English Version | Got Milk?

This isn't an article about decisions. And it's not an article about judgments, especially of those who cannot or won't breastfeed. It's an article to inform, it's an article to demystify and, above all, an article to feed: conversations, discussion, clarification of doubts. And donations of breast milk, which are more necessary than we think — no wonder May 19th signals World Human Milk Donation Day: being able to donate human milk can be vital for the development of a newborn who may not have access to it otherwise. According to the World Health Organization (WHO) and UNICEF, babies should be breastfed within the first hour after birth and exclusively breastfed until six months, that is, without other types of food or liquids, including water. From then on, introduce appropriate foods progressively, but maintain breastfeeding until at least two years of age. This is because breast milk is the best and most complete food there is for the baby: breastfeeding a newborn can significantly reduce neonatal mortality (that which may occur up to the 28th day), says UNICEF, in addition to preventing infections, obesity and diabetes. On the other hand, it has advantages in terms of convenience, accessibility and availability — it's always ready and at the ideal temperature, being economical and easy to digest (the high bioavailability of nutrients in breast milk allows for better digestion, absorption and use), as well as being a vehicle for the water needed to keep the baby well hydrated. The benefits are not unilateral, since breastfeeding, for the mother, prevents bleeding in the postpartum period and helps with uterine contractions, as well as reducing the risk of osteoporosis, breast cancer and ovarian cancer, also helping the mother to regain her usual weight.

“There are so many advantages… But, above all, it's the NORM.” Ana Lúcia Torgal responds to us in writing, but her enthusiasm and passion seem audible in each response, her years of experience evident in the fluidity of her explanations. She is an Obstetric Nurse and Lactation Consultant and therefore a more than capable authority to help us navigate this very special milky way. “It shouldn’t be necessary to talk about the advantages, we are mammals — we have breasts, which produce milk, which are used to feed our young. The human species has the potential to feed two babies at the same time, which is why women have two breasts. We now need to talk about the ‘advantages’ of breast milk because of the marketing of formula milk. Breast milk is a ‘living tissue’, in addition to water, proteins, carbohydrates, fats, vitamins and minerals, it also has living cells, hormones, enzymes, immunoglobulins, antibodies, etc. (…) This milk will protect the baby from infections, allergies and it is scientifically proven that breastfed babies have less risk of becoming obese. For mothers, the risk of developing breast and ovarian cancer is also lower”, the specialist explains. Unfortunately, there are situations in which there are no conditions for breastfeeding to occur and donating milk can help ensure that, at least the child, enjoys its benefits. “This [donated] milk is essentially used to feed very premature newborns, who are born at less than 32 weeks, and whose mothers do not yet have milk, have insufficient milk or have a clinical prescription not to breastfeed their baby (due to some sort of issue related to the mother's health). This milk can also be used in full-term babies, with health problems, particularly cardiac or gastroenterological problems”, the nurse clarifies about the destination of the donations, a topic that, surprisingly, in a quick survey at discussion tables around me, seemed to be too unknown for a practice as important as this one.

