‘Donor Breast Milk is a Product from the Hospital, not Somebody’: Disassociation in Contemporary Breast Milk Banking

Introduction

When bodily substances and fluids appear or are used outside of widely accepted margins they have the potential to be read as contaminable or threatening. Contemporary breast milk banking is a process which utilises breast milk outside of its (socially constructed) ‘natural’ framework which privileges the exclusive mother child dyad, so it has the potential to be read as dangerous and threatening particularly to bodily, social and cultural boundaries. This perceived threat is mostly why traditional breast milk sharing practices including shared breastfeeding and milk pooling disappeared during the twentieth century. Yet, in the last decade the trend for sharing breast milk has been (re)established through formalised, contemporary breast milk banks (BMBs) which facilitate the impersonal exchange of pasteurised human milk. In these facilities, the ongoing threat to mother-child exclusivity and potential ‘danger’ associated with the exchange of a bodily fluid means it is necessary to eliminate the threat of potential contamination. Consequently, along with stringent treatment and testing procedures, contemporary BMBs also incorporate methods of ‘disassociation’ to remove any undesirable meanings from breast milk so it appears impersonal, thus ‘safer’ and more acceptable for exchange. Here, I have used the term disassociation to mean the separation and depersonalisation of breast milk from an embodied substance to a consumerable product—which my research reveals, is a necessary condition of accepting donor breast milk (DBM). For the mothers involved in one of Australia’s BMBs, this disassociation is actively sought out and participated in, but often results in the fragmentation and disembodiment of maternal roles. This fragmentation and disembodiment has the consequence of enabling an objectification and in a contemporary context, a potentially exploitive or empowering commodification of women’s bodies and their breast milk.

Breast milk: The Historical Shifts from Suspicious to Salubrious

Breast milk and breastfeeding have had shifting and somewhat contradictory meanings throughout history. These meanings have been historically, socially, culturally, and scientifically constructed and have largely been depended on beliefs relating to gender and embodiment. During the Enlightenment period, for example, men and women’s bodies were perceived quiet differently, where the valorisation of reason over bodily processes meant that men were revered for their rationality and had ‘ideal’ bodies because they were able to be controlled and contained. In contrast, women’s bodies were and (continue to be) frequently defined as lacking boundaries and therefore inferior and potentially dangerous in comparison to the tightly controlled boundaries of men’s bodies (Shildrick, 1997; Weitz, 1998). Thus, the female body had the ability to arouse anxieties particularly because its uncontrollable nature constantly posed a threat to tightly compartmentalised male corporeality.

In this dualism, bodily fluids such as breast milk and menstrual blood often accentuated this uncontrollable aspect of women’s bodies since they were only possible in women’s bodies. The expulsion, seepage, leaky, dripping, gushing nature of these fluids was read as problematic and a challenge to corporeal integrity because they threaten to ‘dissolve the border or boundary’ that separates one individual from another (Shaw, 2004: 292). Elizabeth Grosz explains that this unpredictable threat of expulsion has ‘inscribed’ women’s bodies in ‘a mode of seepage’ and lacking self containment (Grosz, 1994: 203). This lack of self containment is particularly problematic whilst pregnant and lactating because it involves zones of the body that have the capacity to cause unease (i.e. the female, sexualised vagina and breast). It also brings these fluids and their associated body parts into a public domain, generating apprehension regarding the inside/outside, public/private, self/Other parameters of the body (Shaw, 2004). This is why public breastfeeding is often seen as problematic and disruptive; since it not only traverses bodily boundaries (because it has the potential to reveal a fluid that should be well contained) but also has the potential to traverse sexual boundaries as well because it is a practice that threatens to reveal a part of the body that many believe should remain ‘hidden’ (Bartlett, 2005; Stearns, 1999; Young, 1990). Consequently, women are forced to sanitise and streamline their bodies to control any potentially dangerous crossing of boundaries and avoid any unnecessary revealing of fluids and body parts that carry these complex connotations (Schmied and Lupton, 2001, Stearns, 1999). In this way, breast milk is often a substance that is seemingly expected to pass from a mother to her own baby directly through discreet breastfeeding, an embodied practice involving the use of a female part of the body with multiple and contested social and cultural meanings.

