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I (Beatriz) met Anna in her modest apartment in Casselberry, a middleincome community in Central Florida. She opened the door holding six-month-old Grace, a beautiful baby girl with twinkling blue eyes. Anna was young, only 21, younger than most of the women who had participated in our study. When her baby girl was born, Anna was a single mother, working two minimum-wage jobs to support herself and her baby. Her story was harrowing: she explained that although she had been planning a vaginal birth, she experienced complications that led to a caesarean section (C-section). She qualified for Medicaid and thus had health insurance; however, like most women in the US, she did not have access to paid maternity leave, and her wages were very low. So, even though she was still physically recovering from major surgery, and even though her infant daughter was still very young, Anna had no choice but to return to work only 15 days after giving birth.
Anna firmly believes that human milk is the best possible nutrition for her baby. When Grace was born, nearly everything that could go wrong did go wrong: Grace was taken from Anna during the C-section and not returned to her for 90 minutes, despite Anna being promised that she would be able to have skin-to-skin contact with Grace in the operating room. Then Grace developed jaundice and had to be hospitalized. For four days, Anna slept in the hospital lobby, getting up every two hours to go to the NICU to nurse her baby.
Things got harder once Anna was able to bring Grace home. She knew federal law guaranteed her the right to express her milk, and that her employer was required to give her a space to do so. But she knew that because she held an unskilled job and worked for low wages her position was vulnerable. Her supervisor agreed to give her breaks so she could pump, but there was no space for her to do it at the gas station where she worked, so she had to do it in her car.
As we approached the final chapter of this book, two news headlines were circulating within the milk-sharing communities we studied. The first, an article in The Washington Post titled “Why These Bikers Crisscross New York Delivering Donated Breast Milk” (Free 2019), tells the heartwarming story of a motorcycle club that has partnered with an HMBANA milk bank in New York to deliver pasteurized breastmilk to homes and hospitals for babies who need it. The article emphasizes the altruism in both breastmilk donation and delivery by the motorcyclists, showing how two unlikely worlds – motorcycling and breastmilk feeding – come together for a greater purpose. The milk is referred to as ‘precious cargo’, and its health benefits to the receiving babies are presented as scientifically indisputable. The article emphasizes the social relationships that emerge from the partnership, where the motorcyclists connect with the founder of the milk bank as well as the parents and babies to whom they bring milk. These community connections, along with the greater purpose of delivering human milk to needy babies, is described as ‘wonderful’, ‘rewarding’ and ‘inspired by kindness’.
The second headline derives from a news article from Physician's Weekly titled “AAP: Most Moms Unconcerned with Informal Milk Sharing” (HealthDay News 2019). The article reports a new study presented at the American Academy of Pediatrics annual meeting that used survey data to assess concerns related to breastmilk obtained through ‘informal milk sharing’ rather than through milk banks. The article reports that a high percentage of participants who used peershared milk were not concerned about the quality of the milk, and most did not screen donors because they trusted them. These findings are presented as problematic, and cause for serious concern. The article characterizes peer milk in terms of risk, stating that peer milk sharing is ‘discouraged by the pediatric medical community’. It concludes with a quote from one of the researchers, stating that it is ‘crucial that physicians become aware of this practice and the associated risks so that they can educate patients and address this growing concern’.
These articles reflect an ongoing cultural narrative that presents the use of banked breastmilk as safe, medically supported, and contributing to a greater moral good, and the use of peer breastmilk as risky, medically discouraged, and an emergent social problem.
