Kim Kardashian certainly is not the first celebrity to hire a surrogate to carry her baby—Sarah Jessica Parker, Tyra Banks, Elizabeth Banks and many others did so before her—but she is the first to publicly hint (via Instagram) at her intentions to breastfeed her newborn child. This left many people perplexed. If Kim K didn't carry or give birth to her baby, how in the world is she planning on breastfeeding her new daughter?
While the verdict isn't totally clear as to whether or not the slew of breastfeeding gifts she posted on her social media feeds, including a nursing pillow and electronic feeding system, is intended for Kim to use herself or for the continuation of her surrogate, it's stirred up a much-needed conversation over whether or not this, in fact, is possible.
The short answer is, yes—with patience and reasonable expectations, breastfeeding your surrogate-born baby is totally possible, and the benefits are rewarding, most notably bonding through skin-to-skin contact. But that's not to say it's easy. "Breastfeeding, even for a mom whose body is already primed for it, is very challenging and requires hard work," says Anate Brauer, M.D., attending physician, Greenwich Hospital and NYU Medical Center. "Even for some who are doing everything possible to try and make it work, it doesn't."
The breastfeeding process for an intended mom is complicated
New moms who did not carry their child have to undergo a process of induced lactation or production of breast milk that's triggered by a complex interaction of several hormones—estrogen, progesterone, human placental lactogen, prolactin, and oxytocin. These hormones are instrumental in growing and developing breast tissue during pregnancy. "Upon delivery of the baby and placenta, estrogen, progesterone and HPL levels drastically drop, which, in the presence of high prolactin levels, stimulates milk production," Dr. Brauer explains. "Nipple stimulation promotes release of oxytocin which stimulates contraction of smooth muscle that surrounding ducts in the breast which then release milk."
So long as this process is replicated successfully, inducing lactation in a non-pregnant woman can be achieved, although Dr. Brauer explains that this typically requires several months of hormone therapy with a combination of estrogen and progesterone available in the form of either a combined oral contraceptive pill or overlap of estrogen and progesterone supplements. "About 8 weeks prior to delivery, one would stop the supplements and start pumping with a hospital grade breast pump," she says. "These devices mimic suckling of a baby and stimulate production of prolactin." In other words, the more an intended mom pumps, the more prolactin is stimulated and released.
"Most lactation consultants would recommend an intended mom start out pumping 5-10 minutes about 3-4 times a day, with the goal of increasing to 15-20 minutes every 2-3 hours," says Dr. Brauer. "Once the baby is born, even if breastfeedings are accomplished successfully, pumping after feeds is still encouraged." Still, it's important to note that even women who have followed all the necessary steps to ensure that they can produce milk will most likely need to supplement their supply with either pumped milk or formula.
However you choose to feed your surrogate-born baby, experts agree that the key is to do so safely and adequately. Although various pro-GI motility medications, such as Domperidone and Reglan, are used off-label to induce lactation, Dr. Brauer says this is not generally recommended, due to the slew of side effects that can accompany them. In fact, Domperidone is no longer available for any use in the United States due to potential cardiac complications and even sudden death. Additionally, she notes that the safety of such medications has not been extensively studied in babies.
Before considering induced lactation, do your homework
In addition to learning all you can about the process, some good soul searching can also help moms-to-be in their decision to induce lactation. "Breastfeeding is a very personal and individual decision, and you should never feel guilty, shamed, or judged for your decision either way," explains Patricia A. Evans, N.P, C.N.M., nurse practitioner and certified nurse midwife at MemorialCare Medical Group in Fountain Valley, California. "Asking yourself why you want to consider induced lactation in the first place, realistically considering the time, effort, and difficulties involved, as well as your personal, family, and work commitments, and family's support will help you adjust your expectations accordingly." It's also wise to consult your pediatrician, lactation specialists, donor banks, and breastfeeding websites before beginning the process of induced lactation. "Some surrogates may be willing to pump for a few months to give to the baby, so don't be afraid to ask them," adds Evans.
If bonding with your infant is your main goal for induced breastfeeding, know that it can be achieved in many more ways than nursing alone. "There are a number of ways that the connection between the intended mom and baby can be strengthened, such as listening to the baby’s heartbeat at doctor’s visits, attending ultrasound visits to catch glimpses of a face or a foot, recording their voice reading a book or singing a song for the carrier to listen to regularly, skin to skin time after delivery, and even breastfeeding," says Daniel Kaser, MD, FACOG at Reproductive Medicine Associates of New Jersey. Ultimately, he explains that the decision of how to bond with your surrogate-born baby, be it through induced lactation or some other method, is a personal choice.
Whatever your decision, remember that everyone has a different journey to parenthood and it's important to do what suits you best as a new parent. "New moms or dads of babies resulting from surrogacy have potential to feel additional guilt, as they have not had the opportunity to carry their babies, so will put additional pressure on themselves to bond in other ways," adds Dr. Brauer. "We should encourage these new parents to let go of the guilt and understand that as long as their babies are fed and safe, they will love them unconditionally, breastfed or not."