“Wet nursing,” or the practice of allowing a woman other than the mother of a child to provide milk to an infant, has been practiced for millenia. Two hundred years ago, wet nursing was common for a variety of reasons. Upper-class families could hire a wet nurse to enable the mother to more quickly become pregnant again, ensuring adequate nutrition for the newborn infant without the associated decrease in fertility that accompanies breast-feeding. In middle class families, employing a wet nurse allowed the mother to return to her job in the factory or in the field. This practice began to decline in the 1800s in the United States and Europe, as the use of animal milks and milk-based infant formulas began to increase in popularity.

Use of formula increased throughout the first half of the 20th century, as formula-feeding was heavily marketed and became the norm, leaving breast-feeding mothers in the minority of the population in many industrialized nations. The pendulum began to swing back the other way, however, in the 1960s and 1970s, with increasing numbers of new mothers using their own milk to feed their baby. Currently, approximately 70% of mothers in the United States breastfeed their infants for at least a short period of time.

While numerous studies have shown that breastfeeding is preferable to formula feeding for a number of health reasons, nursing isn’t always possible or practical for every woman. Some women find themselves unable to nurse for a variety of reasons: prior surgery, working outside the home and being away from the baby for extended periods of time; adoption of the child and not being the biological mother, etc. A new Time article notes that one solution to this problem is the resurrection of wet nursing and milk banking in developed countries.

While wet nursing has typically referred to a paid employee of the family, women are also using what is called “cross-nursing:” or breast-feeding one another’s babies. These activities have continued in developing countries even as they declined in developed ones, so it’s not as if they ever totally went away; they’ve just not been on the radar in countries like the United States in many years. As the author notes, some acceptance of this phenomenon reflects cultural trends:

…more U.S. babies–upwards of 70%–are breast-fed than at any time in at least 50 years, more women work outside the home, and more young women undergo breast surgery. Advocates argue that milk sharing lets women be good moms while fulfilling other goals. Says Natalia Chang, 29, who has cross-nursed with her San Jose, Calif., neighbor: Breast milk is “a communal commodity around here.”

Of course, there are trade-offs for this sharing. Microbes can be transmitted via the breast milk from nurser to infant during the process. However, here is a way to obtain breast milk that has been screened for known pathogens via milk banks, one of which just happens to be headquartered a floor above my office. Milk banking is a growing phenomenon. When the bank here at Children’s Hospital of Iowa was first established in 2002, there were 5 milk banks in the nation. Currently, there are double that.

Milk banks provide an important resource, supplying milk to infants whose mothers are unable to provide them with milk. Recipients are frequently premature infants. According to Jean Drulis, co-founder of the Mother’s Milk Bank of Iowa, milk donated to this location is distributed to needy infants all across the state. While typically this includes preemies and full-term infants who are ill, other mothers can also request access to banked milk through their doctor–for example, women who have adopted infants and are not breast-feeding, or who are unable to nurse for other reasons.

However, even with premature infants, donated milk isn’t just forced upon them. Drulis noted that parents are notified beforehand that their infant will be receiving donated breast milk, and that overall, the reaction has been very favorable on the part of the parents. The neonatologists also have been enthusiastic about the program, and cases of necrotizing enterocolitis (NEC), a devastating gastrointestinal disorder that can destroy the bowel and cause death, are rare in the neonatal intensive care unit (NICU) at the University of Iowa Children’s Hospital. One probable reason for this is that NEC has been reported to occur more often in preemies fed formula, while almost all NICU babies here are fed human milk (mother’s own or donor). Therefore, everyone wins: the preemies get the best nutrition possible, mothers are less stressed about their inability to provide their child with their own milk, and other mothers get to help out another child with their excess milk.

