Newsletter #46: Milk Talk – Milk Sharing: Always a Viable Option

By BMSG Editorial Committee

Historically, milk sharing has always been an option for mothers who were not able to breastfeed their babies for one reason or another. Wet-nursing (compensating a lactating woman to breastfeed) or cross-nursing (breastfeeding someone else’s child) were some of the common practices of past communities all over the world to keep babies alive. Mothers who died at childbirth or who were too ill to breastfeed were able to depend on other mothers in the community to provide for their newborns. In this century, milk sharing has once again become a popular choice as breastmilk is now considered a valuable resource.

Milk sharing has always been an option for parents and families who want their babies to consume breastmilk. Donors who have excess milk also appreciate this demand since it is a win-win to help them clear their frozen stash. [Stock Photo]

Another Mother’s Milk Preferred Over Other Milk Substitutes

The demand for donor milk has increased over the last few years in Singapore and the world. An increasing number of people are now more aware about the benefits of breastmilk for babies, even if it comes from other than the babies’ mothers. 

Reasons why mothers sought donor milk vary. Some were due to insufficient milk supply or a preference for their babies to drink breastmilk over formula. Some mothers also stated that their babies react unfavourably to formula due to food sensitivities and allergies. 

One mother we spoke to, who only wanted to be known as Saphira, had received donor milk for her baby when she became ill after giving birth and had to be separated from her baby. “I was given strong antibiotics that were supposedly not breastfeeding-friendly. My baby was also hospitalised separately from me,” she added. Separation after birth and being unwell are one of the reasons that impede a smooth start to breastfeeding. 

Additionally, babies who do not fit certain requirements were not able to receive donor milk from the only human milk bank in Singapore. Donor milk from the bank is reserved for the most sick preterm babies. Milk sharing then becomes an option to ensure a baby is still able to receive breastmilk, if the mother is unable to breastfeed or extract sufficient milk. 

Premature or ill babies thrive well on breastmilk. Donor milk becomes an obvious option when the baby has exceeded the age limit for the milk bank. [Stock Photo]

Other Ways of Milk Sharing

Some mothers also opt for cross-nursing, where a lactating mother directly latches another baby who is not her own. Far’ain Jaafar, a mother of two, had helped to breastfeed her sister’s newborn to help boost her sister’s confidence to breastfeed. She nursed her nephew frequently for about four months and occasionally after that, usually when his mother was away at work or if Far’ain happened to be around. “My sister was mixed feeding initially so I fed my nephew to lessen his formula intake and to help my sister become accustomed to breastfeeding,” said Far’ain, who went on to nurse her nephew till he was almost a year old.

Families who adopt their children have also turned to milk sharing platforms if they choose not to induce lactation or require some time before they successfully do so. Another mother we interviewed, Lina Tan (not her real name), had donated to a friend who had adopted a newborn. She felt that it was an easy process of providing for the baby. “My only concern was that the parents and other caregivers are informed about how to handle breastmilk,” said Lina.

Donor Milk as an Option

The rise of milk banks around the world are also testament to this need for breastmilk. Milk banks are manifestations of milk sharing platforms that have been institutionalised for the needs of fragile, premature babies who are not able to feed on anything else but human milk. Premature babies, or preemies, are prone to necrotising enterocolitis, a life-threatening condition in the gut and human milk is necessary to sustain their health and can very well be the only food they can stomach. Usually, mothers of premature babies would try to provide their own breastmilk but difficulties in latching very tiny preemies may make this challenging to achieve. 

Breastmilk donated to milk banks are pooled together and then pasteurised. Usually, breastmilk from milk banks are for extremely premature babies. In Singapore, this would be babies born before 37 weeks. [Stock Photo]

According to the World Health Organization (WHO) in its Global Strategy for Infant and Young Child Feeding guidelines, another mother’s milk would be preferred over formula should the baby’s mother be unable to breastfeed her own baby:

“Only under exceptional circumstances can a mother’s milk be considered unsuitable for her infant. For those few health situations where infants cannot, or should not, be breastfed, the choice of the best alternative – expressed breast milk from an infant’s own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breast-milk substitute fed with a cup, which is a safer method than a feeding bottle and teat – depends on individual circumstances.”

