Holly Parker, 38, does not cover up when she breastfeeds her son Atlas, 1. In fact, he comes and goes as one does a drinking fountain, not a dinner table.
It's convenient for Parker to pull down one side of her loose-collared shirt. As for the exposure, "it helps that I don't have large breasts."
The North Little Rock high-risk obstetrics nurse and lactation counselor is evangelistic about breastfeeding. She fed her oldest, Story, from the breast until she was nearly 4.
"I've long heard all the many women I've helped through all their years of nursing and baby raising, all the crazy things that people say to them when they're nursing in public or nursing for, quote, 'too long,' or whatever, and I've been so prepared to say the words that they wish they could've said … and unfortunately, I've never had anybody ever say anything to me!"
BREAST MILK HAS ARRIVED
In Arkansas and elsewhere, there are growing online communities of breast milk donors and recipients. Parker is a member — indeed a recruiter. She is less enthusiastic about the parallel online bazaar of human milk sales.
For years now, doctors and public health experts have advocated for babies' consumption of human breast milk over infant formula. It isn't just a cheaper, natural option but something far more consequential. Today, it's a public health imperative.
"Published evidence-based studies have confirmed and quantitated the risks of not breastfeeding. Thus, infant [breast]feeding should not be considered as a lifestyle choice but rather as a basic health issue," says a policy statement from the American Academy of Pediatrics in 2012.
The science and pursuant zeitgeist have pushed mothers who cannot breastfeed because of hypoplasia or mastitis — or babies' own inability to latch — to seek human breast milk from other mothers online, even paying for it, rather than settle for the more convenient, bovine-sourced infant formula in stores.
It's a restoration of the age-old practice of wet nursing, just modified by technology (breast pumps) and more technology (Facebook).
"There is a whole host of immunologically functioning compounds in human milk," says Dr. Misty Virmani, a pediatrician and neonatology faculty member at the University of Arkansas for Medical Sciences. "The most significant of those is secretory IgA."
Baby formula is derived from cow's milk, which contains bovine proteins and supplemental vegetable fats not wholly compatible with newborn digestive systems, the doctor says. Baby formula also lacks human growth hormones, oligosaccharides, stem cells and, perhaps most importantly, immunoglobulins.
"Babies for the most part are born with immune systems that are not prepared to meet the outside world," Virmani says.
An American Academy of Pediatrics' white paper lists more than a dozen health risks substantially reduced by breastfeeding, from allergies and respiratory tract infections to diabetes and Inflammatory Bowel Disease, childhood leukemia and Sudden Unexpected Infant Death.
WHEN BREASTFEEDING FAILS
On a recent morning, Parker, a milk donor, got a visit from 35-year-old Jessica Dziurkowski of Little Rock, and 32-year-old Sheena Bauman of Marche, two mothers who rely on donated human milk.
Dziurkowski discovered she didn't produce enough breast milk when her first daughter, Evelyn, was born. Her cousin back home in Minnesota gave birth about the same time and contributed months' worth of breast milk to Dziurkowski, an event that Dziurkowski remembers with a mix of gratitude and acute despair.
"I'm a huge planner, and I wanted to make sure everything was prepared and perfect for her arrival, so I put my heart into planning her birth, which was awesome — not many people experience a perfect birth," she says. "I didn't put any time into preparing for breastfeeding at all."
When her own milk didn't arrive as planned, "I pumped a lot. I did herbs. I did lactation cookies. I did everything."
But breastfeeding failed.
"It was heartbreaking because I just thought — I felt like a failure as a mom, to not be able to supply her with what she needed."
She geared up for her second, Hannah. After 13 days her daughter wasn't gaining weight like she hoped. She rented a hospital pump to wring as much from her breasts as she could. At three or four months, she gave up entirely.
"It relieved a lot of stress," she says now. "I felt like I was a better mom when I was just focused on nurturing them in other ways."
