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A personal account after
gestational 'surrogate motherhood'
Maggie Kirkman PhD MAPS
Linda Kirkman BA DipEd DipHlthSci
In Australia in 1988, Linda Kirkman gestated a baby for her sister, Maggie Kirkman
(conceived using Maggie's ovum and IVF). During the pregnancy, a variety ofmeans were
used to stimulate lactation. After the birth, several women donated breastmilk as
supplements to Maggie's supply. Thepaper discusses not only the induction oflactation, but
the cooperation ofwomen, that enabled a baby to befed breastmilk exclusivelyfor herfirst
Keywords: induced lactation, expressed breastmilk, Supply Line, gestational surrogacy
Breastfeeding Review 2001; 9(3): 5-11
In Australia in 1988, Linda Kirkman gave birth to the daughter of
her sister, Maggie. This came about using Maggie's egg, in vitro
fertilisation (M), and a great deal of care and ingenuity. Maggie,
who had had a hysterectomy at the age of 30 as a result of
advanced fibroid tumours, was then nearly 41. Linda was 32, with
two young children.
To give birth to another woman's baby is, of course, a
controversial thing to have done. However, it is not
'surrogacy' that is being discussed in this paper (Kirkman &
Kirkman 1988; Zipper & Sevenhuijsen 1987) but how that baby
was fed. This paper is also a testament to women's selfless
cooperation to ensure the best nutrition for a baby who is
not her own.
We are describing our experience of inducing lactation as a
contribution to the protracted debate about the value and place
of breastfeeding; a debate that continues in spite of the
acknowledged superiority of breastmilk for infant nutrition
(DettVl!'yler 1995; Morrow 1995). We live in a time and place
where it is still possible for women to be condemned for
breastfeeding their babies in public, however discreetly. This is
when breastfeeding occurs 'normally'. We are aware that some
people regard our 'abnormal' breastfeeding with distaste, if not
horror. Indeed, one letter to the newspaper after the appearance
of a story about our feeding method described the accompanying
picture as 'obscene' and the auempt to lactate as evidence of 'the
extreme length some people will go to to satisfy their own self-
indulgence' (The Age leuers 1988, 11 June). In contrast, another
s o ~ c a l l e d
Vo! 9 No 3 2001
lener on the same day congratulated us 'for attempting to satisfy
the nutritional and emotional needs of baby Ali.ce'.
It should be stated at the outset that Maggie has never been
pregnant, nor has she taken drugs to induce lactation.
Most ofwhat follows is derived from diaries we kept at the time,
some of which were used as the basis for our book, My Sister's
Child (Kirkman & Kirkman 1988).
On the evening that the subject of Linda gestating Maggie's baby
was first raised between us (in November 1985), Linda
emphasised that Maggie should attempt to induce lactation.
Breastfeeding, she said, was essential to the health of the baby
and an important contributor to the development of the mother-
baby bond. Maggie had not considered the possibility of lactation
and had no idea how to go about it, but she agreed to try: Linda
offered Maggie her support and said that she would donate
breastmilk if necessary. Maggie believed that her baby should not
be disadvantaged in any way, including nutritionally, by the
manner of her birth.
Maggie was not persuaded, however, to take up Linda's
suggestion of borrowing other people's babies for sucking
practice. Although the developed world seems to regard cross-
feeding as an alien or old-fashioned custom, Linda had
experienced i[ when she occasionally put to her breast babies
whose mothers had been hospitalised or were othen:vise
suddenly unable to feed [hem. It seemed to Linda to be an
excellent way of contributing to Maggie's breast stimulation, but
she accepted Maggie's reluctance.
Unda had heard or read somewhere (the source is now
forgonen) that fenugreek tea is a lactagogue. Maggie was more
ready to accept drinking curry·flavoured water, and consumed
several cups a day over the next few years.
At the time, Unda was training as a breastfeeding counsellor
with the Nursing Mothers' Association ofAustralia (NMAA). There
was, in 1985, scant literature on the subject of inducing lactation
(see the review in CAH 1998), and Unda began to pursue it
through NMAA. This was before the days of an easily-accessible
Internet, but Linda's husband, Jirn, who is an information
technology professional, conducted a computer search on
induced lactation. He found many articles about dairy cattle but
few about people.
However, the few papers on humans (Phillips 1969a, b),
stressed the importance of the woman's attitude in successfully
inducing lactation. Unda was confident that Maggie would
succeed because she was so determined to contribute to her baby
in any way she could. The task would be much easier for her than
for women trying to lactate for an adopted baby whose arrival
date is unpredictable, and whose social workers are unlikely to be
sympathetic to the goal of breastfeeding. Unda had heard of an
adoption agency questioning a woman's suitability as an adoptive
mother when they heard of her attempt to induce lactation.