World Health Organization (Global Strategy for Infant & Young Child Feeding Guidleines)

It is clear from the statement that the priority for a newborn is to receive breastmilk from his/her own mother and then from another mother before other milk substitutes should be considered. 

Satisfaction in Receiving and Donating Milk

Despite the risks that have been highlighted in milk sharing, and with the downplaying of the risks of formula, mothers continue to seek the benefits and satisfaction from the milk sharing relationship. 

Donors we spoke to highlighted how they felt happy to have been able to help babies who were in need. Some of them went on to become long-time donors and in turn became good friends with the recipient mum. Some donors were already friends with the recipient family and donating strengthened the bond. One mother felt honoured that her friend had specifically chosen her to donate milk.

Elaine Chow, a mother of four, had shared that her friend who was pregnant had asked her to donate some expressed breastmilk. “She wanted some expressed breastmilk (EBM) just in case her milk came in late after giving birth. I felt really honoured that she chose me and it was a testament to our bonds friends. Milk sharing connects mothers with one another in the sisterhood of motherhood,” said Elaine.

Some donors were also mothers who had earlier received milk when they were previously struggling with their young babies. These mothers then felt the need to pay the good deed forward. 

For Kwan Xiuwen, a mother of two, fearing that her baby would inherit intolerance for lactose led her to accept milk donations from other mothers. She then went on to pass along the good deed by donating her milk after she had her second child. “I felt determined to pass the good deed onto other mums and was very grateful to have a chance to do so. I felt that I was giving back to the community,” said Xiuwen, who had also shared how she was touched that the mother who donated milk to her son did not even ask for milk bags in return. This was a common practice in the milk-sharing community as a form of favour in place of monetary transactions. Financial transactions are discouraged in most breastmilk sharing platforms. “In hindsight, I should have provided her with them (breastmilk bags) since I was a long term recipient of her milk. But when I finally realised it, she was at the end of her milk donation,” said Xiuwen.

Mothers who partake in the milk sharing relationship may eventually become good friends because of the feelings of trust and gratitude. Some milk sharing relationships also solder mothers who are already good friends. [Stock Photo]

Such altruistic reasons show the positive impact of milk sharing and how it has created chains of support among mothers and families who practise milk-sharing. For another mother, Sharon, knowing that her milk has helped another baby to grow and remain healthy makes her happy. “I’m glad to be able to feed not only my own child, but help feed another baby as well. In a way, I feel like I’m paying it forward to help another baby and mummy in need, and that more mummies out there need help and support in their breastfeeding journeys. I understand fully the pain and guilt of feeling inadequate… so knowing that I can help another mum through this difficult journey, makes me feel good about it also,” she added.

Breastmilk is Food Security for Babies During Pandemic

While milk sharing has traditionally been about helping mothers and

While milk sharing has traditionally been about helping mothers and babies have enough supply of breastmilk, in the current pandemic, milk sharing has never been more important. As parents and families struggle with securing food and sustenance for the family, ensuring sufficient food for the young should never be ignored.

Milk sharing can very well be a necessity to be shared in the community for the benefit of the very young or sick babies and children. When either mothers or babies fall ill, breastfeeding can be disrupted if both are separated. This is when donor milk can become a useful resource to rely on when a mother is unable to breastfeed her baby because of separation. Caregivers who are tending to the baby left behind can very well be equipped with a resource that provides protection to the baby, and not just a form of sustenance. 

Furthermore, with supply chains disrupted all over the world, the reality is that formula can become an expensive resource that can be difficult to find in the event of mass hoarding. Breastmilk, on the other hand, is a viable option since mothers in the community can help sustain a child by milk sharing or cross-nursing.

Empty supermarket shelves are not a nightmare – it could very well be a reality. For parents who need formula for their babies, disrupted supply chains can mean danger for their children. Breastmilk donations should be part of our nation’s emergency-preparedness policies for the young. [Stock Photo]

Is Milk Sharing Safe?

There is an abundance of literature on the concerns about milk sharing from research papers to news articles. A lot of concern centres on the safety of milk sharing especially since there is an assumption that babies who receive donor milk are also at risk falling ill from poor handling and hygiene of donated breastmilk as well as illnesses obtained from the milk donor. 