Dziurkowski, a chiropractor who's opened offices and started practices, says she'd open three or four businesses before she would undergo that strain again.
LIQUID GOLD AND THE BANK OF AMERICA
Parker's donated milk comes frozen in bags, bottles and jars. Handling breast milk is a serious matter for donors and recipients alike.
Sterilization of containers and refrigeration (or freezing) of milk is sacrosanct. Milk banks, such as any of the two dozen overseen by the Human Milk Banking Association of North America, pasteurize all of the milk they send hospitals for neonatal consumption.
Talk to milk-sharing mothers, lactation experts or public health officials long enough and eventually someone lands on the metaphor "liquid gold."
Mother's Milk Bank of North Texas is the leading merchant of milk to sick and preterm Arkansas infants inside many neonatal intensive care units (including Arkansas Children's Hospital and UAMS Medical Center). The milk bank bills hospitals $10 for every 3.5 ounces. That milk is donated to them, following an extensive screening process for donors that includes blood lab work.
In spite of everything we know about the stimulating effect of money on value, the milk bank only trafficks in donated supply because "donation yields a safer product," says Amy Vickers, executive director of the milk bank in Fort Worth.
"When you have someone motivated by getting paid, it might not be the same product you get. That's what we saw in the blood industry. It is a different risk pool when you pay people for blood than when blood donors just donate."
MOTHER'S MILK AT THE SWAP SHOP
Earlier this year, Terry Paul, a branch chief inside the Arkansas Department of Health, sent colleague David Cornell a concerned email.
"I don't do Facebook but I have a complaint on a man selling Mother's Milk on the Benton Bryant Swap Shop."
"What is mothers milk?" Cornell asked.
The concern made its way up to Dr. Dirk Haselow, the state's chief epidemiologist, who wrote back "You need to call him and ask him to stop. This is not something that can be sold."
But it is sold, commonly.
There are posts on Craigslist for human milk sales. The website OnlyTheBreast.com is given over exclusively to breast milk commerce. Many of the buyers make no charade of being new parents but, rather, adults who want to consume human milk for its perceived healing properties or human growth potential.
"I am a 31yr male," begins a post by a buyer from Fayetteville who goes by the username SuaveStud.
"I have been drinking breastmilk for 1yr on and off . Ever since I started I have only had 2 colds and never the flu."
He'd gladly pay $2.50 an ounce for a supply.
Sellers, for their part, post pictures of chubby babies in an effort to advertise the goods. Some signal purity — vegan or Paleo diets, immaculate bloodwork — or a no-questions willingness to ship. Some featured posts are in fact paid advertisements.
"So Much Sweet and Creamy Milk!"
"Willing to sell to men!"
"Clean, healthy liquid gold from momma with graduate degree!"
'SOMETIMES PEOPLE LIE'
When Kristy Browning of Gravel Ridge gave birth to Aria Anthony in December, she discovered she produced quite a bit more milk than she needed. She advertised her breast milk for $1.50 an ounce on OnlyTheBreast.com and Craigslist. An electrical technician with the Arkansas National Guard, she highlights being a bodybuilder under the handle FitMama1215.
"I'm a certified personal trainer. I'm in the gym six days a week. I eat healthy," she says. "If I wouldn't give it to my baby, why would I give it to someone else?"
But pressed about milk sales, Browning acknowledges that donation-only is, intuitively, a hedge against fraud.
"You know, when you buying it from someone you don't know, you don't know if they're taking their prenatals ... they doing drugs, they drink. And they can say they don't, but sometimes people lie, especially when they're trying to get money."
In 2015 a team of researchers at Ohio State University made 102 online purchases of human milk and screened their DNA profiles. In 10 of them, they discovered bovine DNA at levels consistent with an admixture of at least 10 percent cows' milk. The study's authors echo Vickers' warning: "Selling rather than donating milk involves a monetary exchange, which may increase numerous risks, similar to those documented for how paying blood donors increases the likelihood of infectious disease markers in the blood supply."