When Maggie began the fVF program, in September 1987, we
told the IVF specialist that Unda was still breastfeeding her son,
William, who was nearly three years old. He was amused, but said
that it would not prevent conception. We were able to point out
that Unda had conceived William while her daughter, Heather,
was still breastfed. In spite of feeding William three times a day;
Unda's prolactin level was appropriate for conception. Maggie
was delighted that the specialist asked her ifshe were planning to
breastfeed the baby; implying that it was feasible, even expected.
In October 1987, around the time that Unda's pregnancy was
confirmed, Maggie read in a newspaper about a South African
grandmother who gave birth to her daughter's triplets. This was
the first known case of 'gestational surrogacy' in the world; ours
was to be the second. The paper went on to say that the triplets'
mother was breastfeeding them after hormone treatment, which
acted as another boost to Maggie's confidence.
On the 9th October 1987 we were given the wonderful news that
Unda was pregnant from our first IVF attempt. That very day,
Unda lent Maggie books and pamphlets on induced lactation
(Minchin 1985; Phillips 1969a, b) from the NMAA library. Reading
books such as Maureen Minchin's Breastfeeding Matters (1985)
was an informative but anxiety-provoking exercise for Maggie
because of the weight of information supporting the value of
breastmilk. It 'was also important to Maggie to make an obvious
contribution to the wellbeing of her baby, othern'ise she could
have been content with donated breastmilk fed to the baby in a
It was about this time that Maggie had a routine visit to a breast
surgeon to examine her breasts, a practice begun after one of
Maggie's friends died of breast cancer in her twenties. Maggie's
breasts feel lumpy, which, in conjunction with the absence of
menses, makes regular breast self-examination difficult. Far from
being concerned about inducing lactation, the specialist said that
Maggie's breasts would benefit.
Towards the end of November 1987, Maggie made her first yisi[
to a lactation consultant at a major hospital in Melbourne. Maggie
felt very apprehensive about the reaction her endeavour would
provoke, but the lactation consultant was encouraging, even
enthusiastic, which was an immense relief. She advised against
taking drugs to stimulate lactation because any breastmilk supply
tended to cease when the drugs are withdrawn. She suggested
that Maggie should stimulate her breasts with a breast pump and
showed Maggie a hand-operated pump designed for one breast at
The lactation consultant also discussed lactation aids for
simultaneously delivering donated breastmilk: to the baby and
stimulating breastmilk production. The idea ofa lactation aid was
reassuring, and reduced Maggie's concern about the need to
lactate before the baby was born. She was particularly pleased
when the lactation consultant said that colostrum could be
delivered by lactation aid, because Maggie knew that she could
not produce colostrum. Maggie was given instructions to massage
her breasts, stroking towards the nipples, for 12 weeks before the
due date. For the first four weeks it could be done a few times a
day; for the final eight weeks, Maggie was to massage each breast
for 11 minutes every three hours, day and night. This was
obviously a demanding regime, but one that Maggie knew was
worthwhile and thought she could manage. It seemed but a small
commitment in comparison with the pregnancy and birth being
undertaken by Unda.
The lactation consultant also generously offered to be at the
birth to help establish feeding. At this stage, of course, we were
envisaging a normal birth with vaginal delivery.
To put all of these endeavours in context, we should also point
out that Maggie had married Sev not long after his house had
been destroyed in the Ash Wednesday bush fires of 1983. They
were living in a tin shed on the property and struggling to finish
the house before the baby was born. In addition, our other sister,
Cynthia, who had been living interstate, moved into the
unfinished house (without electricity, adequate heating, or other
conveniences) along with her husband and three children not
long before the baby's birth. They stayed there until the baby 'was
a few months old.
This is background to the fact that, in late February 1988, the
three sisters took a bath together in the house to celebrate the fact
that we had a bathroom at last. The sorority bath demonstrates,
we think, some of the relaxed family intimacy and comfort with
our own and each other's bodies that contributed to our ability to
undertake all that was required to induce lactation. In the bath,
we were discussing lactation. Both of the experienced sisters
demonstrated to Maggie how to express breastmilk. Cynthia,
whose youngest child was then 11 (and well past breastfeeding),
was able to produce fluid from her breasts with little effort.
The baby was due on the 20th June 1988. On the 10th March,
Unda experienced the first slight discharge as a result ofplacenta
praeoia. It was the beginning of further complications to our
In the meantime, Maggie had her second visit to the lactation
consultant, who had moved to private practice with another
lactation consultant. This time, Maggie tried three breast pumps.