Some medical professionals such as paediatricians and doctors dismiss informal milk sharing platforms because of the concern that the donors are not screened and the donated milk not pasteurised. 

Some literature also urged families to acquire breastmilk only from official milk banks that has a non-profit status. While these are available elsewhere in the world, Singapore only has one official milk bank which only provides the milk to premature babies in government hospitals, the KK Hospital Milk Bank. Unfortunately, the bank is only accessible to premature babies who are warded in local government hospitals. Families who wish to feed their babies with breastmilk therefore have no official platforms to go to should they require milk donations. In other countries, milk banks are considered an expensive options because costs to maintain a milk bank is expensive, making them a less attractive option.

Double Standards in Discussing Risks of Milk Sharing

Dr Karleen Gribble and  Dr Bernice Hausman, researchers who studied the trend of milk sharing, have found that there are double standards when it comes to discussing the risks of milk sharing. They wrote that:

“Breastfeeding is perceived as a risk to livelihood, while infant formulas solve problems for mothers, employers and society as a whole. In this paradigm, risks associated with feeding formula to infants are identified as a bad batch or manufacturing glitch, while risks associated with breastfeeding are represented as problems that any or all breastfeeding infants might face.”

Gribble and Hausman (2012)

The researchers observed that the risks of formula have been shadowed by economic reasons (women having to return to work, breastfeeding as impeding women working) and are downplayed while the risks of milk sharing is always considered as a be-all reason why it should never be done. 

The main fear around milk sharing usually involves contamination of milk and passing diseases to baby. However, contamination can happen in formula feeding as well. Contaminated formula milk such as salmonella and melamine poisoning have happened before that caused illnesses and deaths in babies. Improper reconstitution, dilution of formula milk and many other risks of formula have been left out in discussions surrounding its risks.

This imbalance in talking about risks seems to navigate the discussion to fear and revulsion towards milk-sharing as it is seen as a bodily fluid and not food. Hence, there is a need to educate the breastfeeding community on safe handling of breastmilk and how it can be given to babies safely.

A spokesperson for Human Milk for Human Babies (Singapore), an informal milk sharing platform, also added that the bad press surrounding online milk sharing in mainstream media is also due to how the sharing of human milk due to altruism is often conflated with the buying and selling of human milk, which is often sold for a profit. “Sharing of milk is different from selling it – a mother is simply donating her excess milk out of her own goodwill, to spread the love. She will not have any incentive to dilute the milk in order to stretch profits.”

Milk sharing can be done safely with transparency and informed choice. Trust is the ultimate keyword when it comes to the milk sharing relationship. [Stock Photo]

Safe Milk Sharing is Possible

Dr Gribble and Dr Hausman argue that instead of scoffing at the practice of milk sharing, experts should offer guidelines to how mothers can make informed decisions about doing so. 

Observing many informal platforms around the world such as the Human Milk for Human Babies networks and other online milk sharing platforms, some suggestions on safe milk sharing practices can include the following:

  • Encouraging informed choice
    • Parents should accept and understand that there are risks and benefits of milk sharing, just as there are risks and benefits to other ways of infant feeding, by doing their own research.
  • Screening of Donors
    • Informed choice would also mean that donors and recipients be open about sharing information that is important to the other party, such as diet (vegan diet, food allergies, food sensitivities etc), medical and social concerns (e.g. consumption habits such as diet, medication and if they are involved in smoking), and who the milk is for.
  • Proper Arrangement on the Logistics 
    • Arrange meticulously how the milk will be transported or exchanged.

Other parents would also prioritise different aspects of good practices, such as how long ago was the milk expressed, and the age of the donor’s babies. What is important to a set of prantes may be different to another; it is not rigid. For example, a parent of a sick baby may also ask for a specific way, such as stepped-up hygiene practices while pumping. Some parties may have to reconcile certain considerations if a match is difficult to procure.

According to HM4HB Singapore, the point of this exercise between potential matches of donor and recipient is to ensure transparency and trust between them:

“No one should donate or receive milk from someone they are uncomfortable with.”

