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

当母亲将母乳捐赠给母乳银行时，它被称为给脆弱新生儿的“礼物”。母乳提供肠道保护，防止与配方奶使用相关的危及生命的疾病坏死性小肠结肠炎（NEC）。当一个新妈妈不能产生足够的母乳时，NICU的医疗专业人员将这种捐赠的母乳作为拯救生命的“药物”。Mauss（1925）认为礼物是创造和维持社会关系的工具。捐赠者的母乳是作为礼物赠送的体液，突出了这些社会机构的多孔边界。这个博士学位将提供一种新的方法来母乳人种学通过以下的牛奶从捐赠母亲家的私人领域的流动，到母乳银行，到新生儿重症监护病房的接受者母亲/婴儿二人组，并探索围绕它的信仰，实践和过程。捐赠的母乳将作为两者进行探讨，并有助于对这些关键的人类学概念有更细致的理解。这个博士将探讨在苏格兰的NICU内使用捐赠者母乳作为渗透身体和国家，亲属关系和母亲，营养和医学边界的体液。这是一个及时的问题，因为苏格兰新生儿重症监护病房的母乳捐赠增加了三倍，尽管苏格兰的母乳喂养率仍然是世界上最低的。这个博士学位将提供新的见解苏格兰生殖人种学。要问的首要问题是：1。牛奶作为礼物：为什么苏格兰的母亲捐赠母乳？这涉及到什么？2.牛奶作为药物：将捐赠的牛奶转化为NHS药物和商品的信念，实践和过程是什么？捐赠的牛奶对参与这一过程的人意味着什么？3.牛奶和另一位母亲：在苏格兰的NICU接受捐赠的母乳意味着什么？捐赠者的母乳对捐赠者和接受者母亲的“母亲工作”有什么贡献？作为NHS的注册助产士，我拥有独特而有利的地位，可以在熟悉的环境中提供这项研究，并与现有的连接作为“民族志学者在家里”。由于要求在6个月内使用供体乳汁，因此多个研究中心的人种学工作将在12个月内分为重复阶段（NICE，2010）。多方法的方法将利用参与者观察，实地考察笔记，访谈和文献分析的关键人类学研究方法，以三角和上下文的研究结果。第一阶段：参与者观察和采访苏格兰各地的捐赠母亲，探索捐赠意味着什么，如果他们认为谁的牛奶去和这如何适合自己的“母亲工作”。还将邀请妇女录制其表达方式的图片和录音，以便在传播过程中为调查结果提供视觉和基于感觉的内容。第二阶段：参与者观察到牛奶银行的运输和储存，巴氏杀菌和细菌测试的牛奶转化为“药物”。通过对母乳银行工作人员和志愿者的采访，我们可以了解捐赠母乳对他们意味着什么。第3阶段：位于格拉斯哥和邓迪的两个已确定的新生儿重症监护病房内，因其高社会剥夺率和种族多样性而被选中。NICU工作人员的参与观察将了解有关储存、处理和管理供体乳汁的实践。对政策的文件分析，包括使用中的错误，可以反映所观察到的错误。与新生儿重症监护室的工作人员，母亲和合作伙伴的采访将背景下观察到的数据，并探讨它如何涉及到自己的母亲身份在新生儿重症监护室的工作。最后，在访谈期间，将邀请新生儿重症监护室的父母帮助共同为新生儿重症监护室的未来父母创建一个信息指南，以进一步将调查结果结合起来，并提供切实的成果进行传播。

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.