I recently met Nicole at a local doula gathering. When she shared her breastfeeding story with me, I was overwhelmed by emotion. I immediately asked her two things: 1-How will you work through this to help other women as a doula, and 2-Do you like to write? I am so grateful she generously poured her heart out to let others know how painful and confusing it can be to face the obstacle of not producing enough milk. I say it to moms everyday: We don't expect feeding our babies to be so hard. I have worked with many moms experiencing milk supply issues due to IGT, PCOS, breast reductions, and extreme blood loss during birth. Very often there is a deep sense of loss. Thank you to Nicole, for being vulnerable and honest -- I know it will help others. 

​"Your worth as a mother is not measured in ounces." This, this right here has been my solid ground -- my strength when I just can't seem to stop beating myself up for things I cannot control. Let's rewind a second, shall we?

Being a young mother is never easy, especially when you're the first of all of your friends to have a baby. You have no one to look to for advice or wisdom, it's just you and a new baby who won't stop screaming and nurses who are less than helpful. I was 19 when I gave birth to my greatest accomplishment and I was so proud, but what was I doing wrong? Why wasn't she latching? Sure, I knew breast is best, but as a first time mom, the crying was overwhelming and I just wanted her needs to be met. The night after she was born she got a bottle of formula because she had been crying non-stop and hadn't eaten because she hadn't ever latched for more than two minuets at a time. I was sad but I was just happy she wasn't screaming from hunger anymore. I had about 6 women give or take look at my breasts (or lack there of) and touch them, without permission at that, and no one had any advice for me -- so I went home, formula in tow and with no regrets.

At home I continued trying to pump, trying to latch her, and just trying to get a supply when I only had drops at a time. I tried a nipple shield, pumping religiously, teas, supplements, and I just gave up because I read some women just don't respond to a pump. Afterall, she was fed so she wasn't really going without, was she?

​I have since given birth again, 11 months ago to be exact. This time to my son and my second greatest accomplishment. Before I conceived him and during my pregnancy, I devoted HOURS to researching the best parenting practices, and that included breastfeeding. Breastfeeding: Natural. Normal. Tradition. Instinct. The reason the human race has survived for centuries. I learned that every woman should be able to breastfeed if she "tried" hard enough. I learned about proper latch, feeding on demand, skin-to-skin, the benefits of natural labor, tongue ties, lip ties, no pacifiers or bottles for a minimum of 6 weeks. The list is basically endless, I knew it all and I was confident. You can ask my doula, the one thing I wanted the most out of my birth plan was to be able to breastfeed, and my worst fear was not being able to breastfeed.

After 7 hours of labor I gave birth to my son, completely naturally. Yes! I did it! I was so proud of myself and immediately placed him to the breast. I remember looking at my doula and saying, "look, his mouth is big, he should latch nicely," and he did. He latched and we spent so much time nursing. We denied baths and took off that annoying hat they put on him -- everything was textbook. We went home after some time on the lights for jaundice.

​Did I mention everything was textbook? It was...until it wasn't. He constantly wanted to nurse, which is normal for babies. But then I noticed he wasn't peeing much anymore, and he wasn't satisfied after nursing for what felt like an eternity. I birthed him on Friday afternoon, and by Monday he had extremely chapped lips, yellow skin, yellow eyes and little urine output, but I was basically in denial. The next day he was admitted to PICU for jaundice and had to spend 24 hours on the lights. I HAD to start supplementing because my son was starving. I was starving him. My body was failing him. I cried and cried and cried. From 7 lbs 6 oz, to 6 lbs 3 oz and NO urine output. I did everything right, why was this happening to me? I was devastated, but despite my pain I kept at it. I met with an LC who gave me an SNS and and an abundance of advice that included "if things don't change in 1-2 weeks then you just might be one of the small percent of women who can't breastfeed."

Can't breastfeed, what? Some women can't produce milk, but why?

