while it is true that all the points kathy dettwyler makes, about advocating
for exclusive bf for the first six months, and then weaning, rather than a
mixed program that would promote weaning, it is true that many mothers feel
they cannot provide all the milk to exclusively breastfeed, and are not
willing or not able to do what needs to be done to accomplish this. strictly
in terms of health of the baby, if they were able to continue to provide at
least some of the milk for the entire year, their baby would be better off
(maybe exclusive bf as long as possible, maybe the first four or six months,
then mixed? of course by then they could introduce solids.) the reason i say
this is that many babies and children who receieve donor milk from the milk
bank receive first a complete diet of breastmilk, then eventually are weaned
down to a maintenance amount, which seems to keep them relatively healthy and
able to tolerate the other stuff.

informed consent about this whole issue would mean that mothers would have to
know in every detail what using even one feeding of ABM would imply; they
would also have to know all about the dangers of ABM and the scrupulous levels
of cleanliness etc. they would have to maintain (oh how i love the "how to
teach formula feeding" piece for this data). they would have to know just how
likely they were to end up completely weaning if they introduce mixed feeding.

so while i agree with all that using even one bit of the "other stuff" is to
be avoided, your situation sounds like it needs another approach. educate the
mothers FULLY and see what happens.

carol b.