Uke Goldilocks, she found one to be painful, one too gentle, and
the last one just right. Maggie chose a cylindrical pump, which she
planned to use three-hourly towards the end of April, combined
with breast massage, nipple s[imulation, and thoughts ofthe baby
metoclopramide (Reglan (US]. Maxolon IAustJ) (an anti-nausea
drug that incidentally contributes to lactation) as a back-up, in
Vol 9 No 3 2001
spite of earlier advice. At the time, any possible back·up took
some of the pressure off Maggie to succeed. Maggie was
apprehensive about whether she could make it work, how she
could survive a minimum of 22 minutes of breast stimulation
every three hours, and whether she could organise sufficient
privacy in which to do it.
On the 4th April 1988, Unda was admitted to hospital for the
first time, after a haemorrhage. The baby was at 29 week..<;
gestation. (Uncta was to remain in or near a hospital for the next
seven weeks, until Alice's birth, and for a week afterwards.) A few
days later, our story, withour our names attached, was leaked to
the press by an unknown person. Reading about it in the paper
and hearing it discussed on talk·back radio was particularly
stressful. Maggie was spending every day with Unda, from early
morning to late in the evening. It was all she could do to stop
Unda from publicly defending us in the face of extraordinary
claims, such as Maggie would refuse to accept a 'defective' baby
and that Unda was being coerced into being a 'surrogate mother'.
As a result of the threatened discovery, Unda was transferred to
another hospital late at night and then back again a few days later.
None of this was conducive to a relaxed atmosphere for the
induction of breastfeeding.
Once Linda had been admitted to hospital, Maggie used a
breast pump with Unda's help. Linda went a bit far, however, by
making realistic baby sucking noises and saying 'yum yum', which
reduced Maggie to giggles rather than encouraging warm
thoughts of a well·fed baby. Nevertheless, these cooperative
sessions were valuable; Linda would massage one breast while
Maggie pumped the other. All of this was done as quietly as
possible behind the curtain in a v,rard, not a private room.
At first, the pump made Maggie's nipples and areolae very
tender, but this diminished after a couple of weeks. As time went
by, the prospect of using metoclopramide became less attractive.
It had been shown that it could maintain a milk supply in mothers
of premature babies who could not suck (Ehrenkranz &
Ackerman 1986), but its effect on inducing lactation was
unknown, as were any undesirable side effects. (For a more
recent discussion see Amir & Topp 1993.)
On 13 May 1988, at 34 weeks gestation, Unda had a major
haemorrhage, which indicated that the pregnancy could not be
sustained for much longer. The lactation program continued.
Linda had already contacted joanne, a friend's sister, about our
need for donated breastmilk. joanne's baby was a year old, but
Unda knew that human milk, even when intended for an older
baby, was preferable to milk from other species or manufactured
breastmilk substitutes. joanne came in to the hospital fortuitously
on the 22nd May, none of us knowing that the baby was to be
born the next day, bringing some of her own frozen expressed
breastmilk (EBM). She offered to supply as much EBM as we
needed because her breastmilk was plentiful and she found
expressing easy. Maggie had never met]oanne; Linda had met her
infrequently. The breastmilk was not a gift [Q us as much as a
manifestation of concern for a baby's welfare. After negotiations
with hospital staff, some of whom were reluctant, the labelled
EBM was put in a refrigerator in the hospital. We have no record
of warnings about the possibiliry of infection; the reluctance of
staff seemed to arise from a lack of commitment to breastfeeding
and discomfort in response to our independent actions.
]oanne's gesture was extraordinarily generous. h was most
welcome and reassuring for both of us.
Vol 9 No 3 2001
We were told on the 23rd May, 1988, that the baby was to be
delivered later that day by caesarean section, at 36 weeks
gestation. We were in a major teaching hospital in Melbourne.
The paediatrician came to warn us of problems resulting from a
premature birth, one ofwhich was difficulty in sucking that would
necessitate tube-feeding. He was not a strong advocate of the
value of breastmilk, but seemed prepared to support us and to
instruct the nursing staff not to feed the baby anything else. We
made a sign to this effect to attach to the baby's cot. It was
another thing to worry about, in addition to the constant threat of
having the baby removed by Community Services Victoria.
Linda was moved from the ward to a single room; the charge
sister kindly invited Maggie to bring a camp stretcher in to join
her. The hospital could not admit Maggie because establishing
breastfeeding was not on their admission protocol.
Alice was delivered at 7.35 pm and taken to the special care
nursery. Her weight of2.4 kg was good for her gestational age but
just within the range requiring special care. The lactation
consultants arrived a couple ofhours later for the first breastfced.
