As far as pumping in advance goes, there is lots to consider. You can start now, wait until it gets closer, or not pump at all. Unless you take domperidone, there is not much chance of having a "full" milk supply before the baby comes, no matter how much you pump. I have only ever heard of one mom who has been able to do that, and she had hyperprolactinemia. Many moms who pump in advance without domperidone don't see any more than drops for their efforts. I used to be very cautious in recommending that adoptive moms pump in advance, at all. This was because I had seen so many throw in the towel before they even got their babies because they were so discouraged from looking at an empty pump bottle week after week. It is important to know that what can be pumped is not a dependable estimation of what can be produced to a baby at the breast. This is especially true for moms who do not take domperidone. For the moms I have known who could only pump drops, who stuck with it and eventually replaced the pump with a baby at the breast with a supplementer, those drops soon turned to ounces. I, for example, could never pump more than a dribble, in advance, but produced up to a pint a day of milk with a baby, just by nursing with the Lact-Aid. It is apparent that pumps just are not nearly as good at increasing prolactin levels in someone who has not recently been pregnant or lactating as a baby at the breast. Domperidone increases prolactin levels, without the emotional response of a baby at the breast, which is why most moms who take domperidone and pump in advance are able to get at least a few ounces going before they get their babies. A few do so well that they don't need to supplement their supplies for their babies, at all. Others are able to have enough milk frozen that they do not need to supplement with anything else and virtually everyone is able to offer their babies more milk than if they didn't take it.
Whether to use domperidone is, of course, another issue. Had it been approved in the USA, I'm sure I would have tried it when I was nursing my kids, and may have done so, even if I'd had a way to get it from another country. But, since it isn't approved here, except in rare cases for a digestive disorder, I can't really recommend that moms take it, just that they research it. They cite reports from other countries of the drug being associated with heart problems, but that has been in patients receiving an IV form it. Dr. Thomas Hale, author of "Medications and Mothers; Milk" says that plasma levels in women taking oral domperidone for lactation are much, much lower than in someone on the IV form. More info is on this site http://www.ibreastfeeding.com/about-us I think it is prudent for moms who decide to take it to keep the dosage fairly low. From what I have seen, 80 Mgs total, per day is usually sufficient. Some moms have gone as high as 160 mgs per day, but my gut feeling is that that is too much. American moms usually have to order it from outside the country. There are a few compounding pharmacies that will make it up for someone. The American FDA says that it should only be done for people who have severe GI conditions that do not respond to metoclopramide.
It is also important to consider what options are available for supplementation, too. If donated breast milk is available, it may be more difficult to justify taking domperidone. If donated breast milk isn't available and the baby does not tolerate any commercial formulas well, it is much easier to justify taking it. With most babies, there is a formula that they do well on, although it can take some trial error to find. I believe very strongly that the overall health of baby whose diet is part well-tolerated formula and part breast milk is closer to one who gets only breast milk than one who gets only formula. There are many stories of babies who have had long-term health issues that responded very well to the addition of just a few ounces of breast milk a day. Two of my babies fall into that category. When it comes to nursing an adopted child, there is just an awful lot to consider!
There isn't any way to predict how anyone will respond to efforts to induce lactation. You just have to try it and see. Every once in a while I get a chance to correspond with someone whose history makes me think I might be able to predict her response. Recently, there was a mom who had pumped exclusively for a bio baby for more than a year and had all kinds of milk. I thought she would be able to induce lactation relatively easily, but she didn't I wish it was possible to tell someone that this or that is what they should do, but I feel that the best I can do is just try to give people information about the different possibilities for them to consider. I can say, however, that whether or not you pump or take meds, herbs, etc., if you get a supplementer, preferably the Lact-Aid, and start nursing on demand, you will be able to provide benefits that are worth every bit of effort it takes. While I have known a few never-pregnant moms who could never see that they were producing any milk, I have never heard of anyone who has given birth before who has not produced at least a few ounces a day of breast milk a day. Most have produced somewhere around half of all milk the baby needs while she/he is on only milk or formula, with just the suckling to stimulate it. Of course, there are other options for adding ounces to that, like herbs, oatmeal, etc. It is often possible to dispense with the Lact-Aid at some point, even for those with modest milk supplies, and then just keep nursing until the child self-weans. To me, toddler nursing was a reward for earlier efforts. And, of course, the emotional benefits of breastfeeding are the same, whether you need to supplement a little, a lot or not at all.
I hope this doesn't sound too disjointed. It is very late!
Edited by ashjaygrandma - 9/29/11 at 10:48pm