several interesting points have come up in this discussion. i must say that,
having tried before to get discussions started about milk banking and also
about professional roles and credentials, i am very pleased to see such a
lively discussion about both topics. i don't think we can ignore either
subject, and that it is healthy for us as a group to address them.

about milk banking, i have been involved in the process of screening donors
both as a former donor (three times!) and by having just been around the milk
bank a lot and observing, and being the go-between that tells potential
donors about the process. much of what is involved with screening donors is a
personal "sense" about the potential donor on the part of the milk bank
staff. i know, you can't quantify it, but i bet if you ask the persons who
screen blood donors, they would tell you the same.

yes, of course pasteurization does handle the problem of disease. one of the
things they say at the milk bank is "i would feel completely comfortable
giving this to my children." some of the reasons to continue screening donors
include to protect the donor and her baby. if a baby is not growing and
gaining appropriately, a mother is discouraged from donating milk. what i
think is a major reason for going beyond what some people (not me) might
think is a reasonable level of scrupulousity is the nature of the usual
recipients (not healthy, growing babies) and the extremely ridiculous,
patently absurd attitude of the majority of HCPs towards donor milk.

it is shocking to me to find that there have been several doctors (including
neonatologists) in town who have actively tried to discourage parents from
getting donor milk. the arguments have ranged from "oh, gross, how could you
even think of it? it isn't safe!" to arguments about the cost! "oh, later,
you'll be angry with me about how much it cost!" which was really just a
coverup for the doctor's opinion that breastfeeding was unimportant.

that's why the extremely careful, cautious stance of milk banks is necessary.
you can't build bridges to the medical community without standing firmly on a
basis of defensible medical practices.

but there is indeed a great deal of informal milk donation and wet nursing
going on, as valerie pointed out. is this bad? i don't think so. and while i
have been described as someone who "endorses casual wet-nursing," i must
point out that this is not so. i advocate extremely careful and
fully-informed wet-nursing when that is the desire of the parties involved,
as well as "casual" (i can't think of a better term right now) milk donation
under the same circumstances. why? and under what circumstances?

donor milk is expensive, and beyond the ability of some people to afford even
when they can get it. the expense is due to reasons that are clearly not a
ripoff of some kind, and difficult to reduce. the milk is reserved for
dispensing only for medical reasons. this brings up a difficult philosophical
point. if we do believe that HM is necessary for babies, and that
breastfeeding is a mutual right of mothers and children, and that ABM is
harmful (and i do believe all these things), then it is not ethically
defensible to deny donor milk to any baby. however, the supply problems that
are usual with milk banking (it seems freezers are always bursting or empty)
are probably the main factor limiting who gets it now, as well as the need to
deal with this ethical issue.

so this leaves a large gap in "service provided." i like to think that
someday breastfeeding will be the norm, there will be plenty of donor milk
available, and that babies in the US (i can't really speak about what is
going on elsewhere) can get donor milk when their mothers can't bf for
whatever reason. if we make a value judgement (why should the baby get milk,
when the mother is "too lazy" "too busy" "too selfish" to breastfeed?) about
the mother, then we are extending the value judgement to an innocent baby who
still "deserves" human milk. remember why we don't refer to children born out
of wedlock as "bastards" anymore? we realized that we don't visit the "sins"
of the parents upon the children.

so we are lucky to have any milk banks at all in this country, between AIDS
and ABM acceptance. i see the institutions as in the process of evolution, as
are all things. now about the casual exchange of milk. yes, where pamela is,
AIDS is pretty rampant, and one mother nursing another's without permission
is probably a radically dangerous activity. here in the us, there are various
approaches to other forms of AIDS avoidance. there are people like my SIL, an
AIDS social worker in new york city, who would tell you that any woman (yes,
any) who is in a sexual relationship with any man (yes, any, including her
husband) needs to practice safe sex.

when she first told me this i just laughed. i don't care to be married and
conduct my relationship that way. i could not live with that level of
mistrust. now, if i knew my husband were a questionable type, it would be
different. for women that are in relationships that the word "inequality"
clearly describes, we are probably advising them to practice safe sex and be
tested, etc.

but the same principles apply to casual milk sharing. you might decide that
you could never take a chance with your baby, and never need to have milk
other than your own. but if you have a close relationship with someone and
know their medical history and feel comfortable with it, then you may decide
to nurse their baby, or have them nurse yours. or to accept their milk to use
for your baby. of course you can know someone's medical history, but not know
that last week they did something dangerous. that's called life. we take a
lot of chances in every day we live, and have to do our best to make
reasonable decisions. some mothers feel that accepting the untested,
unpasteurized milk of another mother they have a relationship with is
preferable to exposing them to the known, quantifiable, recognizable,
lifelong risks of ABM.

i also don't believe that i can ethically do this work and tell someone to
use ABM. sorry, i just don't. this business of casually filling bottles with
ABM and giving it to babies (especially in a hospital, for god's sake!) or
giving it to parents to feed to babies is not possibly something someone with
these hotly disputed initials should be doing without the most compelling
reason.

i discuss using ABM only when i have helped someone with information about
breastfeeding, pumping, or obtaining donor milk. if they bring up the subject
of casual milk exchange, i help them with the information they need to make
an informed decision. occasionally, the use of ABM is unavoidable, and i give
parents as much information as i can about its use and how to choose. if they
have been using formula already to supplement, i give them the other
information and tell them "if you feel comfortable continuing to use ABM that
is your choice, i just want you to know the facts."

yes, i have nursed children other than my own. i considered the facts of the
situations extremely carefully and closely. i know the medical history of
those involved very very well. i feel that not being hidebound by fear has
given me an opportunity to have a beautiful, loving and generous human
relationship that has undoubtedly been experienced by millions of women
throughout human history, but is now rarely experienced by those of us in
countries where we "have so much."

i have had a few patients whose husband was from "that kind" of country. they
kiss their babies, they hold them, and one of them, when his wife asked a
question about co-sleeping, exclaimed "of course he couldn't sleep alone, he
would be lonely!"

of course human babies need human milk, that's why the phrase is "the milk of
human kindness."

carol brussel IBCLC

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