The lactation consultants set up the lactation aid, with the
container hung around Maggie's neck, the fine tubing taped to
her breast with surgical tape, and the end of the tube at her
nipple. To Maggie's great delight, Alice immediately latched on
and sucked strongly. In the container was some of the EBM
brought by ]oanne the previous day as well as about 5 ml of
colostrum, expressed by Unda as soon as she had been taken
back to the ward after the caesarean. To Maggie, that was a
supreme gesture of devotion to appropriate infant feeding, as
well as ideal and timely nourishment for her baby. She was not, as
some people have suggested, threatened by the breastmilk from
other women; it gave her a sense of securiry that she would not
be left to feed Alice on her own.
Linda had asked the nursing staff to express her breasts every
two hours after the birth, even jf she were unconscious. At first,
she produced only 2-5 ml of breastmilk. Maggie had to use
additional EBM because the paediatrician insisted that Alice
should have the amount recommended for breastmilk substitutes.
The special care nursery was not set up to encourage
breastfeeding, and many of the staff employed practices which
would discourage success. Supportive staff often seemed to be
battling antagonistic, systemic attitudes. We could not avoid the
conclusion that the conflicting advice must have been very
confusing to new mothers.
From the start, Maggie was called when Alice needed a
breastfeed, and had to manage the lactation aid and the supply of
EBM. It took her a while to learn how to use the aid effectively,
and there were some frustrating sessions for mother and baby.
Skill v.ras needed in positioning the equipment to allow easy flow
of the EBM and to ensure that there were no mechanical
blockages. It was one thing to do it with the lactation consultants,
and quite another to do it in the presence of nursing staff who
were not necessarily supportive and, if they were, not familiar
with the method. At times, Maggie was afraid that her benevolent
plan would actually harm her baby, because the process was so
One dreadful night when Alice was about two days old, the
lactation aid container was aCcidentally thrown away by staff.
Maggie was feeling helpless and just beginning to paniC, her baby
crying with hunger and facing the prospect of gavage feeding,
when ]oanne arrived to deliver EBM. Joanne put the baby to her
breast soothing both a hungry baby and a distressed mother. As
Maggie said the next day, had she been wearing a halo she
couldn't have looked more like ao angel of deliverance.
Maggie relied heavily on Joanne and her EBM supply for the
first few days ofAIice's life. Joanne said that it gave her a sense of
achievement to be able to produce breastmilk for babies other
than her own: This is one ofthefew aspects ofmotherhood that
can be quantified. When Joanne brought her mother to visit us,
we were delighted to discover that our father, Jack, had assisted
at the births of all five of her children.
Unfortunately, the EBM provided by Joanne was not always
used responsibly and some was thrown away by staffbecause they
had not given the earlier dates to Maggie first. There were no
facilities for freezing EBM, and the attitude we encountered was
that it was pointless to do so. Breastfed babies were routinely test-
weighed, in spite of the inaccuracy of this practice, and expected
to ingest the same quantity as infant-formula-fed babies. Had
Joanne's supply of EBM not been there while Unda's supply was
developing, Alice would have been forced to drink a breastmilk
substitute. Unda believed that it can take several weeks for an
infant's gut flora to recover after just one non-breastmilk feed,
and we were concerned about the increased risk of allergy with
breastmilk substitutes, because ofa historyofallergy in Our family.
So Unda persevered with expressing breastmilk. Sometimes
Maggie wheeled her to the nursery so that she could express
while Maggie breastfed. It would have been quicker for the
breastmilk to pass directly from Unda to Alice, but it would have
defeated the long-term aim of indUcing lactation. Maggie was
reassured by Unda's presence and encouragement.
Unda's increasing breastmilk supply was a source of pride to
her. She'd had no difficulties feeding her own children, but had
made unsuccessful attempts to express breastmilk for them. Unda
had had to change her negative attitude to expressing in order to
do so for Alice. She enlisted the help of hospital midwives, but
found none who were able to teach the most effective technique
until we went to a Victorian regional hospital.
Over the first postnatal week, Unda built up to 100 m1 of EBM
per session, taking half an hour to express this amount by hand.
She had tried a cylindrical pump, but found that it pulled her
nipples out and turned them purple. A hospital midWife told
Unda that Alice would eventually need about a litre of breastmilk
a day. Unda was horrified by her calculation that this would mean
five hours a day expressing at the current rate! But the regional
hospital midwife taught the technique of pushing rather than
pulling the breast, with the thumb and forefinger at the rear ofthe
areola where the sinuses are, gently depressing while pushing
back into the breast. This method, unlike the pulling method, was
not painful and was more productive. The lesson in effective
expressing was critical in Unda's successful provision of EBM to
We moved to the Victorian regional hospital when Alice was
four days old (27 May 1988), mainly to be near Unda's family and
because Maggie could be admitted as this hospital recognised
establishing lactation on its protocol of admission. Alice came
into our room at six days so that Maggie could care for her.
