Milk Junkies

Trans Women and Breastfeeding: A Personal Interview

2013-05-09T22:20:00.001-05:00

So far, this blog has exclusively addressed issues faced by transmasculine folks. I started writing it from my personal experience, and I am transmasculine. However, I've received several questions from trans women who are interested in breastfeeding. After doing some Google searches, I realized that just as there is little to no information for trans men on this topic, there is not much written for trans women. In particular, I haven't found any personal accounts or interviews. I will try to do my part to fill a little bit of this gap. This is part one of a mini-series on trans women and lactation. Enjoy!

Trans women, individuals who were assigned male at birth but identify and live as women, CAN breastfeed. It is possible, and totally awesome! Health care providers, volunteer breastfeeding counsellors, and trans women themselves need to learn this important, empowering fact.

Over the last few weeks, I spoke a couple of times with a trans woman and mother, who we'll call Sarah, to better understand how she became a parent and successfully induced lactation. Sarah's baby is now more than a year old and they still enjoy a wonderful breastfeeding relationship. I'll give a bit of background here on conception and then launch into our lactation interview.

Sarah and her wife are both genetic parents to their baby. Sarah explained to me that many doctors, endocrinologists and trans women erroneously believe that after taking antiandrogens and hormone replacement therapy for a relatively short period of time (depending on who you're talking to, they may say something between six months and two years), a trans woman will be permanently infertile, despite not having had 'bottom surgery'. This is to say that even if she halts her hormone therapy, it is claimed that she will not be able to produce viable gametes. Sarah believes this claim is based not on science, but on a widespread lack of understanding of trans women’s bodies and many healthcare professionals’ lack of interest in helping them preserve their fertility.

Despite having taken hormone replacement therapy and antiandrogens for 5 years, Sarah was still able to produce what she calls ‘baby-making ingredients’ following a six-month cessation of her medication. Trans women hoping to help make a little munchkin should note that it takes about three months for their gametes to grow and mature. In addition, this genetic material is very sensitive to heat and needs to develop away from the body, below core body temperature. A trans woman who usually ‘tucks’ will need to change how she dresses for a while to regain her fertility.

Sarah banked her gametes, a choice she believes all trans women should be offered. Another five years later, when she and her wife decided to conceive, Sarah went off her hormones once again to obtain a fresh DNA contribution if possible. She was again successful, after a total of ten years on hormones and antiandrogens. The couple was able to conceive at home, an option that was far less expensive than using the previously banked material at a clinic.

They chose to have a homebirth because they wanted to avoid unnecessary medical interventions. As a lesbian couple, they were also worried about their relationship being questioned by hospital employees.

SARAH: We had the most incredible midwife for the birth. When we first met her, we explained our situation, and she used the term "non-gestational mom," which I’d never heard before. I loved that when confronted with a situation that had been confusing for so many doctors and nurses, she had a perfect, descriptive word for my relationship to my baby, right on the tip of her tongue and didn’t stumble over whether to use ‘non-biological’ or ‘donor’ or something else inappropriate. I'm one of the two genetic moms of my baby, but I'm the non-gestational mom.

ME: So you didn't have to educate your midwife at all about trans issues. That's awesome! What steps did you take to induce lactation? Which health care providers did you approach for help?

SARAH: I didn't know where to start. I looked through my health insurance booklet for an endocrinologist. There was a section that said "reproductive endocrinologist," which sounded just right. I called a couple of different offices until I got someone to call me back.

I said to the nurse, "Here's what I'm looking for. I know that this doctor doesn't have any experience with this, because NO ONE has any experience with it. I'm not looking for her to know what's going on, but I have an idea what I want to do, and I think I know what I need. I just want somebody to work with me."

When I saw the doctor, she said, "I think this is very unlikely to work, but I'm happy to help you try."

I didn't feel like she added that much to the process, other than prescribing the hormones I needed.

ME: When did you first think that you might breastfeed?

SARAH: We definitely thought about it before we got pregnant. It had been a vague part of our plan. I was inspired by the book, Confessions of the Other Mother: Non-Biological Lesbian Moms Tell All. As an aside, I really don’t like this use of the word ‘non-biological,’ referring to both parents and trans people. Just because we transitioned, or just because someone's not genetically linked to their child, that doesn’t mean we’re made of styrofoam. We’re flesh and blood, we have real live bodies that are ours, and that hold and love our children. There is no such thing as a non-biological person. But reading the book was really worthwhile, and one of the things that struck me was the difference in a mom's experience when she had not had a breastfeeding relationship with her baby. I wanted our roles in caring for our baby to be defined as little as possible by who gave birth to him, and for us to be able to give the same kind of comfort to him. As we started reading more, I got pretty attached to the idea of breastfeeding and really hoped it would work out.

ME: What medications did you take to induce lactation?

SARAH: People sometimes say that birth control pills ‘simulate pregnancy.’ Another effect of this medication is to stimulate the development of breast tissue. If you haven't been through a normal female puberty and haven't had progestins in your system, birth control pills are necessary to help build milk ducts and glandular tissue. Estrogen increases during pregnancy, and then after birth it drops sharply.

I modified the Newman/Goldfarb protocol for induced lactation a bit, since I was already taking hormones. I started replacing my usual estrogen with birth control pills (Nortrel 1/35, each pill contains 1mg of a progestin and 0.035mg of synthetic estradiol) about six months before our baby's birth. Closer to the due date, I added half my regular dose of estrogen, and then stopped taking it after the birth. Two weeks after the birth I started pumping and taking domperidone. [Note: Domperidone is a drug generally used to control nausea, but has the side effect of increasing lactation output, often quite dramatically. Domperidone for breastfeeding support is an off-label use of the drug. It can be difficult to obtain for that purpose in some countries such as the US. In others, it is much more commonly available.]

ME: We know that breastfeeding works via a supply and demand system. If the baby does not take enough milk from the gestational mother, her body will produce less milk as a result. If the baby nurses more and demands more milk, the gestational mom will produce more. In the early weeks, the amount that a baby nurses and draws milk helps to determine the gestational mother's milk supply later on. Having the baby nurse from you, Sarah, would also increase your supply, since a healthy baby is more efficient than a breast pump at removing milk from the breast. What did you do after your baby was born? How did you protect your wife's milk supply while bringing in your own?

SARAH: We wanted my wife to breastfeed him exclusively for about the first 4-6 weeks so that she could establish her supply. I pumped during that time. After about the third day of pumping, I started to produce some milk. It was weird, because I was used to pumping and pumping and not getting anything. I looked down that day and there were tiny milky droplets, and they were firm, almost like wax. I kept pumping, and I kept getting that weird consistency, and then the next day, it was softer. It got thinner until it was just milk. I didn't expect it to come in like that – it didn’t come in all at once like my wife’s milk did after she gave birth. It came gradually and it took days before the first drop fell into the pump bottle. But it looked like milk, smelled like milk, and tasted like melted ice cream. You could put it in your coffee or whatever!

ME: How was your experience of latching your baby in the beginning?

SARAH: It probably helped that it wasn't his first attempt. He pretty well knew what he was doing. He’d been nursing on my wife since he was five minutes old. I did find that, especially when I was very full of milk, my breasts were not really soft enough to go into his mouth. Some lactation consultants recommend making a sandwich to help smush your breast into the baby's mouth, and I had to do that. When he was little, I don't think he could get my breast far back enough in his mouth to trigger the sucking reflex without quite a bit of help from me. But after a few months I didn’t have to do that anymore. My wife and I both had more issues with nursing early on than we do now, because when babies are so small, you can't really get very much [breast tissue] in and you have to hold their head at just the right angle.

ME: Yeah, it gets so much easier as they get bigger and stronger. How did you and your wife share nursing duties?

SARAH: When I started nursing, my milk came in quite slowly, so it didn't seem to have any effect on my wife's supply. I would pump every time he nursed on her, and at first, she would try to pump every time he nursed on me. That way we wouldn't be hurting each other's supply. After a couple of months, we stopped pumping. We were sharing nursing and had a freezer full of milk – we decided to just let it be. Neither of us had enough milk to keep him happy all day long, but we both stayed home from work for quite a while so it worked out well.

ME: How was the experience of co-nursing overall?

SARAH: The breastfeeding relationship with my son is so amazing, it's more wonderful than I ever imagined. I feel so connected to him, and he is so bright and independent and I think part of that is having such secure attachments to both his moms. Plus, it's incredibly convenient. I think all parents who can manage to do it should try. In the early months we got twice as much sleep because we were cosleeping and he just rolled back and forth between us to nurse when he needed to. ["Or half as much sleep", Sarah's wife joked.] Either of us could take him out for an afternoon without worrying about bottles or getting him back home in time for a feed.

Then when our baby was about six weeks old, my wife had to go to the hospital for surgery. She was there for almost a week.

ME: Wow, how lucky that you were both nursing then!

SARAH: It was really, really lucky. We didn’t get good breastfeeding support from the hospital. We had doctors insisting she not breastfeed because of medications when our midwife and lactation consultant knew it was fine. They gave us no support with pumping. I think that for a lot of moms a situation like that could have been the end of the breastfeeding relationship, and it was a huge help that we were both able to nurse him.

ME: Do you have any idea how much milk you ended up producing?

SARAH: It's changed over time. I'm working outside the home now. I was pumping at work for the first four months, but he’s nursing less now and I’ve stopped needing to pump. Our baby is eating solid foods really well now. He still loves nursing and when he comes home he really wants a feed. Back when we were full on breastfeeding exclusively all the time... when I woke up in the morning if I hadn't nursed a lot overnight, I could pump and get 4 ounces.

ME: That's amazing! Lots of gestational moms have trouble pumping that much.

SARAH: Yeah, I had a lot of milk! I didn’t expect inducing lactation to work so well. When my wife was in the hospital and he was nursing on me all the time, I did have quite a bit of pain. We sorted that out with our midwife who realized I probably had low-grade thrush, which makes everything very painful. At first, I thought, "It must just hurt to breastfeed this much." I found out that it wasn't normal and we fixed it.

ME: Are you still taking domperidone now?

SARAH: I tried to wean off domperidone. The dose you have to take to induce lactation is quite high. I slowly reduced my dosage. I found though that if I took less than four 10 mg tablets per day, then my supply really suffered. The protocols for induced lactation say that if you take domperidone, you will probably need to take it until you wean. It's not quite the same self-regulating supply and demand system as experienced by a gestational parent. Also, I'm taking half of my pre-breastfeeding dose of estrogen, which is not recommended while nursing because it can have a negative effect on milk supply. It is considered safe for the baby though.

As well, I'm currently taking one combination birth control pill that is mostly a progestin. A lot of literature says that progestin is not advised for trans women because there is supposedly 'no benefit' to it: it doesn’t increase breast size over estrogen alone. But that is not why I take it. When I was preparing to induce lactation [and taking progestins], my moods were so fantastic. I felt much more calm and loving, and I just really liked how I felt in myself. So, I decided after being just on estrogen for a while that I wanted to go back to having a progestin as well.

ME: Did you try to get help with lactation from any other care providers besides your midwife and endocrinologist?

SARAH: I wrote to La Leche League through their web site where you can send a message to a local volunteer. I asked if they knew anything about what we were trying to do. The response I got back was from somebody saying I didn't have real breasts so I obviously couldn't breastfeed. It was from somebody definitely not educated about trans issues. I think this is actually quite commonplace among health care providers, too. I don’t know what goes on in some people’s heads about trans women – I guess they think we all strap on rubber boobs or something? Yet some feel qualified to give medical advice in spite of their total lack of knowledge.

ME: People also focus so much on the amount of milk that is made and not on the relationship. So what if you didn't produce a drop of milk?

SARAH: Yeah, exactly. People should be supported to breastfeed however they can do it. I think it's a shame that so many people don't think about trans people's bodies being capable of breastfeeding, and that they don't consider and value the breastfeeding relationship. They think it's just about gestational moms and that no one else can do it. That presents two problems: how they think about breastfeeding, and how they think about trans people as well. Health care providers need to be more flexible and help trans people have more control over our own healthcare. We deserve to have the same choices that most other people have when it comes to our fertility and to caring for our children.

Big thank you to Sarah for sharing her thoughts and experiences with us! Watch for the next post in this series on trans women and lactation – I'll be talking with lactation consultant, Mary Lynne Biener, and Dr. Jack Newman from the International Breastfeeding Centre in Toronto.

The Gay, Breastfeeding HOCKEY Dad?

2013-04-19T15:55:00.001-05:00

Last week we celebrated our son's second birthday! We've been breastfeeding for two years.

Jacob is still dedicated to 'nay-nay.' He asks to nurse frequently throughout the day, always nurses to sleep for his nap, and still breastfeeds many times during the night.

His other main passion is hockey! We play hockey every day, inside and out, we read hockey books, and watch hockey videos on YouTube.

