Enhancing breastfeeding and reducing neonatal mortality are vital to achieving the Sustainable Development Goals [1]. The World Health Organization recommends donor human milk (DHM) as the next alternative food source when a mother’s own milk (MOM) is temporarily unavailable [2]. Many women use PDHM from a couple of feeds to a couple of days, as a temporary ‘bridge’ when establishing MOM supply or whilst infant feeding issues are resolved. The use of PDHM as a long-term feeding option is less common and requires much higher volumes of human milk as well as continued engagement with human milk banking services. Reasons for long-term PDHM use include infant prematurity, maternal low/absent milk supply, supporting breastfeeding difficulties, maternal cancer/mastectomy, and maternal medication use or other health issues [3]. In 2014, the first human milk bank (HMB) was opened in New Zealand, with six active HMBs across the country [4].  In this blog post, we will highlight the findings of a study investigating the lived experience of six mothers who used PDHM from Whāngai Ora Milk Bank on a long-term basis (equal to or greater than two weeks). Narrative enquiry methodology was used to illustrate lived experiences, and human ethics approval was obtained (Ohu Matatika 1 23/23). Two of the themes emerging from women’s experiences were:

Theme one - Feeling inadequate, but coming to acceptance

Some participants described the preconceived idea that women’s bodies should automatically know how to make enough milk for a baby. When their own experience challenged this societal norm, women described feeling “less of a mother” for not “living up” to this expectation. Kaia expressed a feeling of diminished self-worth and inadequacy when she was unable to fulfil the job of breastfeeding. Additionally, she compared herself to other women who could produce breast milk and conveyed a sense of loss from their ability to do it for her baby, when she was unable to:

“It definitely made me feel less as a parent...It definitely wasn't easy. Knowing that, you know, someone else or some other people were able to feed my child, and I wasn't able to.” (Kaia)

However, over time, long-term users reported reaching a level of acceptance of their own milk supply and what they could or could not produce for their baby. For Jill, this acceptance involved her realising that she needed to regain more of her own health to support her baby:

“I was like, “I'm never going to be able to feed her enough by myself”. And it's just like, physically, it was getting really hard and mentally, it was really hard too. So, we just made the decision to cut the co-feeding and just go with the donor milk.”  (Jill)

 Theme two - PDHM supports the postpartum journey

Mother’s resolve to keep using PDHM long-term was described as stemming from a distrust of infant formula and a strong mindset of not wanting to use it. Some mothers felt this was because they had heard breast milk was the best infant feeding option, whereas others described a true fear of the ‘harms’ of infant formula or an unreliable supply.

“There's been a few too many shortages in formulas, so I didn't want to become reliant on something that I couldn't guarantee was going to be available.” (Farah)

Where PDHM was available, women could maintain their resolve to feed in line with their values, which relieved the stress and effort of constantly trying to establish breastfeeding. Farah described how using PDHM supported her and her husband as it allowed him to take on some of the feeding responsibilities and tube feed their baby while in the neonatal unit. His ability to take on feeding tasks assisted Farah’s mental health and provided bonding opportunities for him. She recognised this same outcome could essentially be achieved through using infant formula, however, she found long-term PDHM more personally acceptable. She expressed gratitude for the availability of PDHM due to her feelings of uncertainty around the formula.

“Having the donor milk, I think, took a lot of stress off me. I know the nurses could have fed him formula during the night as well, but my hubby, he could tube feed him. I know that they would have done the same with the formula, but I think just having the breast milk as an option made me feel less stressed. It was just one less thing to be worried about. I think in the back of my mind, I would have worried a little bit more about formula, and I don't think it's pragmatic and I don't know why I just would have.”  (Farah)

Nourishing hope: Long-term support with PDHM

The voices from these long-term users of PDHM convey complex emotions around how they view themselves as mothers and how PDHM supported them in their postpartum journey. Seagram & Daniluk (2008) explain how societal pressures create a narrative of what a ‘good’ mother looks like, which can be internalised by women during pregnancy or even before[5]. Part of this narrative implies a desire to breastfeed and associates a positive breastfeeding experience with ‘excelling’ as a mother. When a mother is unable to meet these expectations of herself, the result can be a pervasive loss of self, inclusive of self-identity and autonomy[6, 7]. In our study, women expressed gratitude and relief at being able to have a feeding option that aligned with their preference to feed their baby breastmilk. Long-term PDHM users also appreciated that partners and other support people can also contribute to feeding. Our study reveals the demand for positive uptake of PDHM where it is available. For long-term users, human milk banks provide holistic and compassionate care that values the emotional and social dimensions of infant feeding. This highlights the need to support milk banks’ infrastructure, integrate it into the healthcare system, and foster equitable access to protect, promote, and support women in accessing this invaluable resource for strengthening their breastfeeding journey.

References:

1. Israel-Ballard K, LaRose E, Mansen K: The global status of human milk banking. Matern Child Nutr 2024, 20 Suppl 4(Suppl 4):e13592.
2. Geneva WHO: WHO recommendations for care of the preterm or low-birth-weight infant. 2022.https://www.who.int/publications/i/item/9789240058262
3. Brown A, Shenker N: Receiving screened donor human milk for their infant supports parental wellbeing: a mixed-methods study. BMC Pregnancy and Childbirth 2022, 22(1):455.
4. Harris S, Bloomfield FH, Muelbert M: Formal and informal human milk donation in New Zealand: a mixed-method national survey. International Breastfeeding Journal 2024, 19(1):61.
5. Seagram S, Daniluk JC: “It Goes with the Territory”. Women & Therapy 2002, 25(1):61-88.
6. Frankhouser TL, Defenbaugh NL: An Autoethnographic Examination of Postpartum Depression. The Annals of Family Medicine 2017, 15(6):540-545.
7. Constantinou G, Varela S, Buckby B: Reviewing the experiences of maternal guilt - the "Motherhood Myth" influence. Health Care Women Int 2021, 42(4-6):852-876.