Maggie was sure that lactation would be encouraged by learning
to recognise the beginnings of Alice's hunger cries and to
distinguish them from other cries, rather than having to wait for
nurses to summon her as she suspected was occurring after Alice
had been crying for some time.
Moving to the country reduced the ever-present threat of
discovery by journalists but it also meant that we were toO far
from Joanne to continue using her EBM. One of Unda's friends,
Adrienne, had already agreed to take her place as she had a
plentiful breastmilk supply and found expressing easy. Adrienne
came to the hospital daily with EBM, just a.."iJoanne had done. Her
daughter was then two months old. Adrienne told us of having to
stop herself from proudly shOWing people the increasing supply
in her freezer.
Then a chance meeting led to Suzanne volunteering to donate
EBM, which she did for the first crucial weeks. Suzanne's baby
was a month older than Alice.
The three of us left hospital a week and a day after Alice's birth,
going first to Unda's house, then, along with Unda's family, to
Maggie's. It was helpful and reassuring for Maggie, as a new
mother, to be close to Unda for a couple of weeks after the birth
and able to rely on her experience and advice. We had also come
to depend on each other and to enjoy each other's company in
the months we had been together.
Maggie had left home to be with Unda in hospital on 3rd April;
she returned home with Alice on 4th June.
From this point, frozen EBM was delivered in breastmilk storage
bags by whomever happened to be making the hour-and·a-half
journey down the highway from the town where Unda and the
breastmilk donors lived to Maggie's house, or collected by Maggie
when she visited Linda.
Alice was fed on demand. Maggie seemed alv.'3ys to be
preparing for a feed, fee.ding, or cleaning up after one. She could
not have devoted so much time to it without the domestic help of
Cynthia's husband, Bruce, and her own husband Sev. Maggie was
not a fanatic (as some people suggested), just a woman who was
so thrilled to be Alice's mother that it was a pleasure to have so
much time to devote to her.
It was much easier for Maggie to manage the lactation aid at
home than in hospital, knowing that others would not interfere
with the EBM and being able to develop her own skill. What had
been a hard slog in the absence ofa baby became meaningful with
Alice's participation and the obvious benefit to her. She was a
baby who liked to be held and carried, and who responded well
to all that Maggie did, which made her feel competent as a
mother. The baby makes a significant contribution to the mother-
As Maggie could not always predict when Alice would be
hungry, the donated EBM was sometimes very cold, if not still
frozen, coming through the tube, which is possibly why Alice now
prefers to eat her peas frozen. If possible, Maggie defrosted the
EBM in cool tap water. When hunger demanded a feed earlier than
expected, Maggie squeezed the bag to break up the frozen EBM,
transferred it to the lactation aid, then held her hand over the tube
to v.'affi1 the EBM between her vvarm hand and her warm chest.
When Alice was twO weeks old and still two weeks short ofher
due date, our names and full details of our story were somehow
leaked to the press.We were given good advice on how to
respond; hold a press conference, give two days of access to the
news media, then ask to be left in peace. At Maggie's house, our
b r o t h e r - i n - I a v . ~ Bruce, described coordinating the media mobs as
'Hke drafting bloody sheep'.
Among the endless stream of television, radio, and print
interviewers came one journalist who brought with her the [Wo
lactation consultants, understandably keen to gain beneficial
publicity for breastfeeding, relactation, and induction oflactation.
After being persuaded that this would help other mothers, Maggie
agreed to be photographed breastfeeding with the lactation aid.
Vol 9 No 3 2001
The photograph, she was told, would be discreetly placed in the
section of the paper dealing with social issues: a serious,
unsensational article. We should not have been surprised to see
the photograph on the front page ofthe paper the next day (West
1988), to be picked up by many other papers.
After this story appeared, a cartoon by Ran Tandberg v..'aS
published in the Age, with a baby asking, 'Who is my real Dad?
Who is my real Mum? Am I bottle or breast-fed?'. He was not the
only one who implied that our feeding scheme added to the
confusion, rather than understanding it as an attempt to make
Alice's life as secure as possible. Our family saw the cartoon as a
quirky look at the truth and found it amusing rather than
upsetting; our father even wrote to the paper congratulating
Now we would like to explain and apologise for the only
(apparent) untruth we told during all the interviews and
conversations we have had since Alice's birth. Among the media
crush was an overtly antagonistic woman.
person who became unpleasantly intrusive (which included
reading and taking notes from personal correspondence in
Maggie and Sev's house). In one subsequent telephone call, she
told Maggie most forcefully that it was her duty to announce the
identity of the sperm donor who was part of the conception of
Alice, which Maggie refused to do on the grounds of privacy.
