I've been thinking about this post for ages and was finally inspired to sit down and write it when someone asked me for advice on the matter. So, thank you for the question!
On demand, supplemented nursing sessions with a newborn or young baby seemed obvious enough. When Jacob was hungry, we fed him. When he wanted more, we gave him more. I almost always used supplement during our nursing sessions.
When we introduced solid foods, we assumed that food would take the place of some of the donated breast milk we were continually struggling to find. To our surprise and dismay, it didn't seem to work that way. Jacob took a long time to really get good at eating solids, and even once he did, he never seemed to want any less milk. I sometimes tried to nurse him without using supplement, but he strongly preferred the fast flow that he was used to. Some people suggested not using supplement at night, yet I found that if I didn't he would get increasingly frustrated until he was wide awake. If I used the supplement, I could get him back down to sleep much more easily in the middle of the night (not that it has ever been easy, per se...).
I casually asked friends what they thought I should do, and several pointed out that if a parent with normal milk making capacity nurses frequently, he or she will continue to produce plenty of milk even as the child gets older. In contrast, a La Leche League Leader explained that as the baby gets older, the parent's milk supply naturally decreases. Others noted that babies who were bottlefed typically still get, even as toddlers, a large bottle of milk before going to bed and another one for nap time.
Around the time I was trying to figure out how to proceed, I saw a post in my parenting group from a mom of a 14 month old baby. She was newly pregnant, and her milk supply had disappeared. Her 14 month old still badly wanted to nurse, but this was painful for the mom. They went through a challenging weaning process and the mom started giving bottles of donated breast milk. Her child needed both the milk and the nursing relationship, but it was not possible for her to give. They did the best they could under the circumstances.
I know of another parent who, like myself, is breastfeeding after having had chest surgery. She makes enough milk to have the occasional let-down, but does not have a full supply. Her toddler is two and a half years old and nurses a lot AND gets a significant amount of milk in bottles. Early on, they used a supplementer, but they eventually got to a point where the child no longer wanted it. Their nursing relationship is still very strong.
In another example, the parent of a friend of mine used a supplementer due to her diagnosis of insufficient glandular tissue (IGT), and continued nursing until her child was three. As a toddler, the child would ask for "big milk" when she wanted to nurse using the supplementer, and "little milk" when she wanted to bare nurse. Given the variety of stories I'd heard, I decided to just keep doing what we were doing, since it seemed to work okay for both of us. We switched to putting cow's milk in the supplementer when we could no longer get donated human milk, with no apparent ill effects.
The issue came up again last fall when Diana West came to Winnipeg for a conference. She is the author of Defining Your Own Success: Breastfeeding After Reduction Surgery, and, of course, she is an expert on at-breast supplementation. She stayed with us for a few nights, and was shocked to see just how much supplement we prepared to take to bed with us in the evenings. I felt so busted! If I remember correctly, the much-admired breastfeeding authority said that Jacob doesn't need much milk at this point – it is the nursing relationship that he wants and needs. She reminded me that he was getting some milk from me. She also enthused about how much easier my life would become if I no longer needed to carry supplement around on outings or take it with me to bed at night.
I tried harder this time to wean ourselves from our crutch, but with the same result as before. If I didn't use the supplement, Jacob would quickly get frustrated. The universal and incredibly irritating toddler habit of nipple twiddling got infinitely worse (not surprisingly, this is something babies do to try to get a let-down!), and I again couldn't get him back to sleep at night. To add to the troubles, nursing without much coming out was quite uncomfortable for me, too. Jacob will be two in April, and this is where things stand: we still use lots of supplement at night, during naps, and to re-connect at other points during the day. Sometimes we go on outings without it and I nurse him as needed, but often I take it along for back-up, and then don't end up using it.
As Jacob's vocabulary increases, he is beginning to express how he would like to nurse. He says "nay-nay" for nursing, but also "milk" when he wants to use the supplementer. Sometimes he pleads with me "up!" and "fridge!", until I get up and grab the supplement from the fridge. Other times I ask him if he wants me to get the extra milk and he shakes his head "no" while he is latched on. Ultimately, Diana and everyone else said that we have to do what works for us, and I couldn't agree more. We'll let you know as we go.