5.30 am. A baby stirs, then cries. His mother, Cassie, lying in bed beside him, latches him to her breast, half asleep, and the nursling settles. A few minutes later, she gets up and heads to her rocking chair in the room next door, where her double electric pump is set up. She sits down and starts her morning pumping routine, washing her hands beforehand and ensuring all of her pump parts are clean and sanitized. Twenty minutes later, after making sure she washes her hands again, she carefully transfers the milk to storage bags, lays them flat on a cookie sheet, and places them in the freezer. Once they freeze flat, she will stack them neatly and slide them into a gallon-sized storage bag that will go into a specially designated freezer in her garage. Throughout her day, she repeats this same routine at least four times. By the end of the week, her freezer will be full of gallon-sized zipper bags full of eight-ounce milk-storage bags. Some of the milk is meant for Get Pumped, but on any given week she might offer some up to a desperate mother posting on Human Milk 4 Human Babies, or to a friend of a friend who is just not making enough milk. Cassie is very proud of the fact that she produces thick, creamy milk – she calls it buttermilk – and she's sure the babies she has fed have benefitted greatly from it. Meeting babies who drink her milk, she says, “lights her heart on fire”.
Meanwhile, in another part of town, another mother, Thelma, is also starting her day. Her own baby stirs, and she gets up to retrieve the bag of milk she left to defrost in her fridge the day before. She washes her hands, sighs in relief to see the bag didn't leak into the bowl it was sitting in, pours its contents into a bottle, and sets it into a bowl of warm water to heat it. She opens her freezer, frowns at the dwindling supply of frozen milk bags, and grabs her cell phone as she picks up the warmed bottle of donor milk and walks back to her bedroom to feed her baby. She logs on to a local Facebook group and posts some information about herself, her baby, and her need for milk.
Table A.1 displays the demographic characteristics of survey participants. Participants consisted of 392 individuals who reported engaging in peer milk sharing. Demographic data show that nearly 90% of respondents were white. Most participants were college-educated, with 64.6% reporting a bachelor's degree or higher. The sample was also socioeconomically privileged: nearly half of participants reported household incomes above US$70,001 a year and nearly 25% reported incomes above US$100,000 per year. The most common employment status was ‘not employed’, indicating that respondents were likely raising small children at home with the financial support of a spouse, followed by ‘employed full-time’. More than 70% of participants reported having only one or two children (see Table A.2). The majority identified as cisgender (99.7%) and heterosexual (95.3%). All but five of our respondents (99% of the sample) reported participating in peer breastmilk sharing since 2010, the year that Eats on Feets and Human Milk 4 Human Babies first appeared.
The feeding of human milk to socially and biologically unrelated infants is not a new phenomenon, but the Euroamerican values of individualism have generated expectations that mothers are individually responsible for feeding their own infants. Using a bio-communities of practice framework, this dynamic new analysis explores the emotional and material dimensions of the growing milk sharing practice in the Global North and its implications for contemporary understandings of infant feeding in the US. Ranging widely across themes of motherhood, gender and sociology, this is a compelling empirical account of infant feeding that stimulates new thinking about a contentious practice.
Table A.2 displays the demographic characteristics of interview participants. Participants consisted of 30 individuals who resided in Central Florida and took part in peer milk sharing at the time of the interview. All identified as cisgender, heterosexual women. They were predominantly white, with two of the 30 identifying as white-Hispanic. They ranged in age from 20– 45, with a median age of 30. With regard to marital status, 22 were married at the time of the interview, five were cohabiting with two of these five engaged to marry, two were single and one was divorced. Most participants had some college education, with six holding a master's degree or higher, six holding a bachelor's degree, 15 reporting some college education, an associate's degree, or current college enrolment at the time of interview, and two participants had a high school diploma or equivalent. Regarding income, 13 participants reported annual incomes lower than US$48,900, the median household income in Florida in 2015 (US Department of Labor 2018), with two reporting below the poverty threshold US Department of Labor 2018), whereas 17 participants reported annual incomes higher than the median, with four reporting incomes higher than $100,000. In terms of religious affiliation, 19 participants identified as Christian or as a particular Protestant sect such as Methodist, three identified as Catholic, one identified as Jewish, six reported no religious affiliation, and one reported being agnostic.
The Educated Mama, a closed Facebook group devoted to natural parenting and informed choice, is a busy place. With over 10,000 members, new posts devoted to questions of child development, baby sleep and cloth diapering appear constantly. Breastfeeding struggles are a frequent topic of conversation, and in these contexts milk sharing often comes up. In an age of visual storytelling and memes, one of the most visually striking posts observed are those of collages lovingly created by mothers whose babies have benefitted from donor milk. These visual stories present a narrative of interconnectedness, of babies connected to unrelated mothers and each other by the milk they consume. In this chapter, we explore the nature of these connections.