Teresa de Lima Mayer, dentist and a newly mother, appears here with the empirical authority that all mothers enjoy: that of first-hand experience, that of curiosity and that of trial and error. She speaks with motherly love on the tip of her tongue, the kind of expert this article also needs. It was through Lima Mayer that we heard about this act of donating human milk. “This idea was presented to me by nurse Torgal while I attended the birth preparation course at the Oeiras health center”, she tells us, deconstructing the process of which she is now part of as a donor. “There is an initial process that involves a consultation, to ensure that a series of health rules and some behaviors are complied with, and I also carry out check ups with a pre-defined regularity to see if everything is ok with me, for safety reasons. There is no minimum amount of milk to be donated, the commitment is to pump milk once a day for a few minutes, so as not to interfere with breastfeeding. The idea is to accumulate the milk in sterilized bottles (provided by the program — the pump can also be provided, if necessary, during the donation period), which go directly to the freezer for subsequent transportation in isothermal boxes by the nurses responsible for the program. There is direct contact with these nurses not only regarding the collection, but also the replacement of the bottles”, she says. Ana Lúcia Torgal delves into the logistics, particularly in another nuance that may not be obvious: not all maternity wards are prepared to receive and store these donations. It is possible to donate milk, “but only to the Maternidade Dr. Alfredo da Costa (MAC), in Lisbon, and to the Maternity of Hospital de São João in Porto, where there are the only two Milk Banks in Portugal”, highlights Torgal. “There is also the possibility of donating milk through the Western Lisbon and Oeiras Health Center Group, my place of work. In the community, we promote the project, carry out screening consultations and monitor donors, namely collecting milk at home, carrying out the necessary tests every quarter, and providing all the support if there are any doubts among donors. This milk is analyzed, pasteurized and only then offered to premature newborns in various hospitals”, she reports, explaining further that “potential donors can contact the Milk Bank directly, and in that contact a nursing consultation and doctor (can be in person or over the phone) will assess whether the donor meets the necessary criteria.” Can any mother donate milk? “All healthy women who feel they have a slight excess of milk (the priority is always your baby)”, she says. “At the beginning of the donation, the baby must be less than four months old and the donation can continue until the baby is 12 months old. Women cannot smoke, use medication or drugs, or drink alcohol. Your baby must be growing as expected. At home, there must be good hygiene conditions and a freezer with space to store milk. The tests carried out must be within the expected values.” The conditions are more than justifiable, since it's necessary to guarantee the quality of breast milk for these beings who have just arrived into the world and whose fragility may even be greater if they require donation, since many of the situations are related to premature babies, who are very underweight, and who need this food for the quality of their nutrition. Listing the benefits of breast milk may clear doubts, but feeling its benefits fills the heart. “I followed a woman who was a milk donor for ten months”, shares the nurse. “She had just had a baby who was born at 25 weeks and who was still hospitalized in Neonatal Intensive Care. She realized that it was very important to pump milk to breastfeed her daughter, as this milk would make all the difference in the way the baby would develop. She was so touched by the importance of human milk that she decided to become a donor. While she fed her daughter (always with breast milk), she donated around 140 liters to the MAC milk bank. It was the donor I accompanied who donated the most milk.”

In addition to the clear nutritional benefits, there's also a strengthened bond between mother and baby when breastfeeding, another reason why the medical community recommends the practice. Clinical psychologist Catarina Lucas agrees, but with some reservations: “Breastfeeding can significantly influence the psychological well-being of a new mother in several ways, both positively and negatively. It is an intimate moment of connection between mother and child. For some women, this connection can strengthen emotional bonds and provide a sense of fulfillment and satisfaction. Self-confidence can also be influenced in that for some mothers, the ability to breastfeed successfully can increase self-esteem and confidence, providing a sense of accomplishment and competence. On the other hand, social pressure and expectations around breastfeeding can create stress and anxiety in some women. Feelings of guilt or inadequacy may arise if breastfeeding is unsuccessful or if the mother faces difficulties. Fatigue and exhaustion also arise, as breastfeeding can be physically demanding, especially in the first weeks after giving birth. This can contribute to tiredness and exhaustion, affecting psychological well-being. Another relevant factor is social isolation, as the need to breastfeed frequently can lead mothers to feel socially isolated. Ultimately, if breastfeeding is not successful, the mother may experience frustration, worry, and even feelings of failure. This can negatively affect her psychological well-being, especially if she feels judged by others or internalizes feelings of inadequacy.” The psychologist also adds that breastfeeding is often described as a special moment to create a bond between the mother and the newborn and that “there are several ways in which breastfeeding can contribute to this bond, namely through physical contact; the release of hormones such as oxytocin, which play an important role in emotional regulation; visual and emotional interaction; feeding and care”, but she reminds us that “breastfeeding is not the only way to create an emotional connection with a newborn. The bond between mother and child can be strengthened through other forms of care, such as skin-to-skin contact, bathing the baby, care during diaper changes and loving and attentive interaction in everyday life.” A particularly welcome alert because in this breast milk donation there are two sides — those who give and those who receive, because they can't breastfeed. “If a mother cannot or chooses not to breastfeed, this does not necessarily mean that her bond with her child will be affected.” Whatever the reason why she breastfeeds or stops breastfeeding, it is important that she does so in an informed and pressure-free way, even to prevent some of the feelings that seem to guide less happy breastfeeding, as Lucas lists. In the case of Lima Mayer, it's already a win that this topic is being addressed: “It's great to see that this is already starting to stir the interest of the media, as is the example of this specific case. I feel that it's an important path for breastfeeding to be understood by everyone, embraced and even adored, if possible! In my case, breastfeeding had a transformative and even restorative power, which resolved some dilemmas related to self-esteem and self-perception, making me question very intimate and deep issues.”