But the authors also say that milk banks are neither flush enough, nor cheap enough, to compete with private and unregulated milk sharing and selling.
Vickers can imagine a calculus wherein new mothers who could breastfeed their infants instead bottle feed them formula while selling off all they can pump.
Jerrika Longueville of Fayetteville has hypoplasia, and a lot of experience hunting milk online. She's a member of the Facebook groups Human Milk 4 Human Babies Arkansas and Eats On Feets Arkansas.
"I had a donor [who] donated to me free and clear and gave to me a lot of milk, but she said she sells on the side, and most of who contact her are bodybuilders and weird fetishists."
Longueville isn't opposed to human milk commerce; "I'm not competing with them because I don't buy milk."
She is competing with other needy moms who won't buy because of the aforementioned risks — Dziurkowski is another — and sometimes she confronts age discrimination.
"The competition for milk is definitely brutal. … I've had women tell me they don't want to donate to me ... because my son was a little too old. They'd rather it go to a younger baby."
On OnlyTheBreast.com and other human milk classifieds, sellers vamp for the screen, but over on Facebook community pages "there's a lot more asking for milk than … donating."
Back at Holly Parker's North Little Rock bungalow, Sheena Bauman admits she pays a woman for milk.
"This mom is working as well, too, and … she's also a full-time mom. I understand what it's like to be attached to this pump like — all — the — time. So, I'm like, yeah, sure, I will give her this money that I feel she's due."
But Bauman is fortunate to have one mother who is committed to her needs. She is, in part, rewarding that convenience. Also, it was Bauman's suggestion to pony up a dollar an ounce.
"When it's not something I think is expected, that compensation," it feels right.
But Longueville, the Fayetteville mother of two, had a similar arrangement go sour. Her donor began asking for money, though not explicitly in exchange for a load of breast milk.
"At that point, I started to get uncomfortable just because of how I feel about buying milk and not knowing what was going to happen to the milk at that point. So I stopped."
Longueville didn't hear from that supplier for a time, "and then she sent me a message out of the blue one day, saying she was moving, and she had all this milk in the freezer, and she was just ... going to leave it" to spoil. Then the woman disabled her Facebook account.
"She was probably the closest to being a regular donor [I've had], so it was a very disappointing, and twisted, ending to that relationship."
A MILK DEAL
In a Chick-fil-A parking lot in Maumelle, Mary Catherine Fortier of Conway hands Glenda Nielsen of Little Rock more than $500 for about 1,500 ounces of Nielsen's breast milk.
"We joked, my mother and I," Fortier says, "that if a police officer came by, I'm sitting here counting money. Does he think there's a drug deal going down? No sir, it's a milk deal."
Fortier is fortunate to have a huge overproducer in Nielsen, one who can meet all of her demand for weeks at a time, at a price so attractive ($.50/oz.) that Fortier sighs — "whew" — when she considers it.
"It's a time consuming thing to try to pump every three hours," Nielsen says, "then clean and sterilize … all day, every day. I can't be out of my house for a few hours I have to come home and do it, or pump in my car. I think if I'm going to do that much I should be compensated just a little for this."
"I'm all on board on this," says Fortier.
BREAST MILK IS WHITE PREFERENCE OR PRIVILEGE?
Nielsen, the supplier, is black; and Fortier, the client, is white. Neither mother seemed very interested in this distinction — "my husband's Caucasian," Nielsen said — but it does appear human milk commerce demonstrates yet another American racial disparity.
Longueville, who is white, has accepted supplies of milk from African- and Asian-American women and would never seek or refuse a donation based on race, she says, but many more women seeking milk are white, she says.
"Most of the women who want [this] have been white," agrees Kristy Browning, the Gravel Ridge seller, who is black.