Breastfeeding and parenting from a transgender perspective.
Showing posts with label donated breast milk. Show all posts
Showing posts with label donated breast milk. Show all posts
11 Feb 2013
29 Sept 2012
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.
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| Milk siblings forever. |
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 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
Many thanks to Peaceful Parenting for hosting Lisa's piece in World Milksharing Week's Blog Carnival.
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.
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.
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.
Many thanks to Jodine Chase, blogger at Human Milk News, for hosting Dr. Gribble's post in the carnival.
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| Photo: Bart Everson |
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.
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!
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| Sharing a happy moment after getting through very difficult times. |
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!
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.
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.
17 Sept 2012
"I wish I'd Known About Milksharing When..."
In this post Dinnae Galloway, blogger from Complete Wellness Concept, touches on some of the many reasons people choose to give or receive donated milk.
I’ve heard time and time again from many many parents: “I wish I’d known about milksharing when – *insert specific situation here.*”
…. my baby was little – she couldn’t handle formula and was constantly sick until we got her on solids.
…. I was lactating – I had so much oversupply it was CRAZY!
…. I was pumping at work – my son wouldn’t take expressed milk, hated bottles, so ALL of my expressed milk got dumped down the drain!
…. my niece was little – she had eczema really bad, and my sister suspected it was the formula, but she had no other options!
…. my son was born – my wife got sick, and lost her supply, and we were unable to follow through with our plan to breastfeed him.
REALLY, these are things I hear and read ALL. THE. TIME. And multiple different variations of them all too.
World Milksharing Week was created to celebrate peer-to-peer milksharing, this grassroots movement of parents being empowered to make *informed decisions* about their infant feeding options. But not only do we want to celebrate, we also want to help educate – by getting the word out there about milksharing, people will get the info they need, and will understand that there ARE options for them!
What do YOU wish you had known before getting into this journey we call parenting?
…. my baby was little – she couldn’t handle formula and was constantly sick until we got her on solids.
…. I was lactating – I had so much oversupply it was CRAZY!
…. I was pumping at work – my son wouldn’t take expressed milk, hated bottles, so ALL of my expressed milk got dumped down the drain!
…. my niece was little – she had eczema really bad, and my sister suspected it was the formula, but she had no other options!
…. my son was born – my wife got sick, and lost her supply, and we were unable to follow through with our plan to breastfeed him.
REALLY, these are things I hear and read ALL. THE. TIME. And multiple different variations of them all too.
World Milksharing Week was created to celebrate peer-to-peer milksharing, this grassroots movement of parents being empowered to make *informed decisions* about their infant feeding options. But not only do we want to celebrate, we also want to help educate – by getting the word out there about milksharing, people will get the info they need, and will understand that there ARE options for them!
What do YOU wish you had known before getting into this journey we call parenting?
10 Jun 2012
Petition to Ease Restrictions on Breast Milk in Carry-On Baggage
Last week we packed up yet again and got ready to make our trip out west to visit our relatives. We don't have any family in Winnipeg, but we believe it is very important for our child to have a strong relationship with his grandparents. So, as much as I hate it, we fly frequently.
We took along several bottles of donated breast milk in a cooler, as well as an ice pack. At security, they asked to open up our cooler as usual. All seemed normal. And then came the question, "But how old is your baby?"
"He's thirteen months."
"Oh, ok. This is fine. Go ahead."
The exchange seemed simple enough, but suddenly left me wondering, is there an age at which I won't be able to bring milk along for my baby? Is thirteen months ok, but say, eighteen months too old? Why did they ask my baby's age?
