Mandi Porta's first draft:  "Non-Diseased Milk from another mother--When the
mother is unable to provide breastmilk herself but decides to give milk from
another mother who is free from contagious diseases such as HIV or AIDS,
HTLV-1, TB, CMV, and when the donated milk mother is not taking
antimetabolite medication, or therapeutic doses of radiopharmaceuticals, or
takes drugs of abuse."

In theory, I love the concept of wet nursing, but I have to be a wet blanket
and add:

"...a mother who is free from contagious diseases...and the possibility of
contracting contagious diseases..."

Which, the human pleasure drive being what it is, is difficult to ensure. A
milk bank can with impunity ask for tests and a doctor's recommendation, but
friends and relatives would find this a social barrier.  A mother may feel
she knows her alternative breastmilk provider(s) very well, and she may be
correct in her assessment. But it would be severely misleading not to let
mothers know that their friends AND their friends' sexual partners' lives
are under scrutiny here.  The risk exists, and until mothers are cognizant
of it, they cannot assess for themselves whether they wish to undertake that
risk in their own particular circumstance.  They won't be prepared to have a
frank discussion on the right subjects with their proposed alternate
breastmilk providers unless they know this discussion needs to happen.

This becomes a bigger issue as each unofficial donor mother enters the
picture, because the risk is multiplied by each mother.  A mother whose
entire milk supply is donated by others might have a single other mom in her
supply chain or she may have many other moms, some of whom are strangers,
donating to her child.  In general, the risk is probably mitigated by the
altruistic motives of milk donors, but it is not eliminated, and mothers
need to be informed. 

In some situations, the risk of accepting untested milk from strangers has
to be accepted, despite the unknowns, because the child will not survive
without human milk, which the mother is unable to obtain from a milk bank
due to the intransigence of health care administrators and insurance
companies/HMOs.  One can speculate about collusion with the formula industry
but it would be pointless here. 

Some mothers suspect or are well aware that their partners have outside
sexual relationships, which may be high risk or low risk.  Women may be
using a variety of prescription, over-the-counter, herbal, illegal, or
quasi-illegal substances and may not consider these uses relevant unless
asked directly about them.

Some drugs and diseases did not exist when wet nursing was last popular;
others existed but the potential for exposure was markedly less than it is
today.  While I would like to see all artificial infant milk substitutes
eliminated in favor of human milk for all babies*, I do think moms need to
have enough information to decide between human milk bank-supplied milk and
informal wet-nursing in their own particular circumstance.

Furthermore, I would clarify "drugs of abuse," since all drugs can be
abused, whereas some are always abused when used, and some are politically
considered more dangerous than their medical effect seems to warrant.  At
the least, there is a question of dosage in many
drugs/medicines/pharmaceuticals.  For instance, alcohol and marijuana are
both "drugs of abuse" but a fully informed mother might be better armed to
weigh the risk of small amounts of either against the risk of artificial
substitutes (within the limitations of current and evolving medical
knowledge).

Also, I would suggest an alternative name to "Non-Diseased Milk."  If
formula were re-labeled "Non-Diseased Formula" it would probably boost
breastfeeding rates.

Arly Helm, MS, IBCLC

*For those who believe that animal-based or vegetable-based speciality
artificial substitutes have their place, let me say that human milk can be
modified just as animal milk can, and would be infinitely preferable.

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