How did the gay, breastfeeding dad end up with such a hockey-loving son, you ask? A few months ago, we took Jacob swimming at a sports complex that also had a hockey rink. On a whim, we wandered in to watch the game that was going on, and our kid has been hooked ever since. That day, he watched the big kids playing and hitting the boards. He eagerly called out, "Owee! Crash!" and immediately learned the words 'hockey,' 'puck,' 'net,' and 'goal.' He sobbed in anguish, toddler-style, when the game was over and it was time to go home.

Another word my son shouts during hockey games is 'nay-nay.' When he sees a player take a hard fall, he insists the guy should nurse. It's what makes sense to him. I've nursed Jacob several times when we're both wearing skates and parkas following owees of his own on the ice at our community club.

I have a feeling that both hockey and nursing will be with us to stay for quite a while, and I'm curious to see how that will play out. These days, I get approving smiles from the macho hockey dads who see us at the ice rink. "He just loves it!" I tell them. They respond with, "It's good to start 'em young! Good on ya." We do some skating on our own and then usually find a place to nurse for a bit to recover from the cold. So far no one's noticed.

I'm trying to imagine nursing Jacob in a year or two amongst the other hockey dads after he's cut his lip in an 'owee crash.' I can't quite picture it yet, but I'm sure we'll find our way, and hopefully make some friends in the process.

Queering Arizona's Toilets

2013-03-24T00:05:00.001-05:00

The Arizona state legislature is considering passing a bill that would prohibit a person from using a restroom that is not associated with the sex listed on his or her birth certificate. A large part of me feels like this is too stupid to bother blogging about. Another part of me can't stop laughing. My serious side is extremely concerned by the fact that, if this bill was to actually pass, transgender men and women in Arizona would likely face an increase in violence.

Perhaps a visual would help. Below is a photo of Buck Angel, a transgender man. Representative John Kavanagh, the genius behind this piece of legislation, is insisting that men like Buck should use the women's restroom.

Buck Angel

The basics of the proposed legislation is this: if you go to the "wrong" potty and get caught, you could be jailed for six months. The idea is ridiculous for a number of obvious reasons. Who will police and enforce this law? Will people have to show their birth certificates (not just their driver's licenses, even!) before they can pee? Yes, we could joke quite a bit here about the "potty police".

The terrifying aspect of this bill is that it would force already vulnerable trans women to use men's restrooms. As Ida Hammer from the Trans Women's Anti-Violence Project points out, violence against trans people is almost always committed against trans women. In 2009, 50% of lesbian, gay, bisexual, transgender, queer and HIV-affected (LGBTQH) murder victims were trans women. However, trans people only make up 1% of the LGBTQH population. Obligating trans women to use men's washrooms is asking for trouble – this forces them to out themselves and highlight their transgender identity in order to pee.

It is evident that Representative Kavanagh has no knowledge of the transgender community. He reportedly stated that "this law simply restores the law of society: Men are men and women are women." I believe that he thinks all transgender people are trans women in the midst of transition or who do not pass easily.

Kavanagh wants these women, the intended target of his legislation, to use men's facilities, presumably because he thinks that they look like men and are "actually" men. What he doesn't realize is that there are many trans women and lots of trans men who no one would ever suspect as being trans. For example, if I walked into a women's bathroom today (under Kavanagh's proposed law, I would have to – my birth certificate says female), I'm sure the women there would be rather surprised. The effects of testosterone therapy (facial hair, male pattern baldness, thickened vocal chords resulting in a deep voice, etc) are extremely powerful for most trans guys, who virtually always pass as male. Even though I stopped taking testosterone a couple of years ago to have a baby, I still pass (and identify) as male at all times.

Kavanagh's bill would result in queering washrooms, not straightening them out. Trans men who are indistinguishable from cisgender (non-trans) men would have to use women's bathrooms. Hence, Kavanagh wants Buck Angel in the ladies' room. In a certain way, I think this could be great! If trans men were to obey such a law, the general public would suddenly realize just how many trans people there really are and how "normal" we look (not to mention that we all have to pee, just like everyone else). It's hilarious to think that Kavanagh's bill would inadvertently turn restrooms into mixed gender spaces. I've often thought that doing away with gender-segregated restrooms would be nice.

Using a Supplementer Long-Term

2013-02-11T16:30:00.001-06:00

I've been thinking about this post for ages and was finally inspired to sit down and write it when someone asked me for advice on the matter. So, thank you for the question!

On demand, supplemented nursing sessions with a newborn or young baby seemed obvious enough. When Jacob was hungry, we fed him. When he wanted more, we gave him more. I almost always used supplement during our nursing sessions.

When we introduced solid foods, we assumed that food would take the place of some of the donated breast milk we were continually struggling to find. To our surprise and dismay, it didn't seem to work that way. Jacob took a long time to really get good at eating solids, and even once he did, he never seemed to want any less milk. I sometimes tried to nurse him without using supplement, but he strongly preferred the fast flow that he was used to. Some people suggested not using supplement at night, yet I found that if I didn't he would get increasingly frustrated until he was wide awake. If I used the supplement, I could get him back down to sleep much more easily in the middle of the night (not that it has ever been easy, per se...).

I casually asked friends what they thought I should do, and several pointed out that if a parent with normal milk making capacity nurses frequently, he or she will continue to produce plenty of milk even as the child gets older. In contrast, a La Leche League Leader explained that as the baby gets older, the parent's milk supply naturally decreases. Others noted that babies who were bottlefed typically still get, even as toddlers, a large bottle of milk before going to bed and another one for nap time.

Around the time I was trying to figure out how to proceed, I saw a post in my parenting group from a mom of a 14 month old baby. She was newly pregnant, and her milk supply had disappeared. Her 14 month old still badly wanted to nurse, but this was painful for the mom. They went through a challenging weaning process and the mom started giving bottles of donated breast milk. Her child needed both the milk and the nursing relationship, but it was not possible for her to give. They did the best they could under the circumstances.

I know of another parent who, like myself, is breastfeeding after having had chest surgery. She makes enough milk to have the occasional let-down, but does not have a full supply. Her toddler is two and a half years old and nurses a lot AND gets a significant amount of milk in bottles. Early on, they used a supplementer, but they eventually got to a point where the child no longer wanted it. Their nursing relationship is still very strong.

In another example, the parent of a friend of mine used a supplementer due to her diagnosis of insufficient glandular tissue (IGT), and continued nursing until her child was three. As a toddler, the child would ask for "big milk" when she wanted to nurse using the supplementer, and "little milk" when she wanted to bare nurse. Given the variety of stories I'd heard, I decided to just keep doing what we were doing, since it seemed to work okay for both of us. We switched to putting cow's milk in the supplementer when we could no longer get donated human milk, with no apparent ill effects.

The issue came up again last fall when Diana West came to Winnipeg for a conference. She is the author of Defining Your Own Success: Breastfeeding After Reduction Surgery, and, of course, she is an expert on at-breast supplementation. She stayed with us for a few nights, and was shocked to see just how much supplement we prepared to take to bed with us in the evenings. I felt so busted! If I remember correctly, the much-admired breastfeeding authority said that Jacob doesn't need much milk at this point – it is the nursing relationship that he wants and needs. She reminded me that he was getting some milk from me. She also enthused about how much easier my life would become if I no longer needed to carry supplement around on outings or take it with me to bed at night.

I tried harder this time to wean ourselves from our crutch, but with the same result as before. If I didn't use the supplement, Jacob would quickly get frustrated. The universal and incredibly irritating toddler habit of nipple twiddling got infinitely worse (not surprisingly, this is something babies do to try to get a let-down!), and I again couldn't get him back to sleep at night. To add to the troubles, nursing without much coming out was quite uncomfortable for me, too. Jacob will be two in April, and this is where things stand: we still use lots of supplement at night, during naps, and to re-connect at other points during the day. Sometimes we go on outings without it and I nurse him as needed, but often I take it along for back-up, and then don't end up using it.

As Jacob's vocabulary increases, he is beginning to express how he would like to nurse. He says "nay-nay" for nursing, but also "milk" when he wants to use the supplementer. Sometimes he pleads with me "up!" and "fridge!", until I get up and grab the supplement from the fridge. Other times I ask him if he wants me to get the extra milk and he shakes his head "no" while he is latched on. Ultimately, Diana and everyone else said that we have to do what works for us, and I couldn't agree more. We'll let you know as we go.

Trans Kids and Reproductive Choices

2013-01-25T15:02:00.001-06:00

Trans kids today have new options for transition. Few people even know about these possibilities, although awareness is increasing. In my own pre-teen years, I noticed that my girlfriends were starting to change, and I felt different from them. In my private, inner thoughts, I believed I should be a gay boy, but that seemed so very far from what was possible in reality that I wondered from time to time if I was crazy. I didn't know about the existence of transgender people until I was an older teenager, and even then, I had no idea that trans kids could access any kind of specialized medical help.

Photo: Visit Cape May (Creative Commons)

Hormone blockers have long been used to delay the development of secondary sex characteristics in children experiencing precocious puberty. More recently, paediatricians have started prescribing them for trans kids. This prevents a female-to-male (FtM) trans boy from growing unwanted breasts and experiencing other pubescent changes. In the case of a male-to-female (MtF) trans girl, the blockers halt all the powerful effects of testosterone, including deepening of the voice and changing of the face shape. At age 16 or 18, depending on who you're talking to, patients can begin taking synthetic hormones so that they will develop the secondary sex characteristics of their intended gender, or they can take nothing and develop according to their genetics.

The effects of the hormone blockers are completely reversible. Nevertheless, if an FtM teenager takes them and then takes testosterone as a young adult, his female sexual organs will not mature. I don't know if they would ever mature if he stopped taking the testosterone some years later. Testosterone use in FtM trans guys who transitioned after puberty can cause female sex organs to atrophy, and may also result in polycystic ovary syndrome (PCOS), which can lead to permanent infertility. I haven't been able to find good information concerning its effect on individuals who used hormone blockers and never produced natal hormones.

If I'd known about hormone blockers and the possibility of transitioning earlier in my life, would I have done so? I don't know. I didn't have the social supports necessary for transition at that time. It's hard to separate such a support system from an individual's emotional readiness. I wonder if I may have been much happier earlier in my life if I'd been able to transition as a teenager. I don't know if the choice would have been as clear for me at age 12 or 14 as it was at 23.

If you had asked me when I was ten years old if I thought I would ever want to birth a baby, or even adopt one, I would have for sure said no. At age twenty and even twenty-four, I would have still said no. Nobody asked me. When discussing transition, I don't remember being asked by my therapist, family doctor or endocrinologist if I thought I ever would want to have kids. My surgeon definitely didn't talk to me about future breastfeeding. I'm guessing that most trans people and their health care providers assume that infertility is the price we pay for transitioning. Recently, some people have accused me of wanting to "have it all" – meaning the correct gender identity and my child. Well, isn't that what most others can enjoy?

I didn't contemplate having a relationship and a family until after I'd taken testosterone and had top surgery. I wasn't content enough before that to have any inkling of what I really wanted in that regard. Now, my son and my husband are the most precious parts of my life.

Do I think that trans kids shouldn't take hormone blockers so that they can maintain their reproductive potential? Do I think they shouldn't transition at a young age? No and no. Each individual has to make his or her own decision. Others can guess at how badly someone needs to transition and when, but only the person contemplating transition can really know. Some trans kids suffer from such severe gender dysphoria that they are depressed and even suicidal. These children often feel that they need to transition as soon as possible. Others, like I was, can kind of manage by keeping very busy and not being terribly self-aware – they might not need to transition as urgently.

Sometimes I wish that I could wake up in the morning with a physiologically male body, but I would never trade my baby for anything. Most of the time, I enjoy traveling my unique path. I am comfortable enough with my male-sounding voice, my beard, and my flat chest. The parts of me that I don't love so much are what helped to make the family I love so deeply. This is my conundrum.

Malunggay: Breast Milk Super Vegetable

2013-01-10T20:50:00.001-06:00

For those of us whose jeans are noticeably tighter as a result of endless holiday feasts, this is a post about an Asian super vegetable, called malunggay, that happens to be great for breast milk production. Ian and I need this more than most right now because we just returned from a trip visiting (and eating heartily with) Jacob's grandparents, after celebrating Christmas at numerous indulgent gatherings with our friends here in Winnipeg. It has all added up to way more meat, baked goods, and candy than we care to admit. We came home vowing to exercise more, eat healthier, and to avoid buying anything other than fresh produce since our pantry is overflowing with slimming foods like lentils and beans (nice that these foods have already been purchased – flying across the country was wonderful, but pricey).

Cooking malunggay into a curry

I first heard about malunggay when my dear friend and the very fancy author Diana West came to Winnipeg to speak at the Baby Friendly Conference in the fall. As a lactation consultant, she says that malunggay is her number one go-to food for increasing milk production. It is native to the foothills of the Himalaya and is sometimes called moringa, horseradish tree, benzolive tree, kelor, marango, mlonge, moonga, nébéday, saijhan, sajna or Ben oil tree. India is the largest producer of Malunggay, although it is also grown in the Philippines, Thailand, Taiwan, Malaysia, Africa, and Central and South America. Cultivation is in early stages in Hawaii for the US market.

