There is a very interesting article in Discover magazine this month about
the wonders of human milk and how hard scientists are trying to tease out
and then manufacturer those pieces that seem most closely tied to health
and could be used to treat a wide range of infant and adult diseases. This
is not going to stop. Formulas will continue to add ingredients found in
mother's milk and thus make it easier and easier for moms to feel
comfortable with skipping breastfeeding, especially after the first weeks
at home when they start to have to deal with separation and pumping and all
of that. New medications based on human milk components will emerge in the
coming years. And really, since almost the beginning of time, mothers have
searched for ways to feed their babies other than at their own breasts -
this is not a new behavior. We need to acknowledge that and continue to
investigate why it is that mothers do choose to breastfeed and why they
don't and work from there. It is true that each mother's milk will be
unique for her child, no matter how sophisticated formula may become.
Another aspect that I think does not get enough play is the benefits to the
mother - these cannot be duplicated by any special formula. In the end, if
the mother does not feel that breastfeeding is worth the effort, then she
will quit.

For communities to underwrite the establishment of human milk banks, they
will need money and volunteers to make it happen. Many folks will be asking
for proof that this milk will make a significant difference in the lives of
a majority of babies and children. For mothers to make the choice to
breastfeed, they need similar assurances. We all need to work together to
stay abreast of the latest research on human milk and breastfeeding and
also what the scientists are cooking up in their labs. We need to focus on
a strategy that will speak to the greatest number of women no matter where
they are or what are the circumstances under which they live and raise
their children.

Sharon Knorr, IBCLC, Colorado



On Fri, May 11, 2012 at 2:43 AM, Sarah Vaughan
<[log in to unmask]>wrote:

> On 10/05/2012 18:10, Nikki Lee wrote:
>
>> Dear Lactnet Friends:
>>
>> "Because the reality is that many babies, for whatever reason, are going
>> to
>> be fed either completely or partially on formula ...."
>>
>> If we who are the world's breastfeeding guides and therapists, espouse the
>> belief that formula is ubiquitous, breastfeeding can not advance.
>>
>
> Aiming for a better future as soon as we can bring it about doesn't
> exclude recognising the reality of the present and of the imminent future.
>  Formula *is* ubiquitous.  Of course we want to change that, and of course
> we *plan* to change it, but it would be rather ostrich-like to refuse to
> recognise that that isn't going to happen at any time in the immediately
> foreseeable future.  So, yes, I stand by my statement - there is, currently
> and for the foreseeable future, an important role for specialists in infant
> nutrition to oversee the quality of that product, and it is therefore quite
> ethical and appropriate behaviour for such a specialist to choose to take
> up such a role.  (To answer another post on the subject from yesterday, I
> entirely agree that this should not slip over into a promotional role.)
>
> As for milk sharing... OK, here is where I recognise my viewpoint is going
> to get controversial. I think there are two important problems with milk
> sharing to bear in mind.
>
> Firstly, human milk that has been pasteurised, frozen, stored, defrosted,
> stored for a few hours further, and then fed from a bottle is likely to be
> fairly different from human milk fresh from the source in terms of outcomes
> for infants. Some of the immune factors will have been destroyed by the
> pasteurisation and freezing process, and any storage outside the body will
> allow at least some chance for bacterial multiplication, so the differences
> in infection rates between donor milk-fed babies and FF babies will likely
> be less than the differences between directly breastfed babies and
> formula-fed babies. Without the sucking action at the breast itself, we
> won't get the benefits in terms of improved dentition and possibly otitis
> media reduction.  And, as yet, we don't really seem to have anything much
> in the way of research on outcomes of donor milk feeding outside relatively
> uncommon situations such as premature NICU babies.  So, as far as I can
> see, we don't actually know how donor milk and formula would compare in
> terms of outcomes on a more population-wide basis. Although I would expect
> that donor milk will probably still turn out to have advantages over
> formula, I would expect those advantages to be rather smaller than those
> shown in studies comparing breastfeeding with formula.
>
> Secondly, the need for screening, processing, and refrigeration of human
> milk mean that it's currently orders of magnitude more expensive than
> formula and presents practical difficulties in distribution to boot.  I've
> no doubt there's scope to improve things considerably on that score, but I
> doubt it would be possible to remove those difficulties entirely.  (And,
> again for practical reasons, I think the direct 'wet nurse' option is never
> going to be that common a solution.)
>
> The combination of both those problems means that, before rolling out the
> kind of widespread milk donation programme you describe, we really ought to
> know a great deal more than we currently do about how the benefits and
> costs of donor milk actually stack up in practice on a population-wide
> basis. The question isn't just whether donor milk is still going to turn
> out to be better than formula feeding - we also run up against an issue
> that I believe is known as 'opportunity cost', namely, the fact that there
> are always going to be a number of possible beneficial ways that the
> resources under consideration (in both money and time) could be spent, and
> that we need to consider whether this is actually going to be the most
> beneficial possible use.  I just don't think we can or should assume that
> that will be the case.
>
> Finally, even given a best-case scenario with milk donation - that we do
> eventually discover ways of making the processing and storage much cheaper
> without sacrificing safety, that we also find that the benefits of donor
> milk are close enough to those of breast milk to make it worth rolling out
> a much more universal milk donation programme, and we have enough willing
> mothers without health contraindications to supply those who can't or don't
> wish to breastfeed - there are still going to be rare scenarios such as
> babies with severe multiple food allergies where donor milk would only be
> possible in situations where the parents can find accessible donors on the
> appropriate exclusion diet, or babies with metabolic problems such as
> galactosaemia.  Or, for that matter, much more prosaic situations that you
> wouldn't necessarily think of when thinking of all the reasons why a baby
> might end up getting some formula - such as my own daughter, who became
> very distressed on giving EBM when I was at work and was much happier
> getting formula (we theorised that the EBM might just have been too
> tantalising a reminder of the important person in her life who wasn't there
> right then).  No matter how widespread the milk donation programme
> eventually becomes, I don't think it will ever totally get rid of the
> requirement for formula in some situations.  So, I stand by my initial
> statement - I want to know that, when that formula is used, it's as
> good-quality a product as is possible, and, for that reason, I think it
> entirely ethically appropriate for HCPs with specialist knowledge of infant
> nutritional needs to work in the quality control area of formula production.
>
>
>  Best wishes,
>
> Dr Sarah Vaughan
> MBChB MRCGP
>
>
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