We rely upon donated breast milk to feed our baby. I nurse him using an at-breast supplementation system, and am able to enjoy a satisfying breastfeeding relationship as a result. I would like to keep breastfeeding my child as long as he needs it. Since the World Health Organization recommends breastfeeding for two years AND BEYOND, I am and will continue to be grateful for human milk donations. If and when we are no longer able to find donated human milk, we will probably move to using whole goat's milk in the supplementation system. Goat's milk is closer to human milk than cow's milk is, but it is probably not commonly available beyond airport security.
During our stay in Vancouver, I looked up the rules. In Canada, you may only bring extra liquid aboard a flight for a child UNDER the age of 2. So, I decided to start a petition on change.org. Please sign it and share widely!
http://www.change.org/petitions/canadian-air-transport-security-authority-ease-restrictions-on-breast-milk-in-carry-on-baggage#
"Canadian parents using expressed breast milk currently face greater restrictions when flying with their children than do their American counterparts. Only passengers traveling with infants UNDER the age of 24 months may bring aboard more than 100ml of liquid per container, inside a 1 litre plastic bag. Women traveling without their babies are not permitted to bring their expressed milk on board. Those traveling with children above age two are not exempt from restrictions on liquids.
"The World Health Organization recommends breastfeeding until age 2 AND BEYOND. For those parents who must express their milk and bottlefeed, or who use donated milk and an at-breast supplemental nursing system, carrying liquid on their persons is a must. Why should the Canadian Air Transport Security Authority decide at what age a child no longer needs breast milk, especially during potentially stressful travel?
"Passengers traveling without their babies should also be allowed to carry their precious breast milk rather than pump and dump. Breast milk, known in the birth world as "liquid gold" for its important health benefits, should be exempt from the usual restrictions on liquids.
"In the US, breast milk is treated as liquid medication and passengers may carry it on board in quantities greater than 3 ounces WITH OR WITHOUT A BABY OR TODDLER PRESENT. Sign this petition and tell the Canadian Air Transport Security Authority to start valuing breast milk as vitally important nutrition for babies and children!"
http://www.change.org/petitions/canadian-air-transport-security-authority-ease-restrictions-on-breast-milk-in-carry-on-baggage#
We took along several bottles of donated breast milk in a cooler, as well as an ice pack. At security, they asked to open up our cooler as usual. All seemed normal. And then came the question, "But how old is your baby?"
"He's thirteen months."
"Oh, ok. This is fine. Go ahead."
The exchange seemed simple enough, but suddenly left me wondering, is there an age at which I won't be able to bring milk along for my baby? Is thirteen months ok, but say, eighteen months too old? Why did they ask my baby's age?
We rely upon donated breast milk to feed our baby. I nurse him using an at-breast supplementation system, and am able to enjoy a satisfying breastfeeding relationship as a result. I would like to keep breastfeeding my child as long as he needs it. Since the World Health Organization recommends breastfeeding for two years AND BEYOND, I am and will continue to be grateful for human milk donations. If and when we are no longer able to find donated human milk, we will probably move to using whole goat's milk in the supplementation system. Goat's milk is closer to human milk than cow's milk is, but it is probably not commonly available beyond airport security.
During our stay in Vancouver, I looked up the rules. In Canada, you may only bring extra liquid aboard a flight for a child UNDER the age of 2. So, I decided to start a petition on change.org. Please sign it and share widely!
http://www.change.org/petitions/canadian-air-transport-security-authority-ease-restrictions-on-breast-milk-in-carry-on-baggage#
"Canadian parents using expressed breast milk currently face greater restrictions when flying with their children than do their American counterparts. Only passengers traveling with infants UNDER the age of 24 months may bring aboard more than 100ml of liquid per container, inside a 1 litre plastic bag. Women traveling without their babies are not permitted to bring their expressed milk on board. Those traveling with children above age two are not exempt from restrictions on liquids.
"The World Health Organization recommends breastfeeding until age 2 AND BEYOND. For those parents who must express their milk and bottlefeed, or who use donated milk and an at-breast supplemental nursing system, carrying liquid on their persons is a must. Why should the Canadian Air Transport Security Authority decide at what age a child no longer needs breast milk, especially during potentially stressful travel?