Malunggay grows as a slender tree, with all its parts, including bark, stems, roots and leaves, being edible. The most nutritious part of the plant is the leaves, which contain, gram per gram, "SEVEN times the vitamin C in oranges, FOUR times the Calcium in milk, FOUR times the vitamin A in carrots, TWO times the protein in milk and THREE times the Potassium in bananas." A double blind study suggested that consuming malunggay leaves has a considerable positive impact on breast milk production.

Malunggay helps increase milk production

A number of companies include malunggay in capsules meant to increase one's milk supply, but I prefer to buy it fresh. I have found the leaves at several local Asian markets. I simply asked, "malunggay?" and got pointed in the right direction by someone who knew. The leaves are very versatile ingredients – they are wonderful in soup, but also delicate enough to be added fresh as a garnish to salads. One of the most traditional dishes that includes malunggay leaves is sour Thai curry.

Wish us luck with our New Year's resolution and let me know if you come up with your own great malunggay recipes. I'd love to hear them!

Breastfeeding: My ultimate parenting tool

2012-12-11T16:56:00.001-06:00

I am so grateful for nay-nay. That's Jacob's term for nursing, one that he started using about two weeks ago. Before that, I relied on cues like his thumb sucking and pulling at my shirt buttons to figure out when he wanted to breastfeed.

We've entered a new stage of toddlerhood that I'm told is normal, and familiar to parents everywhere. It's called "NNNNNNNNOO!" It is accompanied by furrowed little eyebrows, pursed lips, and flailing arms and legs.

This morning when we woke up, I tried to kiss Jacob on the forehead, and he said, "NNNNNOO!" I asked him, "Do you want eggs or oatmeal for breakfast?" I got, "NNNNNOO!" Later, he brought me his boots, and I said, "Good idea, we'll go outside," to which he responded, "NNNNOO!" In the afternoon, I said, "I love you, you're sooooo sweet," and, you can guess it, he replied, "NNNNNOO!"

Mercifully, he is almost always happy to nurse, and frequently asks for his nay-nay. In these moments of peace that punctuate Jacob's otherwise limitless and energetic curiosity, I know that he loves me. He is busier than any person I know, constantly exploring the world and striving to be independent, until he insists that he needs nay-nay.

I need it, too. Nursing is my most effective parenting tool. When Jacob is overwhelmed with frustration over having to take turns with a toy or eat only one treat instead of ALL the treats, we can turn to nay-nay to cope with the exploding emotions.

I once read a wonderful essay on this subject by Ruth Kamnitzer, a Canadian woman raising her child in Mongolia. She described how Mongolian mothers and even grandmas and grandpas literally wave their breasts around to try to distract toddlers in the middle of an argument. Instead of tediously explaining how to share, over and over again, they simply breastfeed, with a 100% success rate. Finally, I understand this anecdote on a personal level. I can open my shirt and point to my nipples, saying "nay-nay!" and thereby get Jacob to calm down and nurse.

In public, I don't often use nay-nay as a parenting tool, but I know that it is available in my repertoire if we need it. Tonight, for example, a well-meaning stranger tried to pick Jacob up to help him into a shopping wagon. He turned and ran from her, utterly terrified. As I held him, he gasped for breath and said a broken "nay-nay," a request that I couldn't possibly deny. I unzipped my winter coat and sweater and nursed him at the check-out counter. I waited for Ian to pay, and then we walked out of the store together, Jacob still nursing, his sobs slowing down. Ian smiled at us and nodded, agreeing, "Nay-nay."

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Birth and Death: Helping a Toddler Say Goodbye

2012-11-28T16:51:00.001-06:00

I've learned a lot in the last few days. Our family knew already for a few weeks that a tough time was looming ahead of us. Our dog was diagnosed with stomach cancer and wasn't responding well to medications. After a difficult, painful weekend, I arranged for a veterinarian to come to our home to euthanize her.

I had asked my vet what she thought we should do with Jacob, now 19 months, during this process. She recommended that her assistant take him into a different room, and told me that when I talked to him about our beloved Quinoa, I should try not to cry because it could make him fear death. Well, I knew right away that this wouldn't be possible for me to accomplish.

Quinoa was a sweet, gentle soul who taught me about good parenting, including cuddling, co-sleeping, and patience. Oh, the patience that this dog had! She taught Jacob the importance of being kind (she would get up and calmly walk away if he wasn't), sharing food with others (she was always polite but she did have a way of letting him know when she deserved a piece of his bread or a morsel of his egg) and catching snowballs (he hated snow this season until he saw Quinoa playing in it about two weeks ago). There was no way I wasn't going to cry over parting with her.

As Quinoa's final days approached, Ian and I both realized that Jacob would be most upset if he saw me having such intense emotions but was separated from me. He had to be there with us. When the time came, Ian cradled Quinoa's head in his lap, and I put my lips to her ear and told her all about the car rides she would enjoy and the cheese she'd love to eat again. Jacob stood quietly between us and watched, one small hand on my back and the other holding my shirt sleeve.

We stayed with Quinoa for many hours after she died. I washed off the urine that she had released at the moment of her passing, and we took turns grooming her still soft and shiny coat. Jacob found an old bottle of her ear drops and tried to administer them. We went over every single part of her body - we felt every lump and bump, noted which of her toes were white and which black, remarked on the beautiful, warm orange colouring on the underside of her tail and the details in her clear, blue eye. We felt her body become cooler, and then stiff. Spending this time with her body helped each of us to celebrate her life and accept her transition. Jacob looked at her and asked me, "Owee?" I told him, no, not anymore. He responded, "Oh."

I remembered that we deeply need to do many of these tasks with our newborns, too, in order to meet them, celebrate their birth, and establish bonding and breastfeeding. When new parents are free from medical interference, they examine every tiny bit of their babies, touching them everywhere, even smelling and licking them. This is what we require as mammals and humans. We and our loved ones, both those we are welcoming and those we are wishing farewell, deserve this time and space together to try to come to terms with the mystery of consciousness. Too frequently, babies are whisked away and bathed by nurses, and bodies of loved ones are "touched up" and cleaned by professionals instead of those who knew them best.

Everywhere I go, I think of Quinoa. I look around for her, but she's not lying under the painting of Everest on the wall, or by the window, or at the front or back door, or on our bed. I regret that Jacob is not at an age where he will remember her, but we'll tell him stories and show him photos of his dear friend. He may have a sense that death is something that happens, and through which we hold each other, in the midst of our tears.

Saying No to Nursing for the First Time

2012-11-02T17:17:00.001-05:00

Yesterday we had to take our dog to the vet. We had a 10am appointment, but Jacob decided to have a party from 5am to 8:30am, after waking every half hour to nurse throughout the first part of the night. I think somebody was processing his Halloween experience (no, he didn't have much candy at all). I called the vet to get a later appointment and we all slept in.

Minutes before our new and improved appointment time, I was still scrambling to get everyone ready. Diaper (we don't tend to bother with them in our own house), two layers of pants, socks, shoes, sweater, coat, and the hat and mitts that my boy won't wear but I feel I should have with me so that I don't look like quite such a neglectful parent. What can they say if the mitts on a string are dangling from his sleeves? I'm trying, right?? I whip his hat out of my pocket and stick it on him when someone walks by, and then he promptly rips it off. Somehow we WILL get this figured out by the time it gets dangerously cold here.

I got my own shoes on, found the dog's leash under a mountain of toys, and was finally putting on my coat when Jacob pointed at the zipper I was doing up. He started to pull it down. "You want to nurse?" He nodded. Now? "We can't right now. We're late. We really have to go. We're going to the vet's office – maybe you can pet the cat. Would you like that?" He nodded again. For pretty much the first time ever, I said we couldn't nurse right then. I offered to trade nursing for a cat, and it worked!

We rushed down the road and coaxed the dog into the vet's office (at least this time I didn't have to carry all forty pounds of her AND the toddler up the stairs). I thought we might have a moment to nurse while we waited, but since we were late, we were ushered straight into an exam room. The vet came right in, and Jacob was well enough distracted by all the goings-on. As we were wrapping up our conversation, Jacob zipped open my sweater and started pulling at my shirt. The vet smiled and said, "He just wants to be really close right now doesn't he?" I SO didn't feel like explaining that I'm trans, had this baby myself, and yes, still breastfeed him at 18 months. I zipped my sweater back up and cuddled him instead, which more or less worked.

Nursing is the fastest way to get Jacob to sleep

By the time we got back home and sat down for a nice, unhurried nursing, over an hour had passed since he had first asked. It is incredible to think of how this has changed since the newborn days when waiting a few extra seconds to get the supplement from the fridge seemed like a disaster. This is the beginning of a gradual, gentle weaning process that I expect will take years. If Jacob had fallen and bonked his head and NEEDED to nurse at the vet's office, I would have done it no matter what. Had he badly wanted to nurse for any reason, we would have nursed. But this time he didn't. While typing this post, I've been holding him asleep on my chest, and we've nursed a few times when he fussed over the last hour. I'm sure we've got hundreds, if not thousands, of hours of nursing time yet to come, but things are starting to shift.

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Using an At-Chest Supplementer

2012-10-31T16:28:00.001-05:00

Making an at-chest supplementer is easy and cheap.

Note that this post is not medical advice. I am sharing here what I have learned through personal experience. If you are concerned about your baby's health, seek help from a doctor.

Using an at-chest (at-breast) supplementer is a great way to feed your baby if you are unable to produce all of the milk he or she requires. This method is completely supportive of the nursing relationship, and does not involve your baby latching on to any artificial nipples, such as bottle nipples. As wonderful as it is, this kind of supplementer can be brutally hard to use at first. I've been using one for over eighteen months, so I'll share some tips!

First, let me explain what it is. All the different versions consist of a container to hold the supplement and a long, narrow tube. One end of the tube goes into the supplement, and the other end is placed right by your nipple. Your baby latches onto both the tube and your nipple simultaneously, drawing supplement from the container and getting all the milk that you are producing, too.

What's great about it? Using an at-chest supplementer allows you to do all feedings at your own chest. This is amazing for your nursing relationship and all the bonding that comes with it. It's also important for promoting normal jaw development in the infant – the physical action of chestfeeding develops a baby's muscles differently than bottlefeeding does. Using the supplementer helps you produce more milk, too, because even at times when your baby is only receiving supplement and you are not producing any milk, your chest tissue is being stimulated to make more. For those who produce little to zero milk, using the supplementer makes it possible to still have a nursing relationship.

How do I get one? You can buy a commercial supplementer, or you can easily and cheaply make your own. I prefer the homemade kind, so that's what I'll describe first. You can use any baby bottle to hold your supplement. Get gavage tubes from a pharmacy, or in bulk from a medical supply store. The kind to look for is 5 French (that's the diameter), 36 inches in length. You might want a tube with a bigger diameter if your baby has a weak suck, a complication of some conditions such as cleft palate or prematurity. Using a shorter tube is super irritating because it forces you to hold the supplement container so close to your baby's mouth (who has enough hands to do all that?!). Cut off the extra plastic bits, if there are any, on one end of the tube. The other end will be closed and rounded and will have two or three holes just before the tip – I cut off this part too because otherwise the supplement doesn't seem to come out easily. Some don't do this because they believe that cutting this end makes the tube sharp (we never experienced a problem with this). Thread one end of the tube through the bottle nipple (expand the opening of the nipple with a knife if required) so that it is sitting in the supplement. To clean the tube after use, just suck some hot water through it. Do not boil this kind of tube – it is not made from materials designed to withstand such a hot temperature.

The main difference between the homemade and commercial systems is cost. The Lact-Aid is $48.75 or $62.50, depending on whether you get the deluxe or standard model. The Supplemental Nursing System (SNS), made by Medela, was $42.99 on Amazon when I checked at the time of writing. It should be noted that Medela is a company that violates the World Health Organization's code on the marketing of bottles and artificial nipples. Unfortunately, its product name, SNS, is often incorrectly used as a generic name for a supplementer. You can make your own supplementer for the cost of any baby bottle and nipple and a $5.00 gavage tube. If you use this system in the long-term, you will end up spending a fair bit on tubes. They can be bought in bulk for about $1.00 a piece, and most people replace them once per week (or when they get too stiff to use) – so, you could spend $52 on tubes if you use the homemade supplementer for one year. I've been told by several people who used an SNS or Lact-Aid for over a year that both systems hold up very well to wear and tear and rarely need replacement parts.

With both the SNS and the Lact-Aid, the supplement container hangs around your neck. I like my homemade version because I can put the container down beside me on a table or hold it between my knees – I hated the idea of something relatively heavy dangling from my neck. I also like being able to have a decent amount of supplement on hand. The containers of the SNS (re-usable) and Lact-Aid (disposable bags) are smaller than most baby bottles. My number one reason for using my homemade version is that it is simpler – it has only three parts (bottle, nipple, and tube).

Moulding the chest tissue and positioning the tube

How do you actually use this thing?? Some people latch the baby on first, and then sneak the tube in through the corner of the baby's mouth by moving a bit of breast tissue gently out of the way. This never worked for me. I have so little chest tissue that if I moved any part of it, my baby would lose his grip immediately. A downside of this method that a friend of mine learned the hard way is that it may become impossible to sneak the tube into your baby's mouth once he or she has teeth getting in the way.