These complexities have meant that breast milk as a product and breastfeeding as a practice have generated ambivalence and frustration. This frustration is particularly accentuated because breast milk as a product has not necessary shared the same meanings and connotations that breastfeeding has. For instance, during the eighteenth century, although attitudes towards the female body considered the practice of breastfeeding as ‘animalistic’, breast milk  was still considered valuable so there was a huge demand for women to be employed as wet nurses. In this type of formalised, paid sharing arrangement lower class women were typically employed to feed wealthier women’s babies who would typically reside in the wet nurses’ home for the first few months, sometimes years of their lives (Fildes, 1988). However, during the late nineteenth to early twentieth century the impact of ‘social Darwinism’ cast these lower class women employed as wet nurses as a threat where it was assumed that their poorer environments, diets, immoral recreational activities (i.e. consumption of alcohol), hygienic practices, ethnicity and demeanour tainted their milk supply and caused the high infant mortality rates in the babies they were paid to breastfeed (Featherstone, 2002; Fildes, 1986; 1988; Golden, 2001; Thorley, 2008). Outbreaks of typhoid, tuberculosis and influenza amongst the urban poor also came to be linked to unhygienic practices and environments and increasingly babies were removed from the wet nurses’ homes (Golden, 2001). For some time this meant the wet nurses came to live with their wealthier employers but this too was a practice that ceased due to the discomfort many wealthy employers experienced with having a lower class woman living in their home (Wolf, 1999). These circumstances led many women to seek alternatives in synthetically manufactured substitutes and eventually contributed to the growth of the formula industry during the twentieth century.

Additionally, towards the end of the nineteenth century, women had begun to experience feelings akin to jealously towards the position of the wet nurse (Wolf, 1999). So not only were wet nurses and their lower class status perceived as a ‘threat’ to the quality of their breast milk but (both informal and formal) shared breastfeeding arrangements also become intrusive to maternal roles. This is in line with the changing attitudes towards children which began during the Industrial period where parents were no longer indifferent to children and theories regarding the healthy emotional development of children became an intrinsic aspect of parenting (Thurer, 1994). Concepts from Freudian psychoanalysis and ‘attachment theory’ pioneered by John Bowlby (and later Mary Ainsworth) also indicated that the early experiences and relationships with adults (usually parents, most prominently the mother) formed kinships and emotional stability that continued into later life (Blum, 1999; Yalom, 1998). This constructed breastfeeding as a practice that generated an intimate (and irreplaceable) relationship between mother and infant and the idea of ‘bonding’ became a significant aspect of the ‘breast is best’ discourse from the mid-twentieth century onwards.

As knowledge regarding environmental and chemical pollutants and transmittable diseases, especially venereal diseases like hepatitis and syphilis evoked panic and anxiety regarding bodily fluids in general, this sharing practices more or less disappeared (Palmer, 1993: 76). There is some evidence that suggests milk pooling and even breast milk sharing through breastfeeding was still occurring during the 1970s the global fear regarding the human immunodeficiency virus (HIV) contributed to the complete disappearance of sharing practices by the 1980s (Thorley, 2008). This emphasises that historically, breast milk has been defined as a product that is simultaneously a beneficial and natural source of nutrition and bonding but also a substance that generates apprehension. Although this apprehension caused the cessation of breast milk sharing practices some research indicates that it is still a practice which has continued into the twenty-first century. Since the sharing of breast milk has become a fairly taboo practice in mainstream, Western cultures it is rarely discussed and not well documented so knowledge is mostly based on anacedotal discussions (Long, 2003, Thorley, 2008, 2009, numerous pers. comm.).

Most recently the apperance of internet based organisations like Only the Breast and Eats on Feets suggest that the informal practice of sharing breast milk and breastfeeding have been re-established as an infant feeding choice. However, various government and safety regulators such as the U.S. Food and Drug Administration (FDA) have issued numerous warnings regarding the ‘safety’ of informally sharing breast milk. The following extract from the FDA (2010) website advises against unsafe practices relating to the informal sharing of untreated human milk facilitated by internet groups:

FDA recommends against feeding your baby breast milk acquired directly from individuals or through the Internet.

When human milk is obtained directly from individuals or through the Internet, the donor is unlikely to have been adequately screened for infectious disease or contamination risk. In addition, it is not likely that the human milk has been collected, processed, tested or stored in a way that reduces possible safety risks to the baby.

