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Breast Milk: A Woman-to-Woman Commodity

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Breast Milk

A woman-to-woman commodity

Breast milk.  Women produce it, quite literally, and babies consume it.  History shows that production and consumption is not always between biological mother and child, and that there has been a supply chain in play for as long as women have been having babies. 

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Wet nurses, cross-nursing, informal milk sharing, and milk banks are all part of the chain today.  New Zealand is no different to the rest of the world and through organisations such as Piripoho Aotearoa, Mothers Milk NZ Charitable Trust, and Human Milk for Human Babies NZ the process of sharing breast milk is easily facilitated. For most families informal exchanges occur but the recognition, backed up by scientific studies, that human milk is the best food for babies born prematurely has resulted in New Zealand’s first donor milk bank opening in February 2014.

Feedback from women linked to Neonatal Intensive Care Units (NICU) around the country showed there was a real demand for donor breast milk.  It is with these women, the women who see it as crucial for their babies, who have shaped the donor milk ‘industry’ and who hold the power in this particular supply chain.


Sidney Mintz (1995: 8) states, “We do not understand at all well why it can be claimed both that people cling tenaciously to familiar old foods yet readily replace some of them with others”.   This could not be more true of breast milk which is the ultimate first food for babies.  If humans don’t eat they die.  For centuries babies whose mothers were not able to supply breast milk would have died, and so wet nursing or cross-nursing would have been necessary for survival.  Today artificial baby milk (formula) is widely and easily available.  Aggressive marketing by companies such as Nestle has seen women the world over turning to these products, mostly made from cow’s milk, rather than trusting their own milk made specifically and perfectly for human babies.  The tide is turning however and with programmes such as the Baby Friendly Hospital Initiative, launched by the World Health Organisation (WHO) and UNICEF in 1991, breastmilk is being acknowledged as the optimal nutrition for babies. 

Even celebrities are doing it.  The Daily Mail reported in 2011 that Salma Hayek had wet nursed a one week old baby in Sierra Leone because that baby’s mother was malnourished and unable to produce milk herself.  As a result the baby was hungry and crying.  Hayek brought the baby to her breast as naturally as if it were her own.  Sir Elton John and his husband had the milk of their baby’s biological mother sent by FedEx to their home rather than turning to artificial baby milk, and according to Diana Appleyard a household staffing agency in Beverley Hills, USA has been receiving more and more requests by its wealthy and breast implanted clients for wet nurses. The message is slowly taking hold. 

“Human milk for human babies”, “breast is best”, and the United Nation’s statement “breastfeeding can save your baby’s life” are just a sample of the phrases being freely and liberally spread by proponents anxious to see the next generation of human babies off to the very best start.  It is not difficult to find comprehensive lists, compiled from various studies, which show health benefits such as lower risks of Sudden Unexpected Death in Infancy (SUDI), lower incidences of allergies, asthma, obesity, and diabetes, lower rates of cholesterol and inflammatory bowel disease, and even higher IQ in children who received mother’s milk.

Breastfeeding women also benefit with lower rates of osteoporosis, greater postnatal weight loss and having their risks of breast, ovarian and uterine cancer being much lower than non-breastfeeding women.  Given the benefits that come with breastfeeding for both mother and baby it seems breastmilk is truly a miraculous substance.

The team who campaigned hard for the donor milk bank which opened in Christchurch in February 2014 agree that breast milk is the best food babies born before their due dates can be given.  Dr Maggie Meeks, NICU paediatrician at Christchurch Women’s Hospital, told Nicole Mathewson in an article for Stuff.co.nz that, “Nothing is better than breast milk; it’s the most immunological and nutritious milk that they could have.”

The demand for donor milk in New Zealand was such that after four years of campaigning and fund-raising by various groups such as Neonatal Trust (Canterbury), Mother’s Milk NZ, and Homebirth Aotearoa, and key individuals including Dr Maggie Meeks, Anthea Franks, Helen Little and Bernard Hutchison, a milk bank was opened in February 2014 in Christchurch.  In response to a need a formal way of exchange was born. 

Milk banks attached to some maternity facilities were closed in the 1980s due to the HIV virus becoming an increasing concern.  It wasn’t then a completely foreign concept to think that donor milk banks might happen again.  In response to campaigning many people in the Canterbury and West Coast regions donated money to the Canterbury Neonatal Unit Trust Fund so they were able to provide the $150 000 in start-up costs.

The Canterbury District Health Board has agreed to cover annual running costs of around $50 000.  Because the operating costs will be coming from the NICU budget this donor milk will only be available to the high risk infants in the unit.  The main costs come from the pasteurisation process with Australian estimates putting costs at $11AU to produce 100mls of pasteurised human milk.  This is considerably more expensive than the cost of producing artificial baby milk however Dr Meeks points out that the long term savings and health gains will outweigh these costs (Press release Canterbury District Health Board 12 Feb 2014).
 