HM4HB Singapore

Conclusion

The fears that encircle the discussions on milk-sharing understandably point out the fact that breastmilk is a bodily fluid and sharing it with other babies results in risks for the receiving babies. However, the community at large is still understanding very little about breastmilk. 

Donor milk remains a very valuable option and resource for families who want to provide breastmilk to their babies. However, feeding babies with other substitutes comes its own sets of risks as well that are not commonly discussed despite the dangers being real – chemical poisoning, contamination and scarcity of formula feeding, for example, are very rarely discussed openly while breastmilk sharing is frowned upon and faced with revulsion by members of the community. 

With time, we hope that more parents and families will be more open to the idea of informed milk sharing as the next best thing to a mother breastfeeding her own children.

Newsletter #46: Breastfeeding Crucial During COVID-19

By BMSG Editorial Committee

Since it appeared in late 2019, we have been continuously learning about the SARS-CoV-2 virus and COVID-19. We don’t yet know of its full impact on the world. Understandably, parents have particular concerns for their young children including wanting to know if breastfeeding is safe during this pandemic.

Parents would naturally be concerned about breastfeeding their newborns in the midst of COVID-19 [Stock Photo]

Why Breastfeeding Should Continue During COVID-19 

It is imperative to understand that breastfeeding is not just for nutrition and nourishment; it also plays a huge role in the developing immunity of a child.  It has been shown that the level of SARS-CoV-2 virus particles present in the breastmilk of mothers who test positive for COVID-19 is  insignificant, and that COVID-19 does not pass through breastmilk.

When  the human body encounters  a virus, the immune system works to produce antibodies to part or all of it. Generally  these antibodies, specific  to particular viruses and pathogens, are present in breastmilk. There are some preliminary findings which suggest that breastmilk actually provides babies with protection against COVID-19.

When a mother is infected with COVID-19, it is recommended that simple hygiene measures such as hand-washing and mask-wearing should be taken when breastfeeding. Breastmilk is still the best food (in the presence of COVID-19 or not) for babies – including for those who require donated breastmilk.

Breastmilk Contributes to Food Security  

The COVID-19 pandemic has also had  massive economic repercussions. Rates of unemployment have increased exponentially due to disrupted economies. In a highly commodified world, this naturally translates to limited resources, including food.

Formula milk, which has become a very common milk substitute for babies in developed countries, is expensive and is also vulnerable to supply disruptions. In times of crisis, it may become an even more costly commodity and may run off the shelves due to panic buying. The World Health Organization (WHO) is now encouraging mothers to consider relactating  or delay weaning off the breasts, to continue providing immunity to their breastfeeding children.

Empty shelves at supermarkets threw people into a frenzy, including parents who wanted to obtain formula milk for their babies. [Stock Photo]

Improving Management of COVID-19 for Postpartum and Breastfeeding Mothers in Singapore  

WHO guidelines on management of COVID-19 encourage breastfeeding and advise against the separation of mother and child. 

As the only Singaporean charity that supports breastfeeding mothers via various counselling channels, BMSG encourages mothers to continue breastfeeding and for family members to give their strong support. A previous article outlined the worries of our mothers during the initial Circuit Breaker period and we want to offer recommendations for mothers to continue breastfeeding even if they are infected with COVID-19 at the time of their pregnancies or when giving birth.

  • Infected Mothers Should Continue Rooming-In with Newborns After Giving Birth

Most hospitals which are Baby-friendly Hospital Initiative (BFHI) certified have policies where mothers and babies are able to room-in together after birth, unless there is a medically indicated reason for it. It also allows mothers and their newborns to have unrestricted skin-to-skin time after delivery, a recommendation by the WHO that helps to facilitate  breastfeeding. Hearteningly, this guidance has been instituted at the various maternity hospitals in part or in totality since 2013.

While there have been no reports of infected mothers giving birth as of yet in Singapore, there was a mother in Australia who was infected with COVID-19 and was allowed to room in together with her baby until discharge. The baby did not contract COVID-19 and was breastfed by the mother from Day 1. India has also reported that 100 babies born to mothers who had contracted COVID-19 before they went into labour had shown negative results for COVID-19, with the exception of two babies. These babies were also quick to bounce back, showing negative results after subsequent tests were done just a few days later. These mothers and their babies were also allowed to room-in together and the mothers had breastfed their infants.

