30 Sept 2012

Milk-Sharing: Safe Infant Feeding and Being a Human

The last post for this year's World Milksharing Week Blog Carnival comes to us from Jake Marcus at Sustainable Mothering. She shares with us her personal story of a huge oversupply, and hosts a highly informative piece by James Akre that was originally published by babygooroo on June 28th, 2012. For those of you who may be just joining us now in the blog carnival, Deena Blumenfeld brings us an introduction to milksharing that you can read on her blog, Shining Light.

Milk-Sharing: Safe Infant Feeding and Being a Human
from Sustainable Mothering

Back in the 1990s, I had more breast milk than I could handle. I knew then and know now that many women, due largely to the circumstances of their lives and not their biology, are not able to produce all the milk their children need. And there are breastfeeding people (some cis-female and some not) who have biological reasons why they can't produce enough breast milk for their children.
Well, that is where people like me can come in.

By the second trimester of my first pregnancy, my perfectly happy "Barely B" cups had become G cups. I didn't know there were G cups and never had desired to own them. When my first son was born, I pumped in the fruitless hope that he would drink breast milk from a bottle while I was in court. He had other ideas. Then I pumped for comfort because I was constantly engorged. I could pump eight ounces in five minutes, switch bottles, and pump another eight ounces. But my son would have none of it. He wanted breasts or nothing.

Pretty soon I had a freezer stocked full of pumped breast milk my son wouldn't drink. So, after some research, I contacted HMBANA in the hope of finding a good home for my gallons of milk. But I was also on an SSRI at the time – one then and now considered entirely safe for breastfeeding children. The HMBANA policy, I was told then, was that no milk donations would be accepted if the donor was on any medications whatsoever. So HMBANA would not accept my milk.

When son number two was born, not only did I have over supply but overactive let-down. That meant my first let-down would hit the back of my son's throat with such force it triggered his gag reflex and he chomped down in an attempt to slow the flow. There are only so many times a baby, affectionately nicknamed "Moose" for his ten pound birth weight and trap-like mandibles, can chomp on your nipples before something must be done. That something was pumping before each feed so that my let-down was not so fast. And that meant more gallons of breast milk in my freezer.

There were no informal milk-sharing networks on the Internet in the nineties. Or if there were, I didn't know about them. So I was forced to pour gallon after gallon of breast milk down the drain.
Menschheit is a difficult word to translate. Literally it is the German noun meaning "humanity" or "mankind," but I grew up hearing it used in Yiddish to describe a quality – the quality of acting like a real human being. This, in Yiddish, is considered a good thing. Giving my abundant excess breast milk to a baby who needed it seemed to me to be the most basic menschheit. It is what a person does if she is really human.

It made me incredibly sad that I couldn't find a home for my breast milk. And it makes me very happy that today people with excess milk can find other people who need milk and make the exchange. This is menschheit; it was what humans do for one another.
Following is a post written by economist and breastfeeding expert James Akre about the safety and necessity of milk-sharing. It was originally published by baby gooroo on June 28th and is reprinted here with the kind permission of Akre and baby gooroo:
A breast pump is attached to a woman's left breast, and she has expressed a few ounces into the container.
    Since pre-history, mothers in need of human milk have relied on other mothers in their family and community with milk to spare and share. According to the World Health Organization (WHO) and UNICEF, the second-best feeding option, after breastfeeding, is breast milk expressed by a child’s own mother, followed by milk from a healthy wet-nurse or from a human-milk bank.
    The Human Milk Banking Association of North America (HMBANA) acknowledges that its not-for-profit member banks—two in Canada and 11 in the U.S. serving a total population approaching 350 million — cannot satisfy even a quarter of the current demand for banked milk. Under the circumstances HMBANA rightly gives priority to sick and premature babies. But at $3–$6 an ounce, a week’s supply could cost as much as $750—something few parents can afford to pay even if banked milk were available.

    “A growing awareness of the importance of breast milk for babies has accelerated the demand for human milk at a time when processed donor milk is scarce and costly,” says Amy Spangler, president of baby gooroo. “Intent on giving their babies what every baby needs most, mothers are bypassing milk banks and going directly to the supplier—other breastfeeding mothers with milk to spare.”

    The Milk-Sharing Debate
    With the help of social media, mothers are increasingly aware that milk-sharing is a viable option for mothers who can’t breastfeed or obtain banked milk. Mothers of healthy babies who need milk are linking with other mothers willing to donate milk via chapters of two popular Facebook-based communities—Eats on Feets and Human Milk 4 Human Babies—operating in more than 50 countries.

    These online communities allow donor mothers to share their milk, safely and ethically, in the belief that they and recipient mothers are capable of weighing the inherent benefits and risks and making informed decisions. This altruistic commerce-free exchange is grounded in the principle that all who are involved in milk sharing take full responsibility for their actions and subsequent outcomes.

    However, the position staked out by some public health authorities, notably in Canada, France, Israel, and the U.S., including the Canadian Paediatric Society and the American Academy of Pediatrics is clear: Don’t do it!

    Some in the health and medical establishment regard internet-based sharing as a threat both to their authority and to public health. They reject a system that operates outside their influence, that can’t be regulated, and where mothers alone exercise control. Some especially anxious observers go so far as to allege that mother-to-mother milk sharing undermines the ability of the few under-provisioned human-milk banks to meet the urgent needs of sick and preterm babies, by further reducing potential milk donations.

    It should be noted that donor mothers have been breastfeeding their own children. With few exceptions, these mothers and their children are being followed closely by health care professionals with all that this implies for health status monitoring; and they are ready to discuss their lifestyle and disclose their medical records before sharing their milk. And yet health authorities are contending that mother-to-mother milk sharing is fundamentally riskier than feeding infant formula, and that it’s impossible for mothers, acting on their own, to minimize health risks.

    Those in favor of milk sharing disagree.

    Weighing and Managing Relative Risk

    Milk banks function according to a strict medical model where regulations, rules, and protocol determine what is done, when, and for whom. Babies receiving banked donor milk are virtually always sick and hospitalized; healthy children seldom qualify for access to the limited amount of banked milk. Health professionals prescribe milk for the sickest, neediest, and most fragile babies, who are frequently immuno-compromised and risk death.

    In addition, the screening criteria that milk banks typically apply disqualify many otherwise healthy women who might be willing to donate their milk. Exclusion criteria include previous residence in the UK (due to possible infection with mad cow disease), regular consumption of caffeinated beverages, a baby older than 6 months of age, and a small amount of available milk.
    In contrast, milk sharing takes place in the community where interpersonal contact plays a significant role. Typically, the personalities and values of those involved are largely responsible for influencing decisions; the children concerned are healthy; and mothers are motivated by a heightened awareness of the importance of human milk for human babies and a desire to contribute to the common good.