"Passengers traveling without their babies should also be allowed to carry their precious breast milk rather than pump and dump. Breast milk, known in the birth world as "liquid gold" for its important health benefits, should be exempt from the usual restrictions on liquids.
"In the US, breast milk is treated as liquid medication and passengers may carry it on board in quantities greater than 3 ounces WITH OR WITHOUT A BABY OR TODDLER PRESENT. Sign this petition and tell the Canadian Air Transport Security Authority to start valuing breast milk as vitally important nutrition for babies and children!"
http://www.change.org/petitions/canadian-air-transport-security-authority-ease-restrictions-on-breast-milk-in-carry-on-baggage#
22 May 2012
My Queer Conversation With a Ninety-Year-Old
A conversation I had today reminded me yet again that age is not necessarily a good predictor of open-mindedness and compassion.
First, a bit of background. I met Luanne, a ninety-year-old woman, through a friend. This summer I am planting and maintaining Luanne's large vegetable garden and flower beds along with another friend of mine, Ana.
Today it was just me and my little boy, Jacob, weeding at the garden. Luanne opened her back door to say hello. I chatted with her for a few minutes and we both enjoyed watching Jacob crawling on the lawn. And then came the question: "Who is the baby's mother? Is it Ana?"
"No, he's my baby. Ana is my friend."
'"But who is his mother?"
"Ummm, well, my partner... well, we're a gay couple." I blurted it out and then looked at her, waiting.
"Gaaaaaaay...?"
"Yes."
"You mean, your wife is a man?"
"Yessss..." Close enough.
"So where did you get the baby from?"
I'd really been hoping she'd stop at gay. I couldn't bring myself to lie to her either though. "That's a bit complicated." I hesitated.
"Oh, I hope you don't mind my asking. It's not too personal, is it?"
"I hope you don't mind hearing the answer." I paused and looked at her. She looked back inquisitively. Ok, fine. "I'm transgender. I was born female but I transitioned to male. Have you heard of that before Luanne?"
"Well, on TV, yes, I suppose so."
"Ok, so, I took testosterone to transition, and had a chest surgery. But when my partner and I got together we decided we'd really like to have a family. We thought about adopting, but realized it might take a very long time. So, I talked to my doctors about it and asked if it would be safe for me to carry a child [I always emphasize the doctor/safety part of the story, especially around potential skeptics], and they said to stop taking the testosterone and it should be fine. I got pregnant, and had the baby. He's our biological child."
"Oh, wow, I've never heard of such a thing."
"It's a bit unusual, isn't it?"
"Well, as long as you have a baby, that's what's important."
I left the breastfeeding and milk sharing discussion for another time... And then we went back to talking about the geraniums. She didn't want white ones after all because they apparently turn brown when they get rained on. Too bad Ana probably already bought them this morning, following yesterday's instructions.
If Luanne, at ninety, born in 1922, can get all this, and simply be happy that we have a baby (and that we've pulled out an awful lot of grass and dandelions the last few days), what is anybody else's excuse?
First, a bit of background. I met Luanne, a ninety-year-old woman, through a friend. This summer I am planting and maintaining Luanne's large vegetable garden and flower beds along with another friend of mine, Ana.
Today it was just me and my little boy, Jacob, weeding at the garden. Luanne opened her back door to say hello. I chatted with her for a few minutes and we both enjoyed watching Jacob crawling on the lawn. And then came the question: "Who is the baby's mother? Is it Ana?"
'"But who is his mother?"
"Ummm, well, my partner... well, we're a gay couple." I blurted it out and then looked at her, waiting.
"Gaaaaaaay...?"
"Yes."
"You mean, your wife is a man?"
"Yessss..." Close enough.
"So where did you get the baby from?"
I'd really been hoping she'd stop at gay. I couldn't bring myself to lie to her either though. "That's a bit complicated." I hesitated.
"Oh, I hope you don't mind my asking. It's not too personal, is it?"