Donors are generally women who have a baby in the NICU at Christchurch Women’s hospital and who may be expressing far more milk than their own baby requires although any woman who has milk in surplus of her own baby’s requirements is invited to check their suitability.  To begin the process they will be given information on milk donation, asked to complete a questionnaire, and then given blood tests to ensure they are free of HIV, Hepatitis B and C, and syphilis, as well as HTLV 1 & 2.

A health screen asks if mothers have insulin dependent diabetes, chronic illnesses, or have been in intimate contact with likely carriers of STIs.  Anyone answering yes to these questions as well as organ or blood donation recipients, and those who have had a tattoo in the previous six months will be declined as a donor.  The screening goes further and looks at dietary habits, smoking, alcohol consumption, illegal drug use, prescribed medication, and herbal and vitamin supplements.  Suitable donors are then required to sign a consent form.

Donors are given a breast milk pump if required, sterile collection bottles, labels for the bottles, plastic bags and ties, ‘amounts’ tags, and a human milk bank donor card.  They will also be given information on hygiene guidelines as it is crucial that everything is kept as clean as possible in order that the milk doesn’t become contaminated.Breastmilk.  Women produce it, quite literally, and babies consume it.  History shows that production and consumption is not always between biological mother and child, and that there has been a supply chain in play for as long as women have been having babies.  Wet nurses, cross-nursing, informal milk sharing, and milk banks are all part of the chain today.  New Zealand is no different to the rest of the world and through organisations such as Piripoho Aotearoa, Mothers Milk NZ Charitable Trust, and Human Milk for Human Babies NZ the process of sharing breastmilk is easily facilitated.  For most families informal exchanges occur but the recognition, backed up by scientific studies, that human milk is the best food for babies born prematurely has resulted in New Zealand’s first donor milk bank opening in February 2014.  Feedback from women linked to Neonatal Intensive Care Units (NICU) around the country showed there was a real demand for donor breastmilk.  It is with these women, the women who see it as crucial for their babies, who have shaped the donor milk ‘industry’ and who hold the power in this particular supply chain.\

Sidney Mintz (1995: 8) states, “We do not understand at all well why it can be claimed both that people cling tenaciously to familiar old foods yet readily replace some of them with others”.   This could not be more true of breastmilk which is the ultimate first food for babies.  If humans don’t eat they die.  For centuries babies whose mothers were not able to supply breastmilk would have died, and so wet nursing or cross nursing would have been necessary for survival.  Today artificial baby milk (formula) is widely and easily available.  Aggressive marketing by companies such as Nestle has seen women the world over turning to these products, mostly made from cow’s milk, rather than trusting their own milk made specifically and perfectly for human babies.  The tide is turning however and with programmes such as the Baby Friendly Hospital Initiative, launched by the World Health Organisation (WHO) and UNICEF in 1991, breastmilk is being acknowledged as the optimal nutrition for babies. 

Even celebrities are doing it.  The Daily Mail reported in 2011 that Salma Hayek had wet nursed a one week old baby in Sierra Leone because that baby’s mother was malnourished and unable to produce milk herself.  As a result the baby was hungry and crying.  Hayek brought the baby to her breast as naturally as if it were her own.  Sir Elton John and his husband had the milk of their baby’s biological mother sent by FedEx to their home rather than turning to artificial baby milk, and according to Diana Appleyard a household staffing agency in Beverley Hills, USA has been receiving more and more requests by its wealthy and breast implanted clients for wet nurses. The message is slowly taking hold. 

“Human milk for human babies”, “breast is best”, and the United Nation’s statement “breastfeeding can save your baby’s life” are just a sample of the phrases being freely and liberally spread by proponents anxious to see the next generation of human babies off to the very best start.  It is not difficult to find comprehensive lists, compiled from various studies, which show health benefits such as lower risks of Sudden Unexpected Death in Infancy (SUDI), lower incidences of allergies, asthma, obesity, and diabetes, lower rates of cholesterol and inflammatory bowel disease, and even higher IQ in children who received mother’s milk.  Breastfeeding women also benefit with lower rates of osteoporosis, greater postnatal weight loss and having their risks of breast, ovarian and uterine cancer being much lower than non-breastfeeding women.  Given the benefits that come with breastfeeding for both mother and baby it seems breastmilk is truly a miraculous substance.