We went home the next day and he was thriving from being supplemented, but I hated myself -- hated the body that birthed two beautiful children. It's an awful feeling, a feeling that left a wound that is still as fresh as when it appeared. I kept at everything I had learned and I never got an increase in supply. Between both sides I couldn't even pump to cover the bottom of a bottle. Prescription drugs, water, clean diet -- NOTHING helped, but why?

IGT: insufficient glandular tissue. I found a great support group on Facebook that was my saving grace, they encircled me with comfort and understanding. There are markers for IGT and I realized that I had most of those markers. Buy why hadn't I heard of this before? All of the articles I read and people I talked to and I had never heard of it. All of the medical professionals that had seen me topless and I never heard a word spoken about it. Why aren't people trained to notice this, and why isn't this a more well-known issue?

This has been a long road and I'm still suffering. I can't feed or nurture my baby the way I was designed to. He's missing out on the best kind of milk his little body was designed to live off of. We did donor milk but it's hard to come by, honestly. He's now exclusively formula-fed and I hurt every time I wash or make a bottle.

I have since became a birth doula, and I almost feel hypocritical about it. How can I offer breastfeeding support to women when I can't breastfeed myself?

I'm healing and I've come to be a huge lactivist. Just because I wasn't and couldn't be successful doesn't mean I don't know the dos and don'ts of breastfeeding, and it doesn't mean that I won't run in to someone who will struggle like I did (and still do).

My heart hurts often and I still cry a lot, but I am healing. I need to start loving my body again. My first step to forgiving the things I can't control is writing this in hopes that more people will understand this kind of terrible struggle. It may not be a big deal to some, formula vs. breast, but to others, it's extremely difficult to accept.

And that's what I have learned to accept.

One of the jobs of a doula is to provide resources to pregnant women and their families. We may provide a list on a piece of paper, or provide verbal information regarding different resources in the community. It could be anything from where to find a childbirth educator, a lactation consultant, an IBCLC, or even where to locate other new moms. Often an area that is forgotten or which is not known is information regarding milk sharing. What is milk sharing and how can doulas offer this as a resource to new mothers?

On page 10, paragraph 18, in the “Global Strategy for Infant and Young Child Feeding” by The World Health Organization (WHO) and Unicef (2003), it states the hierarchy for infant feeding. If a child cannot be fed directly from the mother’s breast, first the child should be fed the mother’s expressed milk, secondly the child can be fed donor milk through a wet nurse or milk bank, and then finally a breast milk substitute can be fed (WHO & UNICEF, 2003). There is caution to be taken when feeding a breast milk substitute, though. WHO and UNICEF (2003) state, “Infants who are not breastfed, for whatever reason, should receive special attention from the health and social welfare system since they constitute a risk group.” In this hierarchy of infant feeding options, donor milk is often neglected, but should be considered before a breast milk substitute is given.

Milk sharing is a centuries old tradition. Centuries past there was a process called wet nursing which utilized the services of a mother, with or without her baby, to feed another woman’s baby (Thorley, 2008). Sometimes this was done forcibly by slave owners, and other times there was compensation given to the lower class women who provided this service to those in the upper class (Thorley, 2008). In modern times, wet nursing is sometimes confused with cross-nursing which is the feeding of another woman’s baby out of a sincere desire to help without compensation. With time, these traditions began to fade away, and soon it was close to non-existent (Thorley, 2008). Oh, that’s not to say it wasn’t happening! It just wasn’t widely practiced anymore, because it was much harder to find someone who could cross nurse a baby. However, in the last four and half years, there has been an increased awareness of the benefits of peer-to-peer milk sharing also known as: informal milk sharing.

Currently, informal milk sharing is the process of donating excess, expressed breast milk to another baby in need of breastmilk without going through a milk bank. A mom who is producing enough milk for her baby, may choose to pump additional milk over and above what her baby needs in order to donate this excess milk to another baby. Many woman have chosen to save their milk to donate it to a baby whose mother is not able to produce enough for their own baby. A breastfeeding mom will generously donate her milk in an altruistic fashion. There is no monetary compensation during this milk DONATION. The compensation is knowing that her milk is feeding another baby in need.