Unless either a mother or her baby is ill right after birth, it is recommended that mothers and babies are together to establish breastfeeding through efforts such as skin-to-skin and initiating the first latch. [Stock Photo]

If you come down with COVID-19, you can insist on rooming-in with the baby as long as you and all visitors practise good hygiene. The precious hours and days right after the birth are when babies receive the goodness of colostrum which can be considered their very first immunisation. Every single drop is filled with antibodies and immune factors that serve to develop the child’s fighting capacity against the very pathogens that we seek to protect them from.

  • Babies of Mums with COVID-19 May Not be Allowed in Quarantine Facilities  

In relation to the above point, BMSG has contacted the Ministry of Health (MOH), and from our communication there seems to be no clear guidelines as to whether or not  breastfeeding mothers can be housed with their babies should they be infected with COVID-19.  

If you find yourself in this situation, advocate strongly for your baby to be allowed in the facility with you to protect your breastfeeding relationship. Breastmilk is one of the best ways to protect babies from the infection, which is why it is crucial to ensure that the breastfeeding relationship continues.

If it is not possible for you to be with your child (e.g. warded in ICU), you can still continue to pump milk. As always, practise good hygiene while pumping, such as washing hands before pumping and storing milk, sterilising all pump parts before pumping and making sure that milk is stored according to the recommended milk storage guidelines.


Breastfeeding remains the best form of protection for babies against COVID-19. Breastfeeding should begin right from the moment baby is born. [Stock Photo]
  • Lack of Postpartum & Breastfeeding Resources for Mothers at Home 

Many mothers struggle with breastfeeding in the few days after birth, particularly after discharge from hospital. Breastfeeding challenges typically arise around days 2 to 4 when breast engorgement, difficulty in latching, and the overall struggle of caring for a newborn can impede mothers’ efforts to breastfeed.

The Circuit Breaker that started in early April 2020 affected mothers and infants at their most vulnerable period. Mothers who required a Lactation Consultant (LC) to assist with breastfeeding were not able to have one visit them and yet may not have been well enough to visit one at the hospital. Families who were expecting confinement nannies from Malaysia to help care for newborns had to cope on their own. Other postpartum care services such as postnatal massages were similarly nonexistent for isolated new mothers, and more so with no visits from extended family members for support. This posed a huge challenge and strain, physically, emotionally, mentally.

We know that the first two to four weeks are when both mothers and babies learn how to latch well and we often refer to this as the “golden period”. When mothers receive adequate support during this time, they tend to have a better breastfeeding journey. By the time a mother is able to access help, she may have already given up on breastfeeding.

Breastfeeding feeds not just a baby, but the whole nation. If we aim for a healthier generation, we need to be able to support our breastfeeding dyads.

How Should Singapore Move Forward?

It is clear that Singapore needs to create or adapt our own national guidelines to safeguard our vulnerable young children in the event of a future crisis – be it another pandemic, a natural disaster, or others. 

Australia updated its IYCF-E guidelines this year after the catastrophic Australian bushfires in 2019. Dr Karleen Gribble, a breastfeeding advocate, produced detailed recommendations for families with young babies to plan for evacuation. We also looked for inspiration from Safely Fed Canada, an organisation that offers very clear advice to parents on how to facilitate breastfeeding and sustainable infant feeding during times of crises. 

We urge Singapore to create ICYF-E policies that will help policymakers and our nation be more prepared on safe infant feeding during national crises, which include and promote breastfeeding at home and in institutions, and which guide parents and carers in detail on safe formula preparation and feeding. The availability of formula milk for babies is at the mercy of supply chains and carries with it increased risk of infections and contamination, especially in emergencies. Ample preparedness will safeguard the health and security of our children.

We also urge that Singapore create a national breastfeeding committee to encourage, facilitate and protect breastfeeding at a national level, for all times. When breastfeeding becomes part of our national policies, and our culture as a society, we will be providing our babies their primal rights, maintaining food security and improving overall health for our children now and in the future.

Breastfeeding remains a crucial aspect of infant and young children feeding in emergencies (IYCF-E) and should be part of nationwide policies in the event of a pandemic or national emergency. [Stock Photo]