The team who campaigned hard for the donor milk bank which opened in Christchurch in February 2014 agree that breastmilk is the best food babies born before their due dates can be given.  Dr Maggie Meeks, NICU paediatrician at Christchurch Women’s Hospital, told Nicole Mathewson in an article for Stuff.co.nz that, “Nothing is better than breastmilk; it’s the most immunological and nutritious milk that they could have.”

The demand for donor milk in New Zealand was such that after four years of campaigning and fund-raising by various groups such as Neonatal Trust (Canterbury), Mother’s Milk NZ, and Homebirth Aotearoa, and key individuals including Dr Maggie Meeks, Anthea Franks, Helen Little and Bernard Hutchison, a milk bank was opened in February 2014 in Christchurch.  In response to a need a formal way of exchange was born. 

Milk banks attached to some maternity facilities were closed in the 1980s due to the HIV virus becoming an increasing concern.  It wasn’t then a completely foreign concept to think that donor milk banks might happen again.  In response to campaigning many people in the Canterbury and West Coast regions donated money to the Canterbury Neonatal Unit Trust Fund so they were able to provide the $150 000 in start-up costs.  The Canterbury District Health Board has agreed to cover annual running costs of around $50 000.  Because the operating costs will be coming from the NICU budget this donor milk will only be available to the high risk infants in the unit.  The main costs come from the pasteurisation process with Australian estimates putting costs at $11AU to produce 100mls of pasteurised human milk.  This is considerably more expensive than the cost of producing artificial baby milk however Dr Meeks points out that the long term savings and health gains will outweigh these costs (Press release Canterbury District Health Board 12 Feb 2014).
 
Donors are generally women who have a baby in the NICU at Christchurch Women’s hospital and who may be expressing far more milk than their own baby requires although any woman who has milk in surplus of her own baby’s requirements is invited to check their suitability.  To begin the process they will be given information on milk donation, asked to complete a questionnaire, and then given blood tests to ensure they are free of HIV, Hepatitis B and C, and syphilis, as well as HTLV 1 & 2.

A health screen asks if mothers have insulin dependent diabetes, chronic illnesses, or have been in intimate contact with likely carriers of STIs.  Anyone answering yes to these questions as well as organ or blood donation recipients, and those who have had a tattoo in the previous six months will be declined as a donor.  The screening goes further and looks at dietary habits, smoking, alcohol consumption, illegal drug use, prescribed medication, and herbal and vitamin supplements.  Suitable donors are then required to sign a consent form.

Donors are given a breastmilk pump if required, sterile collection bottles, labels for the bottles, plastic bags and ties, ‘amounts’ tags, and a human milk bank donor card.  They will also be given information on hygiene guidelines as it is crucial that everything is kept as clean as possible in order that the milk doesn’t become contaminated.  Once a donor has 1 litre of milk frozen in her home freezer (stored for up to three months) she will take it into the Human Milk Bank where it is given a unique number and kept frozen until it is required for pasteurisation.  At this time a sample is taken and a bacterial count done.  Random samples may be checked at any point for quality control purposes.

Donated breast milk is considered such an important commodity that strict criteria are in place regarding the babies who will be given this precious substance.  The Human Milk Bank aims to have enough donor milk available for all infants under 35 weeks gestation whose mothers are unable to express. Other babies who may be considered suitable to receive donor human milk are those with surgical or ischaemic gut risks, and at the Neonatal Consultant’s discretion.  It is only ever given with the consent of the baby’s mother and only until her own milk supply is able to support her baby’s needs, or for as long as the criteria apply.  All potential risks are explained as are alternatives to donor breast milk.

Storage freezers at the Milk Bank are colour coded – red for raw milk, yellow for pasteurised milk awaiting test results, and green for the pasteurised milk which has been given the all clear and is safe for babies to consume.  Only milk from the ‘green’ freezer will make it into the ‘milk room’ (located within the NICU but away from the Milk Bank) where individual babies feeds are made up.

A lot rides on the donors.  Here is where the power lies.  Without women willing to be screened, and tested, and taking the time to clean, sterilise, express and store, this type of milk donation would not happen.  In New Zealand there is no payment made to donors so they really are doing it for love and the good of compromised babies who thrive on breast milk.  It is recognition of the age old sharing of resources between women.  A desire to help the sisterhood and their babies.  A recognition of human milk as an important and natural food source far superior to any manufactured between the walls of a laboratory and warehouse.

The monetary costs involved are significant especially when considered on a per millilitre basis however the savings in terms of health benefits and less strain on the health system, in the short term, and potentially over the recipient’s life time, are immeasurable. There is a cost in time for the donors as well.  It can be taxing emotionally, mentally and physically to feed a child at the breast and then sit a while longer to remove what is left in order that it be appropriately packed, stored and transported before being used by a stranger’s infant.  While it is fortunate and necessary for Government agencies, in this case the Canterbury District Health Board, to legislate and put into place stringent guidelines to ensure the safety of all involved, there would not be a milk bank without milk to bank. 