"I hope you don't mind hearing the answer." I paused and looked at her. She looked back inquisitively. Ok, fine. "I'm transgender. I was born female but I transitioned to male. Have you heard of that before Luanne?"
"Well, on TV, yes, I suppose so."
"Ok, so, I took testosterone to transition, and had a chest surgery. But when my partner and I got together we decided we'd really like to have a family. We thought about adopting, but realized it might take a very long time. So, I talked to my doctors about it and asked if it would be safe for me to carry a child [I always emphasize the doctor/safety part of the story, especially around potential skeptics], and they said to stop taking the testosterone and it should be fine. I got pregnant, and had the baby. He's our biological child."
"Oh, wow, I've never heard of such a thing."
"It's a bit unusual, isn't it?"
"Well, as long as you have a baby, that's what's important."
I left the breastfeeding and milk sharing discussion for another time... And then we went back to talking about the geraniums. She didn't want white ones after all because they apparently turn brown when they get rained on. Too bad Ana probably already bought them this morning, following yesterday's instructions.
If Luanne, at ninety, born in 1922, can get all this, and simply be happy that we have a baby (and that we've pulled out an awful lot of grass and dandelions the last few days), what is anybody else's excuse?
30 Apr 2012
Shipping Bodily Fluids
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| Breast milk storage bags! |
When Jacob was a few weeks old, a generous mom in Thunder Bay sent us her freezer stash. After a night of "sleep" with our newborn Ian went early in the morning to meet the incoming bus. We thought we were receiving the Holy Grail - this batch of milk would keep Jacob exclusively breastfed for his first month of life. We breathed a huge sigh of relief when we opened the cooler and saw that the milk was still frozen solid.
Shipping breast milk is obviously a time-sensitive endeavor. It also depends upon the milk being well-packed in a sturdy cooler, especially in the summer. If the amount is over about 500 ounces, there is no need to use dry ice, but in any case breast milk should be packed tightly. Any remaining air space in the cooler should be taken up by newspaper, foam, or other material. We always try to pick up shipped milk as soon as it has made it into town, although that sometimes involves a bit of convincing (shall we say prodding, even?) and educating about the importance and benefits of human milk.
Last summer when we were visiting Calgary, we asked friends back home in Winnipeg to ship us additional milk because Jacob had jumped into a growth spurt, quickly eating his way through what we'd brought with us. We struggled to reach the bus company on the phone, and when we did we were given an incorrect shipping schedule. In short, we realized at 6:40pm that the milk had already arrived and that the depot closed at 7pm. There was no way we would make it to the depot in time, but we got a friend who was closer to try to collect the milk for us.
"I can only release this package to Ian. That is, unless you have written permission from him to pick it up." Apparently the tracking number and confirmation via phone would not do.
My friend blurted out, "But this is breast milk for a very sick baby. It will go bad if we leave it here overnight. We have to get it into a freezer."
Of course, Jacob was fine, but we certainly didn't want to be tossing out spoiled breast milk the next day and feeding him formula. The woman gave up the parcel, and back at my friend's place we unpacked the milk to find it on the verge of starting to thaw.
More recently, we've been receiving breast milk from a prolific, amazing donor in Saskatoon and sharing the goods with several other local families in need. The bus from Saskatoon gets into Winnipeg at 9pm, exactly when the bus depot's counters close. Twice Ian has managed to convince an employee to keep one counter open just a little later.
"Well, how warm is your warehouse?" he asked the shipping guy.
"Does this stuff have to stay frozen or something?"
"Yes," he repeated, "It's frozen human breast milk. It will spoil if it thaws. You could help feed several babies tonight, you know!" Each time, the man at the counter relented and admitted that it didn't make much difference to him if he stayed open a few minutes longer - he had to be there still anyway.
Finally, this last time, one of the Greyhound employees saw Ian and said, "Oh, yeah, you're here for breast milk, right?"
He told Ian that they regularly keep a counter open late for a few doctors receiving samples and for the guys from Canadian Blood Services. How appropriate that, in the shipping world at least, breast milk is taking its place among other human medical necessities.
