Yesterday, I was asked a question I’ve heard several times before (and one I expect I’ll hear again): “I am taking care of a baby whose gay parents used a surrogate mother for the pregnancy. They are using donor milk for the baby. Our hospital does not have a policy for this. Is there anything specific we need to do?

In any infant-feeding situation, our main focus needs to be on the baby. If the parents are unable to produce milk and want their baby fed donor milk, that should be our focus.

The optimal source of nutrition in any surrogacy situation is the surrogate mother. If she is able and willing to lactate for the baby, we need to support her in doing so, since her milk would be uniquely suited for the newborn.

If the surrogate’s milk is unavailable, we need to clarify the source of the “donor milk.” Is it milk from a human milk bank? This milk undergoes a rigorous screening and Holder pasteurization, and is available based on need with a physician’s prescription. Unfortunately, milk bank reserves are limited. Since it is dispensed based on need, most banked milk goes to premature and sick babies.

Or—and this hints at why I am hearing the question over and over again—is the donor milk from a non-surrogate, non-milk bank source? With the advent of groups such as Human Milk 4 Human Babies and Eats on Feets, it has become easier for breastfeeding mothers to connect with parents who have babies that could benefit from their surplus milk. And with the World Health Organization (WHO) recognizing “milk from a healthy wet-nurse or from a human-milk bank” as a viable infant feeding option when breastfeeding isn’t possible, more parents are considering milk-sharing over formula.

“Shared milk” calls for a well-considered policy and procedure in many if not all hospitals. At the very least, hospital staff ought to ensure that the baby’s parents are informed of potential risks associated with milk sharing, and that the baby’s doctor is aware of this feeding choice. (Note: Hospital staff should never “broker the deal” and connect patients with donors. This would be a violation of professional ethics.)

Whereas the couple was forthcoming about their intentions in the example above, some couples are not, and what to do about the “shared milk” situation becomes even more complicated. It may seem that milk is coming from an outside source, but staff cannot confirm that it is actually being given to the baby. We can’t wish away these thorny situations. Again, a good policy and procedure would help the guide staff in what needs to be done.

In drafting a suitable policy for your hospital, there are several resources you might use. James Akre and others have authored a paper
entitled “Milk sharing: from private practice to public pursuit,” which is available as an open-source article from the International Breastfeeding Journal and may provide some insight.
Also, you might consider the Appendix documents (see 4-C and 4-D) compiled by the California Perinatal Quality Care Collaborative. These documents are written to direct the care of very low birth weight (VLBW) infants and so may be more rigorous than your hospital needs in its care of healthy, full-term infants. However, the documents point to issues parents ought to consider, such as donor criteria, informed consent, liability waivers, and milk storage. (Of special interest may be the “Fresh Donor Breastmilk Information Sheet for Recipient Parent.”)

While milk sharing may seem an alarming feeding choice, hospital personnel will need to respect the parents’ role in determining their baby’s nutrition. The baby does not, after all, belong to the hospital but to the parents.

Q & A: Counseling the mother of a preterm or ill baby
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Barbara Latterner, RN, IBCLC · July 19, 2013 at 11:14 am

Marie, Do you think a hospital has the right to forbid use of donor milk for a term healthy baby unless it is from a millk bank? I feel strongly that the baby belongs to the parents and it is their choice what they feed their baby. I’ve worked with parents before who were unable to use donated milk and so baby is fed formula and this to me seems more a liability for the hospital.

Marie · July 19, 2013 at 3:20 pm

Barbara, thank you for your insightful question.
Your question does not specify who is the “doer of the deed.” To me, that is the key. What do you mean by forbid? Do you mean that the milk is at the hospital, and the hospital policy forbids the staff nurse to feed it to the baby? Or do you mean that the nurse must tell the mother she (mom) is forbidden from feeding it to her baby? Or something else?

When you say that you’ve worked with parents who are “unable to use donated milk and so the baby is fed formula,” do you mean that the hospital told them they couldn’t offer it to the baby, and the hospital provided a bottle of formula?

My thoughts on what parents do: Unless we handcuff them, I don’t see where we can really control what they do or don’t do. We can advise and even admonish, but in my experience, parents are going to do what they deem appropriate when we aren’t watching.

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