    There are risks associated with milk sharing just as there are with feeding babies formula.
    It is thus a question of weighing and managing relative risk, minimizing potential harm, and maximizing benefit. Rather than resisting and dismissing milk sharing, the constructive approach would be for health authorities and health care professionals to engage with mothers in ways that help make the practice as safe as possible, such as providing reliable information on donor screening, milk collection, storage, pasteurization, and feeding practices, and expediting voluntary sharing of medical records.

    There are encouraging signs of a more nuanced attitude among health professionals. For example, based on their survey of more than 400 health professionals, two researchers from the University of Wisconsin School of Medicine and Public Health in 2010 concluded that those knowledgeable about breastfeeding overwhelmingly support wet-nursing and sharing of unpasteurized human milk. The majority of those surveyed recommended that donors should be screened like blood donors, and should be instructed on safe milk handling and storage techniques. Although health professionals view all infants as possible candidates for unpasteurized donor human milk, concerns remain about safety and social problems with wet-nursing and milk sharing. Lastly, survey participants agreed that professional recommendations should be developed to optimize safety and acceptance of wet-nursing and human-milk sharing.

    What the Milk-sharing Community Advises
    The four pillars to support the safe sharing of breast milk from Eats on Feets stress:
      Informed Choice — Mothers are responsible for understanding the options, including the risks and benefits, of all infant and child feeding methods.
      Donor Screening — Mothers can communicate with donors by asking questions about their health and lifestyle, and by requesting blood screening test results.
      Safe Handling — Mothers and donors should handle milk with clean hands and equipment and use proper storage methods.
      Home pasteurization — If in doubt, mothers can pasteurize milk at home: on the stovetop in order to inactivate HIV; or using a single bottle pasteurizer that performs the Holder method of pasteurization.
    Meanwhile, Human Milk 4 Human Babies stresses that, “It is in the spirit of informed choice that milk sharing on these [Internet] pages will occur, and all people posting here will take complete responsibility for the outcome of milk sharing.” It also reminds mothers that:

    Full Disclosure Reduces Risk
    Suggested points of discussion can include medications, alcohol and drug use. In many countries, testing for infectious diseases is done during routine prenatal/antenatal care. You may be able to consult a health care provider to obtain further testing if desired. You can ask for copies of those test results. If you cannot get a complete picture of the health of your donor, one option is to look into at-home pasteurization.

    Mother-to-mother human-milk sharing is here to stay. Though technology has transformed the practice, it remains fundamentally identical to what mothers of good will have been doing since pre-history on behalf of other mothers and their babies.

    Not-for-profit human-milk banks and commerce-free mother-to-mother milk sharing can and should operate on parallel non-competitive tracks. They are complementary, not antagonistic. Indeed, there is significant untapped potential for both systems to play mutually supportive roles in pursuit of a single common objective—helping to ensure that no babies are denied their nutritional birthright.

29 Sept 2012

The Lorax and Other Milksharing Stories

World Milksharing Week's Blog Carnival is pleased to present two blogs in Spanish. Vilma Badillo Rodriguez shares posts from her blog, Borinquen Lacta con Amor. One story reveals how a milk donation allowed a family to get their first night of real sleep in three months, while another involves the good fortune of one mother suffering from low supply meeting a parent with a great abundance.
Jesusa Ricoy-Olariaga, drawing from Dr. Seuss, explains in the following post how as a society we have completely mistaken milksharing for what it actually is. She's brilliant – I can't say anymore, you just gotta read it! In English, below, and here in Spanish.
I was kindly invited by a breastfeeding dad - yes you read that right - to write a post on milk sharing.
I am currently on holiday in my home town of Alicante in Spain where my brain has gone into relax mode but have still found myself trying to stumble across a story for the purposes of this article.
I wanted to look back and find the commonality of women feeding their children, their sisters' children and their friends' children.
I spoke with my mother who recalled talk of milksharing in her own family but, it was in connection with an older brother who died before she was born. Then I met a Muslim friend in the street and we talked about how in her culture babies who are not part of the same family but have been breastfed by the same woman are considered siblings and therefore can't marry. I called some associations in Alicante and a lovely girl told me that although she didn't know where I could find historical information, she did mention that her late grandmother breastfed other children.
"Mister" he said with a sawdusty sneeze, "I am the Lorax. I speak for the trees. I speak for the trees, for the trees have no tongues. And I'm asking you sir, at the top of my lungs" – he was very upset as he shouted and puffed "What's that THING you've made out of my truffula tuft?"What I was looking for I couldn't seem to find so I just tried to relax with my family. So we rented the movie The Lorax based on the tale by Dr. Seuss. It's an ecological story of how greed destroyed nature until everyone forgot how nature looked like and what impact it had for ourselves and all the things around us. There is a point in the story where the main character is explaining what real trees are like and the evil guy trying to control everything reacts by shouting how disgusting the earth is and how it breeds dirt and bugs and pollutes the air. He has become rich and all powerful by selling bottled air to people in this polluted world and I couldn't help thinking of the similarities with the way milksharing is depicted today on the few ocassions that it is even mentioned: as something that is weird and disgusting, risky, dirty even, as something that it is alien to us when actually it's what makes us us.
Earlier this year a couple of friends had minor issues with their babies. The biggest problem was trying to gain support from professionals for formula not to be administered as a simple remedy. One midwife threatened my friend with calling the social services if she accepted donated milk from any of us which we had expressed, something that for me came naturally after feeling my milk building up as the mum was telling me she needed help. I never felt anything beyond the fact that a human baby needed milk, a friend's baby. I had milk so why wouldn't I help?  It was as natural as if someone was crying and I happened to have a handkerchief with absolutely no relation to the social perception of women fighting each other in their motherhood capabilities according to production, quality or endurance of their 'job'.
We do not do that. We mammals mother our babies. We nurture and care for them. We impose milksharing on cows. We steal their babies milk for our babies while we censor our own mothers' power and abilities because somebody once put a label to an imitation of something that cannot be imitated.
In The Lorax a tree was cut down. Then another and then some more until there were no trees left of even a memory of them. The perpetrator didn't have bad intentions. He simply saw that there was a need for his product.
Not that long ago there was a culture of normality of mothers feeding their babies, and indeed the babies of others. I am glad that even if I was personally unable to find out much from our past culture of milksharing, perhaps because milksharing was seen as an ordinary act of love within the greater matriarchal story that remains unwritten, I was thrilled to see so many references in my life to the new seed that will not allow our 'tree' - the milk of human kindness - to be forgotten. 
Our milk is ours. Our babies are ours.
Our milk is free. Our babies are too.
UNLESS someone like you 
cares a whole awful lot,
nothing is going to get better.
It's not." Dr. Seuss  

Ps: This post is dedicated to Trevor Macdonald a breastfeeding dad and everyone who cares a whole awful lot.

