Feeding a newborn born through surrogacy: mother's milk or formula?

Introduction

Surrogacy is when a surrogate assists intended parents in fulfilling their desire for children. The surrogate becomes pregnant with the intended parents' baby because they are unable to carry a baby of their own. The intended parents care for the baby after it is born. 

After the birth, the surrogate's mother's milk comes in and the baby needs to be fed with suitable milk. There are various decisions you need to make together. Will you feed the baby with the surrogate mother's milk or will you opt for formula? Or are there other options?  

How you feed the newborn baby affects how you organise the postpartum period. The ways you can feed a newborn are: 

  • mother's milk
    • From the surrogate
    • From the intended mother
    • From a donor
  • Formula feeding 

 

You'll find information on the different options on this page and how you can talk to each other about them. 

Contents of this page

How do you approach a conversation about feeding after the birth?

The child's interests

What matters most is for the child's interests to be paramount. Newborn feeding can be a sensitive topic. Some intended and surrogate parents put off having the conversation or avoid it altogether. Yet it's important to actually talk about it.

Open conversation

Try to have this conversation with openness. Listen to each others' wishes without judgement. Make sure to make space for different thoughts and feelings. Trust is essential here: you need to be able to talk about everything within the bond you've built together.

Do you have a strongly held opinion? Then find out what the other person considers important.

A surrogate should never feel compelled to breastfeed if she doesn't want to. It takes a lot of time and energy.

If the surrogate does want to breastfeed, then it's important that the intended parents only agree to this if they feel good about it too. It can be confronting for the intended parents to see the surrogate breastfeeding when they are unable to do it themselves.

Counselling

It takes courage to have this conversation. A counsellor specialized in surrogacy can help you here. Everyone's thoughts and feelings can be expressed in a counselling session. Only then can you make a decision that everyone can get behind. 

If you can't come to an agreement

Sometimes your opinions differ so much that you can't reach a satisfactory joint decision. In that case, it's best to think carefully about whether you want to enter this surrogacy journey together.

How does feeding affect attachment?

The child grows in the surrogate's womb, thus creating a lifelong bond. Sometimes people think that a child will be less able to attach to the intended parents if the surrogate continues to breastfeed. This is not true. The bond the child has with the surrogate doesn't get in the way of creating a bond with the intended parents.  

It's worth acknowledging that feeding times are often important moments of connection between parents and their child. They can help foster attachment between the intended parents and the child.   

This connection is also important for attachment at other moments of caring for the child such as during: 

  • Bath time
  • Nappy changes
  • Getting dressed
  • Playtime
  • Bedtime
  • Comforting

 

In general, it is important for you to reflect together on what you all can do to foster the bond between the intended parents and the child. You can read more about attachment and surrogacy here.

Have you decided to feed mother's milk? These are the options

If you make a joint decision that the baby will be fed its mother's milk, you will need to discuss how to go about this. There are several options: 

  • Milk from the surrogate
    • Feeding directly at the surrogate's breast
    • The surrogate expresses her milk which is then given by bottle
  • The intended mother starts her milk production during the pregnancy and feeds this to the child after birth
  • Donor milk 

 

From the surrogate's breast 

If the surrogate is going to breastfeed, this will have an influence on how you organise the period immediately after the birth. Babies need to be fed 8-12 times per 24 hours. It means you need to stay very close to one another in the postpartum period. 

Expressed breast milk 

The surrogate can also express her breast milk for the intended parents to feed to the baby in a bottle. The health benefits of expressed milk for the child are the same as if it nurses directly at the breast.   

You need to know that expressed breast milk: 

  • Can be kept in the fridge (at 7 degrees) for 8 days
  • Can be stored in the freezer compartment of the fridge for 2 weeks
  • Can be stored in a small freezer for 4 months
  • Can be stored in a deep freezer (-18 degrees) for 12 months 

 

Intended mother will breastfeed  

Some intended mothers who are unable to carry a pregnancy of their own to term nevertheless manage to breastfeed their babies. Breastfeeding can be stimulated in various ways. It demands a lot of time and application. For further explanations see Breastfeeding by the intended mother

Donor milk 

If neither the surrogate nor the intended parents can or want to provide mother's milk of their own, You can consider using donor milk. This is expressed milk from mothers who produce more milk than they need for their own child. The Moedermelk network can help you here. Please visit Moedermelknetwerk for how it works and how you qualify for it.   

What you need to know about how breastfeeding (lactation) works

Pregnancy

During pregnancy, the breasts increase in weight by ±150 to ±500 grammes. The breasts will get ready for providing milk to the newborn. From the second half of the pregnancy, colostrum is present in the glands. Colostrum is the mother's milk that comes out of the breasts in the first couple of days after the birth. Over time, the composition of the milk changes. Mother's milk contains the exact nutrition a newborn baby needs.  

During pregnancy, milk production is inhibited by high concentrations of progesterone. This is one of the female hormones. This hormone is produced by the placenta.   

After the birth

The placenta is birthed after the baby. As soon as the placenta is birthed, there is a reduction in the hormone progesterone. This allows the hormone prolactin to increase. This hormone further stimulates milk production and ensures that the breasts continue to produce milk.

When the breasts fill up with milk without being emptied, the quantity of prolactin in the blood reduces and milk production tapers off. If the breasts are emptied regularly (through the baby nursing or expression), milk production will increase.   