FDA recommends that if, after consultation with a healthcare provider, you decide to feed a baby with human milk from a source other than the baby’s mother, you should only use milk from a source that has screened its milk donors and taken other precautions to ensure the safety of its milk. (emphasis in original, no page number).

This highlights how breast milk is constructed as a threat when used outside of socially appropriate or ‘natural’ boundaries either through the practice of breastfeeding or other means. As I will illustrate in the following section, the (re)establishment of modern BMBs addresses the concerns regarding the safety of sharing of breast milk by promoting a facility that operates through the impersonal exchange of treated breast milk.

Contemporary Breast Milk Banking: The Study

Background
Contemporary BMBs have evolved out of the historical response to the practice of sharing breast milk. Unlike traditional versions, the contemporary version of sharing breast milk involves the organised, impersonal exchange of pasteurised (heat treated) breast milk. In these contemporary arrangements, the donors are women with an abundance of breast milk who extract their breast milk through expressing and donate their oversupply, which is screened and then provided to babies whose mothers are not able to provide an adequate supply.

Recently these facilities have (re)opened in most continents and countries including Europe, North America, South America, South Africa and Asia (including India and the Philippines) and Australia. In Australia at the time data for this project was collected in 2007, there were two breast milk banks: one in the Gold Coast, Queensland (which has since been closed and then re-opened) and another in Perth, Western Australia. Since the commencement of this project another two banks have opened in Victoria and New South Wales.

This particular project has focused on the experiences of mothers involved in the BMB in Perth. Established in 2006 this facility is officially named, the Perron Rotary Express Milk (PREM) Bank and is incorporated into the care of premature infants admitted into the neonatal nurseries at King Edward Memorial Hospital for Women (KEMH). The aim of this facility is to provide donated breast milk to premature babies instead of formula (when a mother’s own milk is not available) so babies can access the widely known health benefits associated with breast milk (Simmer and Hartmann, 2009). These benefits include better developmental, cognitive, psychological, digestive and immunological outcomes for babies (Ackerman, 2009). For premature babies the benefits are even more significant since they lack fully developed digestive systems, are less able to tolerate synthetic substances and more susceptible to fatal infections (i.e. sepsis and necrotising enterocolitis (NEC)) (Schanler, 2001; Wight, 2001). The provision of (donor) breast milk has been known to significantly reduce the risk of these potentially fatal complications in premature babies.

At PREM bank donor milk is restricted to use by premature infants born under 34 weeks gestational age (however this is not a criterion adhered to by all BMBs). This eligibility criterion has been established because after 34 weeks a premature baby is far less susceptible to fatal infections and complications associated with the use of formula (i.e. NEC) and it is also expected that a baby will develop the suck-swallow-breathe reflex required to successfully suckle unassisted. At PREM bank, DBM is provided to recipients anonymously and free of charge. However since there is no international or national regulator these criteria vary from milk bank to milk bank.

Aims
The aim of this wider research is to understand how mothers navigate and negotiate the use of shared breast milk in a site where they have to ‘unnaturally’ rely on another woman to nourish and feed their baby, a role that has socially been constructed as an exclusive role for the bio-genetic mother. The wider project and this paper aim at considering some of the challenges and issues the use of the breast milk bank presents to the maternal role and the impact sharing has had on their maternal identities.

Recruitment
  I recruited 24 participants who lived between an 80-100km radius of KEMH in Subiaco (approximately 4km from the Perth CBD). Each woman was invited to take part in a one-off interview at a location of their choice or at KEMH (which had provided me with the use of an office for this purpose). At the participants’ discretion and convenience most interviews were conducted in their homes, with two interviews in the hospital and one over the telephone.

Ethical considerations
Since this project is aimed at considering the experience of being involved in PREM Bank as either a donor or a recipient this project was developed utilising both semi-structured interviews and observation when I was invited to visit KEMH on a few occasions. This required ethical support and approval from the Human Research Ethics Committees at both KEMH and the University of Adelaide. This project was approved by both committees on the condition that I provide KEMH with annual updates on the progress of the research and a report whence the research has been completed. Additionally, in compliance with ethical guidelines each participant was given a pseudonym.