Nicolle Fletcher, a certified lactation consultant, a doula and owner of Birth By Design, hasn't detected discrimination among milk recipients — that is, white recipients refusing or eschewing black donors or sellers.
But in her own consultancy there is a conspicuous imbalance: Fletcher has had 300 or so clients and just six have been black women like her.
"When your mindset is, 'This is a luxury, and a luxury I can't afford,'" she imagines, "then you don't pursue it. But what I'm saying is, it's not a luxury; it's a necessity, especially when there's huge health care disparities."
According to National Centers for Health Statistics data, of every 100,000 live births between 2011-2014, sudden unexpected infant deaths (SUID) claimed 170 non-Hispanic black babies and 84 white ones. American Indians had the highest rate, 194, while Hispanic, 51, and Asian/Pacific Islander, 38, fared best.
If African-American women are underrepresented among the ranks of new mothers needing breast milk on merchant or donor sites and message boards, Fletcher says, it's because black women choose infant formula easily, perhaps because of a stronger preference for convenience, but perhaps from stigmatization.
"These breasts are to provide nourishment to humans. Well, African-American women were not allowed … to nourish their own children with their own breasts" for centuries under slavery, Fletcher said. "They were made to nourish white babies at their breasts, and if they were allowed to actually nurse their baby, then one breast would be designated for the white child and the other breast for the black child, but after the white baby had consumed all that it needed.
"There's a bitterness that comes with that."
Infant formula, on the other hand, is neatly packaged, manufactured with technological precision — it comes by way of adult food, from a store.
"You know, I posted something" related to milk sharing, Fletcher says, "and an African American woman was like, 'That is gross. That is just nasty,' and she was like, 'Somebody just dropped some titty milk at your house? What?'"
LACTATION AND LOUIS PASTEUR
Eww, human breast milk!
"We don't get that like we did 14 years ago when we started," says Amy Vickers, the director of Mother's Milk Bank of Texas. "When people say that, I say, 'Well, you know, it's a lot less eww than blood transfusion. Or even cow's milk. If you've ever been to a dairy, that's what's eww.'"
Still, Vickers' milk bank pasteurizes every ounce of donated milk it sends back out. There's bloodborne viruses such as HIV, hepatitis and cytomegalovirus, and even more transmissible bacteria and pathogens such as streptococcus and staphylococcus.
Back at Holly Parker's house with Jessica Dziurkowski and Sheena Bauman (and Story Parker, 6, and babies Atlas Parker and Hannah Dziurkowski), the moms agree they don't prefer pasteurization. They believe it's a threat to beneficial stem cells or other organic agents.
Bauman had a donor who was pasteurizing her bagged milk before handing it off. The process involves simply heating milk to a temperature roughly that of very hot coffee for a period of several minutes. Bauman gently asked her not to for fear of nutrition loss.
"My best friend needed some donor milk for her first child," Parker says. "She was having very severe postpartum depression and was not wanting to put the baby to breast, and she's a lactation consultant! And I knew if we did not get her some good donor milk, that she would be, at the end of this, when she came out of the dark she was in, that she'd be pretty disappointed that we'd given her baby formula when she wasn't able to do anything for her child.
"Her husband is an ER physician, and he was not comfortable with just donor milk given in the community because of, you know, potential exposure to things. So he was in charge of low-heat pasteurizing all the milk that his baby got until [my friend] recovered. And she was actually able to breastfeed her baby until almost 2, which is pretty miraculous, because she didn't put him to breast at all for almost two weeks."
"It's just a sign that your body bounces back," Bauman says.
This story is produced by Arkansas Public Media. What's that? APM is a nonprofit journalism project for all of Arkansas and a collaboration among public media in the state. We're funded in part through a grant from the Corporation for Public Broadcasting, with the support of partner stations KUAR, KUAF, KASU and KTXK. And, we hope, from you! You can learn more and support Arkansas Public Media's reporting at arkansaspublicmedia.org. Arkansas Public Media is Natural State news with context.