IMPORTANT POLICY UPDATE
In March 2010, the LLLI Board of Directors adopted the following policy regarding the donation of human milk:
La Leche League International fully supports the use of human milk for babies. The first priority of LLLI is to help mothers breastfeed their babies. A second priority is helping mothers to express and safely store their own milk for their babies. When their own mother's milk is unavailable, babies may need human milk donated by other mothers. It is essential that this donated milk be safe. As an international organization, LLLI is aware that many mothers in many cultures have informally shared their breastmilk and wet nursed among family members and trusted friends. LLLI also recognizes that in times of severe maternal illness/death and natural disaster, sharing milk has been lifesaving. The latter special circumstances, however, are beyond the scope of this policy statement. In keeping with the recommendations of the Health Advisory Council of the LLLI Professional Advisory Board, LLLI has developed stringent guidelines concerning the collection and use of donated human milk.
When a mother contacts a Leader seeking donated human milk, the Leader shall respond with information and support. This shall include information about induced lactation and/or relactation. The Leader shall also suggest the mother dialogue with an appropriate, licensed health care provider and contact a licensed human milk bank or other regulated and medically supervised human milk collection center in her country. The Leader shall inform any mother interested in using donated human milk for her baby, whether on an occasional or on a long term basis, of the documented benefits and risks connected with this form of infant feeding. Benefits include, but are not limited to: optimal nutrition, easy digestibility, and immunologic protection. Risks can include, but are not limited to: transmission of certain infectious agents, like bacteria or viruses, some of which may be found in milk expressed by asymptomatic women; drugs; possibly some environmental contaminants, and potentially unhygienic storage and handling of unprocessed donated milk. Milk from a qualified milk bank will require donors meet specific health requirements before accepting their donated milk, which eliminates many of those risks. Each country sets its own standards for milk donors and these screening criteria are available by contacting the milk banks directly. If a mother is interested in donating her milk, a Leader shall provide contact information for licensed human milk banks or other regulated and medically supervised collection centers. A Leader shall never pressure a mother to donate or to continue donating her milk. All identifying information concerning the donors and recipients shall remain confidential. A Leader shall remind a potential donor mother that her own baby has a natural priority to her milk. A Leader shall inform a potential donor that: 1) a donor may request complete information from the milk bank or collection center about how her milk will be used; 2) a donor may inquire if she may restrict how her milk will be used; 3) a donor may make her decision about donation in the light of the information she receives from the milk bank or collection center.
A Leader shall never initiate the suggestion of an informal milk-donation arrangement or act as an intermediary in such a situation. If a mother wishes to discuss these options - which may include donating expressed milk, wet-nursing or cross-nursing - the Leader's role is to provide information about the benefits and risks, as mentioned above, including the limitations of home sterilization of expressed breastmilk. If the baby is hospitalized, the mother is directed to dialogue with the medical staff caring for her regarding hospital policies on providing human milk for a baby in their care. The mother will then make her own informed decision based on her situation and culture.
A Leader shall not ever suggest an informal milk-donation arrangement, including wet-nursing or cross-nursing. If a mother wishes to discuss these options, the Leader’s role is to provide information about the risks and benefits so that the mother can make her own informed decision based on her situation.
Wet Nursing and Cross Nursing
from LEAVEN, Vol. 31 No. 4, July-August 1995, pp. 53-5
by Judy Minami
Ed. Note: We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time.
Wet Nursing--the complete nursing of another's infant, often for pay.
Cross Nursing--the occasional nursing of another's infant while the mother continues to nurse her own child, often in a child care situation.
Although rare, Leaders do receive questions from mothers about wet nursing and cross nursing. La Leche League does not encourage or suggest wet nursing or cross nursing of infants. Indeed, the practice is discouraged for a number of physical and psychological reasons.
If a mother says she plans to cross nurse we can point out the hazards. Most important is the hazard of potential infection for mother and baby. In recent years, the media have reported various "new" viruses and diseases. We are all more aware that the possibility of transmitting infections is heightened. Fear of infection has caused mothers who once shared breastfeeding in a child care situation to no longer consider cross nursing as an option.
The mother who is cross nursing may experience a reduced supply of milk for her own baby. Nursing another baby during the day may leave the cross nursing mother with an inadequate amount of milk for her own baby later in the day. Various factors including the ages of the two babies and the regularity of the cross nursing schedule would affect whether or not the cross nursing mother's milk supply would build up to meet the needs of both babies.
Babies of different ages require a specific composition of milk. Milk from the baby's own mother will provide the exact make-up the infant needs; another mother whose baby is not the same age may not provide the same components.
Cross nursing can also affect the baby psychologically. A difference in the let down, either in the timing or in the forcefulness, can confuse and frustrate an infant. In many cases, a baby will refuse to nurse from a cross nursing mother/ child care provider, especially if the baby is four months or older.