Methods & Analysis
This project has a qualitative framework, where I took a semi-structured, open-ended approach to interviewing. This meant that I predominately asked open-ended questions or statements which the participants elaborated on through discussion. These open-ended questions related to the topics and issues that I presumed might be relevant but was also a flexible method used to explore issues that were unexpected yet relevant to the participants’ experiences. This technique has been used as a method for ‘probing’ certain views and opinions and allowed me, as the interviewer, to encourage the participant to expand in order to understand their responses (Gray, 2009, p. 373). All interviews were tape-recorded and transcribed by hand, and then thematically coded and organised into categories and sub-categories in order to form a conceptual map of the process of the BMB (Seale and Kelly, 1998). Patterns emerged from this data that resulted in the construction of empirically based theories, written about in the wider project, some of which are presented in this paper.

Participant characteristics
Each mother I interviewed was involved as either a donor or a recipient on behalf of their children, and one participant who was both. Of the 24 women interviewed, 12 recipients had babies that were hospitalised due to their prematurity. Of the 11 mothers who were donors, the majority had premature babies who were being cared for in the neo-natal nursery (inside donors) however, there were some donors who had healthy, full term babies in other Perth hospitals and became involved through their own inquiry (outside donors). The following table provides a brief overview of demographic characteristics of the women interviewed.

Recipients: 12

Donors: 11
- Inside: 9
- Outside: 4

Recipient & donor: 1

Average age of mothers: 34 years old (range 21-42)

Relationship status: 22 married/de facto, 2 single parents

Average household income: 70,000-80,000

Place of birth: 14 Australian born (0 Indigenous & TSI), 9 outside Australia

Education: 16 Tertiary, 5 Secondary, 3 not specified

Average number of children: 2 (range 1-5). Total 46 children (36 births resulted in involvement with BMB)

Average gestational age of babies involved in BMB: 28 weeks

Demographic characteristics*

*One participant did not complete the demographic form

Findings and Discussion

The combination of the negative attitudes towards breast milk as both a beneficial yet suspicious fluid, and the history of panic associated with traditional sharing practices have developed a deep-seated fear and anxiety regarding the concept of sharing and the potential dangers of breast milk outside of ‘natural’ use. As my research indicates this fear and anxiety has not dissipated, hence the reason why the concept of ‘disassociation’ is necessary to reinforce the treatment and safety measures carried out by the BMB. As I will explain in the following section this disassociation was sought out for a number of reasons and was achieved in several different ways.

Donor Milk and the Fear of Potential Contamination

As demonstrated, historically breast milk and the sharing of it, first through breastfeeding and later through informal milk pooling, was eventually constructed as a fairly dangerous activity. The women I interviewed who used PREM Bank initially held similar perceptions regarding sharing: they were afraid that their babies could be exposed to unwanted contaminates such as certain drugs, foods and infectious diseases if given another woman’s breast milk. Responses to the receipt of DBM varied, some embraced it whilst others requested that it be stopped as soon as possible. Most mothers like Amy experienced doubt and misgivings regarding the receipt of another woman’s breast milk:

there’s always you know back in the 80s there was AIDS you know what its, and my aunty had a prem baby in the time when AIDS was, it wasn’t discovered yet and her baby had to have a blood transfusion and so did she...so they actually had to go and get checked I think but they didn’t have it [...] so...I guess that always sorta [sic] slips into your head. But like I said, you know, we were, it wasn’t that I was really uncomfortable but, there’s always just that thing in the back of your mind, that you know if I could give them just my milk I would have (INT05: 159-176)

For many mothers like Amy these misgivings and anxieties made the acceptance of donor breast milk a difficult choice. Although all the recipients included in this research group accepted donor milk (since this was an eligibility criteria in recruitment for this project) some experienced extended periods of doubt and misgivings, requiring substantial persuasion before they agreed to accept it. For instance, there were two women who perceived DBM to be so dangerous and untrustworthy and initially rejected its use outright. Natasha was one of these mothers explaining that she initially, adamantly rejected donor milk because she was afraid that it was unsafe. Although she was eventually ‘talked into it’ she still continued to harbour doubt months later:

And, and I think at the back of my mind there’s always the infection or...like other bugs or I mean what else can be passed through, you know...yeah I mean like you say things are a lot more safe these days but yeah still...I mean, mistakes are made aren’t they, you know and ah...yeah, so (INT12: 820).