1 Apr 2012
Pump It Out!
This evening when I thawed some donor milk for Jacob, I noticed that written on that bag was not only the date and amount of milk pumped, but also, "Happy Birthday Auntie Sue *heart*!" This is not the first time I've seen notes written on milk bags. Donors frequently mark Christmas, Valentine's Day, Easter, and other holidays on their liquid gold. There are no vacations from pumping.
Anyone who has breastfed a baby for even a short period of time understands that there is serious commitment involved in the enterprise, but the full-time pumpers are truly in a class of their own when it comes to dedication. They spend a minimum of fifteen minutes, at the very least three times a day, but more often something like five, attached to a machine. This includes nighttime sessions, where they must get up and pump, in addition to feeding their babies bottles when required. Nursing, on the other hand, is also time consuming and sometimes very challenging, but when it is going well, it is the best cuddling anyone can give or get. It is a pleasure, while pumping is something that must be done.
Pumped breast milk marks the passage of time in many ways. The date is of course written on the bags, and in the case of one of our donors, this includes the time on the 24-hour clock. The little messages and congratulatory notes remind us of the big calendar days. The milk too changes with time. Milk pumped for a newborn is very yellow and rich and then gradually becomes more clear and pale as the baby gets older. People who nurse their babies directly don't get to see any of this and are often surprised to observe the sheer volume of milk that Jacob drinks.
Our main donor has been pumping for us for nearly an entire year now. Every week we have driven to her house to pick up fresh breast milk. Her production is finally slowing down, and she has happily given up her middle of the night pumping session. Last week, after suffering from the flu, her supply took a real hit and there was no fresh milk for our boy. This woman pumped not only for her own baby who never learned how to breastfeed, but also for ours, for almost twelve months straight, multiple times per day. To top it off, she seems terribly apologetic for no longer being able to give us milk for Jacob. My only question is, how can we possibly thank her appropriately for this astonishing gift?
Pumped breast milk marks the passage of time in many ways. The date is of course written on the bags, and in the case of one of our donors, this includes the time on the 24-hour clock. The little messages and congratulatory notes remind us of the big calendar days. The milk too changes with time. Milk pumped for a newborn is very yellow and rich and then gradually becomes more clear and pale as the baby gets older. People who nurse their babies directly don't get to see any of this and are often surprised to observe the sheer volume of milk that Jacob drinks.
Our main donor has been pumping for us for nearly an entire year now. Every week we have driven to her house to pick up fresh breast milk. Her production is finally slowing down, and she has happily given up her middle of the night pumping session. Last week, after suffering from the flu, her supply took a real hit and there was no fresh milk for our boy. This woman pumped not only for her own baby who never learned how to breastfeed, but also for ours, for almost twelve months straight, multiple times per day. To top it off, she seems terribly apologetic for no longer being able to give us milk for Jacob. My only question is, how can we possibly thank her appropriately for this astonishing gift?
24 Mar 2012
Newborn Bliss All Over Again
A few days ago I enjoyed a most powerful deja vu with a teeny tiny baby. I can still see her little mouth gaping wide open searching for my nipple as she tries again and again to latch. Her hands make tight fists that press into my chest, pushing herself away from my nipple, and away from what she wants so desperately - the food source. Not having much, if any, breast tissue to accommodate her limbs, I gently move her arms out of the way to bring her lips in contact with my nipple. In hunger, she puts her finger in her mouth at the same time as my nipple. Again, I move her hand out of the way. Absolutely everything in her life is about wanting to suckle and swallow.
And then I feel her finally grab hold and not let go. The pull of her lips is strong and determined, yet precarious. I don't dare move my arms for fear of unlatching her. I hear her rhythmic, satisfied gulping and know that I am the centre of her universe. Nothing can distract her from her desire to breastfeed. She doesn't know or care that I'm a transgender guy using a supplemental nursing system and donated breast milk. I share in her bliss.
