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Wet Nursing 2.0

In an image seen around the world a few weeks ago, actress Salma Hayak breastfed a sick African baby on camera. California mother Nadya Suleman‘s octuplets are reportedly being fed donated breast milk. And Russian scientists claim to be genetically modifying goats to produce milk that is similar to that of humans. Breast milk is all over the news.

When my daughter Mirah was born, full term and healthy, I never imagined that I would not be able to breastfeed her. But after two days of nipple pain and blistering, my husband and I took our three-day-old daughter to a lactation consultant at a nearby hospital. We learned that her latch – or her sucking technique – was so bad that not only was she causing me pain, she was getting little, if any, milk from nursing. She was immediately given a bottle of formula and I was sent home with a breast pump to use while we tried to teach her to breastfeed. For the next two and a half months I pumped eight times a day while we tried all manner of therapies to help her. Breast milk is produced on a supply and demand basis, and breast pumps, despite all their technology and expense, are not the same as a baby’s suckle. My production couldn’t keep up with Mirah’s needs.

After a month of pumping, and trying everything from herbs to medication, I was still producing only a third to a quarter of her daily sustenance. The rest was formula. I was devastated that I couldn’t provide her with what she needed. While I tried to assure myself that being a parent was more than just feeding, I felt that both she and I were missing out on something important. And I was worried about the effect that so much formula would have on her health.

To add to my grief, even as I was feeding her formula, the news from China came out: infant formula with the industrial chemical Melamine had killed and sickened babies there. Though I knew there was little chance of the formula I used being tainted, the news nevertheless added to my worry and guilt. (In fact, later in the year trace amounts of Melamine were found in U.S.-made formula, but the Food and Drug Administration insisted that there was no risk to infants. This seemed to contradict an earlier FDA statement that there was no safe level of Melamine in formula.)

Nobody argues with the benefits of breast milk. Babies fed human milk are less likely to suffer from infections, diabetes, asthma, allergies, obesity and many other health problems. According to Dr. Lori Feldman-Winter, a pediatrician at Cooper University Hospital in Camden, New Jersey, breast milk can also be “a matter of life and death for premature babies.” Feldman-Winter, who is also on the Executive Committee of the American Academy of Pediatrics’ breastfeeding section, points out that human milk reduces the risk of sepsis and infection, as well as a life threatening infection in the intestines, known as necrotizing enterocolitis, which afflicts some premature infants. Both the World Health Organization and UNICEF recommend that in the absence of mother’s milk, infants should be fed human milk from donors.

And it isn’t only babies who benefit from breast milk: along with its scientifically documented benefits to new mothers, human milk is now being used to treat certain cancers and fight infections in adults.

Although it is fairly rare for a woman to not be able to produce enough milk for her child, there are a number of reasons why infants might not have access to their mother’s milk. Illness, previous breast surgery, substance abuse problems and emotional and physical stress can all take a toll on milk supply. Certain medications that are not safe for infants are passed through breast milk. When a baby is born prematurely, it can take days or longer for the mother’s milk to come in. And a mother of multiples may not have enough milk for all of her children.

But where can you go if you have little or no supply?

Once upon a time, infants whose mothers could not (or would not) breastfeed employed wet-nurses to feed their babies. These women were generally women of a lower social class or relatives. The practice of wet nursing is mentioned in documents as early as 2250 BC. With the invention of the first breast pump in 1863, milk could be removed from the breast and shared. In 1911, a doctor in Boston who had trouble finding a wet nurse for a sick infant established the first milk bank in the United States. Women began to sell their milk to these banks, a practice that continued through the Depression.

After World War II, as infant formula began to be promoted as a superior food for babies, human milk banks seemed less necessary. And in the first years of the AIDS crisis many banks shut down (HIV can be passed through breast milk). In recent years, as the pendulum has swung back in favor of human milk over substitutes and as new technologies have kept milk deposits safe, milk banks, which intensively screen donors, and then collect, pasteurize and distribute human milk, have enjoyed a resurgence.

Between 2000 and 2008, the Human Milk Bank Association of North America (HMBANA) saw a 185% increase in the distribution of donor milk. In 2000 there were six HMBANA affiliated non-profit milk banks in the United States and Canada. Today there are eleven that serve various regions of North America. Pauline Sakamoto, President of the HMBANA and Executive Director of the Mother’s Milk Bank in San Jose, California estimates that in 2008, 1.4 million ounces of donor milk was distributed, by physician prescription, mostly for premature infants. But Sakamoto says that more than five times that amount, or eight million ounces, are necessary to feed all the premature infants in need. Many new donors are needed.