There's a lot to have to juggle between latching your newborn and placing a tube. This is how I do it: I get my baby in position and latch him first without the tube (otherwise he gets too antsy waiting for me to have everything ready). Then I take the end of the tube and get it near the end of my nipple. I briefly un-latch my baby. I use my thumb and middle finger to mould my chest tissue into a shape that my baby can latch to, and use my index finger to position the tube so that the end of it is in line with the tip of my nipple. The tube comes from above my nipple so that it points to the roof of my baby's mouth when he latches. I slip my index finger out of the way just as he is latching on and then I hold the tube in place for an extra second or two until the supplement is flowing up the tube. Some people tape the tube to their chest, but this didn't work for me. The tube would always flip in the wrong direction when I tried to mould my chest tissue for my baby to latch.

About to latch

Using a supplementer is initially very challenging. I couldn't position it on my own for the first two weeks! My partner had to help me with every single feeding until I developed this method of doing it on my own. It helped when my baby's latch became stronger. Nowadays, at eighteen months, I don't even think about it. My baby latches himself on, and I know exactly where the tube needs to go so that the supplement will come up easily.

Have you used a supplementer? Do you have any additional tips to share that we should know about?

The End of Donor Milk

2012-10-15T00:12:00.001-05:00

Yesterday, Jacob turned 18 months old, and tonight I thawed our last remaining bag of donated human milk. About two weeks ago, we saw that the end was near and started mixing donor milk about half and half with cow's milk. So far, Jacob has tolerated this reasonably well. We'll continue to give him donor milk when we can find it and families with younger babies don't want it, but at the moment, our freezers are storing nothing but the summer's vegetables.

I can hardly believe that we did this for 18 months. Jacob took about 25 ounces of supplement a day for much of that time, adding up to nearly 14 000 ounces of donor milk in total. We never needed formula. Some donors gave us a few two-ounce bags, while others filled our deep freezer. We are deeply grateful for every drop of it.

When Jacob was four days old, and we began supplementing, we wanted to make it to just one week on only human milk. We knew that even this would make a difference to his rapidly developing gastrointestinal tract. When we got to one week using human milk, we wondered if perhaps we could find donations for him for one month. Then two months. Then three. Six (plus solid foods). One year?! 16 months?!!! Yes. The World Health Organization recommends breastfeeding to two years of age and beyond, remember?

Finally, in the last few weeks, Jacob's first set of molars finished coming in and he has been starting to chew food with considerably more ease. I guess it's time. He's ready to start munching solid foods as a large part of his diet!

I suddenly had the thought as I thawed this last bag, "Tomorrow will be Jacob's first day having only cow's milk and no human milk." Then I realized what an incredible disservice that notion is to myself. I have been breastfeeding, and producing breast milk for my boy, for the past 18 months. The donor milk is what I see all the time. I collect it, store it, thaw it, pour it into bottles, and Jacob sucks it up the at-breast supplementer. It's easy to feel as if I make nothing for him.

I don't know how much I actually produce considering how much supplement Jacob takes, but I can still spray milk when I hand express. Perhaps this amounts to a few ounces per day. Eventually this evening it dawned on me: Jacob will keep getting human milk as long as I keep breastfeeding him. I'm really doing it.

I LOVE Toddler Nursing

2012-10-08T15:36:00.001-05:00

Nursing my kiddo has never been more fun than it is now.

Boy covers my nipple with his hands. Looks at me. Grins. I show my surprise and confusion: "Where, oh, where did my nipple go? I just can't seem to find it anywhere!" Boy takes his hands away, with a triumphant ta-da type gesture. I demonstrate my delight: "Oh, there's my nipple!" Repeat in classic peekaboo-with-toddler fashion.

Boy looks at my nipple. Yep, he's got that I'm-about-to-latch look on his face. He obviously wants to nurse. He leans in, kisses my nipple, and then pops back up and laughs uproariously. He tricked me! Repeat and repeat.

Some of the best moments of all happen after my boy has had a usual toddler tumble. He reaches up for my arms. Once I'm holding him, his right thumb goes in his mouth and his left hand searches through my shirt buttons. "Do you want to nurse?" I ask him. He nods his head quickly between full body sobs. There is no more guessing – he knows what he wants and how to tell me. He can affirm that, yes, absolutely yes, the only thing that will do right now is nursing.

We started out assuming we would formula-feed with bottles, and now I'm nursing an 18-month-old. I can't wait to see where the rest of this amazing parenting journey will take us.

Milk-Sharing: Safe Infant Feeding and Being a Human

2012-09-30T18:20:00.001-05:00

The last post for this year's World Milksharing Week Blog Carnival comes to us from Jake Marcus at Sustainable Mothering. She shares with us her personal story of a huge oversupply, and hosts a highly informative piece by James Akre that was originally published by babygooroo on June 28th, 2012. For those of you who may be just joining us now in the blog carnival, Deena Blumenfeld brings us an introduction to milksharing that you can read on her blog, Shining Light.

Milk-Sharing: Safe Infant Feeding and Being a Human
from Sustainable Mothering

Back in the 1990s, I had more breast milk than I could handle. I knew then and know now that many women, due largely to the circumstances of their lives and not their biology, are not able to produce all the milk their children need. And there are breastfeeding people (some cis-female and some not) who have biological reasons why they can't produce enough breast milk for their children.
Well, that is where people like me can come in.

By the second trimester of my first pregnancy, my perfectly happy "Barely B" cups had become G cups. I didn't know there were G cups and never had desired to own them. When my first son was born, I pumped in the fruitless hope that he would drink breast milk from a bottle while I was in court. He had other ideas. Then I pumped for comfort because I was constantly engorged. I could pump eight ounces in five minutes, switch bottles, and pump another eight ounces. But my son would have none of it. He wanted breasts or nothing.

Pretty soon I had a freezer stocked full of pumped breast milk my son wouldn't drink. So, after some research, I contacted HMBANA in the hope of finding a good home for my gallons of milk. But I was also on an SSRI at the time – one then and now considered entirely safe for breastfeeding children. The HMBANA policy, I was told then, was that no milk donations would be accepted if the donor was on any medications whatsoever. So HMBANA would not accept my milk.

When son number two was born, not only did I have over supply but overactive let-down. That meant my first let-down would hit the back of my son's throat with such force it triggered his gag reflex and he chomped down in an attempt to slow the flow. There are only so many times a baby, affectionately nicknamed "Moose" for his ten pound birth weight and trap-like mandibles, can chomp on your nipples before something must be done. That something was pumping before each feed so that my let-down was not so fast. And that meant more gallons of breast milk in my freezer.

There were no informal milk-sharing networks on the Internet in the nineties. Or if there were, I didn't know about them. So I was forced to pour gallon after gallon of breast milk down the drain.
Menschheit is a difficult word to translate. Literally it is the German noun meaning "humanity" or "mankind," but I grew up hearing it used in Yiddish to describe a quality – the quality of acting like a real human being. This, in Yiddish, is considered a good thing. Giving my abundant excess breast milk to a baby who needed it seemed to me to be the most basic menschheit. It is what a person does if she is really human.

It made me incredibly sad that I couldn't find a home for my breast milk. And it makes me very happy that today people with excess milk can find other people who need milk and make the exchange. This is menschheit; it was what humans do for one another.
Following is a post written by economist and breastfeeding expert James Akre about the safety and necessity of milk-sharing. It was originally published by baby gooroo on June 28th and is reprinted here with the kind permission of Akre and baby gooroo:

Since pre-history, mothers in need of human milk have relied on other mothers in their family and community with milk to spare and share. According to the World Health Organization (WHO) and UNICEF, the second-best feeding option, after breastfeeding, is breast milk expressed by a child’s own mother, followed by milk from a healthy wet-nurse or from a human-milk bank.

The Milk-Sharing Debate

Weighing and Managing Relative Risk

What the Milk-sharing Community Advises

Informed Choice

Donor Screening

Safe Handling

Home pasteurization

Full Disclosure Reduces Risk

The Lorax and Other Milksharing Stories

2012-09-29T23:52:00.000-05:00

World Milksharing Week's Blog Carnival is pleased to present two blogs in Spanish. Vilma Badillo Rodriguez shares posts from her blog, Borinquen Lacta con Amor. One story reveals how a milk donation allowed a family to get their first night of real sleep in three months, while another involves the good fortune of one mother suffering from low supply meeting a parent with a great abundance.

Jesusa Ricoy-Olariaga, drawing from Dr. Seuss, explains in the following post how as a society we have completely mistaken milksharing for what it actually is. She's brilliant – I can't say anymore, you just gotta read it! In English, below, and here in Spanish.

I was kindly invited by a breastfeeding dad - yes you read that right - to write a post on milk sharing.

I am currently on holiday in my home town of Alicante in Spain where my brain has gone into relax mode but have still found myself trying to stumble across a story for the purposes of this article.

I wanted to look back and find the commonality of women feeding their children, their sisters' children and their friends' children.

I spoke with my mother who recalled talk of milksharing in her own family but, it was in connection with an older brother who died before she was born. Then I met a Muslim friend in the street and we talked about how in her culture babies who are not part of the same family but have been breastfed by the same woman are considered siblings and therefore can't marry. I called some associations in Alicante and a lovely girl told me that although she didn't know where I could find historical information, she did mention that her late grandmother breastfed other children.

What I was looking for I couldn't seem to find so I just tried to relax with my family. So we rented the movie The Lorax based on the tale by Dr. Seuss. It's an ecological story of how greed destroyed nature until everyone forgot how nature looked like and what impact it had for ourselves and all the things around us. There is a point in the story where the main character is explaining what real trees are like and the evil guy trying to control everything reacts by shouting how disgusting the earth is and how it breeds dirt and bugs and pollutes the air. He has become rich and all powerful by selling bottled air to people in this polluted world and I couldn't help thinking of the similarities with the way milksharing is depicted today on the few ocassions that it is even mentioned: as something that is weird and disgusting, risky, dirty even, as something that it is alien to us when actually it's what makes us us.

Earlier this year a couple of friends had minor issues with their babies. The biggest problem was trying to gain support from professionals for formula not to be administered as a simple remedy. One midwife threatened my friend with calling the social services if she accepted donated milk from any of us which we had expressed, something that for me came naturally after feeling my milk building up as the mum was telling me she needed help. I never felt anything beyond the fact that a human baby needed milk, a friend's baby. I had milk so why wouldn't I help? It was as natural as if someone was crying and I happened to have a handkerchief with absolutely no relation to the social perception of women fighting each other in their motherhood capabilities according to production, quality or endurance of their 'job'.

We do not do that. We mammals mother our babies. We nurture and care for them. We impose milksharing on cows. We steal their babies milk for our babies while we censor our own mothers' power and abilities because somebody once put a label to an imitation of something that cannot be imitated.

In The Lorax a tree was cut down. Then another and then some more until there were no trees left of even a memory of them. The perpetrator didn't have bad intentions. He simply saw that there was a need for his product.

Not that long ago there was a culture of normality of mothers feeding their babies, and indeed the babies of others. I am glad that even if I was personally unable to find out much from our past culture of milksharing, perhaps because milksharing was seen as an ordinary act of love within the greater matriarchal story that remains unwritten, I was thrilled to see so many references in my life to the new seed that will not allow our 'tree' - the milk of human kindness - to be forgotten.

Our milk is ours. Our babies are ours.

Our milk is free. Our babies are too.

" UNLESS someone like you

cares a whole awful lot,
nothing is going to get better.
It's not." Dr. Seuss

Ps: This post is dedicated to Trevor Macdonald a breastfeeding dad and everyone who cares a whole awful lot.

Winning the Milk Lottery

2012-09-29T13:38:00.000-05:00

In celebration of World Milksharing Week 2012, Diana West, BA, IBCLC, contributes this post about her personal story involving her son’s extreme allergies. Diana experienced internet milk donation before the existence of Facebook-based networks. Her highly informative books, Defining Your Own Success: Breastfeeding After Reduction Surgery and The Breastfeeding Mother’s Guide to Making More Milk have helped many thousands of parents struggling with low milk supply and have great relevance to the milksharing community. She is also the co-author of the bestselling book, The Womanly Art of Breastfeeding, 8th ed. Watch for her upcoming book about sleep and the breastfed baby, co-authored with Diane Wiessinger and Linda Smith, to be published by Ballantine Books in July, 2013.

Through the years, I’ve shared my story about breastfeeding after breast reduction surgery with many people. I didn’t have enough milk for my first son, Alex, but I was proud to be able to provide about 2/3 of his daily needs with my own milk, which I was pumping exclusively because he had a nursing strike at three months that I hadn’t known how to get past. Unfortunately, we had discovered from several scary reactions that he was severely allergic to cow’s milk protein, so we had to use the uber-expensive hydrolysate formulas to take up the slack. The part of the story that most folks don’t know is that he was once the lucky recipient of 700 ounces of human milk that was given to us by a very special mother in New Jersey.