In 1981, Krantz and Kupper published an article, "Cross-nursing: Wet-nursing in a Contemporary Context." In this study, mothers of four-month-old babies said that when cross nursing, the babies "looked puzzled" when offered the breast of the "other" mother. One baby, although she latched on and nursed well, became disturbed if the surrogate mother spoke while nursing. The baby "stopped nursing and whimpered" each time the woman spoke and continued to do so until the woman stopped talking. The involvement of a substitute nursing mother also detracts from the unique bonding a nursing mother and her baby share.
If a mother asks about cross nursing, a Leader can suggest that a substitute nursing mother needs to be screened carefully using the following criteria:
- She should be healthy, well-nourished and taking no medication. Ideally, she has an infant about the same age as the one she would be cross nursing.
- She should be screened for tuberculosis, syphilis, hepatitis-associated antigen, cytomegalovirus, herpes virus, HIV and other infectious agents.
- She should not smoke, drink alcohol, or consume large amounts of caffeinated or artificially sweetened beverages.
- Her own infant should be healthy, gaining well and free of all infections.
Present Day Attitudes About Wet Nursing/Cross Nursing
A review of the literature shows that present day attitudes about wet nursing/cross nursing run the gamut from total acceptance to complete outrage that anyone would even consider such a practice. In the 1981 Krantz and Kupper study, the authors interview three women who cross nursed while babysitting each other's infants. The article notes that cross nursing is "a logical and practical extension of the resurgence of breastfeeding, in that the mother would not be as 'tied down' and thus more willing to try it (breastfeeding)...especially true in the case of employed mothers." Krantz and Kupper reported later encountering other examples of cross nursing in other parts of the United States and thus felt that cross nursing could be "a common, if unreported, practice."
Gabrielle Palmer in The Politics of Breastfeeding asks a mother about allowing another mother to feed her baby. The mother compared it to adultery. Palmer herself feels that "shared breastfeeding is a unique opportunity for solidarity and friendship among women." Many women interviewed by the author said they were happy with their cross nursing experiences.
Maureen Minchin's Food For Thought suggests, "Maybe it's time for the wet nurse to make a comeback." Acknowledging that it may be impractical, she says the idea needs to be discussed. Such a debate may provide impetus to change an unacceptable situation--babies not receiving human milk for the first six months of life.
In Feedback, a publication of LLL in Great Britain, the Spring 1989 issue contained replies to an earlier item that dealt with wet nursing by an infant's grandmother. Replies varied from acceptance to a feeling that it should be discouraged.
The Nursing Mothers' Association of Australia (NMAA) in a 1994 issue of their newsletter, published 16 letters from readers in a column called "Talking Point." Every writer described her experience with cross nursing in a positive, accepting tone, some saying it was a "wonderful idea." NMAA has no policy on wet nursing, believing it should be "an individual decision made by the mother concerned." The published replies seem to back up Krantz and Kupper's conclusion that cross nursing is more practiced than reported.
Most situations in which cross nursing is practiced are private arrangements made by the mothers involved. Day care or babysitting seem to be the most common conditions in which it is used. Cross nursing or wet nursing has also been used when hospitalization of the mother is necessary. This is especially true in an emergency when the mother is unable to nurse or the effects on the infant of the mother's prescribed medication dictates temporary weaning. Cross nursing can also be used to stimulate a mother's milk supply when her own baby cannot. This might be considered when the mother has a premature or physically handicapped baby.
Cross nursing has also been used to stimulate the milk production of an adoptive mother. When an adoptive mother and a fully lactating mother nurse each other's infants, the adoptive mother's milk supply is stimulated by an experienced nursing baby and the adoptive baby learns how to nurse at the breast.
The incidence of cross nursing in modern society may never be known, although most Leaders have probably heard about it at least once or twice. As in the previously cited references, Leaders themselves may have widely differing reactions to this situation. Regardless of the individual circumstances or a Leader's reaction to it, cross nursing is not something that should be undertaken lightly, if considered at all.
Committee on Nutrition American Academy of Pediatrics: Human Milk Banking. Pediatrics 1980; 68:854.
Counts, DA. Infant Care and Feeding in Kalai, West New Britain, Papua New Guinea. Ecol Food Nutr 1984; 15:49-59.
Golden, J. From wet nurse directory to milk bank: the delivery of human milk in Boston 1909-1927.
Krantz, J.Z. and Kupper, N.S. Cross-nursing: wet nursing in a contemporary culture. Pediatrics 1981; 67:715-17.
Lawrence, R.A. Breastfeeding: A Guide for the Medical Profession, 4th ed. St. Louis, Missouri: Mosby-Year Book, Inc., 1994.
McLaren, D. Nature's contraceptive: wet nursing and prolonged lactation: the case of Chesham, Buckinghamsire 1578-1601. Medical History; Vol. 23.
Ratner, H. The nursing mother: historical insights from art and theology. Child and Family 1949; 8(4):19.
Riordan, J. and Auerbach, K.G. Breastfeeding and Human Lactation. Boston, Massachusetts: Jones and Bartlett, 1993.
Van Esterik, P. and Elliot, T. Infant feeding style in urban Kenya. Ecol Food Nutr 1991; 45:67-75.
Wickes, l.G. A history of infant feeding. Part Il: Seventeenth and eighteenth centuries. Arch Dis Child 1953; 28:232.