Winning the Milk Lottery

In celebration of World Milksharing Week 2012, Diana West, BA, IBCLC, contributes this post about her personal story involving her son’s extreme allergies. Diana experienced internet milk donation before the existence of Facebook-based networks. Her highly informative books, Defining Your Own Success: Breastfeeding After Reduction Surgery and The Breastfeeding Mother’s Guide to Making More Milk have helped many thousands of parents struggling with low milk supply and have great relevance to the milksharing community. She is also the co-author of the bestselling book, The Womanly Art of Breastfeeding, 8th ed. Watch for her upcoming book about sleep and the breastfed baby, co-authored with Diane Wiessinger and Linda Smith, to be published by Ballantine Books in July, 2013.
Through the years, I’ve shared my story about breastfeeding after breast reduction surgery with many people. I didn’t have enough milk for my first son, Alex, but I was proud to be able to provide about 2/3 of his daily needs with my own milk, which I was pumping exclusively because he had a nursing strike at three months that I hadn’t known how to get past. Unfortunately, we had discovered from several scary reactions that he was severely allergic to cow’s milk protein, so we had to use the uber-expensive hydrolysate formulas to take up the slack. The part of the story that most folks don’t know is that he was once the lucky recipient of 700 ounces of human milk that was given to us by a very special mother in New Jersey.

The way this came about was that I saw a posting on a breastfeeding usenet newsgroup – in 1995, usenet newsgroups were the way people connected online using very basic, non-website message boards (pretty primitive, I know! – but it was great at the time). One day when Alex was about six months old, I saw a posting from a mom who had a seven-month-old baby. She wrote that she had accumulated more frozen milk for going back to work than her baby could ever use and she wanted to give it to a mom who didn’t have enough milk and a baby who had a special need for it. She had also undergone extensive infertility treatments in order to conceive her baby, so she had negative test results for just about every communicable disease under the sun to prove that her milk was safe. She clearly expressed that she didn’t want any payment for the milk other than the good feeling that it was going to a mom and baby who really needed it. With my low supply and Alex’s severe cow’s milk allergy, we fit the bill perfectly. The only catch was that the recipient needed to be within driving distance of her home to be able to transport the large quantity of milk inexpensively without thawing. Fortunately, we lived only three hours away.

Hoping against hope and feeling like it was almost too good to be true, I responded to her post as soon as I saw it, telling her our story and how much we would value her milk. I was amazed and elated when she responded just a few minutes later, agreeing that we were the perfect match and choosing us to receive her milk. I felt like we won the lottery. Not only would this help Alex with his allergies tremendously – hydrolysate formula has pre-digested milk proteins that cause fewer allergic reactions, but Alex’s severe eczema was proof that he still reacted to it – it would also save us a lot of money because hydrolysate formula cost about four times the price of regular formula. I was a stay-at-home mom and my husband was just starting out in his IT career, so times were tough and the cost of the special formula was a real stretch for us.

Once it was confirmed that we had “won” the milk, the milk-rich mom and I emailed back and forth to figure out how to get the milk from her location in New Jersey to ours in Maryland. The biggest challenges were figuring out how to keep the hundreds of two and four ounce bags of milk frozen on the three-hour journey home. My husband Brad and I also had to think of a way to store them safely when our only freezer was the small one on top of our fridge that was already jam packed with food. And all the maneuvers had to include our six-month old baby and Brad’s work schedule since we didn’t have family nearby to help out.

The storage problem was solved by deciding to buy the deep freezer we’d always wanted anyway. It was a big expense for us in those days, but we knew it would give us a way to buy food in bulk so it would actually pay for itself in the long run. We solved the journey problem by working out that we could drive there on a Saturday afternoon with baby Alex and lots of toys to entertain him (this was before DVD players and iPads!), pick up the milk bags, put them in several large insulated coolers that we borrowed from friends, stay long enough to visit with the family and thank them properly, and then drive back home fast enough without breaking any speed limits to put the milk in the new deep freezer before it thawed.

As it turned out, on the morning of the trip it took us forever to get the car packed with Alex, his toys, the many coolers, and everything else we needed for a day away from home with a little baby and an exclusively pumping mom. By the time we hit the road, we were running several hours behind, which kept the New Jersey family waiting anxiously for our arrival. The whole family had dressed up and readied their home for our visit, and while they waited and waited for us to get there, the older kids rode their bikes up and down their road looking for our car. We felt like such newbie, inefficient parents to keep them waiting like that, but they were so sweet and welcoming when we finally arrived.
Diana's son and his milk sister sporting their specially made milk sibling t-shirts.
Milk siblings forever.
As a special (but very token) way to thank them, I had made up a purple t-shirt for Alex that said “Milk Brother” and one for her baby that said “Milk Sister,” based on the Islamic teachings that children who share a mother’s milk are considered siblings and not allowed to marry. (Neither of us is Muslim, but we liked the tradition.) The mom loved the shirts. We put them on the babies and let them crawl around each other in her back yard while we snapped pictures. Then both families went out to a nice dinner and basked in the good feelings of their altruism and our deep gratefulness. Afterward, we loaded all the milk into the insulated coolers and started the urgent (but not speeding!) drive home. We made it back in good time and got all the milk safely into its new home in the deep freezer.

I don’t remember how long the milk lasted, but because he was so severely allergic to cow’s milk and many other foods, Alex needed milk and formula until he was nearly two. So we stretched those 700 ounces out as long as we could and always felt so happy each time we could use human milk instead of the expensive and horrible smelling hydrolysate formula. Eventually, the deep freezer bought just for the milk became more and more empty and we began filling it up with frozen vegetables and other foods. Alex is now almost 17 years old, and shaving and driving if you can believe it (and very embarrassed that I’m blogging about this). The milk and his need for it are long gone, but we still have the deep freezer and we’ll always have the warm and wonderful memory of a mother in New Jersey who shared her milk bounty to help our baby.

28 Sept 2012

Scared Milk-less

This beautiful, eloquent post by Lisa van den Hoven gives us a few straight truths about milksharing and helps put it all in perspective. What does it really mean to give your milk to a "stranger"? What exactly does milksharing look like?

Many thanks to Peaceful Parenting for hosting Lisa's piece in World Milksharing Week's Blog Carnival.

Lisa smiles down at her baby as she breastfeeds. Her baby grasps Lisa's necklace.
Lisa and her little one, who shares her milk.

Let’s talk about that controversial thing called milksharing. The facts, as I understand them, are that Emma Kwasnica, with the help of many other like-minded people, launched a global network, through Facebook, called Human Milk 4 Human Babies. The aim of the network is to connect moms who need milk for their babies, with other moms, who have milk that they can share. This was about meeting a need.The World Health Organization’s position on infant feeding is that if, for some reason, a mother is not able to feed her own baby, milk from another human mother is a better alternative than formula. Milk banks do exist that could theoretically meet this need, but there are some problems. First, there are very few of them, so the milk that they do have to give gets prioritized to very sick or premature babies - the infants that desperately need the milk. Second, milk bank milk is almost always pasteurized, which turns human milk from the living miraculous stuff that it is, into dead milk, losing much of its value. Finally, it costs money to access the milk of many milk banks. So even if your baby is among the few that make the cut, and you are happy to accept pasteurized milk, you may still have to come up with the cash to cover it.