The way this came about was that I saw a posting on a breastfeeding usenet newsgroup – in 1995, usenet newsgroups were the way people connected online using very basic, non-website message boards (pretty primitive, I know! – but it was great at the time). One day when Alex was about six months old, I saw a posting from a mom who had a seven-month-old baby. She wrote that she had accumulated more frozen milk for going back to work than her baby could ever use and she wanted to give it to a mom who didn’t have enough milk and a baby who had a special need for it. She had also undergone extensive infertility treatments in order to conceive her baby, so she had negative test results for just about every communicable disease under the sun to prove that her milk was safe. She clearly expressed that she didn’t want any payment for the milk other than the good feeling that it was going to a mom and baby who really needed it. With my low supply and Alex’s severe cow’s milk allergy, we fit the bill perfectly. The only catch was that the recipient needed to be within driving distance of her home to be able to transport the large quantity of milk inexpensively without thawing. Fortunately, we lived only three hours away.

Hoping against hope and feeling like it was almost too good to be true, I responded to her post as soon as I saw it, telling her our story and how much we would value her milk. I was amazed and elated when she responded just a few minutes later, agreeing that we were the perfect match and choosing us to receive her milk. I felt like we won the lottery. Not only would this help Alex with his allergies tremendously – hydrolysate formula has pre-digested milk proteins that cause fewer allergic reactions, but Alex’s severe eczema was proof that he still reacted to it – it would also save us a lot of money because hydrolysate formula cost about four times the price of regular formula. I was a stay-at-home mom and my husband was just starting out in his IT career, so times were tough and the cost of the special formula was a real stretch for us.

Once it was confirmed that we had “won” the milk, the milk-rich mom and I emailed back and forth to figure out how to get the milk from her location in New Jersey to ours in Maryland. The biggest challenges were figuring out how to keep the hundreds of two and four ounce bags of milk frozen on the three-hour journey home. My husband Brad and I also had to think of a way to store them safely when our only freezer was the small one on top of our fridge that was already jam packed with food. And all the maneuvers had to include our six-month old baby and Brad’s work schedule since we didn’t have family nearby to help out.

The storage problem was solved by deciding to buy the deep freezer we’d always wanted anyway. It was a big expense for us in those days, but we knew it would give us a way to buy food in bulk so it would actually pay for itself in the long run. We solved the journey problem by working out that we could drive there on a Saturday afternoon with baby Alex and lots of toys to entertain him (this was before DVD players and iPads!), pick up the milk bags, put them in several large insulated coolers that we borrowed from friends, stay long enough to visit with the family and thank them properly, and then drive back home fast enough without breaking any speed limits to put the milk in the new deep freezer before it thawed.

As it turned out, on the morning of the trip it took us forever to get the car packed with Alex, his toys, the many coolers, and everything else we needed for a day away from home with a little baby and an exclusively pumping mom. By the time we hit the road, we were running several hours behind, which kept the New Jersey family waiting anxiously for our arrival. The whole family had dressed up and readied their home for our visit, and while they waited and waited for us to get there, the older kids rode their bikes up and down their road looking for our car. We felt like such newbie, inefficient parents to keep them waiting like that, but they were so sweet and welcoming when we finally arrived.

Milk siblings forever.

As a special (but very token) way to thank them, I had made up a purple t-shirt for Alex that said “Milk Brother” and one for her baby that said “Milk Sister,” based on the Islamic teachings that children who share a mother’s milk are considered siblings and not allowed to marry. (Neither of us is Muslim, but we liked the tradition.) The mom loved the shirts. We put them on the babies and let them crawl around each other in her back yard while we snapped pictures. Then both families went out to a nice dinner and basked in the good feelings of their altruism and our deep gratefulness. Afterward, we loaded all the milk into the insulated coolers and started the urgent (but not speeding!) drive home. We made it back in good time and got all the milk safely into its new home in the deep freezer.

I don’t remember how long the milk lasted, but because he was so severely allergic to cow’s milk and many other foods, Alex needed milk and formula until he was nearly two. So we stretched those 700 ounces out as long as we could and always felt so happy each time we could use human milk instead of the expensive and horrible smelling hydrolysate formula. Eventually, the deep freezer bought just for the milk became more and more empty and we began filling it up with frozen vegetables and other foods. Alex is now almost 17 years old, and shaving and driving if you can believe it (and very embarrassed that I’m blogging about this). The milk and his need for it are long gone, but we still have the deep freezer and we’ll always have the warm and wonderful memory of a mother in New Jersey who shared her milk bounty to help our baby.

Scared Milk-less

2012-09-28T15:09:00.001-05:00

This beautiful, eloquent post by Lisa van den Hoven gives us a few straight truths about milksharing and helps put it all in perspective. What does it really mean to give your milk to a "stranger"? What exactly does milksharing look like?

Many thanks to Peaceful Parenting for hosting Lisa's piece in World Milksharing Week's Blog Carnival.

Lisa and her little one, who shares her milk.

Let’s talk about that controversial thing called milksharing. The facts, as I understand them, are that Emma Kwasnica, with the help of many other like-minded people, launched a global network, through Facebook, called Human Milk 4 Human Babies. The aim of the network is to connect moms who need milk for their babies, with other moms, who have milk that they can share. This was about meeting a need.The World Health Organization’s position on infant feeding is that if, for some reason, a mother is not able to feed her own baby, milk from another human mother is a better alternative than formula. Milk banks do exist that could theoretically meet this need, but there are some problems. First, there are very few of them, so the milk that they do have to give gets prioritized to very sick or premature babies - the infants that desperately need the milk. Second, milk bank milk is almost always pasteurized, which turns human milk from the living miraculous stuff that it is, into dead milk, losing much of its value. Finally, it costs money to access the milk of many milk banks. So even if your baby is among the few that make the cut, and you are happy to accept pasteurized milk, you may still have to come up with the cash to cover it.

The medical community is aware of how difficult it is to access human milk when you need it -- this is why they do not often advise mothers to try this option. Instead, supplementing with formula is quickly suggested. I do not intend to go into why this is such a poor choice here. Suffice it to say there are mothers out there for whom supplementing with formula is not an option that they are comfortable with. So, do they have to? Is there no other choice?

Let’s be realistic: human milk is not a scarcity! Many mothers have ample supply for their babies, and then some. Some women struggle with oversupply! It is also a vastly renewable resource - empty breasts will fill themselves again and again. It should not be so hard to connect people who need milk to people who have milk to give. And it turns out, it isn't. But fear is alive and well.

When a group of parents decided they were done waiting for the medical community to fix this problem, and opened up a way for donors and recipients to easily match up, there was massive push back. It must not be safe, right? People could have disease! You never know what they might be smoking in their spare time... That's just gross, anyway.

Really, all of the arguments against this wonderful, simple milksharing solution to a common problem sound the same to me as razor blades in apples at Halloween. I doubt that there are all kinds of sadistic, lactating weirdos out there, masquerading as concerned moms, handing out drug-laced human milk donations just for jollies.

Here are a few facts:

Human Milk 4 Human Babies donors do not charge for their milk. There is nothing to be gained by donation, save the truly awesome global village feeling that you are helping to feed another's child.

Milksharing is done person to person. That means you meet that person you are getting milk from. You ask questions. You go to their house and meet their family. And you decide whether or not your baby eats that milk. You decide.

This is not a new idea. Wet nursing has been done throughout human history.

And, now a confession: My name is Lisa, and I have donated my milk to a stranger.

Based on the oh-so-educated comments that I read elsewhere on the internet, a common reaction to this is, “Omigosh! Weirdo!” or maybe just, “Yuck. I could never do that.”

But before you decide how you feel about informal milksharing, read just a teensy bit more.

I say I gave my milk to a stranger, in that this was someone that I initially met over the Internet. But when she sat in my living room, with her husband and new son, and we chatted while my similar-aged daughter cooed in her swing nearby, stranger was not the word I would have used to describe her. It actually didn’t feel strange at all. We were just two moms. She had a problem, and I was in a position to help her out, in a meaningful way. I am so glad she was not too scared to accept my help. Donating milk was hugely rewarding for me, even renewing much of my faith in the spirit of community.

If only more moms were not scared milk-less. We don't always need to turn to the authorities to fix our problems. Sometimes, with a little courage, we can find our own solutions.

Lisa is Mom to two, wife to one, and lives in Winnipeg, Manitoba, Canada. She loves being busy in her local, gentle parenting community, and blogs occasionally at Swirls and Swings.

Related Reading:

Breastmilk Donation Page [This page was created prior to milksharing communities existing as they do in 2012. For many years peaceful parenting served, in part, to connect mothers with donors locally via email, phone and community networking. Today, thanks to the new mother-to-mother milksharing set-ups, we hear from far fewer who don't already have their needs met or connections established.]

Joshua's Story: Why I Choose Another Mother's Milk
Joshua's Story: Why I Still Choose Another Mother's Milk
Human Milk for Human Babies After Japan Tsunami
Reasons Not to Send Formula or Human Milk to Haiti and Other Disaster Locations
TIME Reports on New Global Milksharing
Delaney Rose: 6 Months of Milksharing
A Modern Day Wet Nurse
From Despair to Donation: A Mother Loses Her Baby and Shares His Milk

Overcoming Difference Through Milksharing

2012-09-27T23:38:00.001-05:00

I've been having tons of fun reading and posting everyone's pieces for World Milksharing Week's Blog Carnival. After musing on it forever, I finally wrote my own today, about finding my place in the milksharing community.

I am a transgender man. I am in a gay relationship. I breastfeed my kiddo.

And I can tell you right now that I feel a deeper connection to our Mormon and Mennonite milk donors than I do to many of my other friends and community.

My past experiences as an LGBT person encountering religious folk have generally not been pleasant. Among many other comments, a Muslim friend once told me that being gay is worse than committing murder (I hadn't yet transitioned at the time), and a Christian noted that queer people burn in hell forever. My partner and I posted on Human Milk 4 Human Babies that we were a gay couple looking for milk for our baby, and assumed that LGBT-friendly donors would self select. We hoped that others would remain silent.

When I first realized that one of our milk donors, we'll call her Sherry, was Mormon, I was totally shocked that she would want anything to do with us. We had received her milk through a friend, and I thought that perhaps the original donor just didn't know much about us. We met for the first time a few days later, and Sherry gushed over our ten day old boy. In fact, I believe she said to him something like, "You make my uterus ache! Holding you makes me want another baby."

At that moment, I realized that Sherry and I had much in common. We both love holding babies, we are both attachment-minded parents, and we both really care about the health of babies – all babies. Sherry's milk maintained my son's normal gut flora on his fifth day of life, while a feeding of formula would have altered it, for the worse, for weeks to come.

Some Christian donors have told us that they don't understand everything about who we are, but they are open to learning, and they have a whole lot of respect for our commitment to breastfeeding and human milk. I am learning that there is great variety amongst individuals' religious paths. Not every Christian I meet is like the woman who once hurled the phrase "Jesus loves you" at me as if it was some kind of insult.

Outside the milksharing community, I often get comments like, "You're sure letting the baby run the show, aren't you? You know he would be fine. Formula isn't evil. It's ok to cry." I am simply responding to my son's needs – to be picked up, to nurse, to have human milk. I feel misunderstood, defensive and embarrassed when someone criticizes my parenting in this way. I know that I have done my own reading about everything from the risks of formula feeding to the effect of excessive cortisol in the brain of a baby who is left to cry. It's not that I lose confidence in what I'm doing when I listen to such remarks, but I very quickly feel that I am an unwelcome, "other" kind of person ("other" being a word I had previously associated only with being transgender in a cisgender world.)

A few years ago, I would never have guessed that my family's strongest, most supportive parenting community would include people who are aligned with religions that have deeply conservative threads. The milksharing community is incredibly diverse in terms of ethnicity, family structure, sexual orientation, financial status, religion, and language – it is expanding rapidly all over the world.

When one parent goes to the trouble to express and store her milk, and she posts on a social network to find someone to give it to so it won't go to waste, we know that she values human milk. When another parent responds to her post and drives across the city to pick up that milk rather than buying a can of formula from the corner store, we know that he or she prioritizes normal infant nutrition. Donors and recipients meet on the common ground of good health. It is that simple.

Biomedical Ethics and Peer-to-Peer Milksharing

2012-09-27T15:37:00.001-05:00

Dr. Karleen Gribble, adjunct research fellow in the School of Nursing and Midwifery at the University of Western Sydney, has generously allowed us to adapt her PowerPoint Presentation to a blog post as part of World Milksharing Week's blog carnival. This post outlines Dr. Gribble's application of six ethical principles to health worker / patient interactions in the area of peer-to-peer milksharing. Rather than investigating the merits of milksharing itself, this piece looks at the obligations of health workers and parents to discuss the practice. Keep an eye out for Dr. Gribble's upcoming article on this topic in Clinical Lactation.

Many thanks to Jodine Chase, blogger at Human Milk News, for hosting Dr. Gribble's post in the carnival.