Then my back starts to ache from the stiffness of my pose. I look at the clock and see that forty-five minutes have gone by and she's only taken an ounce or two. Those newborns take forever to eat! She sleeps for a brief few minutes and then is ready to nurse yet again. Now I remember the sheer exhaustion of the early weeks. Still, my day spent with this seven-week-old was a gift.
My friend had called us around 10am that morning to say that she was feeling very ill. Ian picked her up and brought her to the hospital. He took her infant, Lila, and toddler, Samuel, to our home where I was entertaining a number of friends and their babies. It turned out that the poor sick mom had appendicitis and would spend that night and the following day in the hospital.
First we tried to bottlefeed our tiny charge, but she choked and gagged on the fast-flowing milk. Then my friend Emily attempted to finger-feed her with an SNS tube - sometimes it worked, other times the milk wouldn't flow at all.
In the afternoon, Ian walked Lila over to the hospital to be nursed by her mother in the emergency waiting room. He suggested that I could breastfed Lila the next time around, and my friend agreed. So, a few hours later, after a failed attempt at finger-feeding, I did what was easiest for everyone and nursed the babe.
Breastfeeding Lila was beautiful and joyful, and also brought up some anxiety for me. I have so little breast tissue that latching on a baby takes tremendous focus and determination from both parties involved. Today I am suddenly in awe of myself for having done it, day in, day out, and never, ever giving in to a single bottle feeding when Jacob was little. And I got a good reminder this week of WHY I did it: even with all my specific challenges, nursing was obviously a happier and more comforting experience to Lila, who surely must have been missing her mother.
My own Jacob is almost a year old, and I breastfeed him with ease. He crawls into my lap, pulls my usually open, button-down shirt out of the way, and latches on by himself whenever he wants. If he seems tired, or upset, or out of sorts, or even if I'm just sick of running after him and badly want to sit down for a few minutes, I get out the SNS and nurse him. I wish that more people knew about the pleasures of nursing an older baby or toddler. Gone is all that intensity and effort of feeding a newborn, and what is left, for us anyway, is a comforting, easy relationship.
After my friend received her diagnosis and a surgery was planned for later in the evening, her husband came over to pick up their kids. Lila was full and fast asleep, and Samuel, the toddler, grinned from ear to ear at the sight of his Dad. We were thanked profusely, but in all honesty I just about feel guilty: I got to nurse a precious, heart-melting seven-week-old baby and hang around with her sweet, surprisingly helpful toddling brother while their Mom was dealing with a ton of pain. I'm pretty sure I got the long end of the stick on that one.
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| Lila doesn't care that I'm transgender - she just wants to breastfeed. |
Then my back starts to ache from the stiffness of my pose. I look at the clock and see that forty-five minutes have gone by and she's only taken an ounce or two. Those newborns take forever to eat! She sleeps for a brief few minutes and then is ready to nurse yet again. Now I remember the sheer exhaustion of the early weeks. Still, my day spent with this seven-week-old was a gift.
My friend had called us around 10am that morning to say that she was feeling very ill. Ian picked her up and brought her to the hospital. He took her infant, Lila, and toddler, Samuel, to our home where I was entertaining a number of friends and their babies. It turned out that the poor sick mom had appendicitis and would spend that night and the following day in the hospital.
First we tried to bottlefeed our tiny charge, but she choked and gagged on the fast-flowing milk. Then my friend Emily attempted to finger-feed her with an SNS tube - sometimes it worked, other times the milk wouldn't flow at all.
In the afternoon, Ian walked Lila over to the hospital to be nursed by her mother in the emergency waiting room. He suggested that I could breastfed Lila the next time around, and my friend agreed. So, a few hours later, after a failed attempt at finger-feeding, I did what was easiest for everyone and nursed the babe.
Breastfeeding Lila was beautiful and joyful, and also brought up some anxiety for me. I have so little breast tissue that latching on a baby takes tremendous focus and determination from both parties involved. Today I am suddenly in awe of myself for having done it, day in, day out, and never, ever giving in to a single bottle feeding when Jacob was little. And I got a good reminder this week of WHY I did it: even with all my specific challenges, nursing was obviously a happier and more comforting experience to Lila, who surely must have been missing her mother.