I wonder why there is still so much discussion — or lack thereof — surrounding breastfeeding, after reading the recommendations of the scientific community and hearing these and other women talk about breastfeeding with such passion, as well as realizing how much misinformation and pressure can be harmful. Is it silence that undermines breastfeeding? It's deeper than that. “Fortunately, rates are increasing, but still far from what is recommended by the WHO”, says Ana Lúcia Torgal. “In Portugal, parental leave does not cover the mother's first six months, and for this reason it's more difficult to exclusively breastfeed during this period. Women who are becoming mothers now still don't have many role models... their mothers and mothers-in-law probably didn't breastfeed, or did so for a short time. Some women need specialized support in this area and we still have few health professionals prepared and qualified to provide this response.” None of this contributes to the attempt to delve deeper into the topic or even pursue this path for longer than necessary. Furthermore, “I feel that there is still a taboo, unfortunately, and there is no reason for it to exist”, says Teresa de Lima Mayer. “I know of a case of a friend who was in a hotel restaurant breastfeeding her baby, she was covered up, and was approached by an employee who informed her that it was not the right place to breastfeed, because it could disturb other customers. I find this perfectly unacceptable, and, in fact, illegal, breastfeeding is considered a woman's right that must be exercised freely in public and private spaces.” Psychologist Catarina Lucas reminds us that “there are several aspects involved. On the one hand, it is still considered an area of the body with a sexual component that should not be exposed in this way. However, there is also another reading of things. This taboo is even associated with the way we look at motherhood and breastfeeding — as an intimate thing, which should not be exposed to everyone’s eyes.” Often, is it the woman herself who conditions herself, a reflection of these external issues? “We are the result of the society in which we grew up and our beliefs shape our behavior”, explains Lucas, remembering that “it is important to mention that women do not have to breastfeed in public if they do not feel comfortable. This moment is seen by many women as something special, intimate and, therefore, they want to experience it in a more intimate way, not intending to expose themselves publicly in this moment that is theirs”, she concludes. Of course, choosing not to breastfeed in public is different from external pressure not to do so. The fact that it is a practice that doesn't choose time or place — the interval between each breastfeeding has great variability from mother to mother — means that social condemnation can also accelerate early weaning for the purpose of greater independence, therefore, the taboo and misinformation can be a strong vehicle for abandoning breastfeeding for the wrong reasons. “Breastfeeding can be a taboo for those women who have not managed to overcome difficulties”, points out nurse Ana Lúcia Torgal. “They didn’t get all the help they needed. It can be very frustrating to want it a lot and not get it done.” Even though, as the psychologist says, it is “necessary to eliminate the current discourses, easily conveyed through social networks, and which constantly tell us what we have to do, the tips for achieving something, how bad we are when we don't achieve it or as it seems easy to others”, it is also important to emphasize that “breastfeeding is normal but so is not breastfeeding. These are choices that mothers have to be comfortable with. Don't criticize, don't replicate models, be an effective help. Motherhood and breastfeeding are individual processes, let’s not generalize,” she warns. “Decisions must be made according to what makes sense for each person and their physical and emotional capabilities.”