The medical community is aware of how difficult it is to access human milk when you need it -- this is why they do not often advise mothers to try this option. Instead, supplementing with formula is quickly suggested. I do not intend to go into why this is such a poor choice here. Suffice it to say there are mothers out there for whom supplementing with formula is not an option that they are comfortable with. So, do they have to? Is there no other choice?

Let’s be realistic: human milk is not a scarcity! Many mothers have ample supply for their babies, and then some. Some women struggle with oversupply! It is also a vastly renewable resource - empty breasts will fill themselves again and again. It should not be so hard to connect people who need milk to people who have milk to give. And it turns out, it isn't. But fear is alive and well.

When a group of parents decided they were done waiting for the medical community to fix this problem, and opened up a way for donors and recipients to easily match up, there was massive push back. It must not be safe, right? People could have disease! You never know what they might be smoking in their spare time... That's just gross, anyway.

Really, all of the arguments against this wonderful, simple milksharing solution to a common problem sound the same to me as razor blades in apples at Halloween. I doubt that there are all kinds of sadistic, lactating weirdos out there, masquerading as concerned moms, handing out drug-laced human milk donations just for jollies.

Here are a few facts:

Human Milk 4 Human Babies donors do not charge for their milk. There is nothing to be gained by donation, save the truly awesome global village feeling that you are helping to feed another's child.

Milksharing is done person to person. That means you meet that person you are getting milk from. You ask questions. You go to their house and meet their family. And you decide whether or not your baby eats that milk. You decide.

This is not a new idea. Wet nursing has been done throughout human history.

And, now a confession: My name is Lisa, and I have donated my milk to a stranger.

Based on the oh-so-educated comments that I read elsewhere on the internet, a common reaction to this is, “Omigosh! Weirdo!” or maybe just, “Yuck. I could never do that.”

But before you decide how you feel about informal milksharing, read just a teensy bit more.

I say I gave my milk to a stranger, in that this was someone that I initially met over the Internet. But when she sat in my living room, with her husband and new son, and we chatted while my similar-aged daughter cooed in her swing nearby, stranger was not the word I would have used to describe her. It actually didn’t feel strange at all. We were just two moms. She had a problem, and I was in a position to help her out, in a meaningful way. I am so glad she was not too scared to accept my help. Donating milk was hugely rewarding for me, even renewing much of my faith in the spirit of community.

If only more moms were not scared milk-less. We don't always need to turn to the authorities to fix our problems. Sometimes, with a little courage, we can find our own solutions.

Lisa is Mom to two, wife to one, and lives in Winnipeg, Manitoba, Canada. She loves being busy in her local, gentle parenting community, and blogs occasionally at Swirls and Swings.

Related Reading:

Breastmilk Donation Page [This page was created prior to milksharing communities existing as they do in 2012. For many years peaceful parenting served, in part, to connect mothers with donors locally via email, phone and community networking. Today, thanks to the new mother-to-mother milksharing set-ups, we hear from far fewer who don't already have their needs met or connections established.]

Joshua's Story: Why I Choose Another Mother's Milk
Joshua's Story: Why I Still Choose Another Mother's Milk
Human Milk for Human Babies After Japan Tsunami
Reasons Not to Send Formula or Human Milk to Haiti and Other Disaster Locations
TIME Reports on New Global Milksharing
Delaney Rose: 6 Months of Milksharing
A Modern Day Wet Nurse
From Despair to Donation: A Mother Loses Her Baby and Shares His Milk

27 Sept 2012

Overcoming Difference Through Milksharing

I've been having tons of fun reading and posting everyone's pieces for World Milksharing Week's Blog Carnival. After musing on it forever, I finally wrote my own today, about finding my place in the milksharing community.

I am a transgender man. I am in a gay relationship. I breastfeed my kiddo.

And I can tell you right now that I feel a deeper connection to our Mormon and Mennonite milk donors than I do to many of my other friends and community.

My past experiences as an LGBT person encountering religious folk have generally not been pleasant. Among many other comments, a Muslim friend once told me that being gay is worse than committing murder (I hadn't yet transitioned at the time), and a Christian noted that queer people burn in hell forever. My partner and I posted on Human Milk 4 Human Babies that we were a gay couple looking for milk for our baby, and assumed that LGBT-friendly donors would self select. We hoped that others would remain silent.

When I first realized that one of our milk donors, we'll call her Sherry, was Mormon, I was totally shocked that she would want anything to do with us. We had received her milk through a friend, and I thought that perhaps the original donor just didn't know much about us. We met for the first time a few days later, and Sherry gushed over our ten day old boy. In fact, I believe she said to him something like, "You make my uterus ache! Holding you makes me want another baby."

At that moment, I realized that Sherry and I had much in common. We both love holding babies, we are both attachment-minded parents, and we both really care about the health of babies – all babies. Sherry's milk maintained my son's normal gut flora on his fifth day of life, while a feeding of formula would have altered it, for the worse, for weeks to come.

Some Christian donors have told us that they don't understand everything about who we are, but they are open to learning, and they have a whole lot of respect for our commitment to breastfeeding and human milk. I am learning that there is great variety amongst individuals' religious paths. Not every Christian I meet is like the woman who once hurled the phrase "Jesus loves you" at me as if it was some kind of insult.

Outside the milksharing community, I often get comments like, "You're sure letting the baby run the show, aren't you? You know he would be fine. Formula isn't evil. It's ok to cry." I am simply responding to my son's needs – to be picked up, to nurse, to have human milk. I feel misunderstood, defensive and embarrassed when someone criticizes my parenting in this way. I know that I have done my own reading about everything from the risks of formula feeding to the effect of excessive cortisol in the brain of a baby who is left to cry. It's not that I lose confidence in what I'm doing when I listen to such remarks, but I very quickly feel that I am an unwelcome, "other" kind of person ("other" being a word I had previously associated only with being transgender in a cisgender world.)

A few years ago, I would never have guessed that my family's strongest, most supportive parenting community would include people who are aligned with religions that have deeply conservative threads. The milksharing community is incredibly diverse in terms of ethnicity, family structure, sexual orientation, financial status, religion, and language – it is expanding rapidly all over the world.

When one parent goes to the trouble to express and store her milk, and she posts on a social network to find someone to give it to so it won't go to waste, we know that she values human milk. When another parent responds to her post and drives across the city to pick up that milk rather than buying a can of formula from the corner store, we know that he or she prioritizes normal infant nutrition. Donors and recipients meet on the common ground of good health. It is that simple.

Biomedical Ethics and Peer-to-Peer Milksharing

Dr. Karleen Gribble, adjunct research fellow in the School of Nursing and Midwifery at the University of Western Sydney, has generously allowed us to adapt her PowerPoint Presentation to a blog post as part of World Milksharing Week's blog carnival. This post outlines Dr. Gribble's application of six ethical principles to health worker / patient interactions in the area of peer-to-peer milksharing. Rather than investigating the merits of milksharing itself, this piece looks at the obligations of health workers and parents to discuss the practice. Keep an eye out for Dr. Gribble's upcoming article on this topic in Clinical Lactation.

