Dear Lactnetters,
This is a current case story (to be continued)
A woman who is 
- pregnant with her first child, 
- who is under the care of the public obstetric clinic of a Level 3 hospital, 
- and for whom I am providing private midwifery care, developed gestational diabetes at 34 weeks.  
- Her blood sugar levels were consistently high, and she has been monitored carefully for the baby's condition and her condition  She has been on insulin injections for several weeks.  The pregnancy is now at 38 weeks.

This woman has no professional medical background, but is eager to be well informed.  We have discussed breastfeeding the newborn, and the hazards of artificial formulas.  The woman understands the possibility that the medical care of her baby is likely to include early supplementary feeding, if the baby's blood sugar levels are low when tested.  (The hospital involved has good laboratory testing available.)
The woman visited a "baby friendly" neonatologist working in that unit, and has discussed her situation.  The woman's sister in law is willing to become her milk donor - should a back-up to her own milk be needed.  The doctor has agreed, and a consent form has been signed.  The milk donor has had blood tests for HIV and hepatitis.  Sterile containers have been provided, and the doctor has asked that a supply of 1 litre of frozen milk (in small containers) be made available from the time of the baby's birth.

This process is what I see as the best model for milk banking in a place where no formal milk banking (pooling and pasteurisation) is available.  I am very conscious of my need to facilitate the effective breastfeeding when this baby is born, but I feel confident that this baby need not receive any non-human milk.  I hope that others who advise women whose babies may have a medical need for supplementation will be prepared to tell the women that there is a reasonable alternative to artificial formulas.

I'll let you know how we get on.
Joy Johnston
Midwife IBCLC
Melbourne, Australia