The first thing I (Beatriz) did when I found out I was pregnant with my oldest son was go on the internet. I spent hours reading up on pregnancy on websites like BabyCenter and The Bump. Before I was even out of my first trimester, I had devoted an inordinate amount of time to reading reviews for car seats, stroller, and bassinettes. I marvelled at the biological process of lactation and eagerly repeated to myself the mantra ‘breast is best’. Home birth wasn't right for me, but when I saw that having a midwife-attended hospital birth reduced the chances of C-sections, I immediately decided that was the care I would seek – and then spent hours researching local nurse-midwives. Once I found a provider, I attended my appointments and read the pregnancy magazines in the lobby. I learned about attachment parenting – a style of parenting that encourages secure attachment through constant bonding and contact between baby and caretaker (Granju and Kennedy 1999; Sears and Sears 2001; Faircloth 2013) – and decided that was what I wanted to do. I saw people wearing their babies in little blue carriers and knew I wanted one too. As the months progressed, I was exposed to a series of discourses and objects that shaped my desires for the baby I was soon to have. Some of these ideas had to do with philosophies of child raising, but others were products I needed to purchase. Pregnancy was both about my changing identity as a mother but also as a consumer (Afflerback et al 2013, 2014; Han 2013; O’Donohoe et al 2013; Kehily and Martens 2014; Tiidenberg and Baym 2017).
Shannon and Beatriz first met at a coffee shop on campus during the beginning of the fall semester in 2013. I (Beatriz) was at the tail end of the first trimester of pregnancy with my second child. Unlike Shannon, I struggled, and ultimately was unable, to exclusively breastfeed my children. My first son, born as I was working to finish my dissertation, spent his first few days in the NICU, and I always believed that my inability to exclusively breastfeed him despite an environment that was generally supportive of breastfeeding was due to the fact that we were separated for the first few days of his life. My second child, another boy, was born under ideal circumstances. His birth was not traumatic, and we were able to initiate nursing immediately. The fact that I was now employed as a professor made the financial transition from one to two children fairly uneventful, and the flexibility of my schedule allowed me to spend most of my time with my baby, even when I returned to work (he became known as ‘my appendage’ because he spent most of his time in a wrap, sleeping against my chest). Nevertheless, his weight gain was extremely slow and his paediatrician became concerned. At his four-month appointment, my baby's weight had barely crept up from our prior checkup. On the growth charts, his weight had plummeted from the 24th percentile to the fifth.
Despite a parade of lactation consultants, breastfeeding support groups, ‘power pumping’ (aggressively pumping at short intervals to stimulate milk production), ‘breastfeeding vacations’ (stopping all activity and spending entire weekends in bed skin-to-skin with my baby), and an endless supply of various galactagogues (fenugreek, blessed thistle, fennel, moringa root, oatmeal, flax, brewer's yeast and Domperidone), my supply simply couldn't keep up with his demand. I had completely bought into the notion, freely circulating in my support circles, that low milk supply was due to social causes, that it was an artificial phenomenon resulting from aggressive formula marketing and ill-informed pediatricians following inaccurate growth charts based on the growth patterns of formula-fed babies.
In a time where breastfeeding has re-emerged as the most widely promoted method of infant feeding, a distinct form of sharing breastmilk has emerged in the United States (US) and other postindustrialized societies in the Global North. Parents and other caretakers who are unable to provide sufficient breastmilk themselves are increasingly turning to peers to acquire human milk for their babies. They meet these peers through a combination of online and offline social networks, and form communities with distinct spoken and unspoken rules about how milk sharing takes place. These communities are reflective of emerging socialities made possible by 21st-century advances in technology, new forms of communication, and changing understandings of the human body and its products.