Many thanks to Jodine Chase, blogger at Human Milk News, for hosting Dr. Gribble's post in the carnival.

A large ziplock bag of filled breast milk storage bags.
Photo: Bart Everson
Health authorities in Canada, the US and France have publicly warned parents not to feed their babies peer-shared milk. Many health workers are unsure about how to respond to mothers who are considering being involved in peer-to-peer sharing of milk.Applying the principles of biomedical ethics to the problem may assist in guiding action.

Biomedical ethics can be used to explore actual or anticipated dilemmas in medicine and find reasoned, consistent, and defensible solutions to moral problems.

Principle 1: Autonomy- individuals should be supported to make health care decisions free from deceit, duress, constraint and coercion.

Health Workers are obliged to provide individuals with the information they need to make informed decisions. Limiting of information for the “good of the patient” is paternalistic and interferes with autonomy. Information should only be withheld in very limited circumstances: if the health worker believes that the sharing of information might seriously harm the physical or mental health of the individual or if the individual states that they do not want the information.

Principle 2: Veracity- patients and health workers must be honest with each other.

When parents seek information about alternatives to a mother’s own milk, health workers must discuss all alternatives including infant formula, banked donor milk, peer-to-peer shared milk and wet nursing in an unbiased and non-judgmental way.

Parents must discuss consideration or actual involvement in milk sharing with their health workers.

Policies that prohibit discussing the option of peer-shared milk with mothers could be considered as breaching the ethical principles of autonomy and veracity. They are also dangerous.

Principle 3: Beneficence- minimization of harm and risk and promotion of good outcomes.

The interpretation of “good outcome” depends upon the specifics of a situation and the beliefs and values of the individual. Individuals seeking health care are those who define “good outcome.”

In peer-to-peer milk sharing, beneficence might involve health workers providing information or directing the patient toward information on the correct way of storing and dispensing expressed breast milk or on flash heating or on medications and milk. It might also involve facilitating the sharing of medical records between milk donor and recipient.

Principle 4: Nonmaleficence- active avoidance of harm to the patient.

A health worker who dismisses, mocks, berates or derides an individual seeking advice or information about milk sharing and so humiliates or belittles them could be considered as having breached the principle of nonmaleficence.

A health professional who withdraws care from a mother or child because they wish to be involved in the peer-sharing of milk and does not ensure that appropriate alternate care is available could be considered as having breached the principles of nonmaleficence and the principle of autonomy.

Principle 5: Confidentiality- health providers must not reveal private information without consent.

While sharing of medical records may assist in reducing the risks of peer-sharing of milk, donor records cannot be shared with a potential recipient without the consent of the donor.

Principle 6: Justice- individuals must be treated fairly.

Aspects of justice to consider in the distribution of resources include: distribution equally, or according to need, effort, contribution, merit or notwithstanding ability to pay.

The application of Justice to milk sharing has proven contentious in North America where donor milk banks are experiencing shortages of milk.

Milk banks distribute according to need but payment is required.

Peer-to-peer donors distribute for free and to those who do not qualify for banked milk.

Both groups are applying justice but neither application is unproblematic. Such conflict is not uncommon in biomedical ethics and indicates that further discussion between the players involved is necessary.

Health workers cannot ignore, dismiss, discount or demonize peer-sharing without acting unethically. What then should they do?

• Educate themselves about the various options for infant feeding including the benefits, risks and costs of each option and the ways in which the risks and costs might be managed, reduced or eliminated

• Be open and honest with mothers about each option and refrain from using pejorative terminology in relation to any option

• When speaking to the media ensure that information is provided in such a way that it cannot be used to portray breastmilk as inherently dirty and dangerous and that the risks associated with other alternatives to mothers' own milk are considered.

26 Sept 2012

Getting Through Thrush With a Milk Donor's Help

I love this story by blogger Michelle Bowman. Her up-front and entertaining piece highlights a common nursing problem and shows us how the gift of donor milk enabled her to overcome it and breastfeed successfully. Like many recipients, Michelle didn't need all that much milk in order to get her own supply back on track. However, the relatively small donations made an enormous difference to her nursing relationship with her baby.

Mom and baby sharing a happy moment next to a flowering bush.
Sharing a happy moment after getting through very difficult times.
A month or so after I returned to work, my daughter and I got thrush. It's one of those chicken/egg deals. Who knows where it started, all I know is we had it.

It was so painful, I cried nursing, I cried pumping. My nipples were raw, red and even fabric hurt against my skin. And thus began the decline of the milk factory. Slowly, we were burning through my precious milk stash. My once ample supply, enough to feed multiple babies, dwindled down lower and lower. The pain I was having was preventing let downs while pumping, so I was no longer producing what I needed to produce for bottles during the day when I was at work. My in-laws were great, but they tended to be a bit liberal with the milk, always having a bottle on hand. Even if it was 4 in the afternoon, they preferred the security of a bottle in case Little Miss A started fussing. And since you shouldn't re-refrigerate a warmed bottle, we wasted quite a bit of milk in November and December.

Once Little Miss A started attending daycare in January, I was frantic for ideas. Hubby was about to leave to train for his promotion, and stress set in. If there's two things you should know about stress, it can affect your milk supply and affect your sleep patterns. I wasn't sleeping well, Little Miss A was still waking up multiple times a night and my milk supply suffered. Some days, I could pump 10-15oz when I was working. But most days days, I only pumped 3 or 4 oz total on my lunch hour. This was with galactalogues and extra pumping sessions.

I started testing formulas midway through January. I would make a bottle, she would either refuse, spit up, or take it. The ones she took, she ended up having such bad diaper rash that I would have to bust out the big chemicals. We tried four different formulas before I felt desperate. We tried three soy formulas. Little Miss A was NOT having it. She did not want a bottle, and she did not want it if it was not mommy's milk.
I started researching milk banks, figuring I could swing the purchase of milk through my flexible spending account. As long as I could get a physician's prescription, flexible spending would cover the majority of the cost. However, milk from a milk bank can cost around$4.50 per ounce, which could be anywhere between $300-$1200 per month depending on how much I needed to supplement. At that rate, I'd burn through our flexible spending in just a few months. Not only did the cost stop me, but milk from the milk banks are reserved for sick babies, usually preemies in the NICU. I was certain there would be a long waiting list for healthy babies to get milk. So, I was at an impasse. I wondered daily if I should wean entirely or if I should force formula supplement at daycare- I just did not know what to do. Now that I am thinking back, I cannot remember who told me about informal milk sharing, but I began connecting with other moms via Human Milk for Human Babies (HM4HB) and Eats on Feets.

I thought to myself: "If she can't get only mommy's milk, shouldn't it be milk from somebody's mommy?"

I met with a few women, one of whom is a nurse for one of the hospitals I work at, and is friends with some of my friends. You know, that whole small world thing? Totally felt that when talking with her. She has two children, a little one month old guy she was nursing and said she had over 100 oz to share. I felt safe feeding my child her milk- because she fed it to her daughter.

