I have to admit I’m worried. I’m worried that we have so successfully indoctrinated new mothers that their babies will suffer irredeemable hardships if not given breast milk, that they will seek it out whatever the source and wherever the source… My concern is not over the long-since proven benefits of breast milk, nor whether mothers should be counselled to attempt breast feeding whenever possible; it’s the engendered guilt that bothers me.
I also have some concerns with the somewhat paradoxical issues around what has been called the tyranny of the breast and the stigma cast on those who dare to select formula-feeding for their neonates. But I suspect that is probably a manifestation of my concerns about a nanny system forcing its beliefs on any who would opt to choose for themselves even in the face of opposing evidence. We’re very supportive of mothers who accept our advice and then run into problems but less so -or smugly so- if they don’t accede to what we feel should be the norm.
No, my worry is about desperation and what it fosters. The New York Times reported on a study published in a recent issue of the journal Pediatrics which found that breast milk bought from two ‘popular websites’ was often contaminated with bacteria. ( http://nyti.ms/1d9kiiR ) It also discussed milk-sharing websites in general that host advertisements from women offering to donate, sell, or buy breast milk. It goes on to say “The researchers found that 64 percent of the samples from milk-sharing sites were contaminated with staph, 36 percent with strep, and almost three-quarters with other bacterial species. Three of the samples contained salmonella”.
With the exception of officially recognized Milk Banks, online breast milk sources are largely unregulated and free to advertise what they want with very little oversight. And, whether or not the intent is honorable and well-meaning, the quality is suspect. Milk is a sensitive, biological product requiring stringent conditions for its storage and subsequent use. Just like cow’s milk, it is easily contaminated and without sophisticated instruments this would be difficult to detect. The average mother wouldn’t be able to determine if it was safe. Let’s be clear about this: how much trust can one attach to an essentially anonymous online producer -one who probably has no more idea whether her milk is safe than her buyer? And of course there is the whole issue of sterile transportation, packaging, not to mention storage on an ongoing basis. The article reported one of the authors, Dr. Keim, as saying: “There is no way for a consumer to be certain what she is getting from an online source. We looked at everything a buyer could know herself — temperature, the condition of the containers, how long it took to ship, what sellers were saying in their ads — and only the time in transit had any effect on contamination. Buyers have no way of knowing even what they’re getting — it could be cow’s milk or formula.”
There are regulated milk banks that offer safer products of course, but they are often expensive – I mean let’s face it, the average intake of a month old baby is probably around 25 ounces per day according to the article, so even at, say, a bargain $1.00 per ounce, that would amount to a minimum of $750 per month… and the supply is scarce so what is available is prioritized to premature infants with special needs.
No, sometimes a mother has to step back from the ideal, and embrace the practical. Babies may well do better if nourished from the start with breast milk, but the obverse does not necessarily obtain. I don’t advocate formula feeding, but nor do I castigate my patients if they feel that bottle-feeding is something with which they are more comfortable. It is not a choice between nourishment and malnourishment, love or abuse… Sometimes, it is an appropriate decision. A necessary decision.
I wonder if prenatal classes should include an introductory course in critical thinking -a lecture that advocates and facilitates stepping back for a moment to evaluate both the goals and the evidence that supports or refutes those goals. Pregnancy is a time of high emotion, and even higher hopes. Expectations often far outpace reality: a Better Homes and Gardens mentality where everything is tastefully displayed and always goes according to plan. “Is it just right for my baby bear?” one of my more imaginative and embarrassing patients who was obviously doing some prep work in Children’s Literature used to ask each time I measured her abdomen. I never knew how to answer…
But Life plays by its own rules and on its own field. Yes, we want the best for our babies, but what risks might that entail? Breast milk is good, but if yours is not available, what might be a reasonable next step? Depend on a putatively well-meaning stranger online who purports to offer something that you must accept on trust as safe? That you assume and hope is in fact really breast milk and not cow’s milk, or whatever? And, given the lack of guarantees or safeguards, would you really want to take a chance and give it to your baby? I wouldn’t.
Of course, you could always do some simple, basic research for an acceptable infant formula -there are several out there… No, it’s not breast milk; it contains no protective antibodies and nothing that your own body has worked so hard to produce, but at least it’s nourishing. At least it’s safe. There is an equation for all decisions: risks on one side, benefits on the other. Each has to be evaluated realistically; the equation has to be solved. There is simply too much at stake.