After birth, a baby drinks 5 to 12 ml per feeding, 8 to 12 times per 24 hours. Afterwards, the quantities increase. 

Milk production by the mother's body with which the child is fed is also know as lactation.

Advantages of breast milk  

Children fed mother's milk have lower incidences of: 

  • Chest infections
  • Gastrointestinal infections
  • Middle ear infections.  

 

Even after stopping breastfeeding, children get fewer of these infections compared with children who have only ever been formula fed.   

Vitamin K 

Mother's milk contains too little vitamin K to meet the child's needs. Vitamin K is necessary for proper blood clotting. If the blood doesn't clot properly, serious haemorrhages can occur. Brain bleeds, for example. Vitamin K can be given to babies in drop form.  

Babies who are fed mothers's milk need 150 micrograms vitamin K drops daily for the first 12 weeks of life.  

If you'd like to know more about breast feeding, visit:   

Breastfeeding by the intended mother

The advantages of being breastfed by the surrogate or the intended mother are the same.  

How do you get breastfeeding started if you are not pregnant yourself? 

If you're the intended mother and are thinking about breastfeeding, seek advice from a lactation consultant who has experience in getting milk production going without a pregnancy. Some medications can help start milk production. Take a look under the heading Medicines that support breastfeeding. 

It can take weeks and sometimes months to get milk production going. It is important that you  

  • Have confidence in your abilities
  • Support from those around you
  • Realistic expectations  

 

It's possible that you won't be able to breastfeed exclusively. It is a good idea to ask a lactation consultant to guide you.  

There are 3 stages:   

Stage 1 and stage 2 occur before the child is born. Stage 3 occurs after the birth.

Stage 1 preparing the breast: you can prepare the breast through breast massage and nipple stimulation.

Stage 2 starting milk production: expressing by hand or (electric) pump. At least 8 to 10 times a day. Expressing often for a short duration is more effective than for longer and less frequently.  

Stage 3 increasing milk production: by frequently emptying the breasts, milk production is not only maintained but also increases. Frequent feeding is the most efficient way of increasing production provided the baby is properly latched on and can suckle well. If this isn't happening yet, it's important to express the breasts to empty them. 

Medication that supports milk production 

You need a lot of patience for the above process. Don't give up. Certain medications can help stimulate milk production.   

Prolactin 

The hormone prolactin plays an important role in milk production. Unfortunately, prolactin doesn't exist as a medicine you can take.  

Other medicines 

There are medicines that are used for other reasons that raise prolactin levels in the blood as a side effect. Sometimes, when taking these medicines milk production increases spontaneously.   

The drawback of these medicines is that you can't predict ahead of time whether this side effect will happen to you. Furthermore, these medicines can have other, unintentional side effects.  

Domperidon 

An example of a medicine that can stimulate breastfeeding is domperidon. This is medicine prescribed to people suffering from nausea. 

Oxytocin  

Another hormone that plays an important role in breastfeeding is oxytocin. This hormone causes the small muscles in the breast to contract. This releases the milk from storage in the milk ducts. This is also known as the let-down reflex.  

Oxytocin also lowers stress. You feel calmer and more positive. This has a positive influence on your connection to your child. 

The use of an oxytocin nasal spray (Syntocinon) can stimulate the let-down reflex. A good let-down reflex makes it easier for the child to empty the breast which helps milk production increase. This way, an oxytocin nasal spray can contribute to smooth milk production.   

A study of mothers of premature babies who used an oxytocin nasal spray with an electric breast pump showed no difference in the quantities of breast milk expressed during the first five days postpartum. The effects of a longer usage of oxytocin nasal spray has not been studied.  

Please note 

PLEASE NOTE!!! Only use medicine recommended and prescribed by a doctor. Do not buy medicine from the internet. It is possible that the medicine will pose a risk to you. Counterfeit medicines are also sold on the internet. Counterfeit medicines can endanger your health.  

If the surrogate doesn't breastfeed: what you need to know about engorgement and encouraging milk production to dry up

Even if you're not going to breastfeed, milk production will often start. This is driven by hormones. As a result, you can expect engorgement from day 3.  

Engorgement 

Engorgement causes the breasts to feel tight and distended. If you neither breastfeed nor express, this will subside on its own. But until that happens, it can feel anything from very uncomfortable to downright painful.   

Pain with engorgement 

You can take paracetamol for the pain. If that isn't sufficient, you can discuss options for additional painkillers with your care provider. 

If the engorgement is causing you unbearable pain, you can choose to relieve the worst of the pressure just once by expressing. But do this as little as possible because expressing will stimulate production. Excess expressing will maintain the problem and may even make it worse.  

Breast inflammation (mastitis) 

If during this period you sudden run a high fever, have flu-like symptoms and get a very painful breast, then you probably have mastitis. Get in touch with your midwife, general practitioner or the out-of-hours GP service immediately.

Medicine to prevent engorgement 

There exists medication that can partly prevent/relieve engorgement. You start it straight after childbirth. It can be a single dose or a course of treatment.  

This medicine to decrease milk production works for 90 women out of 100 without many side effects.   

These medicines are not suitable for every woman. Take a doctor's advice on what the best option for you is, if you want to use this medication. 

The child is formula fed 

Mother's milk is preferable to formula. However, circumstances may mean that neither the surrogate nor the intended parents are able or willing to provide mother's milk. If donor milk isn't an option for you either, then formula is a good choice. Always be mindful of hygiene when formula feeding and follow the instructions on the packet.   

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