FOR FURTHER READING
Fildes, V. A History of Wet Nursing from Earliest Times to the Present. Oxford, Basil Blackwell, 1988.
Fildes, V. Breast, bottles, and babies. Edinburgh: Edinburgh University Press, 1986.
Palmer, G. The Politics of Breastfeeding. London: Pandora Press, 1988.
History of Wet Nursing/Cross Nursing
Wet nursing and cross nursing have been controversial since the beginning of recorded history. About 2000 years B.C., the Code of Hammurabi became the law of the Babylonian Empire. Believe it or not, this oldest of written laws included rules for wet nursing. One of the rules stated that if a wet nurse had been feeding an infant who died for any reason, she was prohibited from taking on another infant to wet nurse.
The Book of Exodus in the Old Testament of the Bible, written about 1250 B.C., tells of a wet nurse being hired for Moses. (Unbeknownst to her employer, the wet nurse was Moses' own mother!) In 900 B.C., Homer referred to wet nursing in his famous epic poems. The Koran, written about 600 A.D., permitted parents to "give your children out to nurse." Hippocrates, the Greek physician, stated in 377 B.C., "One's own milk is beneficial, others' harmful."
As you can see, the practice of wet nursing has been controversial and has gone in and out of fashion throughout history. In Sparta during the fourth century B.C., women; including the wives of kings, were required to nurse their oldest sons. Commoners had to nurse all their children. In one instance a second son of a king inherited the kingdom because he had been nursed by his mother while his older brother had been wet nursed. In ancient Greece and Rome, while wet nurses were slaves, they held a position of respect within the household. They were boarded in the home of the infant and often remained as servants in the family home after the baby weaned.
In 1472 A.D., Paul Bellardus wrote the first pediatric text published in northern Italy. The book included a section on the qualities of a good wet nurse.
From the 16th to 18th centuries, well-to-do mothers in Europe and North America rarely nursed their babies. The infants were placed with wet nurses and returned home only when they were weaned, if they lived.
Fashionable women of the period wore corsets made of leather or metal with stays of bone. The corsets not only broke ribs but also damaged breast tissue and nipples, making breastfeeding impossible. Employing wet nurses was a sign of a family's high status in society, showing that the family had the resources to pay someone else to do any physical tasks.
It was expected that the noblewoman would provide heirs for the family. Even in 17th century England, there was knowledge of the contraceptive effect of breastfeeding; to nurse would have reduced the number of pregnancies, thus heirs. For a noblewoman to have 12 to 18 pregnancies was not uncommon.
Peasants, who not only breastfed their own children but wet nursed for hire and cross nursed in child care, rarely had more than a half dozen children. In addition, it was believed that a breastfeeding mother should not have sexual relations while lactating lest it somehow taint her milk. The conjugal needs of noblemen were more important than those of wet nurses and their husbands.
In 18th century France, wealthy and middle income Parisian women sought to keep their beauty by placing their infants with wet nurses. They believed breastfeeding would ruin their figures and make them old before their time. Also in this period, laws regarding wet nurses were enacted. A wet nurse could not nurse more than two infants along with her own. Each infant required its own crib so the wet nurse would not take a baby to bed and possibly suffocate it.
In the 18th and early 19th centuries, bleeding was believed to he a remedy for most ills. It was used during pregnancy for various problems and complaints; as a result many women died in childbirth. The children whose mothers succumbed to poor prenatal care and obstructed labors were saved only by the services of a wet nurse.
During, the latter part of the 18th century, Dr. William Cadogan wrote an essay on nursing and the management of children from birth to age three. He observed that peasant women who nursed their own babies had healthier children and that early breastfeeding prevented mastitis and engorgement. He therefore advocated breastfeeding for the benefit of both mother and baby.
At various times over the centuries, societal support for breastfeeding waned. Mothers refused to take on the function of lactation. The social attitudes of urban women and their greater access to alternatives led to greater use of wet nurses and less focus on the adequate care of children.
In the mid-19th century, a number of physicians began seeking a breast milk substitute to replace the use of wet nurses. Wet nurses were believed to be the source of disease, especially syphilis. The wet nurse also feared being infected by infants with the disease. It was this widespread fear that motivated the development of artificial feeding.
The turn of the century also saw the establishment of human milk banks. Doctors sought to improve the prognosis for babies denied breast milk since their chances of death were six times greater than breastfed infants. This began the separation of the product from the producer and removed control of feeding from wet nurses.
During the Industrial Revolution through World War II, women began working at jobs in factories where babies could not accompany them. Thus, artificial feeding became well established and accepted.
In many countries today, wet nursing/cross nursing is common practice. Some cultures have strong beliefs and customs that dictate the practice of nursing a baby other than one's own baby. A baby whose mother has died or who cannot nurse is passed among nursing mothers or adopted by a lactating mother whose own baby has died. In Japan and Thailand, breast milk can be given only to a baby of the same sex as the mother's own. In other cultures, breast milk is believed to be the conduit through which the child receives his ancestry, thus only women of the mother's or father's family can be a wet nurse for the infant.