My own Jacob is almost a year old, and I breastfeed him with ease. He crawls into my lap, pulls my usually open, button-down shirt out of the way, and latches on by himself whenever he wants. If he seems tired, or upset, or out of sorts, or even if I'm just sick of running after him and badly want to sit down for a few minutes, I get out the SNS and nurse him. I wish that more people knew about the pleasures of nursing an older baby or toddler. Gone is all that intensity and effort of feeding a newborn, and what is left, for us anyway, is a comforting, easy relationship.
After my friend received her diagnosis and a surgery was planned for later in the evening, her husband came over to pick up their kids. Lila was full and fast asleep, and Samuel, the toddler, grinned from ear to ear at the sight of his Dad. We were thanked profusely, but in all honesty I just about feel guilty: I got to nurse a precious, heart-melting seven-week-old baby and hang around with her sweet, surprisingly helpful toddling brother while their Mom was dealing with a ton of pain. I'm pretty sure I got the long end of the stick on that one.
18 Nov 2011
Hospital Visit
The night before, Jacob's temperature spiked to just over 103 degrees. Still, he seemed to be managing ok with it. In the middle of the night he threw up all over our family bed, and then he smiled at us.We didn't mind as long as he wasn't too miserable. By morning his fever was way down. He was quiet but not unhappy. We had a lazy at-home, in-bed kind of day.
At 8pm, Jacob woke up screaming from his nap. I tried to breastfeed him, I bounced him, I walked him up and down the stairs, I walked him in circles around the house, I took him to see the dog, I let him have a whiff of the crisp November air, all to no avail. He cried all out as hard as he could for about a minute, and then would pause, sobbing those huge, full body sobs, for thirty seconds, and then would cry all out again for a minute, and so on.
Finally Ian walked in the door, home from work. I told him how things had been, we deliberated for a few minutes and decided to head to the hospital. Our little guy was in pain. There was something seriously wrong.
I could hear their questions already in my head. So who is the mother? How much formula has he taken today? You don't give him formula? Well, where do you get this donated breast milk? I imagined explaining first to the intake nurse, then to the doctor, then to the next doctor when the shift changed, then to some other nurses, then to another doctor all about how I was transgendered, I'd birthed Jacob myself, and was breastfeeding him using a supplemental nursing system and donated milk from generous women we'd met online.
The hospital we were headed for, only two blocks away, is notorious in our city for being breastfeeding unfriendly. Women and their newborns regularly leave with soothers, bottles and formula in hand after receiving muddled or no advice on breastfeeding. How were they going to cope with a breastfeeding man using donated milk?
Health care providers are supposed to be trained to cope with queer individuals and families. They should know the basics of what it means to be transgendered or gay, and they should at least get their pronouns straight, so to speak. (If you don't know what "transgendered" means, click here to see how I define it for myself) One doctor I encountered confirmed that yes, he knew what a transsexual is, no need to explain. I went on to tell him about my health problem only to realize that he had no idea what it meant to be transgendered. He had my anatomy, well, if not inside out, then certainly backwards. From that day forth, I vowed to always explain myself from the beginning, whether or not the health care professional in question claims to know what I'm all about. "I am transgendered. This means that I was born female, but transitioned to male. I did this by taking hormones..."
As we walked over to the hospital with our seven month old baby, I wondered what kind of conversations this evening would bring. I held him close to my skin underneath my coat. And, as we walked over to the hospital, our baby magically stopped crying. By the time we got to emergency, he was looking all around him and smiling coyly at the intake nurses. They took his temperature and found it to be perfectly normal. We walked around the hospital for about forty-five minutes and then went home with our baby who was fussing over having to be bundled up in the cold. He wanted a better view of where we were off to and his toque and my jacket were getting in the way. But at least we'd finally had the good sense to get out of the house and do something social for a few minutes...
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