The rejection of DBM was often based on the image they had generated of the donor, as someone who may be mistrustful and engage in dangerous behaviours and activities that would compromise the quality of their breast milk (similar to past perceptions of wet nurses). For example, Tanya, who also initially rejected DBM was fearful of where this milk was coming from, she said:

In the beginning I was just like; oh God, you know what if this person was like a crack head or something (laughs) or you know like...they all take heroin or...They’re absolute alcoholic or something like that (INT15: 1055).

Giulia discussed a similar fear of DBM. Her fear was generated after her encounter with another mother in the nursery who had an abundance of breast milk but engaged in recreational activities that would have contaminated and tainted her milk supply. Although the mother Giulia encountered would not have been accepted as a donor this still made her fairly suspicious of donor milk in general:

...the lady next to me, I mean you get all sorts a people at King Edward, and she was saying how the night before they all got stoned and, you know drank lots and had a bit’ve a party and, she had a really good supply and it’s usually, the women that...are in the, the same situation as me but having a huge supply coz they’re freezing it for you and everything, that it’s just easy to donate it, and, and I mean I know they pasteurise it and all of that, but you know, it’s so dependent on what you eat, or smoke or consume that....and you can never be guaranteed that someone else is doing the right thing (INT23: 298).

For Giulia, this encounter generated a general image of all donors as potentially dangerous and not always doing the ‘right’ thing. When her twin boys reached 34 weeks and became ineligible to receive donor breast milk, she was relieved that she would no longer have to be anxious about what they were receiving and its source. This was a common feeling amongst recipients who, after receiving donor milk, generally accepted the use of formula with relief.

Donor Milk as a Threat to Kinship

As mentioned, during the twentieth century, ideologies surrounding bonding gave breast milk a relational meaning where its exchange (typically through breastfeeding) was seen to establish emotional and physical connections. Anthropological research has been significant in exploring these notions of kinship and relatedness revolving around the sharing of substances such as breast milk. For instance, in her ethnographic study Janet Carsten (1995) explored how bodily fluids and substances (i.e. food, breast milk) when exchanged, are able to generate ties that are comparable and sometimes equal to blood kinships. Specifically, she explains how the exchange of breast milk (and not necessarily the act of breastfeeding) is what activates kinships in Malay communities where it is ‘understood as the enabling substance of kinship; a source of emotional and physical connectedness’ (ibid, p. 234). This exchange of breast milk generates what anthropologists have labelled ‘milk kinships’, exemplifying how its exchange can form bonds outside the bio-genetic mother child relationship.

Milk kinships are developed when children who breastfeed from the same woman become ‘related’ forming bonds that are equivalent to biological sibling-ship (even if they have no bio-genetic relationship to each other or the woman feeding them, see Cassidy and El-Tom, 2010; Long, 2003; Parkes, 2005). These milk kinships are so strong that within Islamic family laws, sharing the same ‘milk mother’ generates ‘milk siblings’ who are not permitted to marry one another as their marriages are considered incestuous (Khatib-Chahidi, 1992; Long, 2003; Parkes, 2005). According to Carsten (1995, 2001) this is the case because it is a Muslim belief that breast milk is derived from blood which forms a type of ‘white blood’ in the mother following the birth of a baby. She indicates that in Malaysian Muslims the idea of sharing breast milk, not necessarily directly through breastfeeding, is interpreted as sharing blood, and thus ‘activates’ a kinship (p. 234), emphasised by the Malay saying; ‘if you drink the same milk you become kin...you become one blood, one flesh’ (emphasis added, p.228).

The concept of kinship formation through the exchange of breast milk is evident in the response to contemporary breast milk banking in a (unidentified) Muslim country. As Al-Naqeeb et al (2000) explain, the impersonal exchange and anonymity was not able to prevent the generation of a kinship tie so they modified the process in order to accommodate the formation of kinships. Consequently, donors and recipients became known to each other so that the milk sibling-ship generated could be identified to avoid the potential for incestuous relationships in the future, which can be a constant and considerable threat in milk sharing arrangements (Carsten, 1995: 227).

In a Western context it is not necessarily the process of sharing breastfeeding that crosses boundaries by developing a kinship, but it is the sharing of the substance itself which is considered unwanted or invasive. This notion is significant in modern BMBs where, although the idea of breastfeeding another woman’s baby is eliminated, the idea of sharing their substance is not.