Photo: Bart Everson

Health authorities in Canada, the US and France have publicly warned parents not to feed their babies peer-shared milk. Many health workers are unsure about how to respond to mothers who are considering being involved in peer-to-peer sharing of milk.Applying the principles of biomedical ethics to the problem may assist in guiding action.

Biomedical ethics can be used to explore actual or anticipated dilemmas in medicine and find reasoned, consistent, and defensible solutions to moral problems.

Principle 1: Autonomy- individuals should be supported to make health care decisions free from deceit, duress, constraint and coercion.

Health Workers are obliged to provide individuals with the information they need to make informed decisions. Limiting of information for the “good of the patient” is paternalistic and interferes with autonomy. Information should only be withheld in very limited circumstances: if the health worker believes that the sharing of information might seriously harm the physical or mental health of the individual or if the individual states that they do not want the information.

Principle 2: Veracity- patients and health workers must be honest with each other.

When parents seek information about alternatives to a mother’s own milk, health workers must discuss all alternatives including infant formula, banked donor milk, peer-to-peer shared milk and wet nursing in an unbiased and non-judgmental way.

Parents must discuss consideration or actual involvement in milk sharing with their health workers.

Policies that prohibit discussing the option of peer-shared milk with mothers could be considered as breaching the ethical principles of autonomy and veracity. They are also dangerous.

Principle 3: Beneficence- minimization of harm and risk and promotion of good outcomes.

The interpretation of “good outcome” depends upon the specifics of a situation and the beliefs and values of the individual. Individuals seeking health care are those who define “good outcome.”

In peer-to-peer milk sharing, beneficence might involve health workers providing information or directing the patient toward information on the correct way of storing and dispensing expressed breast milk or on flash heating or on medications and milk. It might also involve facilitating the sharing of medical records between milk donor and recipient.

Principle 4: Nonmaleficence- active avoidance of harm to the patient.

A health worker who dismisses, mocks, berates or derides an individual seeking advice or information about milk sharing and so humiliates or belittles them could be considered as having breached the principle of nonmaleficence.

A health professional who withdraws care from a mother or child because they wish to be involved in the peer-sharing of milk and does not ensure that appropriate alternate care is available could be considered as having breached the principles of nonmaleficence and the principle of autonomy.

Principle 5: Confidentiality- health providers must not reveal private information without consent.

While sharing of medical records may assist in reducing the risks of peer-sharing of milk, donor records cannot be shared with a potential recipient without the consent of the donor.

Principle 6: Justice- individuals must be treated fairly.

Aspects of justice to consider in the distribution of resources include: distribution equally, or according to need, effort, contribution, merit or notwithstanding ability to pay.

The application of Justice to milk sharing has proven contentious in North America where donor milk banks are experiencing shortages of milk.

Milk banks distribute according to need but payment is required.

Peer-to-peer donors distribute for free and to those who do not qualify for banked milk.

Both groups are applying justice but neither application is unproblematic. Such conflict is not uncommon in biomedical ethics and indicates that further discussion between the players involved is necessary.

Health workers cannot ignore, dismiss, discount or demonize peer-sharing without acting unethically. What then should they do?

• Educate themselves about the various options for infant feeding including the benefits, risks and costs of each option and the ways in which the risks and costs might be managed, reduced or eliminated

• Be open and honest with mothers about each option and refrain from using pejorative terminology in relation to any option

• When speaking to the media ensure that information is provided in such a way that it cannot be used to portray breastmilk as inherently dirty and dangerous and that the risks associated with other alternatives to mothers' own milk are considered.

Getting Through Thrush With a Milk Donor's Help

2012-09-26T18:03:00.001-05:00

I love this story by blogger Michelle Bowman. Her up-front and entertaining piece highlights a common nursing problem and shows us how the gift of donor milk enabled her to overcome it and breastfeed successfully. Like many recipients, Michelle didn't need all that much milk in order to get her own supply back on track. However, the relatively small donations made an enormous difference to her nursing relationship with her baby.

Sharing a happy moment after getting through very difficult times.

A month or so after I returned to work, my daughter and I got thrush. It's one of those chicken/egg deals. Who knows where it started, all I know is we had it.

It was so painful, I cried nursing, I cried pumping. My nipples were raw, red and even fabric hurt against my skin. And thus began the decline of the milk factory. Slowly, we were burning through my precious milk stash. My once ample supply, enough to feed multiple babies, dwindled down lower and lower. The pain I was having was preventing let downs while pumping, so I was no longer producing what I needed to produce for bottles during the day when I was at work. My in-laws were great, but they tended to be a bit liberal with the milk, always having a bottle on hand. Even if it was 4 in the afternoon, they preferred the security of a bottle in case Little Miss A started fussing. And since you shouldn't re-refrigerate a warmed bottle, we wasted quite a bit of milk in November and December.

Once Little Miss A started attending daycare in January, I was frantic for ideas. Hubby was about to leave to train for his promotion, and stress set in. If there's two things you should know about stress, it can affect your milk supply and affect your sleep patterns. I wasn't sleeping well, Little Miss A was still waking up multiple times a night and my milk supply suffered. Some days, I could pump 10-15oz when I was working. But most days days, I only pumped 3 or 4 oz total on my lunch hour. This was with galactalogues and extra pumping sessions.

I started testing formulas midway through January. I would make a bottle, she would either refuse, spit up, or take it. The ones she took, she ended up having such bad diaper rash that I would have to bust out the big chemicals. We tried four different formulas before I felt desperate. We tried three soy formulas. Little Miss A was NOT having it. She did not want a bottle, and she did not want it if it was not mommy's milk.
I started researching milk banks, figuring I could swing the purchase of milk through my flexible spending account. As long as I could get a physician's prescription, flexible spending would cover the majority of the cost. However, milk from a milk bank can cost around$4.50 per ounce, which could be anywhere between $300-$1200 per month depending on how much I needed to supplement. At that rate, I'd burn through our flexible spending in just a few months. Not only did the cost stop me, but milk from the milk banks are reserved for sick babies, usually preemies in the NICU. I was certain there would be a long waiting list for healthy babies to get milk. So, I was at an impasse. I wondered daily if I should wean entirely or if I should force formula supplement at daycare- I just did not know what to do. Now that I am thinking back, I cannot remember who told me about informal milk sharing, but I began connecting with other moms via Human Milk for Human Babies (HM4HB) and Eats on Feets.

I thought to myself: "If she can't get only mommy's milk, shouldn't it be milk from somebody's mommy?"

I met with a few women, one of whom is a nurse for one of the hospitals I work at, and is friends with some of my friends. You know, that whole small world thing? Totally felt that when talking with her. She has two children, a little one month old guy she was nursing and said she had over 100 oz to share. I felt safe feeding my child her milk- because she fed it to her daughter.

On Valentine's Day, I received our first milk donation. I finally could breathe again- I wasn't going to run out of milk for my daughter. This angel provided my daughter with over 150 oz milk. It was the BEST gift I received this year- nourishment for my daughter and with that, peace of mind. Over the next few months, we received a few more donations to fill in the gaps of what I was unable to produce. Now when I had a bad day with pumping, I didn't cry every time I pulled a bag of milk from the freezer. With the help of our "donor mom", as I affectionately call her, we made it to a year with breastfeeding. When I left my job in June, I still needed a little mama's milk for supplementation, but I have been able to rebuild my supply since and Little Miss A has been able to get all my milk again!

A Story of Peace and Healing

2012-09-25T22:40:00.000-05:00

This touching, personal milksharing journey was submitted by Diana Cassar-Uhl, IBCLC and blogger at Normal, Like Breathing.

If you’ve visited my blog before, you know that I believe in human milk for human babies, and I have a deep understanding and empathy for those mothers who can’t or choose not to breastfeed their babies, for whatever reason. This week, World Milksharing Week, offers a perfect opportunity to highlight a beautiful story of love and healing, of generosity and peace that have been made possible by the gifts of milk donors.

First, be sure to check out this comprehensive report about mother-to-mother milksharing, by Amber McCann, IBCLC, and, from the International Breastfeeding Journal, Milk sharing: from private practice to public pursuit.

Stephanie was heartbroken after her first baby, Isaiah, was born and she realized she couldn’t make enough milk to meet his nutritional needs and sustain his growth. A condition called mammary hypoplasia/insufficient glandular tissue (IGT) made it so that she could only produce about 4 ounces of milk each day; she had to supplement Isaiah’s intake with something other than her own milk, and at the time, commercially-prepared baby milk (formula) was, as far as she knew, her only option. “I knew there was such a thing as donor breastmilk, but I thought it was only for sick babies,” Stephanie explains. “We supplemented with just about every formula under the sun,” Stephanie recalls. Isaiah had an undiagnosed cow’s milk protein intolerance; watching him suffer, and knowing the cow’s milk-based formula was likely to blame was very difficult. Stephanie felt as if her body had failed her baby, and every day, every supplemental feeding, the pain of this feeling was new. “When I was pregnant again, I heard about mother-to-mother milk sharing on the IGT support page on Facebook and immediately knew this was what I wanted to do.”

Stephanie breastfeeding baby Elliot

The gift of donated milk fills more than the freezer, it fills the hearts of both the donor and recipient families.

During her pregnancy, Stephanie began visiting and posting her story to various mother-to-mother milksharing websites, such as Eats on Feets, Human Milk 4 Human Babies, and MilkShare. She met profound empathy, generosity, and support in these online communities, and, over time, received donated milk from more than 10 mothers in 5 states – over 4000 ounces total. Her first connection, however, was to a mother named Shelly.

Shelly lives an hour away from Stephanie, in southern Maine. The first time she traveled to pick up the milk Shelly was donating to her and her baby, Elliot, Stephanie had to ask friends to loan her coolers – six of them – so they’d be able to keep all of the milk cold on the trip home. “I couldn’t believe it! Our 7 cubic-foot freezer was nearly full after that first donation!” In her two trips to Shelly’s house, Stephanie acquired over 3000 ounces of milk.

The milk wasn’t all Shelly shared, however, and it wasn’t the only thing Stephanie and Elliot gained. The two families became friendly, the dads enjoying each other’s company while the moms gathered Shelly’s milk and supervised their little ones, who, at the last pick-up, were delighted by an impromptu play-date. “The connection was immediate, we clicked,” Stephanie says. “It felt right. The thought that a mother — and her child — would care so much as to aid us in our goals is truly heartwarming. The generosity that she has bestowed upon us leaves me in tears every time I think about it. We could never be grateful enough for the hearts of these mothers.”

Shelly with her children, left, with Stephanie and Elliot, right, at the last milk pick-up

For Stephanie, the ability to nourish Elliot on human milk alone meant a great deal to her, especially after her experience of watching Isaiah struggle with a substitute. “No greater joy could I have than to know that, despite my severely low milk supply, my child is still able to exclusively receive the benefits of human milk. The healing that I have found with donor milk is more than I can put into words. The peace that Shelly, and all of the other wonderful donors, have given me is more than I could have ever imagined.” Stephanie goes on to say that being able to fill an at-breast supplementer with “liquid love” (donor milk) and breastfeed Elliot, just like women without IGT do, has been life-changing for her. “The healing I have found with this is incredible. IGT isn’t easy. There’s nothing easy about it. But what a blessing to have a nursing relationship in the first place, no matter how little I make! This has brought me so much peace.” While her baby, now 16 months old, has weaned since about a month ago, Shelly continues to pump milk for Elliot, who is 7 months old now. She shares in Stephanie’s desire to provide human milk through Elliot’s first year, and feels the joy of the impact she is making in Elliot’s life.
Even after that year goes by, Stephanie knows that Shelly and the other mothers who have assisted with her breastfeeding journey will hold a permanent place in her family’s heart. She hopes her friendship with Shelly will be enduring as their children grow up and breastfeeding becomes a memory for both families. Stephanie says “I will forever be indebted to Shelly and the other mothers who have donated their milk, time, and love. Their giving hearts have changed my life. Shelly has helped us defy all odds. She is amazing and I am blessed having her in my life. I will never take for granted all that she has done for us. Calling her a milk donor will never be honorable enough … these moms are superheroes.”

If you have milk to donate, you have options. Milk banks in the United States are always eager to accept milk donations, but certain requirements, such as the age of your baby, must be met. Read more about donating to an HMBANA milk bank.

If you’d like to share your milk with a mother and baby in need and you don’t meet the requirements for donation to a milk bank, or you would prefer a mother-to-mother arrangement, visit any of the milksharing websites that were linked above. Be sure to adequately inform yourself and examine the risks and the benefits of feeding your baby donated human milk, and determine whether the benefits outweigh the risks for your situation and your baby.

Milksharing and La Leche League

2012-09-24T23:18:00.001-05:00

In this post, Laura Spitzfaden, IBCLC and Leader with the breastfeeding support organization La Leche League, tackles LLL's stance on milksharing. I love that she also addresses an important yet rarely discussed risk of milksharing. An incredibly thought-provoking read!

I was inspired to write about milk-sharing when I read this article by Amber McCann, IBCLC.