While donation of expressed milk is a unique and generous gift, not everyone is eligible to donate. The Human Milk Banking Association of North America describes milk banks as analogous to blood and tissue banks, in that donors must be screened prior to donation, and the product also is screened for the presence of potential pathogens. The milk is then pasteurized for additional protection. These added precautions were put into place beginning in 1985, with the identification of HIV in human body fluids and worries about pathogen transmission via bodily fluids. Banked milk therefore is quite safe, and no disease transmission has been linked to the use of pasteurized milk.

Though milk banks represent a more formal milk sharing arrangement, Drulis also acknowledged that she’s received an increase in inquiries about milk sharing outside of the milk bank, though she’s not followed these up nor asked for more information. What she does recommend, however, is that anyone who is considering accepting donated milk, whether from a friend, neighbor, or family member, speak with a physician first. She cautions, “You think you know your friends and family, but one can’t be too sure.” Milk bank donors are screened for health behaviors and pathogens including HIV, Hepatitis B and C viruses, and syphilis, among others–all organisms that can be tested for by request at a clinic or by a family physician for those considering private milk sharing.

Because of cultural taboos, even nursing one’s own child can be something that’s difficult to talk about. Having your child nursed by someone else, or accepting someone else’s milk, only amplifies that stigma. It’s not really known how many individuals informally share breast milk, or how many employ a wet nurse to assist with feeding their infants. The hiring of wet nurses itself additionally is controversial because of the potential for abuse of status: paying low income women to “outsource” (as the Times article characterizes it) their breast milk to wealthier mothers and their infants. Though these private sharing arrangements have the potential for abuse, the Milk Bank of Iowa avoids this by not providing compensation for their donors, and the HMBANA states that they do not “…endorse the practice of selling or purchasing human milk, human milk components, or human milk by-products.” Milk sharing may be making a comeback, but there still remain a lot of difficult issues to be overcome.

For more information

University of Iowa Children’s Hospital Mother’s Milk Bank

Human Milk Bank Association of North America

Time magazine, “Outsourcing Breast Milk”

Special thanks to Jean Drulis for her information on U of Iowa’s milk bank

Image from http://www.babyreference.com/images/BreastfeedingBaby.jpg

Comments

  1. #1 Rugosa
    April 25, 2007

    Sounds like a great idea to me. I wish milk sharing/banking had been available 27 years ago. My kid was a premie, fortunately with no major problems, but he was so small at first I could have fed 3 of him! Too bad my excess milk couldn’t go to other babies in the nursery.

  2. #2 Alethea
    April 25, 2007

    When I had my first child, I built up lopsided arm muscles with a manual pump in order to provide breastmilk when I went back to work during his first year. I learned toward the end of that period that the local milk bank at the Institut de Puericulture (Paris) would offer an indefinite loan of an electric pump to anyone who could donate a minimum of 250ml of milk every fortnight.

    So, a couple of years later, I signed up. It was easy, I learned that I could freeze in a good -20C freezer and top-up, that production is really on demand, and that indeed the milk was thawed, homogenized and packaged for their preemies in 5 ml quantities! Oh yes, and they sent out a courrier on motorcycle to pick it up and bring the bottles back to them in optimal condition. And they provided the sterile bottles, of course. My daughter had a congenital malformation, not related to prematurity, that made me really sympathize with the worried moms at the Institut de Puericulture whose stress might prevent them from lactating.

    Oddly enough, because I lived in England from 1990-1991, I am ineligible to give my blood in France (they’re afraid of prions from the animal flour-fed beef I might have ingested there) yet the same questionnaire did not disqualify me from making my milk donation. I guess donors are too rare and far between to eliminate on such a minimal risk.

  3. #3 JYB
    April 25, 2007

    My wife couldn’t breastfeed. She had a combination of a low milk supply and the milk she could make was too watery. The doctor just told us to go on formula. I have zero idea if it had any positive or negative affect on our daughter. That being said, using someone else’s breast milk seems a little too….intimate for me. It seems like someone else entering that special mother/child relationship.