Above all, decisions must be made with all the information possible at hand, and to do this it's necessary to promote dialogue with those who know: “Before the baby is born, mother and father (we have to involve the father too) must learn how breastfeeding works”, says nurse Torgal. “Either at a prenatal breastfeeding consultation, or by attending a birth preparation course. If the couple's decision is to breastfeed, then it would be a good idea to talk to another mother who has had a good experience and read up on the topic. They should also know where and who to turn to if they have any difficulties with breastfeeding.” For example, “there is a free service from an association called SOS Amamentação that provides support via telephone to mothers in difficulty” and rejoices in the fact that there is more and more talk [around breastfeeding]. “In Portugal, the most differentiated women are those who breastfeed the most. It is necessary to continue investing in breastfeeding support, especially for socially disadvantaged women.” Torgal also calls for “support for working mothers, so that they can work and breastfeed; information for all pregnant women about breastfeeding; training of health professionals (on breastfeeding) who provide care to pregnant women, mothers and babies; breastfeeding consultations available to those who need it.” The rest is experience. Teresa de Lima Mayer knows this well: “In my journey as a mother, I feel that everything or almost everything is truly understood in the unfolding of the journey itself, in the day to day of motherhood, in the experience that often involves trial and error. A mother and a baby are always an irreplicable pair and, therefore, it's always important to take into account that motherhood is also the adaptation between two human beings and their particularities. No matter how many books or courses you take, I feel that we only truly become mothers when we actually are mothers. Regarding breastfeeding, I think there is already a lot of information, and sometimes it's important to have access to it in a reliable way, and a great way to do this is to seek advice from a specialist on the subject, such as certified lactation consultants, professionals specialized in the area that support breastfeeding. I went to a specialist and it was the best decision I made, I am exclusively breastfeeding my five-month-old daughter, and without this support I don't know what it would have been like. There is a challenge associated with breastfeeding, especially in the first month, which culminates with other challenges at the beginning of the postpartum period, which can be too much for a single woman, especially if she is uninformed, there are still many myths to be debunked. It also happens that we hear, even from healthcare professionals, that ‘one's milk is not good’ or ‘one's milk is not enough’ — very dangerous phrases, but which are still heard, including in maternity wards. There is no concept of bad milk production, the idea that the milk produced by a lactating woman can be weak is perfectly absurd and has zero scientific basis, which can lead to insecurities in breastfeeding and consequently to its discontinuity.”

This isn't an article about decisions. And it's not an article about judgments, especially of those who cannot or won't breastfeed. It's an article to inform, it's an article to demystify and, above all, an article to feed: conversations, discussion, clarification of doubts. Considering everything we've covered here, the biggest conclusion is that knowledge is power. And you can only get there with questions, with answers, with case by case, even with trial and error. “There is a duty associated with motherhood, there is a commitment and there are options, if we're not properly informed, we don't have the necessary tools for the challenge we set ourselves with motherhood”, argues Teresa de Lima Mayer. “Breastfeeding is the best option, there is no doubt, but the best option is not always the one possible and that is why we are extremely lucky to live in a society that has evolved to the point where we have access to formula milk.” And with the help of the donation, hopefully there will be enough breast milk to fill the gaps. “However, if there is early monitoring that answers all of the woman's doubts when starting breastfeeding, I would say that the success rate would increase. There are dangers associated with widespread misinformation and myths, we have to realize that breastfeeding was not socially well regarded in high society less than 70 years ago, when there were 'baby nurses' who breastfed babies who were not their children because breastfeeding was ostracized and considered 'low level' or low social class. It is necessary to understand that breastfeeding has a story that needs to be told to be understood in its social context and why it is still seen as a taboo. There is clearly a path to be followed, but in my eyes it seems to be on the right track.”

Translated from the original on Vogue Portugal's Mother Nature issue, published May 2024. Full stories and credits in the print issue.