The battle now is to begin human milk banks in other areas of New Zealand.  Extensive marketing was done by way of press releases, use of experts in the field of infant health, development and nutrition, to normalise the process of using a woman’s milk other than the mother for a baby in need.  Premature babies and their families in Christchurch who have been recipients of donor milk would no longer blink an eye at the thought of milk sharing.  With good planning and perseverance neither will the premature babies in other regions in time to come.

  
References:
Mintz, S. (1995) Food and its Relationship to Concepts of Power. In Food and Agrarian Orders in the World-Economy, edited by Philip McMichael. Westport: Praegar: 3-13.
 
http://www.radionz.co.nz/news/national/235943/christchurch-breast-milk-bank-opens
 
http://www.dailymail.co.uk/tvshowbiz/article-1141584/Salma-Hayek-breastfeeds-strangers-baby-Africa-mother-runs-milk.html
 
http://www.dailymail.co.uk/tvshowbiz/article-1380266/Elton-John-mothers-milk-brought-baby-Zach-FedEx.html
 
http://www.dailymail.co.uk/femail/article-480407/The-return-wet-nurse.htm

Once a donor has 1 litre of milk frozen in her home freezer (stored for up to three months) she will take it into the Human Milk Bank where it is given a unique number and kept frozen until it is required for pasteurisation.  At this time a sample is taken and a bacterial count done.  Random samples may be checked at any point for quality control purposes.

Donated breastmilk is considered such an important commodity that strict criteria are in place regarding the babies who will be given this precious substance.  The Human Milk Bank aims to have enough donor milk available for all infants under 35 weeks gestation whose mothers are unable to express. Other babies who may be considered suitable to receive donor human milk are those with surgical or ischaemic gut risks, and at the Neonatal Consultant’s discretion.  It is only ever given with the consent of the baby’s mother and only until her own milk supply is able to support her baby’s needs, or for as long as the criteria apply.  All potential risks are explained as are alternatives to donor breastmilk.

Storage freezers at the Milk Bank are colour coded – red for raw milk, yellow for pasteurised milk awaiting test results, and green for the pasteurised milk which has been given the all clear and is safe for babies to consume.  Only milk from the ‘green’ freezer will make it into the ‘milk room’ (located within the NICU but away from the Milk Bank) where individual babies feeds are made up.

A lot rides on the donors.  Here is where the power lies.  Without women willing to be screened, and tested, and taking the time to clean, sterilise, express and store, this type of milk donation would not happen.  In New Zealand there is no payment made to donors so they really are doing it for love and the good of compromised babies who thrive on breastmilk.  It is recognition of the age old sharing of resources between women.  A desire to help the sisterhood and their babies.  A recognition of human milk as an important and natural food source far superior to any manufactured between the walls of a laboratory and warehouse.

The monetary costs involved are significant especially when considered on a per millilitre basis however the savings in terms of health benefits and less strain on the health system, in the short term, and potentially over the recipient’s life time, are immeasurable. There is a cost in time for the donors as well.  It can be taxing emotionally, mentally and physically to feed a child at the breast and then sit a while longer to remove what is left in order that it be appropriately packed, stored and transported before being used by a stranger’s infant.  While it is fortunate and necessary for Government agencies, in this case the Canterbury District Health Board, to legislate and put into place stringent guidelines to ensure the safety of all involved, there would not be a milk bank without milk to bank. 

The battle now is to begin human milk banks in other areas of New Zealand
Extensive marketing was done by way of press releases, use of experts in the field of infant health, development and nutrition, to normalise the process of using a woman’s milk other than the mother for a baby in need.  Premature babies and their families in Christchurch who have been recipients of donor milk would no longer blink an eye at the thought of milk sharing.  With good planning and perseverance neither will the premature babies in other regions in time to come.

 
 
References:
Mintz, S. (1995) Food and its Relationship to Concepts of Power. In Food and Agrarian Orders in the World-Economy, edited by Philip McMichael. Westport: Praegar: 3-13.
 
http://www.radionz.co.nz/news/national/235943/christchurch-breast-milk-bank-opens
 
http://www.dailymail.co.uk/tvshowbiz/article-1141584/Salma-Hayek-breastfeeds-strangers-baby-Africa-mother-runs-milk.html
 
http://www.dailymail.co.uk/tvshowbiz/article-1380266/Elton-John-mothers-milk-brought-baby-Zach-FedEx.html
 
http://www.dailymail.co.uk/femail/article-480407/The-return-wet-nurse.html

 

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