  4. #4 Cirya
    April 26, 2007

    Very interesting about the milk banks. A few years ago I heard a woman was arrested and charged with some kind of felony for breast feeding someone else’s baby. Never heard if she was convicted.

    HIV and Mad Cow of course have to be concerns, but what is the historical evidence that wet nurses infected babies at a higher rate than their own mothers? Are the autoimmune diseases from not getting a immune workout as babes and toddlers?

    It seems like we’re over regulating more than is good in so many areas. How can wet nursing or milk sharing be done without needing the government regulators involved? or do we really need them?

  5. #5 Tara C. Smith
    April 26, 2007

    Cirya, to my knowledge, it’s not illegal, unless perhaps a woman did it without knowledge or authorization of the infant’s parents. Parents *can* share milk without government regulators, but milk banks by their nature must be held to high standards (as I mentioned, analogous to blood and tissue banks). People who share privately don’t need to employ these kinds of standards, but it’s suggested for the safety of the infant.

    HIV and Mad Cow of course have to be concerns, but what is the historical evidence that wet nurses infected babies at a higher rate than their own mothers?

    I’m not aware of any evidence that answers that pro or con, which is why screening was suggested for anyone considering cross-nursing or wet nursing. Sure, depending on one’s background, it’s quite possible that the other woman may have a lower risk of many infections than the mother does, but IMO you’d still want to get them checked out.

    Are the autoimmune diseases from not getting a immune workout as babes and toddlers?

    Well, that’s a whole can of worms there. Long story short, we don’t really know exactly what causes autoimmune diseases, and breast-fed babies aren’t necessarily resistant to them. However, breast milk has been shown to be more beneficial than formula in priming the newborn’s gut, and it also provides protection from a number of diseases via passive antibodies. Especially for preemies, this can be critical, and can literally be the difference between life and death.

  6. #6 Colleen Newman
    April 26, 2007

    This issue is very interesting to me. Thank you for sharing your point of view.

  7. #7 Megan L. Hartman
    April 26, 2007

    Dr. Smith -

    Thanks so much for doing the much needed research on milk banking before reporting on it. We absolutely appreciate you writing about milk banking factually. This is an excellent article in response to the TIME report.

    Sincerely,
    Megan L. Hartman, Outreach Director
    Mothers’ Milk Bank at Austin
    http://www.milkbank.org

  8. #8 daedalus2u
    April 26, 2007

    I remember reading about the woman who was charged for breast feeding someone else’s baby. The parents were absolutely horrified, and had not authorized it, and the woman had not been screened in any way. She might have been a day care provider, so this was a violation of normal infection control procedures.

    If a baby is fed someone else’s milk, there is going to be less stimulation of his/her mother to produce more.

  9. #9 dlanod
    April 26, 2007

    My wife is unable to produce enough breast milk to feed our infant. This is even after intensive work with lactation consultants and pharmacological assistance. We would certainly utilize a milk bank if one were available in our area.

    A friend of ours relates the following story from her last pregancy: She was producing enough milk for three infants, freezing the excess and supplying it to a few women including her sister. At a family gathering, folks were chatting about breast milk. The brother-in-law, who had been proud of his participation in bottle feeding their child, allowed a grin to move across his face as he mentioned that he liked to pour a little breast milk from the bottle into his coffee each morning. Our friend responded to his comment with “you do know that it is MY breast milk in those bottles, don’t you?” Apparently his face went white and he got very quiet. Everyone had a really good chuckle, including us.

  10. #10 sdado1
    August 28, 2011

    I would love your input on a recent incident that happend to us. Two weeks ago at a friends house warming party my wife let a couple of our friends’ kids taste her breastmilk without asking them, she was feeding our five month old daughter at the time. And to our regret, our friends were not too happy at all about it. They were offended, concerned, and angry at us. We were very shocked and apologized but did we do something so terrible?? Now they have everyone ganging up on us like we are some kind of evil people, geez. Go ahead be honest with us how would you react??