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Foster Breastfeeding: A Personal Story
Ruth Piatak
In the fall of 1999 my husband and I decided that we had room in our home and hearts for a baby who needed a home and a family. In the hope of offering a drug-exposed child optimal care and continuity, we decided to get licensed as foster parents and participate in the Options for Recovery program, so that we would be the child's only foster placement, and his adoptive placement if the mother failed to reunify. As our education proceeded, we observed several things that confirmed our resolve to breastfeed any infant placed in our home:
- Classes emphasized that children MUST attach to the foster parents to be able to form healthy attachments in the future.
- We met or heard of several infants suffering from formula intolerance who had had to have their formulas switched two or three times.
- We met a foster baby who had had necrotizing enterocolitis (NEC) who was being fed by pump through a G-tube.
- At one meeting, many foster parents raised their hands when a poll was taken of those who had recently had a foster child in the hospital with respiratory syncitial virus (RSV) infection. At another, a nurse speaking about RSV cited lack of breastfeeding as one of the risk factors for serious RSV.
- A neonatal intensive care unit nurse spoke at one meeting about efforts to prevent positional deformities, stress, and disorganized behavior in preemies, using low light, swaddling, blanket "nests", self-soothing (by sucking on hand), firm and containing touch, and skin-to-skin holding.
- Our neighbors, who are adopting a child with reactive attachment disorder (RAD), lent us a book by foster parent Nancy Thomas titledLove Is Not Enough, which had been recommended by one of our instructors. At the top of the list of interventions recommended for infants at risk for RAD is, "Breastfeed, if possible."
When arranging for approval for me to breastfeed foster infants, our foster care licensing worker spotlighted 3 main fears that would be likely to prevent social workers and birth parents from placing a child in a breastfeeding foster home:
- Foster breastfeeding is somehow strange or perverted.
- Foster breastfeeding would interfere with the bond between the child and the birth mother.
- Foster breastfeeding represents a hidden agenda to adopt the child.
To counter those fears, we prepared a sheet titled "A Breastfeeding Foster Home - Why?" detailing our motives for breastfeeding foster infants, and the motives which social workers and birth parents might have for placing infants with us. In response to the three fears, the sheet emphasizes:
- Before the twentieth century, wet nursing was the only successful way to feed a child whose mother was unable to do so. It is still common in other parts of the world.
- Breastfeeding will teach the child attachment and keep the child healthy. A secure, healthy child will be most ready to reunify with the birth parent.
- We are fostering not to "get a baby," but to give foster babies the same good start our own children got.
At this writing, the above fears prevail and we have been waiting since February 2002 for a child to be placed with us. If I have the opportunity to wet nurse a foster child, I would have a positive outcome to point to. I hope to promote breastfeeding by other foster mothers. A "Wet Nursing Program" with established screening protocols and educational standards could go a long way toward providing optimal care to the at-risk newborns that would otherwise be least likely to get it.
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Foster Breastfeeding: Another Perspective
Nancy E. Wight MD, FAAP, IBCLC
Infants who do not have the opportunity to breastfeed are missing important nutritional, immunologic, hormonal, developmental and social benefits. The infants in our foster care system have the same needs as all infants, and perhaps more need of a stable, "attached" environment. While I am touched by the beautiful intentions to provide optimal nurturance to foster children outlined above, I am concerned that appropriate attention be paid to the medical, social and legal implications of reinstating wet nursing in the USA in 2002.
Wet nursing was the norm among European-based cultures for centuries and was seen in all cultures throughout recorded history. Before technology and milk surpluses created the mass production of, and market for, artificial baby foods, wet nursing was the only option for infant survival if the birth mother was unable to nurse. It began as a way for one woman to help another, but didn't take long for wet nursing to become an example of exploitation of women, with poor, uneducated women hired to nurse wealthy families' infants. The unsavory side of it (poor women having babies and abandoning them just so as to be employed as a wet nurse for a wealthy family) needs to be acknowledged just as the dedicated, humanitarian side. The potential for abuse and exploitation is still there.
Even in past centuries, the risk of transmission of disease was a concern, with wet nurses carefully screened and selected, sometimes for nonsensical reasons (eg. hair color). In the 21st century, where science has discovered the possible transmission of several diseases via breastmilk and breastfeeding, appropriate screening of breastfeeding foster mothers would need to be done, just as is done with donors to human milk banks. Although breastmilk has a multitude of factors to decrease the transmission of infectious disease, there is still some risk, and informed consent from the appropriate legal guardian/parent would also be needed.
The details of standards, informed consent, regulations to ensure safety are onerous, but do-able. The psychosocial issues for the mothers and wet nurses, and public and medical acceptance may prove more difficult to achieve. Breastfeeding does create a special bond, one that when broken, as in the return of an infant to his birth mother, may have long term implications for the child, his mother AND the wet nurse. The current US social milieu, where even breastfeeding of an infant by his own mother in public, or at age 4, is still not readily accepted, would make a breastfeeding foster mothering program very difficult to achieve. Explaining the contradiction of drinking another species milk while being horrified at an infant drinking another woman's milk has proven almost impossible.
Another concern for medical professionals, aside from the infectious disease risk, is the nutritional adequacy of the milk. All species milks change over time (both short and long-term) to meet the needs of the growing, developing infant. One of the drawbacks of human milk banking as it is done today, is the provision of milk from the mother of an older infant, to a newborn. As even pasteurized donor human milk provides advantages to preterm infants (less infections, better feeding tolerance), one would guess that fresh "donor" milk, produced in the child's own environment, would have more advantages. Unfortunately, there is very little research in this area.
If foster breastfeeding is to be accepted, attention must be directed to all these issues. The personal story recounted above (shortened considerably, with apologies to the author) is a tribute to the best qualities of parenting and concern for our (society's) children.
This article is printed to explore the interesting question of a systematic revival of wet nursing and does not imply the SDCBC endorses unrestricted foster breastfeeding.
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