This is a book that analyzes human milk-sharing communities in a large metropolitan area in southeastern US. We have engaged with milk-sharing communities for several years, at times becoming part of them, in our endeavour to understand how these practices are reflective of new and changing ways of establishing and maintaining social connectedness. We describe the practices of milk sharing, the meanings ascribed to human milk, and the labour involved in its production. We build on existing scholarship and theoretical frameworks to develop a model for understanding contemporary forms of bodily sharing.
The feeding of human milk to socially and biologically unrelated infants is not, by any means, a new phenomenon. Rather, it is a normal method of infant feeding documented throughout human history, in societies around the world, and across mammalian species. Nevertheless, Euroamerican values of individualism, the heteropatriarchal nuclear family, and dominant gender roles have generated expectations that mothers throughout the Global North – particularly those who are white, middle-class, heterosexual and cisgender – are individually responsible for feeding their own, and only their own, infants (Shaw 2007, 2015, 2019; Carroll 2014; Palmquist 2015; Falls 2017; Shaw and Morgan 2017; Wilson 2018). This mandate emerges within a broader set of expectations that Sharon Hays (1996) calls ‘intensive mothering’, in which mothers are expected to maintain individual responsibility for their children's health and wellbeing, consult and follow expert guidance on parenting matters, expend vast time and resources into parenting, and prioritize their children's needs above their own.
We report key learning from the public health management of the first two confirmed cases of COVID-19 identified in the UK. The first case imported, and the second associated with probable person-to-person transmission within the UK. Contact tracing was complex and fast-moving. Potential exposures for both cases were reviewed, and 52 contacts were identified. No further confirmed COVID-19 cases have been linked epidemiologically to these two cases. As steps are made to enhance contact tracing across the UK, the lessons learned from earlier contact tracing during the country's containment phase are particularly important and timely.
Introduction: Cannabinoid Hyperemesis Syndrome (CHS) in pediatric patients is poorly characterized. Literature is scarce, making identification and treatment challenging. This study's objective was to describe demographics and visit data of pediatric patients presenting to the emergency department (ED) with suspected CHS, in order to improve understanding of the disorder. Methods: A retrospective chart review was conducted of pediatric patients (12-17 years) with suspected CHS presenting to one of two tertiary-care EDs; one pediatric and one pediatric/adult (combined annual pediatric census 40,550) between April 2014-March 2019. Charts were selected based on discharge diagnosis of abdominal pain or nausea/vomiting with positive cannabis urine screen, or discharge diagnosis of cannabis use, using ICD-10 codes. Patients with confirmed or likely diagnosis of CHS were identified and data including demographics, clinical history, and ED investigations/treatments were recorded by a trained research assistant. Results: 242 patients met criteria for review. 39 were identified as having a confirmed or likely diagnosis of CHS (mean age 16.2, SD 0.85 years with 64% female). 87% were triaged as either CTAS-2 or CTAS-3. 80% of patients had cannabis use frequency/duration documented. Of these, 89% reported at least daily use, the mean consumption was 1.30g/day (SD 1.13g/day), and all reported ≥6 months of heavy use. 69% of patients had at least one psychiatric comorbidity. When presenting to the ED, all had vomiting, 81% had nausea, 81% had abdominal pain, and 30% reported weight loss. Investigations done included venous blood gas (30%), pregnancy test in females (84%), liver enzymes (57%), pelvic or abdominal ultrasound (19%), abdominal X-ray (19%), and CT head (5%). 89% of patients received treatment in the ED with 81% receiving anti-emetics, 68% receiving intravenous (IV) fluids, and 22% receiving analgesics. Normal saline was the most used IV fluid (80%) and ondansetron was the most used anti-emetic (90%). Cannabis was suspected to account for symptoms in 74%, with 31% of these given the formal diagnosis of CHS. 62% of patients had another visit to the ED within 30 days (prior to or post sentinel visit), 59% of these for similar symptoms. Conclusion: This study of pediatric CHS reveals unique findings including a preponderance of female patients, a majority that consume cannabis daily, and weight loss reported in nearly one third. Many received extensive workups and most had multiple clustered visits to the ED.