Day 21: A Doula's Guide to Informal Milksharing

In commemoration of the 34th anniversary of the WHO Code, today's guest post is about donor human milk. Marivette is a local-to-me (Bakersfield) doula with a passion for educating the public about informal milk sharing. In fact, this last summer, she presented information regarding Human Milk 4 Human Babies at The San Diego County Breastfeeding Coalition during a mini seminar for physicians and other health care providers. 

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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? 

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Marivette Torres is the founder and owner of Tender Doula Hands, and is a rebozo instructor, childbirth educator, breastfeeding advisor, and an administrator of HM4HB California. She was part of the grassroots efforts in organizing HM4HB from the ground up. She has eight children ranging in age from 25 to 7 years old. Her first child was born via surgery at a community hospital due to breech presentation. Her subsequent seven children were all VBAC births, two of which were born at a hospital, and five which were born at home. She breastfed all her children with her last child self-weaning at six years old. As a CBI certified, professional birth doula with 17 years’ experience, she provides birth doula services in the Bakersfield, California area. You may visit her website and Facebook page. 

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References:

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.