This is also supported by the women involved in the PREM bank. Since breastfeeding was not achievable because their baby’s prematurity required extended periods of hospitalisation and incubation the mothers used their expressed breast milk as a substance to generate connections with their babies. They were aware that kinship formations were available through the provision of their own breast milk even through it was fed through a nasal gastric tube. However, this was problematic for mothers who were unable to produce an adequate supply through pumping like Jenna who believed that providing her own expressed breast milk would have generated a ‘closeness’ with her twins that she was not able to achieve:

GZ: [S]o why, why would you have preferred to keep them on [your] breast milk?
J: Well, you know, I mean I guess also for the closeness that it brings. I think...I think, not, but then I think it was the whole process, the caesarean, them being in a humidi crib, there was quite a bit of distance coz you can’t touch them either...And you’re supervised with you’re...so initially we couldn’t hold them. And then we could only hold them for 20 minutes once a day and then we had to alternate between the both of them...so I think that’s, that distance that you get as well [...] it’s harder to bond [...] But I think...to have that bond that would’ve hel[ped]—you know that would help... (INT11: 339-353).

Since mothers like Jenna were not able to breastfeed or provide their own expressed breast milk they consequently viewed the provision of donor breast milk as a replacement to them and a triangulation of their (tenuous but) exclusive mother child relationship, as Stacey said:

And even now I still, when I see someone else trying to feed him, I’m like; ‘oh no, no just give him back to me’ (laughs) it’s my, because you do, as horrible as it sounds you do get possessive, that’s my baby and he needs to know me more than anyone else...you know people say, you know when babies are with someone who is breastfeeding and they can smell the milk and...I’m like; ‘oh no but Toby was never breastfed, so he’s, he wouldn’t even know what he’s looking for’ so... (INT10: 874-879).

  Overall, fear of contamination and fear of generating (unexclusive) kinship is why it is necessary for the breast milk bank to create and reinforce structured boundaries which reduce the donor milk simply to a substance with no attachments. Anonymity was essential to the acceptability of sharing breast milk. These boundaries are largely established or re-established within a medical framework through ‘disassociation’ which is relied upon to remove or reduce the potential fears regarding the sharing of a body and a bodily substance. In the following section I will explain the strategies used to achieve and reinforce this disassociation.

Disassociation and Depersonalisation

According to Douglas (1966: 160) when a pollutant is unwanted or abject it carries an identity, which is why it is understood as dangerous and a threat to order. However, as contaminants are discarded they lose their identity and thus become less of a threat. When matter is discarded Douglas (1966: 160) says that,

In the end, all identity is gone. The origin of the various bits and pieces is lost and they have entered into the mass of common rubbish...So long as identity is absent, rubbish is not dangerous...Where there is no differentiation there is no defilement.

Although breast milk is not considered rubbish or unwanted per se, it was commonly perceived as dangerous or as a threat to order when it was used or appeared outside ‘normal’ boundaries, such as in sharing situations. Often this threat associated with breast milk was due to its origins (i.e. from a female body), so the processing through a BMB is critical in removing this original identity. Removing the identity is how it becomes disassociated and detached from its original source thus making it a more acceptable product to share.

Although the women I interviewed were not aware of the term or idea of ‘milk kinships’ per se they were aware of the relational meanings of breast milk and what potential this has to generate kinships between themselves and their own babies. They saw any disruption to the kinship generated from their own milk as a threat, even formula was perceived this way, but more so donor breast milk because it relied on another woman, not just powder in a tin.

For these women, donor breast milk was mostly considered dangerous because there was an allusion to the original source, so to remove this link between donor milk and donors recipient mothers go through a process of disassociation, in order for it to be tolerably used. This meant that the source of the breast milk, the donors, had to be stripped away to reduce the potential for disrupting the mother/child bond and minimise the fear of potential contamination.

Depersonalisation was a method of disassociation some of the recipients relied on to de-indentify and detach DBM. They achieved this by generating a stoic image of who they perceived the donors to be. As mentioned, mothers like Giulia had an image of donors who were potentially dangerous whereas others, like Cathy imagined a very sterile and depersonalised donor that looked like this:

you’d like to see, you know this person sitting in sterile place pumping milk [...] that’s what you’d like to think....yeah you know sitting in a white suit with her little hat and just a pump, with a pump stuck to her, like a cow (laughs) (INT03: 747).

