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!
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