updated 30 Dec 2011, 08:28
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Mon, Sep 19, 2011
New Straits Times
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No breast milk? Here, have ours
by Tan Choe Choe

"EBM needed for a premature baby girl. Born on 12 Aug, weight only 1kg. Her mum cannot feed her because of complications after surgery. Whoever have extra milk in the freezer, please help this baby girl. She's in HKL right now..."

"URGENT: One-week-old Chinese baby whose mother is HIV+ is unable to be breast-fed by his mother. Needs EBM urgently. Location at UMMC, PJ."

The above are just two of many desperate messages for EBM, or expressed breast milk, that have been left on the Facebook page of the "Human Milk 4 Human Baby Malaysia" that was set up last October.

It is the Malaysian chapter of the global Human Milk 4 Human Baby network that was founded on the initiative of a mother of three, Canadian Emma Kwasnica, also around the same time last year, with the simple aim of providing an online platform to connect needy mothers to those with an over-supply of breast milk.

Kwasnica was inspired after having helped a fellow Canadian friend, who was working in Indonesia, to source for breast milk for his son after his wife had died.

"The boy is now 1-year plus and he has never taken anything other than breast milk from many mothers who offered their extra milk," said one of the administrators of HM4HB Malaysia, Siti Nurfatimah Ayuni Zainuddin, or simply known as Ayuni.

"It was this that inspired Emma to think that there might be parents who face a similar situation or just do not have enough milk for their babies. She, then, started this network."

In the weeks and months following the establishment of HM4HB Global, the movement has garnered over 20,000 followers online.

Now, apart from Malaysia, the network has expanded to 54 countries, as more and more mothers subscribe to Kwasnica's belief that "breast milk is not a scarce commodity -- it's a free-flowing resource" and, hence, can and should be shared where needed.

From the messages left on the page, the idea seems quite simple and straight-forward. If have extra milk to offer, leave a note with your location and age of your baby. If you need milk, just do the same and perhaps a breast-feeding mum nearby with a baby around the same age, will be able to help.

"Some people think sharing of breast milk is gross because it's bodily fluids, while some just say that it's food!" said another HM4HB advocate, Amish Shaheeda Ahmad Khan.

Shaheeda said according to World Health Organisation's (WHO) recommendations, the best for a child is his or her own mother's milk.

In a statement, WHO stated: "The best food for a baby who cannot be breast-fed is milk expressed from the mother's breast or from another healthy mother".

Formula milk should only be the last option for mothers, said Shaheeda.

Breast-feeding mothers Chern Pei Wei and Jean Chuah, who are also administrators for HM4HB Malaysia, feel the same.

The petite Chern, a mother of two children, a 4-year-old and 9-month- old baby, has shared her milk with 12 other children.

"They range from newborns to one who is an 8-year-old boy with chronic liver cancer. He needs the antibodies in breast milk to help fight the illness," said Chern, who pumps up to 20 five-ounce bottles a day for distribution.

Chuah, who runs her own business while being a full-time mother, has helped feed two other children not of her own.

Both of them had been offered money in return for their generosity, but both had declined as receiving money would violate the spirit of sharing that HM4HB stands for.

Chuah said the recipient who offered her money thought it was the only way she could show her gratitude, "but it's not necessary because I had extra and if she had not taken it, the milk would have gone to waste anyway".

Meanwhile, although Chern has turned down money, she has started to accept one parent's show of gratitude in the form of milk bottles and plastic storage bags for her EBM.

"We discourage the exchange of money for breast milk, or selling it, because it could tempt some donors to dilute their milk for higher profit," said Ayuni.

And not only is the milk free, this type of sharing does not require the donor to undergo health screenings.

It is up to the recipient to discuss with and trust the donor's lifestyle, or if he or she wants the donor to undertake any extra blood test for further screening to check if the milk is disease-free.

"But it is up to the individuals to make such arrangements on their own. We don't do the actual matching after all. It is up to them to assess and make informed decisions on their own. The basic principle about our group is also about making informed choices," said Ayuni.

At times, it is also not just about knowing the donor mum's health status but closely matching the donor milk to the baby's age because a mother's milk is specific for her baby and changes as the baby grows.

