-related cases in our analysis, because the place of death is not specific enough; these deaths may have occurred in a large adult bed, a single-size adult bed, a child's bed, or a misused crib. Nor can we include the remaining 760 deaths, as we have no idea whether they took place in a sleep situation at all. We also know nothing about the presence or absence of an adult, although a nearby, aware caretaker could have prevented many of these deaths.

So for only 567 (139 plus 428) of the deaths do we know whether they took place in an adult or infant bed. Thus, from 1980 to 1997, 75 percent of the mechanical suffocation deaths of US infants with a known place of occurrence took place in cribs, while 25 percent took place in adult beds.

While it is tempting to make the observation that three times as many babies died in cribs as in adult beds, if three times as many babies were actually sleeping in cribs as in adult beds, the risk would be the same in either place. Based only on this crude death-certificate data, we do not know which is safer. We still need to know how many babies were actually in adult beds or cribs-that is, an estimate of how common cosleeping was.

To estimate cosleeping prevalence, we can turn to the CDC's Pregnancy Risk Assessment Monitoring System (PRAMS).6 PRAMS has been surveying mothers of infants, usually between two and six months of age (but occasionally up to nine months), since 1988. Approximately 1,800 new mothers are sampled each year in each participating state. The sample is rigorously selected to represent essentially every birth in the state, and the response rates are high (70 to 80 percent). Most of the 100 or so PRAMS questions involve prenatal and well-baby care and stressors.

States have the option of adding their own questions and have asked about cosleeping. The basic question asked is, "How often does your new baby sleep in the same bed with you? Always; Sometimes; Never." (Some states add "Almost always.") PRAMS data, therefore, can be used to ascertain cosleeping prevalence in participating states and may be the only data of this kind.

From 1991 through 1999 (the most recent data available) we see that roughly 68 percent (100 percent minus the 23 to 43 percent who "never" coslept) of babies in these states enjoyed cosleeping at least some of the time. Data from the United Kingdom are similar: Helen Ball's Sleep Lab found that around 7 percent always coslept, 40 percent did so for part of the night, and 33 percent never coslept. (6)

Now let's try to estimate a single cosleeping prevalence rate from these data. Let's say that babies who "sometimes" cosleep do so about half the time. Over all the years of this sample, around 42 percent of babies coslept "sometimes." Let's also say that "always" or "almost always" means 90 percent of the time. Roughly 26 percent of infants coslept "always" or "almost always." Adding "always/almost always" (90 percent of the time x 26 percent of babies) to "sometimes" (50 percent of the time x 42 percent of babies), we get 44 percent of babies ages two to nine months who were cosleeping at any given time, presumably in an adult bed.

Now we can use these figures based on CPSC and PRAMS data to calculate the riskiness of these two sleep arrangements, although it's important to understand the limitations of doing so. For example, these PRAMS data are from only five states (although more will be available in the future), while the CPSC data are from the entire US. The years in which the PRAMS cosleeping data were collected are not the same as those covered by the CPSC dataset, although they overlap. The CPSC covers infants zero to thirteen months, while PRAMS asks about infants two to nine months. The CPSC collects demographic details such as state, income, race, and age of mother (as does PRAMS), as well as time of the death, but they are not easily available to do a more detailed analysis. One or both of these data sources lacks information on impairment of caretaker and other known sleep risk factors, exact sleeping and furniture arrangements during different times in the night, overcrowding and other motivation for cosleeping or crib sleeping, clinical pathology findings, previous health of the infant, etc. Plus, a complete risk analysis should include all causes of infant deaths, including SIDS.

Nonetheless, these data are important population-based sources of information on sleep risks that we would not have otherwise. So let's go ahead and use them to estimate a risk ratio for cosleeping. We take the 25 percent of the suffocation risk in the CPSC data linked to being in an adult bed and divide it by the 44 percent of babies who were actually in adult beds. Then we divide that fraction by a similar fraction for cribs, i.e., 75 percent divided by 56 percent. (If we multiplied each of these fractions by an overall infant death rate, we would have the actual risk for each group.)

This result shows that it was actually less than half (42 percent) as risky, or more than twice as safe, for an infant to be in an adult bed than in a crib. Based upon these calculations using the CPSC's own data, we can say that crib sleeping had a relative risk of 2.37 compared with sleeping in an adult bed.

Therefore, cosleep with impunity - but, of course, be sure to follow safe cosleeping guidelines.

NOTES 

1. "CPSC, JPMA Launch Campaign about the Hidden Hazards of Placing Babies in Adult Beds," Consumer Product Safety Commission press release no. 02-153, May 3, 2002.

2. S. Nakamura et al., "Review of Hazards Associated with Children Placed in Adult Beds," Arch. Pediatr. Adolesc. Med. 153, no. 10 (1999): 1019- 1023.

3. Summarized in M. O'Hara et al., "Sleep Location and Suffocation: How Good Is the Evidence?" Pediatrics 105, no. 4 (2000): 915-920.

4. See Note 2.

5. Dorothy A. Drago and Andrew L. Dannenberg, "Infant Mechanical Suffocation Deaths in the United States, 1980-1997," Pediatrics 103, no. 5 (1999): e59.

6. Centers for Disease Control and Prevention, "Pregnancy Risk Assessment Monitoring System," www.cdc.gov/nccdphp/drh/srv_PRAMS.htm [1].

7. "The Sleep Lab Awakening," University of Durham (UK) press release, April 6, 2000.

Tina Kimmel, MSW, MPH, is a PhD student in social welfare at the University of California-Berkeley and is writing her dissertation on "The Effect of Welfare Reform on Breastfeeding Rates: Findings from the Pregnancy Risk Assessment Monitoring System." Previously she worked as a research scientist for California's state health department. She would like to acknowledge the state PRAMS epidemiologists who shared their analyzed data for this article: Rhonda Stephens, MPH (Alabama), Chris Wells, MS (Colorado), Ken Rosenberg, MD, MPH (Oregon), Melissa Baker, MA (West Virginia), and especially Kathy Perham-Hester, MS, MPH (Alaska) for her valuable insights. Tina has two children, Rosie (27) and Jesse (21), and one grandchild, Eli (4)-all born at home and all cosleepers.

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