While Maggie was recovering from thiS egregious demand, the
journalist asked whether Unda had breastfed Alice.
declined to discuss it, and immediately rang Unda to warn her
about the journalist, whose published account asserted that Unda
had never breastfed Alice.
In fact, Unda came to Maggie's rescue on the day of the press
conference in a city hotel (there were neither the time nor the
facilities for Maggie to feed Alice) and on a few other occasions
including, we recall, a changing room at Myer. The assistance was
a relief to Maggie, not a cause of distress, and a straightforward
matter for Unda. Alice gave no indication of noticing the
We hate having this untruth on the public record: because of
the distortion ofthe facts; because it falsely suggests that we were
anxious about the mother-baby bond; and because it undermines
the public perception of the possibilities of cross-feeding.
Meanwhile, the feeding regime continued. Once Maggie and
Alice were no longer with her, Unda did not wake to express
during the night, reducing her sessions from five to four a day and
producing a litre of breastmilk. After a couple of weeks of this,
three sessions daily yielded the same amount. Maggie made it
clear to Unda that she should Stop expressing as soon as she
was ready; there was no pressure on her to supply EBM. At five
weeks. Unda expressed twice daily (skipping midday) and froze
700-800 ml for Alice. Every couple of days Unda needed to
express more frequently or borrow a friend's baby to increase her
supply. Adrienne, who was supplying EBM to Alice, was happy to
hand over her baby to be suckled by Unda. At eight weeks,
expression took about 40 minutes a time. Unda gradually
reduced production and stopped supplying EBM when Alice was
four months old.
Unda realised that she had been either pregnant, breastfeeding,
or both for six and a half years. William had been feeding three
times a day when she became pregnant with Alice and did not
stop completely until towards the end of the pregnancy,
prompled only by the lhreat ofhaemorrhage. We understand now
that the oxytocin release secondary to breastfeeding would have
been unlikely to produce uterine contractions and further
She was the only
Vol9 No 3 2001
haemorrhage (Amir L 2001, pers comm 28 February). Unda's
views on breastfeeding were strongly influenced by the books of
Sheila Kitzinger (1987) and Maureen Minchin (1985, 1986). She
was confident of her ability to produce breastmilk.
Maggie, on the other hand, ~ ' a S not confident about whether
she had succeeded in lactating, and avoided the topic for the first
couple of months. When Alice was about six weeks old, Cynthia
tried rather enthusiastically to express breastmilk from Maggie,
but produced only a few watery droplets which seemed to be an
inadequate sign oflactation, although it suggested that it may not
be far off. At that stage, Maggie planned to use the aid until Alice
was six months old, on the grounds that even watery fluid would
be likely to contain local antibodies. The intimacy was also
significant, being comforting and enjoyable to both Alice and
On the 24th July 1988, Alice was almost two months old. She
was at Maggie's left breast, with the aid, when Unda used her
improved expressing technique on the right breast. Two gentle
squeezes produced white drops of breastmilk. This remains one
of the most thrilling and memorable moments of Maggie's life.
When she visited the breast specialist twO months later, he
described Maggie's breasts as those of a lactating woman.
Nevertheless, she never attempted to breastfeed Alice without
supplements. Maggie interpreted Alice's late night comfort-
sucking as using Maggie as a human dummy rather than
Adrienne supplied 200 ml of EBM daily for six months,
expressing every morning on waking. From four months, when
Unda's contributions ceased, Maggie had made up any shortfalls
with soy-based hypoallergenic infant formula and continued to
use the infant formula, with the lactation aid, until Alice v..'aS ten
months old when she Weighed 8.5 kg. Alice subsequently drank
infant formula from a cup while solid food was gradually
introduced. Maggie could still express small quantities of
breastmilk at this stage, but believed it was not enough to sustain
Alice. After ten months of arranging their lives around feeding,
Maggie and Sev decided that it was time to move on. Maggie
found it almost impossible to use the lactation aid in pUblic.
However, she had no sense that she had been deprived of treats
or a social life; motherhood was a delight and, although she
would have preferred to have been able to breastfeed easily, there
was a sense that she was compensating for her inability to do the
work ofgestation by working hard for lactation.
THIRTEEN YEARS ON
In September 2000, we were invited to talk to a group oflactation
consultants, the first time that we had been asked to discuss our
lactation experience formally. Present on that evening was a
woman hoping to induce lactation. For her benefit one of the
consultants pointed out that, had Maggie relied less on donated
breastmilk, forcing Alice to gain nourishment from her mother
alone, Maggie might have been completely successfuL All she
needed was more confidence. Maggie, having arrived to speak
feeling proud of her achievement, left feeling that she had failed.