"So, if you have an 8-month-old baby, it is best to find a donor who is breast-feeding her own child that is about the same age. But even if that is not possible, it is still best to go with the donor breast milk rather than formula," said Shaheeda.

And increasingly, such informal milk-sharing where the recipient and donor find each other on their own, albeit via the HM4HB online platform, is growing, even in places where there are human milk banks available.

A human milk bank is a service which collects, screens processes and dispenses, by prescription, human milk donated by nursing mothers who are not biologically related to the recipient infant.

In North America alone, there are reportedly about 11 milk banks under the Human Milk Association of North America. Although its guidelines stipulate that the donors are not paid for their milk, the collection, processing and distribution of milk is expensive and recipients can be charged up to US$5 (RM15) per ounce of milk to cover some of the costs.

For hospitalised recipients, some insurance plans would probably cover a part of the cost, but not all do.

The upside about milk banks is that the milk distributed would have passed through the stringent guidelines developed by the Food and Drug Administration and Centres for Disease Control and Prevention to ensure that it is safe, healthy milk.

But the downside is that these milk banks focus more on the needs of ill or premature babies.

"There are many healthy, full-term babies out there who need and deserve donor breast milk because their mothers cannot produce on their own or are under-producing. For them, this sharing is the next best thing," said Ayuni.

Milk-sharing strengthens kinship ONE other reason why human milk banks would not be a feasible choice for many Malaysians, apart from none being available here, is because of the special milk-kinship that would result from the sharing of breast milk among Muslims. Any mother who shares her breast milk with another child would immediately become the milk-mother of the child and the child would be regarded as close to her as her own biological child.

In view of this strong bond, it is necessary for the donor and recipient to get to know and assess one another before they decide to go ahead with the milk-sharing.

"This special bond is as strong as a blood-bond. So the children of the donor mother and the receiving child would immediately be like blood-siblings. It would be taboo for them to marry each other when they grow up," Ayuni explained.

Hence, Ayuni, who has shared her milk with another baby boy about the same age as her 1-year-old son, said it was of vital importance that milk-mothers keep in touch with their milk-children.

"I live in Singapore now, but when I come back, I always make it a point to let my son meet and play with his milk-sibling. When and if I have a daughter in the future, she cannot marry my milk-son. They, too, would be siblings."

Since the issue touches on sensitive religious rules, HM4HB Malaysia has wisely prepared a list of FAQs, with the help of Department of Islamic Development Malaysia (Jakim), to answer any queries by possible Muslim milk donors and recipients.

Although the issue of milk-kinship does not arise for non-Muslims, donors like Chern and Chuah also prefer to keep in touch with the families to whom they have donated milk to.

"I think it's nice because I feel there is a special bond we share because my milk has helped nourish their child," said Chuah.

The history of wet nursing THE idea of allowing another woman to breast-feed your baby sometimes leaves the uncomfortable feeling of boundaries being overstepped, of someone trespassing on a unique relationship.

But the practice of wet nursing is an ancient one. The sharing of breast milk, or wet nursing, has a long and complicated history.

Wet nursing, in ancient times, was carried out when a mother dies during childbirth and another woman breast-feeds and raises the motherless baby. It has been linked to social class, where monarchies, the aristocracy, nobility or upper classes had their children wet-nursed in the hope of becoming pregnant again quickly.

For centuries, the British aristocracy employed wet nurses to feed their babies because breast-feeding was seen as ruining a woman's figure, and, at that time, wealthy women were far more removed from their own offspring.

The practice was commonplace, even among middle-class women, until the middle of the 19th century, when doctors realised that wet nurses might be passing on infections such as syphilis, cholera and tuberculosis. Now with baby formulas being commercially available, wet nurses are needed less.

In the 1980s, it was discovered that AIDS and other viruses could be transferred in breast milk, thus the use of wet nurses declined even further, especially in developed countries.

According to recent reports, however, breast-feeding someone else's baby is making a comeback in some parts of the world, including Britain.

Some mothers believe that wet-nursing is the answer to the eternal dilemma of women who want to go back to work but also want their babies to enjoy the benefits of breast-milk.

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