On Valentine's Day, I received our first milk donation. I finally could breathe again- I wasn't going to run out of milk for my daughter. This angel provided my daughter with over 150 oz milk. It was the BEST gift I received this year- nourishment for my daughter and with that, peace of mind. Over the next few months, we received a few more donations to fill in the gaps of what I was unable to produce. Now when I had a bad day with pumping, I didn't cry every time I pulled a bag of milk from the freezer. With the help of our "donor mom", as I affectionately call her, we made it to a year with breastfeeding. When I left my job in June, I still needed a little mama's milk for supplementation, but I have been able to rebuild my supply since and Little Miss A has been able to get all my milk again!

25 Sept 2012

A Story of Peace and Healing

Breastfeeding using a Lact-Aid supplementer

This touching, personal milksharing journey was submitted by Diana Cassar-Uhl, IBCLC and blogger at Normal, Like Breathing

If you’ve visited my blog before, you know that I believe in human milk for human babies, and I have a deep understanding and empathy for those mothers who can’t or choose not to breastfeed their babies, for whatever reason.  This week, World Milksharing Week, offers a perfect opportunity to highlight a beautiful story of love and healing, of generosity and peace that have been made possible by the gifts of milk donors.

First, be sure to check out this comprehensive report about mother-to-mother milksharing, by Amber McCann, IBCLC, and, from the International Breastfeeding Journal, Milk sharing: from private practice to public pursuit.

Stephanie was heartbroken after her first baby, Isaiah, was born and she realized she couldn’t make enough milk to meet his nutritional needs and sustain his growth.  A condition called mammary hypoplasia/insufficient glandular tissue (IGT) made it so that she could only produce about 4 ounces of milk each day; she had to supplement Isaiah’s intake with something other than her own milk, and at the time, commercially-prepared baby milk (formula) was, as far as she knew, her only option.  “I knew there was such a thing as donor breastmilk, but I thought it was only for sick babies,” Stephanie explains.  “We supplemented with just about every formula under the sun,” Stephanie recalls.  Isaiah had an undiagnosed cow’s milk protein intolerance; watching him suffer, and knowing the cow’s milk-based formula was likely to blame was very difficult.  Stephanie felt as if her body had failed her baby, and every day, every supplemental feeding, the pain of this feeling was new.  “When I was pregnant again, I heard about mother-to-mother milk sharing on the IGT support page on Facebook and immediately knew this was what I wanted to do.”
Stephanie's long hair flows around her shoulder's as she breastfeeds.
Stephanie breastfeeding baby Elliot

Several dozen packages of frozen breast milk laid out.
The gift of donated milk fills more than the freezer, it fills the hearts of both the donor and recipient families.

During her pregnancy, Stephanie began visiting and posting her story to various mother-to-mother milksharing websites, such as Eats on Feets, Human Milk 4 Human Babies, and MilkShare.  She met profound empathy, generosity, and support in these online communities, and, over time, received donated milk from more than 10 mothers in 5 states – over 4000 ounces total.  Her first connection, however, was to a mother named Shelly.

Shelly lives an hour away from Stephanie, in southern Maine.  The first time she traveled to pick up the milk Shelly was donating to her and her baby, Elliot, Stephanie had to ask friends to loan her coolers – six of them – so they’d be able to keep all of the milk cold on the trip home.  “I couldn’t believe it!  Our 7 cubic-foot freezer was nearly full after that first donation!”  In her two trips to Shelly’s house, Stephanie acquired over 3000 ounces of milk.

The milk wasn’t all Shelly shared, however, and it wasn’t the only thing Stephanie and Elliot gained.  The two families became friendly, the dads enjoying each other’s company while the moms gathered Shelly’s milk and supervised their little ones, who, at the last pick-up, were delighted by an impromptu play-date.  “The connection was immediate, we clicked,” Stephanie says.  “It felt right.  The thought that a mother — and her child — would care so much as to aid us in our goals is truly heartwarming. The generosity that she has bestowed upon us leaves me in tears every time I think about it. We could never be grateful enough for the hearts of these mothers.”
Portrait of the donor and recipient families together.
Shelly with her children, left, with Stephanie and Elliot, right, at the last milk pick-up
For Stephanie, the ability to nourish Elliot on human milk alone meant a great deal to her, especially after her experience of watching Isaiah struggle with a substitute.  “No greater joy could I have than to know that, despite my severely low milk supply, my child is still able to exclusively receive the benefits of human milk. The healing that I have found with donor milk is more than I can put into words. The peace that Shelly, and all of the other wonderful donors, have given me is more than I could have ever imagined.”  Stephanie goes on to say that being able to fill an at-breast supplementer with “liquid love” (donor milk) and breastfeed Elliot, just like women without IGT do, has been life-changing for her.  “The healing I have found with this is incredible. IGT isn’t easy. There’s nothing easy about it. But what a blessing to have a nursing relationship in the first place, no matter how little I make! This has brought me so much peace.”  While her baby, now 16 months old, has weaned since about a month ago, Shelly continues to pump milk for Elliot, who is 7 months old now.  She shares in Stephanie’s desire to provide human milk through Elliot’s first year, and feels the joy of the impact she is making in Elliot’s life.
Even after that year goes by, Stephanie knows that Shelly and the other mothers who have assisted with her breastfeeding journey will hold a permanent place in her family’s heart.  She hopes her friendship with Shelly will be enduring as their children grow up and breastfeeding becomes a memory for both families.  Stephanie says “I will forever be indebted to Shelly and the other mothers who have donated their milk, time, and love.  Their giving hearts have changed my life. Shelly has helped us defy all odds. She is amazing and I am blessed having her in my life. I will never take for granted all that she has done for us. Calling her a milk donor will never be honorable enough … these moms are superheroes.”

If you have milk to donate, you have options.  Milk banks in the United States are always eager to accept milk donations, but certain requirements, such as the age of your baby, must be met.  Read more about donating to an HMBANA milk bank. 

If you’d like to share your milk with a mother and baby in need and you don’t meet the requirements for donation to a milk bank, or you would prefer a mother-to-mother arrangement, visit any of the milksharing websites that were linked above.  Be sure to adequately inform yourself and examine the risks and the benefits of feeding your baby donated human milk, and determine whether the benefits outweigh the risks for your situation and your baby. 

24 Sept 2012

Milksharing and La Leche League

In this post, Laura Spitzfaden, IBCLC and Leader with the breastfeeding support organization La Leche League, tackles LLL's stance on milksharing. I love that she also addresses an important yet rarely discussed risk of milksharing. An incredibly thought-provoking read!

I was inspired to write about milk-sharing when I read this article by Amber McCann, IBCLC.