The costs are high: $2 to $4 an ounce. The costs are high: $2 to $4 an ounce, which just covers the price of donor screening and testing and shipping, pasteurizing, and storing of the milk. Most insurance companies have refused to cover the cost of donor milk, says Sakamoto, in spite of its proven record to reduce the amount of time an infant spends in the NICU (Neonatal Intensive Care Unit). And most milk banks can only afford to accept a limited number of charity cases and still continue to function. HMBANA has never turned away a preterm infant in the hospital because of limited financial resources. But sometimes they can’t cover a baby after she leaves the hospital, or a healthy infant; adult patients are at the bottom of their priority list.

A milk bank was not the answer for our family. When I began to research sources of human milk, I found that the twenty-plus additional daily ounces of milk Mirah needed would cost $60 a day from a hospital bank. It was an impossible sum for us. Then I learned of the Yahoo list Milkshare, via an online discussion board. The list connects women with extra milk who wish to donate to families in need of milk.

Milkshare was founded in 2004 by Kelley Faulkener, a mother who could not produce milk for her baby. When a donor and a recipient find each other, milk is either shipped via a complicated process of dry ice and overnight mail, or is picked up locally. Milkshare participants are forbidden from selling and buying milk, though the recipient generally pays for supplies and shipping.

The costs are high: $2 to $4 an ounce. Milkshare strongly recommends that donors provide proof that they test negative for HIV and Hepatitis. People searching for milk on the list range from parents who have recently adopted to mothers who have undergone a double mastectomy to men fighting cancer who believe in the healing powers of human milk. One particularly heart-rending listing I read was from the mother of premature twins, one of whom had died a few hours after birth, and the other who had only been able to thrive on donor milk in the hospital, but whose insurance wouldn’t continue to cover the cost.

As I started looking for donors on the list I worried about the implications of using another woman’s milk for my baby. I checked with my pediatrician and he was unconcerned as long as the donors were negative for HIV and Hepatitis. I also didn’t want to take milk that would otherwise go to a premature or ill baby. After all, Mirah had been full term and was thriving. I made that clear when I contacted potential donors.

We soon found two donors in Philadelphia, a two-hour drive from our home in Baltimore. Tina is in her fourth year of medical school, and Megan is a paralegal. They had different reasons for donating their milk privately rather than through a milk bank. Megan had tried to donate through a bank, but because she was taking Zoloft, an anti-depressant considered among the safest for breastfeeding mothers, her milk was rejected. (I take Prozac and feel that the benefits of human milk outweigh the small risk these two medications might pose.)

Tina decided to donate through Milkshare because, she wrote in an email, “I know I would have been heartbroken had I been unable to breastfeed for some reason. I wanted to share what I had with other new moms. I looked at various websites for milk banks, but my milk would have to be shipped far away and, in at least some cases, given to a for-profit company that would then sell the milk for money.” Both Megan and Tina also appreciated the fact that they would be able to meet the family receiving their milk. They mailed us copies of recent tests showing they were HIV and Hepatitis negative, and our relationships began. Approximately once a month we drive up to Philadelphia, visit both of the families, and return with a picnic cooler filled with ice and frozen breast milk bags that feels like a treasure chest in the trunk of our car.

The picnic cooler filled with frozen breast milk felt like a treasure chest in the trunk of our car. The picnic cooler filled with frozen breast milk felt like a treasure chest in the trunk of our car. This has worked for us, but there are high-profile naysayers. The Centers for Disease Control, La Leche League International, and the American Academy of Pediatrics all caution against using milk that is not provided by a licensed milk bank. Dr. Feldman-Winter says that with privately donated milk there is a risk “of transmission of infection because it is not undergoing pasteurization.” In addition, “Mothers who are overproducing and pumping for donation may pump before or after feeding their own baby, so they might be donating only the milk that is expressed at the beginning or the end of a session.” Breast milk is made up of two different kinds of milk, foremilk and hindmilk, which are released at different times. Babies need both kinds.

Dr. Feldman-Winter continues, “We are concerned that there is no quality oversight” of privately donated milk. The donors could also be using substances that would enter the milk and could contaminate the milk during handling, and they may not know or disclose if they have any infections. She admits that, though she recommends pasteurization, the process does destroy some of the benefits of breast milk. “When milk is pasteurized it definitely makes it safe, but a lot of the benefits of human milk are in its live properties, such as antibodies. Some part of human milk is altered through pasteurization.”

In addition to Milkshare and the non-profit milk banks of HMBANA, there is another source of human milk in the United States. Prolacta Bioscience, a for-profit company, collects human milk through milk collection centers (not those affiliated with HMBANA) and then sells processed milk formulations and human milk fortifiers to hospital NICUs at a much higher cost than milk from HMBANA banks.

Our own story has a happy ending. When Mirah was almost three months old she started to breastfeed. We were overjoyed. As she became more and more adept at nursing, my supply of milk slowly and steadily increased. Now, almost seven months old, Mirah only needs one bottle of the donated milk a day. Soon, she may no longer need extra milk at all. But there are still plenty of babies who do, and – luckily – some women out there who are happy to share.

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