When new mum Christy Johnston wanted to use other mothers' breastmilk to feed her baby, she was worried people would think she was "weird".
Key points:
- A growing number of mothers in Queensland are sharing breastmilk through informal arrangements to feed their babies
- There is only one established human milk bank in the state that supplies screened and pasteurised milk for babies who are not in hospital
- Health professionals say women need to be fully informed of safety risks before using unscreened donor milk
Her daughter Daisy was born weighing just 2.62 kilograms and struggled to put on weight due to a severe tongue and lip tie.
Ms Johnston had a limited breastmilk supply, but she was reluctant to use formula as she believed human milk would be gentler on Daisy's tiny stomach.
So, she turned to strangers on the internet.
"I did a shout-out on Facebook, asking if any mums would be willing to donate [breastmilk]," Ms Johnston, who lives near Toowoomba, said.
"And I was just inundated with mums.
"I was sent donor milk from Mount Isa, from the Gold Coast, all so I could supplement breast milk while feeding Daisy."
She now has a regular donor who lives just two streets away.
Her choice is controversial in medical circles, as the milk she uses is unscreened and unpasteurised.
But in Queensland there is only one milk bank, 180km away on the Gold Coast, that supplies screened human milk for babies outside hospital — and parents have to pay to access it.
"I needed this milk then and there and I could just send my husband around to pick it up, or people could drop it off," Ms Johnston said.
"Every single mum that has donated milk ... has been so forward and so honest.
"It's such a taboo subject ... but I was so desperate to give Daisy the best start in life that I put my pride aside."
Is it safe?
The practice of sharing breastmilk has been around for centuries, with wet nurses popular in western countries until the introduction of the feeding bottle in the 19th century.
The World Health Organisation's guidelines recommend low or very low birthweight infants who cannot be fed their mother's own milk are fed donor human milk before formula.
However, it specifies the recommendation applies to areas where "safe and affordable" milk-banking facilities are available.
Queensland families can only access the Lifeblood milk bank in Brisbane if their baby is in hospital and meets strict criteria.
The only option to access screened and pasteurised human milk in Queensland for babies outside hospital is the charity Mothers Milk Bank, based on the Gold Coast, which ships milk around Australia for the cost of processing.
A Queensland Health spokesperson said the decision to use donor milk should be made on a case-by-case basis, with the support of a medical professional.
The Royal Australian College of General Practitioners said there were risks associated with sharing breastmilk, including potential transmission of HIV, but that was relatively "unlikely" as most donating mothers would have been screened for the infection during their own pregnancies.
"I would really encourage women to inform themselves if they are going to go down that path," antenatal-postnatal interest group chair Wendy Burton said.
"How is the product collected, how is it stored ... that's important to be aware of.
"Then there's the lifestyle factors such as alcohol, cigarette smoking, other drug use, that may impact upon the quality of a breast milk."
Options for women
Online breastmilk sharing communities have flourished in recent years, with nearly 5,000 members in the Facebook group 'Human Milk 4 Human Babies Queensland'.
Despite the growing popularity of donor milk, advocates believe it still carries an unfair "stigma" with some doctors and social groups.
Toowoomba lactation consultant Jen James has become an informal matchmaker for women with an oversupply of breastmilk and those wanting a donor.
Some recipients are undergoing chemotherapy or radiation-based cancer treatment, while others have conditions like breast hypoplasia, or lifestyle factors that prevent them feeding the way they would like.
"For me, it's just a way of making sure that those women have the options that they want and supporting them," Ms James said.
"Most people think if you don't have enough breast milk or breastfeeding's hard, then your only option is formula.
"There's a huge, huge body of evidence around human milk feeding, but that does not translate to normal practice for most of us."
Ms James said her service was still "a little bit under the radar", with mothers driving the practice.
"I talk to them about [how] when it's donor milk, it's fresh frozen, it's not screened, it's not pasteurised as it would be if you purchased it from a milk bank," Ms James said.
"Because they're my clients ... I am able to get to know whether or not those mothers smoke, if they're starting to use substances, if they're on any medication.
Some health professionals, like Christy Johnson's paediatrician, support the practice but Ms James said others had "horrified" reactions.
"It takes a lot of courage for a mother to say to a health practitioner ... that she's using donor milk," she said.
"I would love to see that we could change our culture, so that breastfeeding and breastmilk feeding for human babies is nothing other than normal."
Are milk banks the answer?
Dr Burton said having more regulated milk banks, particularly in regional areas, would be "ideal" but likely expensive.
"I think it would be worth exploring lower cost options to enable women to better connect and to meet this need," she said.
"But ... as soon as it becomes formalised then there are standards to be met, accreditation hoops to jump through.
"Then in the complication comes the expense."
In the meantime, babies like Daisy Johnston are thriving off the milk of neighbours and strangers.
Daisy now weighs more than 5 kilograms and will be fed with donor milk until she is old enough to take solids.
"I cannot wait to tell Daisy how many mums have nourished her little body and put little rolls on her legs," Ms Johnson said.