Pam asks how milk is tested for HIV.  It isn't, to my knowledge, nor is it
tested for any other viruses.  If I am mistaken on this I will let you know.
Milk is cultured for bacteria.  Donors are tested for evidence of various
viral infections, current or past.  Women with no evidence of CMV infection
are in demand as donors for the smallest, most premature babies, because
they are only given banked milk from CMV-negative donors.  If their own
mothers test CMV-positive, the babies can still have their own mothers'
milk.  CMV isn't such a concern for babies of higher gestational age.

I recently encountered a Somali woman whose baby was born at 33 weeks by
emergency CS for cord prolapse.  She vehemently refused to allow her baby to
get donor milk when approached about it in the recovery area after her
surgery under general anesthesia.  She requested a clean container and
promptly expressed enough colostrum to feed the baby then and there, and
continued to do so from then on.  I removed her staples on day 5 and asked
her then about her attitude to donor milk, because I was curious.  She
explained that a woman who provides milk for a baby, becomes its mother, and
her baby already had a mother, namely herself.  "One baby, two mothers, not
good!" was her explanation.  "If I die, and of course I hope that I don't,
insh'allah, then my baby would need another mother.  But I am alive."  Then
she added as an afterthought, "Some men want to have two wives.  I don't
like that either."

I have to say it is a lot more fun caring for immigrant women when we can
converse about things, not to mention how much more I can learn from them
under such circumstances.

Our practice with regard to testing of donor milk reflects several things
about Norway: the low prevalence of many serious viral infections in the
childbearing population, the easy availability of testing for potential
donors, and the high prevalence of lactation, making it possible for us to
be choosy about whose milk is accepted for use by premature or ill babies.
If this were a country with high prevalence of HIV infection, or even
Hepatitis B and C, we would likely have different policies.  Current policy
here is to give HIV-positive women cabergoline when the baby is born and the
option of breastfeeding is not considered for one moment.

Rachel Myr
Kristiansand, Norway

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