There are many reasons why a baby would need donor milk. The baby’s mother may have health issues like cancer, insufficient glandular tissue, may be on medication that is not compatible with breastfeeding, or a host of other health issues too long to name, here. The baby may have been adopted, and the new parents want to provide their baby with the biological normal sustenance, breast milk. The mother’s milk may have taken a dip, and she is no longer producing enough to fulfill the baby’s nutritional needs. The mother may be returning to work or school, and does not have enough of a supply stored away. The baby’s mother may have passed away, and the family seeks out donor milk to continue feeding the baby breast milk. This blog post could be pages long with the myriad of reasons why families seek out donor milk. The simple and hard fact is that there are babies who need donor milk to meet their dietary needs in a manner that is consistent and compositionally the same as their own mother’s milk.

The growth and accessibility of social media has facilitated the exponential increase in the availability of donor milk. In Oct. 2010, in a grassroots efforts which opened up the doors to thousands of babies in need donor milk, Facebook was utilized as a platform to create Human Milk 4 Human Babies (HM4HB). This was the beginning of reaching scores of moms who had an excess amount of breast milk. Donor families used HM4HB to find recipient families who had a need of donor milk and vice versa. Years ago, it would have been difficult, if not impossible, to find someone locally who was breastfeeding and could provide a baby with donor milk. However, using social media, there is now a much faster method of reaching out to people in the community when there is a need. Informal milk sharing, although it had been happening on a much smaller scale, exploded. Volunteers generously committed hours to the creation of HM4HB public Facebook pages. These pages were set up all over the world to facilitate a place where families could search for other families willing to donate their breast milk. 

The process of informal milk sharing is completely dictated and handled by the families who are donating or receiving breast milk. While there are risks involved both in breast milk substitutes and informal milk sharing (Gribble & Hausman, 2012), families must weigh these risks, ask any questions, including health questions or concerns, and make an informed choice. Informal milk sharing on HM4HB is the sole responsibility of each of the individual families. Administrators of the pages do not get involved in any manner other than to post requests/offers, or delete off topic information. Because of this, HM4HB does not have statistics showing how many people on their sites are sharing their milk and receiving donor milk. HM4HB operates much like a bulletin board. People post offers/needs, admins keep the place tidy.

What about milk banks, you might ask? A non-profit milk bank, like the Human Milk Banking Association of North America (HMBANA) receives donor milk from families who have excess breast milk. This milk is reserved for the most vulnerable from our communities, preemies and ill babies. So, a healthy six-month old whose mother has had a decrease in milk production, would not be eligible for milk from a milk bank. While we NEED milk banks to provide milk to an extremely needy population, they cannot provide milk to all the babies. Additionally, there are restrictions for who can donate breastmilk. For example, a mother on herbal remedies would not be eligible to donate. Milk bank donor milk is being served to extremely delicate babies who have fragile immune systems and their donor milk must meet the strictest of standards. Hence, informal milk sharing is a valuable resource for families who don’t meet milk bank requirements for donor or recipient.

As doulas, we can offer much in the way of support to families. An additional way to offer that support is to provide information to clients regarding informal milk sharing. We can share HM4HB with families. We can let them know that informal milk sharing is an option available to them. Now, with this blog post, you will be able to direct them, here, so your clients can read for themselves what informal milk sharing entails. Or you can send them directly to HM4HB.

Had you heard of informal milk sharing before this reading this post? Have you been a donor or recipient? What are your experiences? Will you share this information with your clients? 

Gribble, K. D., & Hausman, B. L. (2012). Milk sharing and formula feeding: Infant feeding risks in comparative persective. The Australasian Medical Journal, 5(5), 275-283. doi:10.4066/AMJ.2012.1222

Thorley, V. (2008). Sharing breastmilk: Wet nursing, cross-feeding and milk donations. Breastfeeding Review: Journal of the Australian Breastfeeding Association, 16(1), 25-29.

WHO & UNICEF. (2003). Global Strategy for Infant and Young Child Feeding.