Breast is best ... Natalie Scobie fed her son Max, now 16 months, with donated milk. Photo: Luis Enrique Ascui
Max Scobie entered the world weighing a healthy 3.8kg. His mother, Natalie Scobie, had breastfed her three older children without a hitch, so it was a surprise when it was revealed Max had stopped gaining weight.
Struggling to latch on, Max was failing to get enough milk, which was affecting his mother's supply.
Reluctant to turn to infant formula, Scobie, 34, reached out through the Victorian Facebook page of global milk-sharing network, Human Milk 4 Human Babies (HM4HB), and soon received milk donations from nearby breastfeeding mothers - enough to supplement her own supply.
Storage at the Mercy Hospital's milk bank in Melbourne. Photo: Justin McManus
"It's been amazing to be the recipient of such generosity from complete strangers [and] I think it will have a long-term impact on his health," she says.
Now 16 months, Max is among a growing number of babies receiving breast milk through online communities such as HM4HB, as part of an international trend back to wet nursing.
Before infant formula became widely available in the 1950s, milk sharing and wet nursing were common practices, but declined during the '80s when people became worried about the risk of infection, particularly of HIV.
Today's technology-driven wet nursing has unsettled many people. It also bears little resemblance to the practices of yesteryear, and this is where health professionals and women desperate to provide breast milk for their babies are divided.
Human breast milk contains antibodies that can help prevent illness, but controversy has surrounded mothers sharing unscreened breast milk because of the risk that it could transmit infectious diseases - such as hepatitis B and C, and HIV - or bacteria from improper collection.
"When you initially think about it, there's a slight hesitation, but because you're meeting the women, you get a general sense of what they're like and their nature, and most of them are feeding their own children, so I guess there's a sense of comfort in that as well," Scobie says.
What the doctors say
Australia has four publicly funded breast milk banks, but the sole purpose of these banks is to provide screened and pasteurised milk to premature and unwell babies within each hospital's neonatal intensive care units. Evidence suggests that where a mother's own milk is unavailable, pasteurised donor human milk is better tolerated than formula for the premmies, and can reduce their risks of developing certain illnesses.
So mothers struggling with their own supply have questioned why milk banks aren't accessible to all babies.
Dr Ben Hartmann established Australia's first human milk bank at the King Edward Memorial Hospital in Western Australia. He says that while donor milk is better than formula for a pre-term baby, there's no evidence to suggest it's better for a full-term baby than infant formula.
He says while a mother feeding her own baby is always best, people shouldn't equate it with another mother's donor milk, because there's a big difference between the two.
The HM4HB Facebook page displays messages from mothers who say they are distraught at the thought of having to use infant formula, but Hartmann says mothers with healthy babies shouldn't discount the formula option on a short-term basis.
"If her own breastfeeding problems are being adequately supported, a few feeds of formula to meet her baby's nutritional needs shouldn't decrease her chances of success [at breastfeeding]," he says.
Australia's milk bank
Despite Hartmann's observations, there will always be women who are determined to supply breast milk to their baby. An alternative for mothers struggling with their own supply is non-profit organisation Mothers' Milk Bank in Queensland, the only community milk bank in Australia, which sells screened, pasteurised breast milk.
The director, Marea Ryan, says the milk is free, but that the organisation asks for a donation to cover processing costs. That donation is $80 a litre, and the milk is unavailable to those who can't pay the fee. Ryan has made several unsuccessful requests for government funding.
"From the recipient's point of view, [people who have a] baby in need and who can't afford the processing fee, that's where the frustration is ... when you know you've got sick babies who need it and the parents don't have access to pasteurised milk because they can't pay the fee," Ryan says.
She says that publicly funded milk banks should be available in every region in Australia, so women don't source unscreened milk - which, apart from the risk of virus contamination, may also carry potential bacteria from incorrect storage and transportation.
"When we first started, we were throwing out 50 per cent of the milk because of bacteria. And then we kept refining it, refining it and going back to see what mothers were doing during collection, or their hygiene practices, and we've refined that down to 20 per cent,'' she says.
Irena Webb, a Queensland mother of one, has donated 170L of milk through the HM4HM network, and regularly sends milk to a recipient in Victoria in an Esky in the post.
Webb, 33, researched safe storage and transport practices and follows a strict hygiene routine when expressing. Her own mother donated milk to the local GP when Irena was a child, inspiring her to follow the same path. But a previous blood transfusion meant she wasn't eligible to donate to a breast milk bank, so looked to an online network instead.
"I'm just open and honest and say there's a small risk because of the blood transfusion," she says.
Another woman, Jennie Jeppesen, says she was pumping double the amount she needed for her 10-week-old son, but can't donate to a milk bank because she has multiple sclerosis.
Jeppesen, 32, explained that regularly expressing milk helped suppress her MS and keep her healthy. She wanted to provide for babies who weren't getting enough breast milk, but felt disappointed when banks wouldn't accept her supply.
"I've got so much that I don't see why someone shouldn't take advantage of it - which is why I think the HM4HB site is so important. There are people like me, who are healthy, except for the MS," she says.
But Ryan, from Mothers' Milk Bank, says these circumstances place an unnecessary risk on the baby.
''We're going to have a negative consequence of a baby getting something through the milk and then they'll be looking around saying, 'How has this happened?''' she says.
La Trobe University child health researcher Dr Lisa Amir says the anxiety around the transmission of HIV during the 1980s meant people are often horrified at the idea of sharing milk now. "Overall the risks of anyone contracting infection is probably very low, but health professionals are concerned because there is that risk," she says.
The GP lactation consultant says it's a natural extension for people to use the internet to share milk, but if it's being used to make money, you can assume the quality wouldn't be as good.
Hartmann agrees and says sites where mothers share their breast milk, especially mothers who are unknown to each other, already relied on a big element of trust, but commodification further complicated the issue.
"Personally, I think it would be very hard for mothers to control those risks - [for example] falsifying donor screening tests because there's a commercial imperative to do so," he says.
While HM4HB does not support payments, other sites, particularly in the US, operate on a fee structure. Recently, the first for-profit milk bank, Prolacta, was established in the US. It sells modified donated milk back to hospitals at a highly inflated cost.
Hartmann says providing donor milk, wet nursing or internet milk sharing reflects an underlying problem: that mothers are not being supported enough in breastfeeding.
"We're doing really well in Australia at encouraging mothers to breastfeed, but what we do really poorly is support mothers who've made that decision to continue to feed their baby," he says.
"We know mums have problems and there's a lack of support for them to get help - whether that's to increase their supply or with other issues to do with breastfeeding. That's where the focus should be. That's where there's a really big hole, and I don't think it should be filled with donor milk."
However for some, like Natalie Scobie, donor milk is a welcome, valuable gift.
"At the end of the day, human milk is designed for human babies and you just can't get better than that," Scobie says. "For me, it feels very natural and instinctive."
Would you accept another woman's breast milk for your child? Or do you donate? Have your say in the comments below.