I've been too busy with other obligations to respond lately, but have
a bit of time now.
This thread has been interesting in a lot of ways, not least for how
few people have responded to one of Sarah Vaughn's original points,
which I cut and paste here, from her post of Saturday 26 May:
"The question I posed above lies in precisely such an area; there
simply *isn't* any evidence that I can see that formula would be worse
than donor milk for supplementation of an older (6 - 12 months)
breastfed baby. So, would you really advise a mother in that situation
that she should if possible get donor milk rather than formula for
supplementing her child? If so, why? After all, that advice is not
free of significant potential disadvantages."

In earlier posts, Sarah pointed out that for some families, the money
required to get hold of enough donor milk to feed the baby might mean
that parents were forced away from their child for much more time
since they might have to hold two jobs or work a lot of overtime to
pay for it. To my mind this is a 'significant potential disadvantage'
.

I think the evidence that formula would be worse than donor milk for
supplementation of a baby over 6 months is indirect evidence.  Have
any studies been done showing the different degrees of harm to a
healthy, previously breastfed child who later is fed on donor milk or
formula?  Is there anywhere in the world where such a study could
conceivably be done (a place with limitless access to donor milk and
no ethical restrictions on research)?  There is no age at which human
milk becomes less suitable for a human than any other milk, but what
is the magnitude of the risk to the individual child, and more
importantly, how are we to frame that risk in an individual
consultation with one family?

Some aspects of breastfeeding protection fit well into the meeting
between mother and baby, and some fit better at policy-making level.
To hold individual families responsible and practically accuse them of
wilfully harming their children if they make use of a breastmilk
substitute seems to me just plain unkind and probably unhelpful to the
cause of promoting breastfeeding. Those responsible for the scarcity
of human milk are the ones we need to target, not those suffering from
that scarcity.

The children I have known who really suffered from being fed
breastmilk substitutes were vulnerable at the outset. I have been
outraged and frustrated to the point of despair at the lack of support
their mothers received for even maintaining their own milk supplies,
and at the cavalier attitude to the risks of artificial feeding of
these children on the part of health professionals who really ought to
have known better. I've counseled numerous women on how to rebuild
their own milk production when it seems a child isn't doing well on
complementary foods and/or formula, and I don't know of any other
health professional in my country who does this - they don't write or
talk about it if they do it. I do not play down the effects of
breastmilk substitutes when informing mothers and fathers in the early
days. I don't have the option of suggesting they go out on the open
market to buy human milk because it is simply not a serious
alternative here. Informal milk sharing and cross-feeding between
relatives and friends takes place and I endorse it fully. But a
Norwegian woman who sells her milk to the highest bidder would be so
out of character for this culture that I would be hard put to
recommend doing business with her. I admit to being completely
ignorant about such activity here; it's not high-profile if it is
going on at all.

Meanwhile, I would love to know more about why, in this country with
paid leave for nearly a year and a hyped-up image in the health
services that we are the World Breastfeeding Champions (they actually
SAY that, in public, to my embarrassment), most children are weaned
before they are a year old and almost none are exclusively breastfed
or breastmilk fed, for six months. If anyone is aware of published
research on breastfeeding support in Norway I would like to know about
that too.

Rachel Myr
Kristiansand, Norway

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