In this image the donor is stripped of identity, depersonalised and sterile. She is not a real mother with real breasts — instead she is imagined as a functional machine with milk production her only purpose. This sterile, mechanical and dispensable image of a donor helped make their breast milk less threatening and thus easier to accept.

The imagery of a cow and other animalistic and mechanical metaphors were relied on by Cathy to generate distance. Many women utilised the image of a dairy cow (since receiving milk from a cow is something adult humans do all the time) in order to make human milk commensurate with its substitutes (i.e. cows milk or formula) and reduce their anxiety about sharing. This, however, has the result of fragmenting women’s bodies which I will address in the next section of this paper.

Naming and Treatment Process

Apart from depersonalising the donors, another dissociative method was the naming and renaming strategies the BMB relied on. This was immediately evident to me through the name given to the breast milk bank. The acronym PREM incorporated into the name of the breast milk bank reflects numerous aspects of the process, such as emphasising that it is a facility strictly used for premature newborns, colloquially referred to as ‘prem’. It also indicates the usage of expressed milk rather breast milk which is necessary to emphasise that the milk being shared has impersonally been removed from its origin.

Naming was also important in the treatment process. In the PREM bank when a mother expressed breast milk she put it in a container and labelled it with her name, her baby’s name, the date and time of expression with a yellow sticker which boldly read ‘Expressed Breast Milk’ (EBM). If any of this EBM is donated it is pooled, treated and tested and then transformed, renamed and relabelled replacing the mothers’ names with a numerical identity on a purple label which boldly read ‘Pasteurised Donor Human Milk’ (PDHM). As with the acronym PREM bank, this renaming from EBM to PDHM further emphasises the disassociation of mother’s milk and its origins. What is noticeable is the removal of the word “breast” from the new name of the milk which eliminates the association of where the breast milk actually came from, thus generating a medicalised connotation that highlighted its safety and separation of PDHM from ordinary, untreated EBM.

These forms of disassociation were obviously successful for recipient mother Belinda who indicated she never thought about DBM as originating from somebody because the disassociation and depersonalisation of the milk her daughter received had been so effective. She reflected that the disassociation changed DBM from a personal substance to a medicalised substance which made it easy to accept for it had no ties or connections to any other women:

If it’s just in a bottle and they’re just feeding it through a tube, there’s nothing there…it takes all the human side out and it just...yeah it’s just completely different…Yeah it just makes it...like part of the hospital…You know, not...from somebody (INT14: 655, 689).

When there was no identity connected to the breast milk it was treated as less suspicious and more like a product, or a medicine, that originated from the hospital. This removal of identity was achieved through depersonalisation and disassociation.

The Impact of BMB on Women: Exploitation or Empowerment?

Unlike the traditional practices of sharing breast milk where a baby was provided donor milk directly from the breast, the modern process of sharing through BMBs relies on disassociation and depersonalisation to be successful. This requires the extraction of breast milk and technology to improve and approve its safety before given to a recipient baby. For the mothers involved in the BMB, the precarious health status and incubation of their premature newborn, combined with their own health and recovery from birth, stress levels, other responsibilities (and sometimes desires), prevented or delayed skin to skin contact. Thus it was necessary to stimulate the breasts in order to induce lactation which was done through a routine of expressing 3-4 hourly with an electric pump. This routine and pumping was performed to mimic a suckling infant and provide the simulation required to generate a supply when a baby was too unstable to remove from the incubator or too weak to suckle.

During the weeks and months that their babies were hospitalised the women were not able to perform many of the maternal tasks they expected such as holding and cuddling their babies, bathing them, changing them or feeding them. When they were able to perform these activities they were observed and limited, leaving these women feeling that they had to mother their babies from a forced distance. Since they experienced their maternal role at a distance, so expressing was often one of the only tangible maternal activities they were asked to engage in. Expressing breast milk and the quantities they produced became symbolic of the hard work and effort mothers put into their own child, since this not only represented nourishment but also their commitment, love and devotion.

