Monday, 8 October 2012

Happy World Milksharing Week

I wanted to have this post ready for September 24th - 30th, which is World Milksharing Week but sadly I didn't get it done in time. When I started this blog I said that it would be for my enjoyment, not something that I would stress over, so this post is late since life happened. So, without any further ado...

World Milksharing Week may well be something that you have never heard of before - either milk sharing, or the event. The goal of WMSW is to celebrate milksharing and to promote human milk as the biologically normal nourishment for babies and children.

There are a few things that I want to discuss about donor milk. As usual when I talk about infant feeding and the like, check out my usual disclaimer.

The World Health Organisation recommends four ways that infants should be fed, in priority order depending on the circumstances. Firstly they should be breastfed by their own mother, or if that is not possible then with their mother's own expressed milk. If that is not available, next in line is milk from another healthy lactating mother; either as directly (wet nurse/ cross nursing) or using EBM (donor milk or milk sharing). If milk from another mother isn't available, then infant formula is the next best option.

In our society, we very quickly jump from options 1 and 2, straight to option 4. Option 4 (formula) is still a very valid and necessary option, but I think that option 3 is too often passed over, or mothers don't even know that it exists.

Most people know stories of cross nursing/ wet nursing in the past, and few have a problem with that. It's actually a quite romantic notion in many people's minds. However, if someone feeds another woman's child these days, it's so controversial that it makes the news - seriously. (I'm not saying that what happened in this story was ok or not of that the reaction by the relevant people was or wasn't ok; I have linked to it to show the horror and outrage which often accompanies stories like this.)

Of course, there are many factors when it comes to deciding what is the best thing to do in a particular scenario, and there are as many different reasons for a baby receiving human milk from another mother as there are babies who do. Here's a selection of possible scenarios:

- Baby is left with a friend/ aunty/ babysitter who also happens to be lactating. Mother and babysitter agree beforehand that baby can/ should be breastfed by the babysitter; either in the event that s/he won't take a bottle or the mother may even not leave a bottle in the first place, knowing that human milk with may be safer than EBM (depending on the circumstances) is readily available

- Baby is left with a friend/ aunty/ babysitter who also happens to be lactating. Something happens - a bottle of EBM or formula gets dropped or leaks in a bag, the baby wakes up unexpectedly and won't resettle, baby is very upset and won't calm down or take a bottle, mother gets stuck in a traffic jam and can't get home in time. Since the baby has been left in the babysitter's care, she does what one would expect, and she acts as she sees fit in that circumstance. In the same way that she would put a bandaid on a skinned knee, or give a cuddle after a fright, or to give a time out for naughty behaviour, she decides that the best thing to do is to nurse the baby. She may have the opportunity to ask the mother if this is ok (if they hadn't discussed this before) but she may not. The mother may be uncontactable, or the babysitter may be too concerned with calming the hungry, screaming child in front of her (and probably her own child(ren) is/are there as well if she's lactating) that she acts in what is, in her opinion, the best interests of the child - as the mother who has left her child with her would expect her to do.

- Mother cannot reliably supply her own child with any/ enough human milk. This could be due to a 'production issue' such as Insufficient Glandular Tissue, complications from previous breast surgery or perhaps the mother is taking medications which are incompatible with breastfeeding, such as chemotherapy. (Side note - very few medications are incompatible with breastfeeding, but that's a for another post...) Perhaps she can't provide her child with enough milk due to circumstance - maybe she works away for weeks at a time and needs to pump and dump, maybe she is an exclusive expresser but despite all the best practise she can't keep up with her baby's(ies?) demands. Perhaps the breastfeeding parent is a transgender man who has had breast reduction surgery. In this circumstance, the family may decide that using donor milk (also called milk sharing) is the best option for their family.

Sometimes milks sharing is a one off, occasional thing involving small amounts of milk; sometimes it is ongoing, constant and the main or sole source of nutrition for the baby. Obviously the risks which surround milk sharing need to be considered and it would be foolish and irresponsible not to do so. However; when considering this risk it is important to compare the risks of milk sharing to the risks of formula feeding, the risks of bottle or other feeding device use, the risk of not breastfeeding.

There a few main things to be considered when it comes to risk. Here is an excellent peer reviewed article which addresses many of the key issues in great detail. It is particularly concerned with peer to peer milk sharing versus formula feeding.

To my understanding, milk sharing falls into pretty much three types

- Direct feeding eg cross nursing/ wet nursing

- Peer to peer milk sharing/ donor milk. A mother pumps breastmilk and gives it to another mother, who then feeds it to her baby usually with a bottle and/or a Supplemental Nursing System (SNS). This happens directly and milk is usually sourced/ donated through informal means - friends of friends, advertising on parenting forums/ magazines and/or through organisations such as Human Milk 4 Human Babies.

- More formal donations through milk banks, where mothers donate their milk which is usually then pasteurised and combined with the milk of other mothers. There is usually no contact between the donors and recipients.

Here are some of the arguments that are often expressed with concern to milk sharing.