When she thought about it over the next few days, Maggie
recalled a child health nurse telling her that Alice at £\VO months
was being over-nourished, on the evidence of loose stools. This
was around the same time that Maggie first discovered that she
,...as lactating. Alice was drinking about a litre a day of donated
breastmilk, so Maggie assumed she wasn't getting much of hers,
but perhaps the overfeeding idemified by the child health nurse
At that same meeting, it was also pointed out to Maggie that
the still..cold EBM between her breasts would have inhibited
let-down. These days, it is apparently accepted that EBM can be
safely left unfrozen for 24 hours or defrosted up to 24 hours in
advance. Maggie had been (Old to leave EBM unfrozen for only an
hour or so.
However, what astonished Maggie was the depths of her
feelings after a remark that was not intended in any way as a
derogatory comment about her attempts to induce lactation. She
realised that she had not reflected on the whole experience; she
had done her best but had not really contemplated lening go of
the crutch of donated breastmilk. She understands now that her
reaction indicates something of the powerful, unarticulated,
emotions that adhere to breastfeeding as a contested marker of
womanhood and motherhood.
After more thought and conversations with Unda and others
(including the lactation consultant who made the remark),
Maggie came to understand why she had not risked brea.."tfeeding
Alice without supplements. In 1985 when we investigated
induced lactation, and even in 1988 when we attempted it, it was
a bold, pioneering step with which few people we knew had had
any experience, even secondhand. It is still probably a bold step
in 2001 but more information is available to lactation consultants
(CAH 1998), to which our experience has contributed.
Funhermore, Maggie was not left in peace to accomplish such
a difficult task. There was the media interest, including a period
of weeks when we were in the paper daily, being discussed on
radio and television, and pursued by the international press. We
were the subjects of controversy for the mode of Alice's
conception and gestation. Even though thiS paper is not about
surrogate motherhood, that is what frames Maggie's experience
of nourishing Alice. And Maggie, Sev, and Alice were living in a
cold, unfinished house in the middle of winter. All of these things
would have disrupted anyone's life with a tiny baby, and cenainly
added to the difficulties of inducing lactation. Maggie needed
privacy, feeding with a lactation aid is not as straightfol"'\vard as
merely putting a baby to the breast. It required equipment and
sterilisation as with bottle-feeding, but Maggie also needed to
expose her breasts and attach tubing. It was harder to be discreet
than with conventional breastfeeding and more likely to provoke
unwanted attention. Feeding with a lactation aid had the
inconvenience of both breastfeeding and bottle-feeding, and the
convenience of neither. We were also asked by our publisher to
rush out our book. We don't know now how we did it, but it was
in the shops before Alice was six months old. On top of all this
came unnerving threats of haVing Alice removed by Community
Services Victoria, especially immediately after birth and during the
subsequent few months. She was not adopted by Sev and Maggie
until she was 14 months old.
We feel proud of doing a good job under the circumstances,
and hope that others can learn from our experiences.
As for the object of all this effort: Alice is now (March 2001) a
happy and healthy 12-year-old. She is 1.7 m tall, with feet that
have outgrown the sizes generally available in women's shoes.
Her unorthodox feeding method does not seem to have held her
back. She has some allergies, but they do not impinge significantly
on her life. The most worrying one was to peanuts, but Alice has
been one of the lucky few who have grown out of that. Her most
severe remaining allergy is to horses, which we choose to see as a
considerable cost-saving in Pony Club fees.
Alice was able to benefit from breastmilk not only because
Maggie attempted to induce lactation but also because of the
generoSity ofwomen who donated breastmilk. That they believed
it was valuable to go to so much trouble helped to shape the
context in which Maggie was supported to persevere and to
achieve as much as she did. Abreastmilk bank would enable other
mothers and babies to enjoy the same nutritional and emotional
benefits. A breastmilk bank would mean that new mothers were
not dependent on developing their own networks, and ensure
that donors were appropriately screened. Breastmilk is a complex
and amazing fluid. It is the birthright of all babies.
Amir L, Topp M 1993, Use of metoclopramide in increasing supply of
breastmilk. Topics in Breastfeeding, Set V. Lactation Resource
Centre, NMAA, Melbourne.
CAH: Department of Child and Adolescent Health and Development
1998. Relactation: Review ofExperience and Recommendations
for Practice. World Health Organisation, Geneva.
Dettwyler KA 1995, Beauty and the breast: the cultural context of
breastfeeding in the United States. In Stuart-Macadam
Dettwyler K (Eds), Breastjeedtng: Biocultural Perspectives.
Aldine de Gruyter, New York. pp 176-215.
Ehrenkranz RA, Ackerman BA 1986, Metoclopramide effect on
faltering milk production by mothers of premature infants.