Like Amber, I am an International Board Certified Lactation Consultant. I am also a La Leche League Leader. La Leche League’s position on milk-sharing discourages leaders from providing moms with information about informal milk-sharing unless the mother specifically requests such information. If mothers ask a LLL Leader how to obtain human milk supplements for their babies, they must be directed to milk banks, even though the cost of purchasing human milk from a milk bank is prohibitive. In most cases, there is not enough milk available for the ill or preterm babies who need it, let alone any excess available for purchase for healthy babies. This is simply not a viable option for most families.

Avoiding the topic of informal milk-sharing does not take into account the changing social environment of the moms we serve. Through social media and the internet, mothers are more informed than ever about the risks of artificial feeding and about what their babies are missing if they do not breastfeed. Over the last few years, I have observed that informal milk-sharing has rapidly become commonplace. I am witness to many instances of mothers offering their milk to other mothers who need or want supplemental milk. Mothers are sharing their milk whether or not any organization believes it is safe.

While there are risks involved with informally sharing breastmilk due to the potential to spread illness or to expose infants to drugs or chemicals, those risks can be mitigated. It seems disingenuous to be concerned about contamination of breastmilk, when it is well documented that artificial feeding carries significant risks for babies and that formula is often found to be contaminated with chemicals and pathogens.

One risk of informal milk-sharing that I have not seen addressed is that accepting donations of milk from another mother, may put a mother’s own milk supply at risk. Often a mother believes she does not have enough milk or that there is something inadequate about her milk and believes she needs to supplement. If it is simple to get milk from another mother, and she doesn’t have access to information about all the risks and benefits of supplementation, she may not explore the reasons for her own supply issues or discover there is no problem with her milk supply. She may supplement unecessarily and unintentionally reduce the amount of her own milk that is available to her baby. If providing information about informal milk-sharing is discouraged, and focus is placed on the risk of possible contamination, the more significant risk to a mother’s milk supply is potentially overlooked.

Research into mother and infant sleep practices by Kathleen Kendall-Tackett, P.h.D., IBCLC, RLC, has shown that dictating to mothers what they should and shouldn’t do, doesn’t work. Telling mothers that they shouldn’t sleep with their babies in adult beds, only results in mothers falling asleep with their babies in even less safe environments, or ignoring the advice while being deprived of the information needed to make bed-sharing safer. Just as many breastfeeding advocates support mothers in bed-sharing with their babies, due to the belief that bed-sharing benefits breastfeeding, and its practice can be made safer, we can also support human milk sharing by providing moms with the information they need to make informal milk-sharing safer. I believe it is time for child health advocates to stop telling moms what to do and instead, provide all the information that moms need in order to make their own informed choices about milk-sharing.

While it is not possible to make any infant feeding option risk-free, mothers can be provided with the information they need to evaluate and minimize the risks and make their own informed decisions. The World Health Organization offers a heirarchy for infant feeding if a baby cannot be breastfed by his or her mother, “..expressed breast milk from an infant’s own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breastmilk substitute…” in that order. It is up to infant health advocates to help mothers to be informed of the risks and benefits of each option, so they may choose for their own babies.

Laura Spitzfaden, LLLL, IBCLC

In March 2011, the LLLI Board of Directors adopted the following policy regarding the donation of human milk: http://www.llli.org/release/milksharing.html

Mother-Infant Sleep Locations and Nighttime Feeding: U.S. Data from the Survey of Mothers’ Sleep and Fatigue-Kathleen Kendall-Tackett Ph.D., IBCLC, RLC et.al.

21 Sept 2012

Supporting Families in Milksharing as an International Board Certified Lactation Consultant

This year's World Milksharing Week Blog Carnival includes posts by a wide variety of individuals, including donors, recipients, activists, academics, authors, and health professionals. I am thrilled to present this piece by Amber McCann, blogger and International Board Certified Lactation Consultant, about why she, as a health care provider, supports milksharing. She explains what people like her can do to help their clients make informed choices in milksharing, an area that many shy away from.

As an International Board Certified Lactation Consultant, I have, first and foremost, an ethical obligation to provide evidence-based information to my clients to support their breastfeeding relationship. Every day, for a variety of reasons, I encounter and encourage families who need to supplement their baby’s nutrition with something other than milk directly from the mother’s breast. Today, they have many options: pump and feed their own milk, supplement with some sort of donor milk, milk-based formulas, soy-based formulas, pre-digested formulas . . . lots of options, lots of questions, lots of opportunities for parents to be confused.

I believe that parents are capable of making the choices that are best for themselves and their families.
It is my job to make sure they have all the information to do so.

The World Health Organization, in its Global Strategy for Infant and Young Child Feeding, says,

“for those few health situations where infants cannot, or should not, be breastfed, the choice of the best alternative – expressed breast milk from an infant’s own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breastmilk substitute…depends on individual circumstance.”

Since this is coming from a global authority on health, I feel pretty darn confident using this hierarchy while supporting my clients in their supplementation decisions.

Most Ideal Option – Expressed breastmilk from the infant’s own mother.
Next Most Ideal Option – Breast milk from a healthy wet-nurse…SCCRREEEEECH!!!!

(do you see the virtual brakes going on???)

Wet nurse? Really? In this day and age? With HIV, hepatitis, and any number of undesirable diseases that can be passed through bodily fluids? What would wet-nursing even look like in today’s society? The first reaction of many is to simply pass off the idea as old fashioned, ancient, and outdated, not to mention dangerous. And in the United States, where I live, it is generally understood that if a mother’s own milk isn’t an option, formula is the obvious default. Why even bother?

Because we, as humans, are designed to consume human milk.

In our current environment, actual wet-nursing (a woman feeding another’s baby directly at her breast) is deemed by many to be inconvenient, too intimate, and—if you will—too gross. But what about the sharing of breast milk from one mother to another? Since most mothers have access to a breast pump, it has become increasingly easy to package milk in a shareable form. And with the formation of groups such as Human Milk 4 Human Babies (HM4HB) that provide a space for families in need to connect with families who want to give, doesn’t it make sense that we would at least explore the option? Can feeding a child the milk from a mother not his own be a viable solution to our supplementation needs? Is it an option that I, as an IBCLC, am willing to share with the families in my care? I answer with a strong and firm YES.

When I first became aware of milk sharing, it was a “secretive” practice, one not discussed openly and one that many organizations (breastfeeding supportive and not) chose to distance themselves from. When an article appeared on TIME.com in November of 2010 about the rise of the use of social media to facilitate milk sharing, I was quick to say “What can I do to help?” because the goal seemed obvious to me: get human milk into human babies.

What I wasn’t prepared for was the strong backlash from my own professional community saying, “But what if a baby gets sick or even dies?” Quite a number of IBCLCs I know were involved in milk sharing arrangements in their own breastfeeding years and some continue to be “closeted” about their own experiences. I attended the FDA meeting in December of that year discussing the regulations in regards to donor milk and while informal sharing wasn’t formally on the agenda, it certainly was on everyone’s lips in the room. There was palpable fear that one bad outcome from milk sharing would halt all the positive momentum that breastfeeding was gaining in our culture. One expert even spat out, “These women…these women who are doing this are going to hurt or even kill their babies.” I maintain that they are simply trying to feed them the food they were designed to eat.