Safety: How can you give your precious newborn child milk from some random that you met on the internet? How do you know that it's safe, that they don't have diseases or take drugs or that they have sterilised the pump and stored the milk properly?

This is generally the concern with peer to peer milk sharing - very few people seem to have problems with banked milk. Again, this is a topic for another post but many seem more prepared to trust a more formal, organised milk bank with policies and equipment and rules than another mother. As I said this is a whole different discussion, but it's prudent to point out here than banked milk is not available or suitable for many women.

Firstly, very few places have human milk banks. They are found in only a handful of capital cities, so if you don't live there, tough luck. Secondly, milk banks rightly prioritise their limited resources (financial and lactated) to those who need it most - sick and premmie babies. If your baby is healthy (or becomes healthy) then banked milk isn't available to you. Thirdly, banked milk is not suitable to all families. For example, Muslim women believe that it is their religous duty to provide their child with breastmilk and that babies who share milk from the same mother have a sibling bond. They therefore need to know where all of their donated milk has come from, as their baby has formed a sibling bond with that woman's (women's) children and therefore can't get married when they grow up. In a bank situation the milk from many different mothers is mixed together and the recipient cannot trace it back, so that would be unsuitable.

How can you give your precious newborn milk from some random you met on the internet? Perhaps I can look at this another way (and please keep in mind my usual disclaimer).

Instead of looking at formula baby food, perhaps we could look at it this way. Another animal, usually a cow, pumps its breastmilk (uddermilk?) and this milk is donated to/ given to/ stolen by someone else. The milk is taken from this mother (the cow) and is combined with the milk from lots of other mothers (cows). No information is kept about which individuals have contributed to this milk pool, and there is no way to know any of the health information about the donor (cow) mothers or about the age of their babies (calves). No information is known about how the milk is collected, stored and transported. After being transported it is highly processed, modified and supplemented. Very little information is available about these procedures. No information is available about all of the 'randoms' (that is, all of the people who have been involved with the process) to the families of the babies who use this milk. This process is all performed by for profit companies who place infant's health second to their own profits and are therefore professionally involved in misleading mothers. This cross species processed milk is then widely available for sale as one for two culturally normal options for the feeding of previous newborns.

When you consider formula in this light, does donor milk really look so strange? Donor milk involves a human mother willingly donating (not selling) human milk to another baby who, for whatever reason, is unable to receive his/her mother's own breastmilk exclusively. The mother(s) are (or become) known to the receiving family. They know where they live, the age of their babies, that their babies are human. Generally receiving mothers ask for blood tests and medical histories about the donor mother, as well as information about any medications, diet and alcohol consumption. They mothers generally discuss milk collection and storage procedures. Yes, the receiving families are trusting the honesty of the donor mothers that they are doing what they say - but remember that formula using families are trusting the formula companies for the same thing, which is by no means reliable. (Melamine anyone? Salespeople dressed up as nurses with quotas to fill? Goodnight milk?) I admit that when I first heard of donor milk from people you don't know, I was dubious about it; however, when you consider how much we don't know about formula (and consider acceptable) then I think it paints donor milk in another light.

Remember that all things in life are about assessing the risks of taking a particular form of action (or not taking it). I again link to this peer reviewed article which details a lot of the issues.

This is nutso extreme. Yes, breast is best but you gave it your best shot. Come on - you have IGT, you are one of the women who genuinely can't breastfeed, aren't you the type of person who is allowed to use formula totally guilt free? Isn't driving around to other women's houses to pick up milk and check blood test results a little extreme?

I would also like to point out something that a friend with IGT said to me. One of the biggest criticisms of those who talk about the risks of formula feeding or the benefits of breastfeeding is that this shouldn't be done because it makes mothers who can't or don't breastfeed 'feel guilty'. However, the marginalisation of mothers who choose to use donor milk and the scaremongering around the risks donor milk are extreme and in my opinion shameful.

Again, 'extreme' is a relative position. Feeding your baby purchased, highly processed milk of another species when there is same-species milk available may be considered 'nutso extreme' too.

It has been with mixed emotions that I have noticed more media coverage about donor milk, particularly peer to peer milk sharing. Firstly, the coverage has in general been pretty unimpressive and full of scaremongering. However, the fact that these articles are finding their way into mainstream tabloid newspapers itself seems like a good step to me, because it is normalising the use of human milk.

I also want to thank three groups of people here. Firstly, I would like to thank the mothers who willingly donate their milk to other precious children who need it. Secondly, I would like to thank those who are advocating for milk sharing, and thirdly I would like to thank all those who support the donors and advocates.

I encourage mothers and families to be aware and informed of the risks and benefits of their chosen way of feeding and how it relates to their particular circumstances, and the risks and benefits of avoiding certain ways of feeding.

Yay for milk!



  1. I love your cows milk analogy!

    1. I really think it changes the way that you look at it. If you consider formula to be trans species processed donor milk, then donor human milk doesn't seem so strange. The 'ick' factor is certainly there, but I think it says more about our cultural expectations than the actual biological process that is going on. Glad you liked it :)


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