Like Amber, I am an International Board Certified Lactation Consultant. I am also a La Leche League Leader. La Leche League’s position on milk-sharing discourages leaders from providing moms with information about informal milk-sharing unless the mother specifically requests such information. If mothers ask a LLL Leader how to obtain human milk supplements for their babies, they must be directed to milk banks, even though the cost of purchasing human milk from a milk bank is prohibitive. In most cases, there is not enough milk available for the ill or preterm babies who need it, let alone any excess available for purchase for healthy babies. This is simply not a viable option for most families.

Avoiding the topic of informal milk-sharing does not take into account the changing social environment of the moms we serve. Through social media and the internet, mothers are more informed than ever about the risks of artificial feeding and about what their babies are missing if they do not breastfeed. Over the last few years, I have observed that informal milk-sharing has rapidly become commonplace. I am witness to many instances of mothers offering their milk to other mothers who need or want supplemental milk. Mothers are sharing their milk whether or not any organization believes it is safe.

While there are risks involved with informally sharing breastmilk due to the potential to spread illness or to expose infants to drugs or chemicals, those risks can be mitigated. It seems disingenuous to be concerned about contamination of breastmilk, when it is well documented that artificial feeding carries significant risks for babies and that formula is often found to be contaminated with chemicals and pathogens.

One risk of informal milk-sharing that I have not seen addressed is that accepting donations of milk from another mother, may put a mother’s own milk supply at risk. Often a mother believes she does not have enough milk or that there is something inadequate about her milk and believes she needs to supplement. If it is simple to get milk from another mother, and she doesn’t have access to information about all the risks and benefits of supplementation, she may not explore the reasons for her own supply issues or discover there is no problem with her milk supply. She may supplement unecessarily and unintentionally reduce the amount of her own milk that is available to her baby. If providing information about informal milk-sharing is discouraged, and focus is placed on the risk of possible contamination, the more significant risk to a mother’s milk supply is potentially overlooked.

Research into mother and infant sleep practices by Kathleen Kendall-Tackett, P.h.D., IBCLC, RLC, has shown that dictating to mothers what they should and shouldn’t do, doesn’t work. Telling mothers that they shouldn’t sleep with their babies in adult beds, only results in mothers falling asleep with their babies in even less safe environments, or ignoring the advice while being deprived of the information needed to make bed-sharing safer. Just as many breastfeeding advocates support mothers in bed-sharing with their babies, due to the belief that bed-sharing benefits breastfeeding, and its practice can be made safer, we can also support human milk sharing by providing moms with the information they need to make informal milk-sharing safer. I believe it is time for child health advocates to stop telling moms what to do and instead, provide all the information that moms need in order to make their own informed choices about milk-sharing.

While it is not possible to make any infant feeding option risk-free, mothers can be provided with the information they need to evaluate and minimize the risks and make their own informed decisions. The World Health Organization offers a heirarchy for infant feeding if a baby cannot be breastfed by his or her mother, “..expressed breast milk from an infant’s own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breastmilk substitute…” in that order. It is up to infant health advocates to help mothers to be informed of the risks and benefits of each option, so they may choose for their own babies.

Laura Spitzfaden, LLLL, IBCLC

In March 2011, the LLLI Board of Directors adopted the following policy regarding the donation of human milk: http://www.llli.org/release/milksharing.html

Mother-Infant Sleep Locations and Nighttime Feeding: U.S. Data from the Survey of Mothers’ Sleep and Fatigue-Kathleen Kendall-Tackett Ph.D., IBCLC, RLC et.al.

Supporting Families in Milksharing as an International Board Certified Lactation Consultant

2012-09-21T22:18:00.001-05:00

This year's World Milksharing Week Blog Carnival includes posts by a wide variety of individuals, including donors, recipients, activists, academics, authors, and health professionals. I am thrilled to present this piece by Amber McCann, blogger and International Board Certified Lactation Consultant, about why she, as a health care provider, supports milksharing. She explains what people like her can do to help their clients make informed choices in milksharing, an area that many shy away from.

As an International Board Certified Lactation Consultant, I have, first and foremost, an ethical obligation to provide evidence-based information to my clients to support their breastfeeding relationship. Every day, for a variety of reasons, I encounter and encourage families who need to supplement their baby’s nutrition with something other than milk directly from the mother’s breast. Today, they have many options: pump and feed their own milk, supplement with some sort of donor milk, milk-based formulas, soy-based formulas, pre-digested formulas . . . lots of options, lots of questions, lots of opportunities for parents to be confused.

I believe that parents are capable of making the choices that are best for themselves and their families.

It is my job to make sure they have all the information to do so.

The World Health Organization, in its Global Strategy for Infant and Young Child Feeding, says,

“for those few health situations where infants cannot, or should not, be breastfed, the choice of the best alternative – expressed breast milk from an infant’s own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breastmilk substitute…depends on individual circumstance.”

Since this is coming from a global authority on health, I feel pretty darn confident using this hierarchy while supporting my clients in their supplementation decisions.

Most Ideal Option – Expressed breastmilk from the infant’s own mother.
Next Most Ideal Option – Breast milk from a healthy wet-nurse…SCCRREEEEECH!!!!

(do you see the virtual brakes going on???)

Wet nurse? Really? In this day and age? With HIV, hepatitis, and any number of undesirable diseases that can be passed through bodily fluids? What would wet-nursing even look like in today’s society? The first reaction of many is to simply pass off the idea as old fashioned, ancient, and outdated, not to mention dangerous. And in the United States, where I live, it is generally understood that if a mother’s own milk isn’t an option, formula is the obvious default. Why even bother?

Because we, as humans, are designed to consume human milk.

In our current environment, actual wet-nursing (a woman feeding another’s baby directly at her breast) is deemed by many to be inconvenient, too intimate, and—if you will—too gross. But what about the sharing of breast milk from one mother to another? Since most mothers have access to a breast pump, it has become increasingly easy to package milk in a shareable form. And with the formation of groups such as Human Milk 4 Human Babies (HM4HB) that provide a space for families in need to connect with families who want to give, doesn’t it make sense that we would at least explore the option? Can feeding a child the milk from a mother not his own be a viable solution to our supplementation needs? Is it an option that I, as an IBCLC, am willing to share with the families in my care? I answer with a strong and firm YES.

When I first became aware of milk sharing, it was a “secretive” practice, one not discussed openly and one that many organizations (breastfeeding supportive and not) chose to distance themselves from. When an article appeared on TIME.com in November of 2010 about the rise of the use of social media to facilitate milk sharing, I was quick to say “What can I do to help?” because the goal seemed obvious to me: get human milk into human babies.

What I wasn’t prepared for was the strong backlash from my own professional community saying, “But what if a baby gets sick or even dies?” Quite a number of IBCLCs I know were involved in milk sharing arrangements in their own breastfeeding years and some continue to be “closeted” about their own experiences. I attended the FDA meeting in December of that year discussing the regulations in regards to donor milk and while informal sharing wasn’t formally on the agenda, it certainly was on everyone’s lips in the room. There was palpable fear that one bad outcome from milk sharing would halt all the positive momentum that breastfeeding was gaining in our culture. One expert even spat out, “These women…these women who are doing this are going to hurt or even kill their babies.” I maintain that they are simply trying to feed them the food they were designed to eat.

But, what about the RISKS, with a capital R? Wouldn’t I be putting the health and lives of the babies I serve at risk if I offer milk sharing as an option? There is nothing in life that is without risk. Is milk sharing risk-free? Absolutely not. There are also risks to breastfeeding and formula feeding. Dr. Karleen Gribble and Dr. Bernice Hausman discuss these concerns in their paper Milk Sharing and Formula Feeding: Infant Feeding Risks in Comparative Perspective. In it, they discuss the issues of contamination of milk with pathogens, chemicals, concerns with milk collection and storage hygiene. The also discuss the risks to formula use that are not present when feeding human milk. In addition, there is a section devoted to the risk of HIV from the use of shared milk. I strongly advise every breastfeeding professional as well as any mother I am working with to read this paper and discuss their concerns. Drs. Gribble and Hausman conclude that “instead of proscribing peer-to-peer milk sharing, health authorities should provide parents with guidance on how to manage and minimize the risks of sharing human milk.”

How do IBCLCs instruct and inform clients about the risks and benefits of consuming or donating shared milk?

How do we advise our clients to mitigate those risks?

Photo via World Milksharing Week on Flickr

For recipients: When one of my clients is in need of milk and is considering milk sharing, I strongly encourage them to think about whether people they already know might be willing to donate. They also might explore location-based online milk sharing groups (like HM4HB), and then groups that facilitate broader-range sharing and the shipping of donor breast milk (like MilkShare). I do not condone the sale and purchase of breastmilk and I strongly encourage my clients to not consider it as an option.

No matter where the milk is coming from, I encourage my clients to thoroughly research what sorts of screening they consider essential (such as blood work from pregnancy and questionnaires about lifestyle choices such as alcohol and medication use). It is important that both parties have clear expectations about what their milk sharing arrangement looks like. At no point do I, as an IBCLC, engage with the recipient family as a “milk broker.” The family is fully responsible for finding, contacting and making arrangements with their milk donors. As an IBCLC, my role with milk recipients is only to provide information and resources.

Of note, it is always my hope that supplementation of any type can be eliminated or minimized because of an increase in a mother’s own ability to make milk. The milk sharing community is often particularly in tune with the need and desire of mothers to work hard to rebuild their milk supply. Some families get a donor and a cheerleader-in-one! Many mothers feed donor milk through the use of a supplemental feeder, which can help mothers to produce increasing amounts of their own milk by stimulating the breast while delivering the supplement. There are many stories of those who were in need of donor milk, were able to rebuild their supply and then donate milk back into the community.

Photo via World Milksharing Week on Flickr

For donors: I often have mothers, in their glee at how much milk their body is providing, send me an email saying they “had so much we had to dump it down the sink.” Nothing strikes panic into the heart of an IBCLC faster! If a mother tells me, as her lactation consultant, that she has more milk than she knows what to do with, I offer her information about donation. I share with her the options of contributing to a HMBANA milk bank, donating directly to another family or sharing her milk with a for-profit milk bank. (Though I have significant ethical concerns about these banks, I do share the information with my clients so that they can make the best decision for their family.)

I stress to the family that the milk they have is first and foremost for their own baby. I know that many families feel incredibly proud and thankful to be able to share of their excess. I encourage families to participate openly and honestly in all screening with their recipient family and to make sure that both parties have clear expectations about what their milk sharing arrangement looks like. At no point do I, as an IBCLC, engage with the donor family as a “milk broker.” They are fully responsible for finding, contacting and making arrangements with their milk recipients. As an IBCLC, my role with milk donors is only to provide information and resources.

An obvious question in all of this is why wouldn’t a mother in need of additional milk for her child simply obtain it from a milk bank? Then we wouldn’t be talking about risks of disease and contamination. In an ideal world, families would be able to receive ALL the milk they need from milk banks. Milk banks would be located in every community and have an unending supply of milk. I believe this can be a reality. I believe that there can be plenty of milk available to every baby that needs it. As a passionate advocate for getting human milk to human babies, Emma Kwasnica says, “milk is a free flowing resource.”

Unfortunately, in the United States, this isn’t yet the reality. As a nation, we need to drastically increase the number of milk banks and the amount of human donor milk available. The Human Milk Banking Association of North America (HMBANA) currently has 12 active banks. These banks do incredible work and, rightly so, their priority is on making sure that the MOST CRITICAL babies receive the milk that they process. For these little ones, having access to human milk can be, quite literally, a matter of life and death. Even this week, several milk banks, including those in Indiana and Utah, have issued pleas in the media for increased donations because their supplies are low. It is absolutely essential that these babies be the first to have access to processed donor milk.

Does every baby need its milk processed by a milk bank focused on the needs of vulnerable infants? For the most fragile babies, the complex processes of a milk bank (milk pooling, pasteurizing, and testing) are critical. The needs of a healthy term newborn are different. I liken it to this: If you had a dear friend who had recently received an organ transplant, you would do everything within your power to visit with them in a healthy manner by scrubbing arms and hands and wearing a mask. But, if that same friend has just gone through a “healthy” event, like birth, you would simply wash your hands. Different circumstances require different levels of caution.

Where does that leave healthy babies? In my practice, I see many mothers who, for of a variety of physical, emotional or circumstantial reasons don’t make the milk that their baby needs. At some milk banks, families of healthy babies can sometimes purchase donor milk but it is typically in limited quantities, and only available when supplies exist to meet the need of critical infants first. While the cost associated is reasonable, considering the cost of processing by the milk bank, it is often prohibitive to the families in need.

Is the only option for these families infant formula? I have every confidence that the human milk banking advocates all over the globe would affirm the belief that all babies have the right to human milk. I think that milk banking and milk sharing CURRENTLY serve very different populations of babies. Above all, my loyalties are not to milk banks or the milk sharing movement, but rather to babies and their families. There is room in the community for both methods of getting human milk to human babies.