Pediatrtcs 78: 614-620.
Kirkman M, Kirkman L 1988, My Sister's Child. Penguin Books,
Kitzinger S 1987, The Experience of Breastfeeding.
Minchin M 1985, Breastfeeding Matters: What We Need to Know
About Infant Feeding. Alma Publications and AlIen & Unwin,
Minchin M 1986, Food for Thought. Alien & Unwin and Alma
Morrow M 1995, Barriers to breastfeeding. TopiCS in Breastfeeding,
Set VII. Lactation Resource Centre, NMAA. Melbourne.
Phillips V 1969a, Non-puerperal lactation amongAustralian AbOriginal
women, pan 1. NMAA Newsletter, 5 (4). Reproduced as NMAA
Research Bulletin No 1, 1969.
Aboriginal women, pan 2. NMAA Newsletter, 5 (4). Reproduced as
NMAA Research Bulletin No 2, 1969.
West R 1988, Breastfeeding of baby Alice. The Age (Accent), 15 June,
Zipper J, Sevenhuijsen S 1987, Surrogacy: Feminist notions of
motherhood reconsidered. In Stanworth M (Ed), Reproductive
Technologies: Gender, Motherhood and Medicine. Polity Press,
Cambridge. pp 118-138.
lactation among Australian
We are grateful to the wonderful WOmen who supplied breastmilk
to A]ice: Joanne Clark, Adrienne Conway, and Suzanne Gould.
Our lactation consultants, Janice Edwards and Rabyn Thompson,
gave warm, professional support. Maureen Minchin invited us to
tell our lactation story, thus encouraging us to understand the
experience more fully. Or Usa Amir and Dr Martha Marrow
proVided helpful advice in the preparation ofthiS paper. We thank
them all. (Names are used with permission.)
Our husbands, Sev and Jim, supported us wholeheartedly
throughout the events described in this paper (as in our other
endeavours). The brief references to our sister, Cynthia, and her
husband, Bruce, do not do justice to their significant role in
dealing with the complications ofinducing lactation. Our parents,
Jack and Yvonne, were loving, proud, encouraging, and amused.
Finally, we would like to acknowledge Unda's children, Heather
and Will, who have shown great aplomb in sharing their mother
in the production and nourishing of their cousin. Aversion of this
paper was presented at the 31st educational seminar organised by
Vol 9 No 3 2001
Breastfeeding Review Download full-text
the Australian Lactation Consultants' Association lnc (Victorian
Branch) Whose Breast, For Whom Best? Royal Women's Hospital,
Melbourne, 17 March 2001.
Lactation Resource Centre
About the authors
Dr Maggie Kirkman is National Health and Medical Research
Council Post-doctoral Research Fellow at the Key Centre for
Women's Health in Society, the University of Melbourne. She is a
psychologist whose research interests include infertility and
assisted reproductive technology. Maggie is currently investigating
psycho-social aspects of conception with donated sperm, eggs,
Unda Kirkman is a secondary school teacher and student
welfare counsellor in central Victoria. She teaches Health
Education, and has a special interest in adolescent mental health
and developmental issues in adolescent sexuality. Maggie and
Unda are co-authors ofMy Sister's Child (1988).
Dr Maggie Kirkman
Key Centre for Women's Health in Society
The University of Melbourne, Victoria 3010
+61 8344 4333
firstname.lastname@example.org (Unda Kirkman)
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Australian BreastfeedingAssociation Book Review Working Group
Journeys (through grief): [loss ofa child ofany
age: from conception through to adulthood: a
bookfor parents, families & supportpeople]
Published in 1998 by lnspirit Publishing, PO Box 2398, Katherine,
1st edition, 290 pages, paperback. ISBN 0-646-35534-1
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Tammie Thomson has compiled stOries written by parents whose
children have died, and put them together with many parents'
responses to questions about what they found useful and helpful
when they were bereaved. There is a wide range of experiences
represented and many different approaches to grief. Grief is a very
individual emotion and the author hopes that bereaved parents
reading this book will feel reassured that 'however they are
reacting, whatever course their grief takes, it is normal and
acceptable' (P12). There is a useful list of support groups and
contacts, and a short list of further reading.
The chapter on suggestions for support people was felt to be
particularly helpful for others who wonder what to say to or do for
a bereaved parent. The author hoped that they would see 'how
important their support and love and understanding is to bereaved
parents'. Specific statements are listed, as well as non-helpful
statements. Actions which might help bereaved parents, such as
naming and holding the dead baby, photographs, funeral options,
etc are mentioned only indirecdy through the parents' stories.
Send to:Lactation Resource Centre, PO Box 4000,
Glen Iris, VlC 3146, Australia.
Vol 9 No 3 200111