Milk, medicine and the other mother: understanding donor milk use in Scotland's Neonatal Intensive Care Units

When a mother donates her breastmilk to a milk bank it is referred to as a 'gift' for vulnerable neonates. Breastmilk offers gut protection and prevents the life-threatening disease necrotising enterocolitis (NEC) associated with formula milk use. When a new mother cannot produce sufficient amounts of breast milk, NICU medical professionals promote this gift of donor milk as life-saving 'medicine'. Mauss (1925) understood gifts as creating and maintaining social relations. Donor breast milk is the bodily fluid, given as gift, that highlights the porous borders of these social bodies. This PhD will offer a novel approach to breastmilk ethnography by following the flow of the milk from the private sphere of the donor mothers home, to milk bank, to recipient mother/infant dyad in NICU and explore the beliefs, practices and processes surrounding it. Building on anthropological theories of gift and commodity, donor milk will be explored as both and contribute to a more nuanced understanding of these key anthropological concepts. This PhD will explore the use of donor breast milk within Scotland's NICUs as the bodily fluid that permeates the boundaries of bodies and state, kinship and mothers, nutrition and medicine. This is a timely issue as milk donation has risen three-fold in Scottish NICUs, despite Scottish breastfeeding rates remaining some of the lowest in the world (UNICEF). This PhD will offer novel insight to Scottish reproductive ethnography. The overarching questions to be asked are:
1. Milk as gift: why do mothers donate breast milk in Scotland? What does this involve?
2. Milk as medicine: what are the beliefs, practices and processes in transforming donor milk to NHS medicine and commodity? What does donor milk mean to those involved in this process?
3. Milk and the other mother: What does it mean to receive donated breast milk within Scotland's NICUs? What does donor milk contribute to both donor and recipient mother's 'motherwork'?
As a registered midwife in the NHS, I hold a unique and advantageous position to deliver this research in a familiar environment with existing connections as 'ethnographer at home'. Multiple sites of ethnographic work will be split into repetitive phases over the course of 12 months due to the requirement for donor milk to be used within 6 months (NICE, 2010). A multi-methods approach will utilise key anthropological research methods of participant observation, fieldwork notes, interviews and documentary analysis to triangulate and contextualise findings .
Phase 1: participant observation and interviews with donor mothers across Scotland, exploring what it means to donate, if they think about who the milk goes to and how this fits around their own 'motherwork'. Women will also be invited to record pictures and sound recordings of their expressing practices to provide visual, sense based content to the findings during dissemination.
Phase 2: Participant observation of transportation to the milk bank and storage, pasteurising and bacterial testing of the milk transforming to 'medicine'. Interviews with milk bank staff and volunteer couriers will build a picture of what donor milk means to them.
Phase 3: located within the two identified NICU sites of Glasgow and Dundee, chosen for their high rates of social deprivation and ethnic diversity. Participant observation of NICU staff will understand the practices involved in storing, handling, administrating donor milk. Documentary analysis of policies, including errors in use, can reflect those being observed. Interviews with NICU staff, mothers and partners will contextualise this observed data and explore how it relates to their own mothering identity work in NICU.
Finally, NICU parents will be invited during interview to help co-create an information guide for future parents in NICU to further contextualise findings and deliver a tangible outcome for dissemination.