But, what about the RISKS, with a capital R? Wouldn’t I be putting the health and lives of the babies I serve at risk if I offer milk sharing as an option? There is nothing in life that is without risk. Is milk sharing risk-free? Absolutely not. There are also risks to breastfeeding and formula feeding. Dr. Karleen Gribble and Dr. Bernice Hausman discuss these concerns in their paper Milk Sharing and Formula Feeding: Infant Feeding Risks in Comparative Perspective. In it, they discuss the issues of contamination of milk with pathogens, chemicals, concerns with milk collection and storage hygiene. The also discuss the risks to formula use that are not present when feeding human milk. In addition, there is a section devoted to the risk of HIV from the use of shared milk. I strongly advise every breastfeeding professional as well as any mother I am working with to read this paper and discuss their concerns. Drs. Gribble and Hausman conclude that “instead of proscribing peer-to-peer milk sharing, health authorities should provide parents with guidance on how to manage and minimize the risks of sharing human milk.”

How do IBCLCs instruct and inform clients about the risks and benefits of consuming or donating shared milk?

How do we advise our clients to mitigate those risks?

Mom nursing with a supplementer
Photo via World Milksharing Week on Flickr

For recipients: When one of my clients is in need of milk and is considering milk sharing, I strongly encourage them to think about whether people they already know might be willing to donate. They also might explore location-based online milk sharing groups (like HM4HB), and then groups that facilitate broader-range sharing and the shipping of donor breast milk (like MilkShare). I do not condone the sale and purchase of breastmilk and I strongly encourage my clients to not consider it as an option.

No matter where the milk is coming from, I encourage my clients to thoroughly research what sorts of screening they consider essential (such as blood work from pregnancy and questionnaires about lifestyle choices such as alcohol and medication use). It is important that both parties have clear expectations about what their milk sharing arrangement looks like. At no point do I, as an IBCLC, engage with the recipient family as a “milk broker.” The family is fully responsible for finding, contacting and making arrangements with their milk donors. As an IBCLC, my role with milk recipients is only to provide information and resources.

Of note, it is always my hope that supplementation of any type can be eliminated or minimized because of an increase in a mother’s own ability to make milk. The milk sharing community is often particularly in tune with the need and desire of mothers to work hard to rebuild their milk supply. Some families get a donor and a cheerleader-in-one! Many mothers feed donor milk through the use of a supplemental feeder, which can help mothers to produce increasing amounts of their own milk by stimulating the breast while delivering the supplement. There are many stories of those who were in need of donor milk, were able to rebuild their supply and then donate milk back into the community.

Baby sitting on the floor surrounded by bags of donor milk
Photo via World Milksharing Week on Flickr
For donors: I often have mothers, in their glee at how much milk their body is providing, send me an email saying they “had so much we had to dump it down the sink.” Nothing strikes panic into the heart of an IBCLC faster! If a mother tells me, as her lactation consultant, that she has more milk than she knows what to do with, I offer her information about donation. I share with her the options of contributing to a HMBANA milk bank, donating directly to another family or sharing her milk with a for-profit milk bank. (Though I have significant ethical concerns about these banks, I do share the information with my clients so that they can make the best decision for their family.)

I stress to the family that the milk they have is first and foremost for their own baby. I know that many families feel incredibly proud and thankful to be able to share of their excess. I encourage families to participate openly and honestly in all screening with their recipient family and to make sure that both parties have clear expectations about what their milk sharing arrangement looks like. At no point do I, as an IBCLC, engage with the donor family as a “milk broker.” They are fully responsible for finding, contacting and making arrangements with their milk recipients. As an IBCLC, my role with milk donors is only to provide information and resources.

An obvious question in all of this is why wouldn’t a mother in need of additional milk for her child simply obtain it from a milk bank? Then we wouldn’t be talking about risks of disease and contamination. In an ideal world, families would be able to receive ALL the milk they need from milk banks. Milk banks would be located in every community and have an unending supply of milk. I believe this can be a reality. I believe that there can be plenty of milk available to every baby that needs it. As a passionate advocate for getting human milk to human babies, Emma Kwasnica says, “milk is a free flowing resource.”

Unfortunately, in the United States, this isn’t yet the reality. As a nation, we need to drastically increase the number of milk banks and the amount of human donor milk available. The Human Milk Banking Association of North America (HMBANA) currently has 12 active banks. These banks do incredible work and, rightly so, their priority is on making sure that the MOST CRITICAL babies receive the milk that they process. For these little ones, having access to human milk can be, quite literally, a matter of life and death. Even this week, several milk banks, including those in Indiana and Utah, have issued pleas in the media for increased donations because their supplies are low. It is absolutely essential that these babies be the first to have access to processed donor milk.

Does every baby need its milk processed by a milk bank focused on the needs of vulnerable infants? For the most fragile babies, the complex processes of a milk bank (milk pooling, pasteurizing, and testing) are critical. The needs of a healthy term newborn are different. I liken it to this: If you had a dear friend who had recently received an organ transplant, you would do everything within your power to visit with them in a healthy manner by scrubbing arms and hands and wearing a mask. But, if that same friend has just gone through a “healthy” event, like birth, you would simply wash your hands. Different circumstances require different levels of caution.

Where does that leave healthy babies? In my practice, I see many mothers who, for of a variety of physical, emotional or circumstantial reasons don’t make the milk that their baby needs. At some milk banks, families of healthy babies can sometimes purchase donor milk but it is typically in limited quantities, and only available when supplies exist to meet the need of critical infants first. While the cost associated is reasonable, considering the cost of processing by the milk bank, it is often prohibitive to the families in need.

Is the only option for these families infant formula? I have every confidence that the human milk banking advocates all over the globe would affirm the belief that all babies have the right to human milk. I think that milk banking and milk sharing CURRENTLY serve very different populations of babies. Above all, my loyalties are not to milk banks or the milk sharing movement, but rather to babies and their families. There is room in the community for both methods of getting human milk to human babies.

Breastfeeding support that believes in you! Supporting families in milk sharing as an IBCLC. Nourishbreastfeeding.com 
I have been privileged to work with a number of families who were involved in milk sharing, both on the donor side and on the recipient side. I have seen milk donations have a significant impact on the health of a child. I have seen milk donations foster community that might not have happened otherwise. I have seen milk donations turn grief into hope. I have seen milk donations empower families and save babies’ lives.*

Milk sharing is not the right choice for every mother in need. Milk sharing is not the right choice for every mother who desires to donate her milk. But for many families, milk sharing facilitates health, community building, and an opportunity to reclaim the breastfeeding experience for those whose journey didn’t go as they planned.

Again, I affirm that parents are capable of making the choice that is best for their families.

It is my job to make sure they have all of the information to do so.

*A nod to Ursuline Singleton for her statement at the 2012 ILCA Conference that “IBCLCs empower mothers and save babies’ lives.” Thank you, Ms. Singleton, for so clearly helping to define what is essential to my profession.