I have been privileged to work with a number of families who were involved in milk sharing, both on the donor side and on the recipient side. I have seen milk donations have a significant impact on the health of a child. I have seen milk donations foster community that might not have happened otherwise. I have seen milk donations turn grief into hope. I have seen milk donations empower families and save babies’ lives.*

Milk sharing is not the right choice for every mother in need. Milk sharing is not the right choice for every mother who desires to donate her milk. But for many families, milk sharing facilitates health, community building, and an opportunity to reclaim the breastfeeding experience for those whose journey didn’t go as they planned.

Again, I affirm that parents are capable of making the choice that is best for their families.

It is my job to make sure they have all of the information to do so.

*A nod to Ursuline Singleton for her statement at the 2012 ILCA Conference that “IBCLCs empower mothers and save babies’ lives.” Thank you, Ms. Singleton, for so clearly helping to define what is essential to my profession.

"I wish I'd Known About Milksharing When..."

2012-09-17T13:51:00.001-05:00

In this post Dinnae Galloway, blogger from Complete Wellness Concept, touches on some of the many reasons people choose to give or receive donated milk.

I’ve heard time and time again from many many parents: “I wish I’d known about milksharing when – *insert specific situation here.*”

…. my baby was little – she couldn’t handle formula and was constantly sick until we got her on solids.

…. I was lactating – I had so much oversupply it was CRAZY!

…. I was pumping at work – my son wouldn’t take expressed milk, hated bottles, so ALL of my expressed milk got dumped down the drain!

…. my niece was little – she had eczema really bad, and my sister suspected it was the formula, but she had no other options!

…. my son was born – my wife got sick, and lost her supply, and we were unable to follow through with our plan to breastfeed him.

REALLY, these are things I hear and read ALL. THE. TIME. And multiple different variations of them all too.

World Milksharing Week was created to celebrate peer-to-peer milksharing, this grassroots movement of parents being empowered to make *informed decisions* about their infant feeding options. But not only do we want to celebrate, we also want to help educate – by getting the word out there about milksharing, people will get the info they need, and will understand that there ARE options for them!

What do YOU wish you had known before getting into this journey we call parenting?

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Waiting for Milk Banks: A Matter of Life or Death

2012-09-15T20:40:00.001-05:00

Jodine Chase of Human Milk News blog discusses the current milk bank shortage in North America and its daily impact on babies' lives. I love her passionate call to action!

Toronto is finally getting a donor human milk bank, and it is not without controversy. Questions have been raised over how many babies have died in the six years it has taken for the milk bank to open, and now a family in Ottawa wants the milk bank to provide donor human milk for healthy, term babies as well as the premature babies it intends to serve.

The milk bank is scheduled to open this fall, six years after it was first proposed and a year after the Toronto government committed $1.2M towards it, reports the Toronto Star. The Star doesn't pull any punches: donor human milk could have saved the dozens of babies who died from necrotizing enterocolitis (NEC) while the milk bank was in the planning and research stages. The Star notes a milk bank in Calgary was up and running just 16 months after it was first proposed. The Star's story has triggered an opinion column in one of Canada's national dailies, the National Post, slamming the Ontario health care system for taking so long to establish the facility. Meanwhile, CBC reports, the mother of a healthy term infant in Ottawa who was unable to breastfeed arranged and paid for donor milk from another milk bank. She wants the Toronto milk bank to serve families with healthy children who can't receive their mothers' own milk, as well as the very low birth weight preemies and babies with bowel disorders the bank intends to target. CBC quotes Ottawa neonatologist Brigitte Lemyre who says, essentially, donor milk is a scare resource and the sickest babies should receive priority. CBC reports Lemyre also says there is no evidence donor milk benefits healthy babies.

Calgary Mothers' Milk Bank's Facebook photo album tells the story - from equipment move-in day March 1 to the first official donation March 18 and the first delivery of pasteurized donor human milk to the Foothills Hospital on April 13 - 6 weeks.

The baby deaths in the years it took for Toronto's milk bank to get off the ground are a tragedy and the resulting controversy is likely to overshadow the issue of who should receive donor milk once milk banks are re-established across Canada.

The delay in establishing the Toronto milk bank was one of the catalysts for the creation of milksharing communities on Facebook two years ago. Canadian breastfeeding advocate Emma Kwasnica and her network of moms from around the world decided to take matters into their own hands. Mothers were clamouring to donate, and were frustrated at being told there was no demand for their extra milk - instead of pouring it down the drain, they started offering it to families in need in their communities. They turned to the networking solutions of their generation to match families in need with mothers who had extra milk, and the resulting global Facebook milksharing network made news in the fall of 2010.

Some health care professionals, concerned about possible risks of milksharing and realizing increased pressure on milk banks from NICUs was making less milk available to babies in the community, found themselves assuring mothers of healthy infants that infant formula is just fine for their babies. This of course is contrary to the messaging breastfeeding advocates have worked hard for decades to get out to the general public. Breast is not best, it's normal, and formula is not fine, it comes with increased risks for all babies, with of course the sickest being at most risk.

One concern at the time was that the popularity of milksharing might reduce the number of moms who donate to milk banks. That concern appears to be unfounded, but when there is a shortage of donor milk in hospital freezers, or when policy glitches or funding issues keep the sickest preemies from receiving donor milk, emotions naturally run high.

On the eve of WorldMilksharing Week (Sept 24-30) USA Today explores the rising popularity of both milk banks and milksharing. Operator of the long-standing milk bank in San Jose, California, Pauline Sakamoto, says HMBANA milk banks distributed 2.1 million ounces in 2011, up from 1.5 million in 2009. And more milk banks are on the way - Kansas City, Orlando, Portland, Missoula will all be getting milk banks soon. In Canada – a new milk bank collection depot is set to open in Edmonton, B.C.'s milk bank system is expanding, and efforts are underway to open milk banks in Saskatchewan and New Brunswick. Sakamoto and HM4HB's Kwasnica both note there is no rivalry between milksharing and milk banking, and acknowledge each practice brings different benefits and risks to a community.

As donor human milk is embraced both in the community and by neonatologists and health care authorities, more families will turn to milksharing, and more milk banks will open. In each community questions will arise:

Why did it take so long to re-establish our network of milk banks after the AIDS panic in the 80s, and how many babies died during this time?

Is there enough donor milk for all who want it?

I hope we will be able to move away from kneejerk responses born of concern over safety and scarcity. We need to acknowledge and applaud the success that has come from decades of hard work on the part of breastfeeding advocates who have clearly convinced families and health care professionals of the value of donor human milk. We need to explore the issues that have arisen and develop thoughtful and sound, evidence-based policies to support the use of all donor human milk.

It's time for stakeholders in North America - families who need donor milk, moms with milk to donate, advocates who support, protect and promote breastfeeding, health care providers, hospital administrators, policy makers, and anyone else with the authority and capacity to restore and improve the system - to come together. It's time we had appropriate policies and processes in place for funding and support for families who wish to use donor human milk when mother's own milk isn't available. Babies are dying in NICUs - and mothers are still pouring excess milk down the drain.

News coverage

Ontario finally getting a breast-milk bank
Toronto Star, August 31, 2012
Six years after it was first proposed for Ontario, a breast milk bank that could have saved dozens of vulnerable babies is still months away from completion. Vancouver has had a facility for more than three decades, and Calgary opened one in April after only 16 months of planning....more

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Mother wants donated breast milk from Toronto bank - Provincial milk bank to provide donated breast milk to ill newborn babies at Ontario hospitals
CBC News, Sept 5, 2012Some parents want a new provincial breast milk bank to do more than provide donated breast milk to unhealthy babies, as it has proposed. The brand new provincial milk bank is set to open in January at Toronto's Mount Sinai Hospital in partnership with the Hospital for Sick Children and Sunnybrook Health Sciences Centre. ... more

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FULL COMMENT
Matt Gurney: Ontario’s healthcare system dithers while

babies die

Matt Gurney | National Post | Sep 4, 2012 10:11 AM ET | Last Updated: Sep 4, 2012 10:16 AM ET

There was an absolutely astonishing article over the weekend on the development of a new Ontario breast milk bank. The facility, to operate out of a Toronto hospital,
will house properly screened donations of human breast milk for babieswhose own mothers are, for whatever reason, unable to nurse their children. A facility such as this will keep babies alive and save taxpayers money.
Yet it has been stuck in limbo for no less than six years....more

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Use of mother's milk banks, milk-sharing skyrockets

By Brian Shane, USA TODAY, Sept 2, 2012

This time last year, Mother's Milk Bank in San Jose may have been able to send a month's worth of donated breast milk to hospitals in Alaska or Hawaii in a single shipment. Now many of those same hospitals can only get their milk by the week.... more

Powerful Images: Supplementing with Donor Milk

2012-09-12T16:17:00.000-05:00

Today's Blog Carnival post was contributed by blogger Paala Anderson Secor at Paa.la. Here, she discusses a device that is at once extraordinarily beneficial and mighty challenging to use – the at-breast supplementer. Enjoy all the fantastic info and resources Paala has gathered!

What an inspirational milksharing image.

via Emma Kwasnica with the caption,

“Breastfeeding mom, Courtney Jarecki, shares her story of donor milk feeding with an at-breast supplementer via this wonderful photo and caption.
I am heartened to see more and more women speaking out about donor milk and at-the-breast supplementation… and yet I am sad that there is still stigma around this (and BF in general, yo!). Please share this photo and honour Courtney and her kiddo, and ALL the mamas who use another mother’s milk to nourish their children.”

Thank you for sharing that powerful image, Emma. Without you, I would have never seen such a thing, a proud mama nursing in public with an at-breast supplementer.

At first glace I thought this mama had ipod wires in her shirt. But after taking a closer look, I realized those were for nursing! At-breast supplementers, like Madela’s Supplemental Nursing System and the Lact-Aid, are options for breastfeeding with donor milk or formula. Because breastfeeding is more than just about the milk. It is about bonding, sharing that special connection, hormones, and so much more.

What is an at-breast supplementer?

Quite simply, an at-breast supplementer is a feeding tube that is attached to a formula or breast milk filled bottle that allows for supplementary feeding at the breast. This system enables mothers (and fathers too!) to breastfeed baby even though baby is being supplemented. One brand, Lact-Aid has been around for over 40 years and is recommended by doctors, nurses, lactation consultants, oral physical therapists & books on breastfeeding, birth and parenting.

What are the reasons for using an at-breast supplementer?

Babies need to nurse for security, bonding and company, all the while positive hormonal releases are happening. The at-breast alternative to bottle feeding is an at-breast supplementer.
An at-breast supplementer is a helpful tool for adoptive mothers to induce lactation.
For currently lactating mothers that are looking for ways to naturally increase their milk supply without pumping or ingesting teas, herbs or taking prescription medications, an SNS or Lact-Aid can enhance milk production by triggering hormonal changes in mothers because the baby is at the breast suckling.
Even if the mother has no milk at all, using a supplementer is a wonderful way for the mother and baby to benefit from the bonding experience.
They are also used to aid in Suck-Training, oral physical therapy for infants.
Using an at-breast supplementer helps prevent nipple confusion because the baby is nursing at the breast, not on a rubber nipple.
If a mother needs to maintain or re-establish the breastfeeding bond, a supplementer is a wonderful tool.

Personally, I have never used one but if for some reason I needed to quit breastfeeding due to surgery or medication or my supply dried up, I would likely select this feeding option because I know how important the physical and emotional connection is while nursing my two children. I would not want them to find comfort in a pacifier for their non-nutritive sucking needs when I am their real thing and am fully available for them. At-breast comfort nursing satiates my baby’s need for a soothing, familiar place or event. As my children sit on my lap and nurse, we hug and I kiss their heads, read them books or I teach them things about nursing or what is going on around us. Mostly though, we just snuggle quietly and enjoy the parent-child exchange.

According to Dr. Linda Palmer, author of The Baby Bond, when a baby is nurtured by the snuggly warmth of our body, comforted by our familiar scent (pheromones), hearing the beat of our heart and the sound of your voice, our baby’s neurons and hormones program them to desire and flourish in this environment.

And bottle feeding can weaken a baby’s suck reflex and even, unfortunately, lead to early weaning. I want my babies to be at-breast for as long as they need to be, not for me, for them, because that is what I believe is in their best interest. The mother above, Courtney, has breastfed her baby for 16 months using an at-breast supplementer because she knows the importance of nursing from the breast, even if her body cannot produce milk. My own personal breastfeeding goal is two years for my new baby, who just turned one last week, and then weaning when she is ready and not a day before if I can help it.

How does this image make you feel? Have you ever participated in milk sharing or tried an at-breast supplementer?

Resources

Low Milk Supply — At-Breast Supplementers
Tips on using the Lact-Aid Nursing System (video) - Youtube
Supplementing with an SNS Kit (video) - Youtube
Supplemental Nursing System - breastfeeding.com

My Related Posts

Watch it! Donor Milk: The Documentary – Trailer - Paa.la
Formula or Donated Breast milk? Donated Breast milk FTW - Paa.la
Got milk? Milk Donors Needed! - Paa.la

Milk Sharing In the News

Mother donates 6,000 ounces of breast milk to Omaha toddler – MSNBC