322 R.M. Shaw and M. Morgan
Code of Practice states, ‘If the mother is unable to establish breastfeed-
ing, an appropriate infant formula should be provided for the baby or
donor milk if available and acceptable to the mother. If used, donor
milk must meet the required standards for safe collection and storage.’
For health reasons, breastmilk from the baby’s mother is deemed par-
ticularly important as a first choice option for premature infants, not
only as a source of nutrition but also due to bioactive factors. Scientific
studies indicate that hormones, growth factors, enzymes, immunoglob-
ulins, lactoferrin, oligosaccharides, nucleotides, antioxidants, and other
components of breastmilk protect an infant from infection, and provide
optimal intestinal bacterial flora for the infant’s future immune health
(Faraghi and Schanler 2013 ; Heiman and Schanler 2006 ; Hair et al.
2016 ). For premature infants, breastmilk offers protection from a con-
dition known as Necrotising enterocolitis (NEC) (Sullivan et al. 2010 ),
late onset sepsis and reduced rates of bronchopulmonary dysplasia, and
severe retinopathy of prematurity (Hair et al. 2016 ).
Breastmilk also assists gastrointestinal development and immunity
to some infections and helps develop the infant’s immune system. In
the last two decades, research looking into the human microbiome and
the breastmilk biome in particular has hypothesised that this primes
the newborn gut for future immune health (Rautava 2016 ). Additional
research shows that feeding tolerance is improved, and attainment of
full enteral feeding is developed more quickly, in preterm infants on a
full human milk diet (American Academy of Pediatrics 2012 ; Schanler
2001 ). Breastmilk is also said to be beneficial for clinical conditions
such as food allergies, food intolerance, immune deficiencies, renal dis-
ease, post-surgical recovery from metabolic diseases, improved neuro-
developmental outcomes, and shortened length of hospital stay for
babies in the NICU (Heiman and Schanler 2006 ; Faraghi, Ahrabi and
Schanler 2013 ; Vohr et al. 2006 ; Hair et al. 2016 ).
There is evidence indicating that women and healthcare profession-
als may support breastmilk donation more readily than other forms of
breastmilk sharing such as cross-nursing or wet-nursing (Long 2003 ;
Shaw 2007 ), both of which involve body-to-body contact. Some stud-
ies also indicate that perceptions of human milk donation as a risky or
ambivalent practice are no less prevalent than criticisms of breastmilk
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