Linda Sweet (2006) highlights through her own research, this type of expressing for premature babies results in the objectification of breast milk. She found this was the case for mothers who expressed for their premature newborns (in a hospital with no BMB) where removal of breast milk with an electric pump forced them to see their breast milk as a ‘detached’ and ‘separate entity’ (Sweet, 2006). In this detachment from their bodies their breast milk became objectified as a measurable, definable and visible product, which was also seen as an item for competition, findings consistent with my own research. The detachment expressing provides, along with the BMB’s disassociation strategies, enables the breast milk to be interpreted as a product rather than an embodied substance which is beneficial for the BMB because the enables the breast milk to be more easily shared.

The consequences of this separation and detachment lead to the fragmentation of the maternal body where feeding practices are disembodied and rendered mechanical (Martin, 1987 discusses how this occurs with birthing practices). Furthermore, since visible breast milk is often representative of mothers’ ‘work’, the supply of breast milk as a disembodied product ‘erases’ and separates women from their expressing labour (Bartle, 2010). This contributes to the construction of ‘breast milk as a product rather than breastfeeding as a process, which can lead to disembodiment because it values technical-physical aspects of breastfeeding over interpersonal and intrapersonal ones’ (Johnson et al., 2009: 901). This type of fragmentation occurred for participants of the breast milk bank where they often thought of breast milk in material, rather than embodied terms, especially since it was made visible and quantifiable through their expressing and the BMB.

Although guidelines at the PREM bank stipulate that it is not an economic commodity, it is made visible and is exchanged uniformly amongst eligible recipients and thus obtains similar characteristics of a commodity. Furthermore, since the breast milk is processed and stored in a ‘bank’ the economic and marketable aspects are accentuated. So, in the BMB breast milk shifts from an embodied substance to consumerable product which is potentially problematic because it allows breast milk to be a possible target of commodification and economic exchange (Van Esterik, 2002; Sharp, 2000). Placing an economic value on breast milk, like any other body or body part (including tissue such as organs, reproductive organs and materials) can be dangerous because it opens up systems of exploitation where it is often women who are most susceptible, particularly poorer, more disadvantaged women (Scheper-Hughes, 2001; Wilkinson, 2003). This type of commodification (and exploitation) is not a new concept in relation to breast milk since we have already seen it through the commodification of breast milk in the wet nursing industry. However, in the contemporary context, technology enables a depersonalisation and disassociation which may help facilitate formalised, profitable, economic exchange in the future. In this way, commodification may not necessarily be exploitive and instead may be a way to represent the high value of breast milk and the unique capability of women’s bodies, in a similar way that some countries, like the United States, commodify semen (Tober, 2001; see also Smith, 2004).

On the other hand, the notion of commodification being empowering rather than exploitive has most recently been raised by a cafe in London where ice-cream was manufactured from expressed breast milk, purchased from 15 women who had replied to an advertisement (ABC News, 26 February 2011). As one of these women explained; ‘What’s the harm in using my assets for a bit of extra cash?’ (ibid). This emphasises the freedom that women now have to remove and depersonalise their breast milk, but as the ‘yuk factor’ still resonates the widespread response to this practices continues to be fairly abhorrent (Shaw, 2004). For example, as Sarah Ditum (2011) an online commentator for The Guardian indicated: ‘[s]till, there's a pretty big "eww!" for us to get over first’.

In response to wide-spread anxiety, the cafe responsible removed the breast milk ice-cream from the menu, reportedly for ‘health and safety checks’. This testing revealed the breast milk was perfectly safe and the ice-cream return to the shelf, yet the initial knee-jerk response and removal highlights how breast milk out of place still has the capacity to evoke fear and anxiety and why it is necessary for the formalised BMB bank to operate the way it does. This also demonstrates that attitudes towards the appearance of breast milk ‘outside’ of its ‘natural’ boundaries, no matter how disassociated or depersonalised is still not something that is widely acceptable, just yet.

Summary

Unlike traditional breast milk sharing practices, the modern version of sharing is strictly regulated and impersonally exchanged through contemporary BMBs. These banks rely on disassociation and depersonalisation strategies in order to alleviate anxieties regarding the potential ‘threat’ of ‘unnaturally’ sharing a bodily fluid. This research indicates that women involved in modern BMBs actively participate in this disassociation which has the consequence of fragmenting their bodies and disembodying their material roles. Disassociation may lead to the wider objectification and commodification of women and their reproductive bodies with potentially positive and negative impacts on women. It may also be indicative of how the exchange of breast milk may evolve herein.