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

当一位母亲将她的母乳捐赠给母乳银行时，这被称为给脆弱的新生儿的“礼物”。母乳提供肠道保护，并预防与配方奶使用相关的危及生命的坏死性小肠结肠炎（NEC）。当一个新妈妈不能产生足够的母乳时，新生儿重症监护室的医学专业人员将这种捐赠的母乳作为拯救生命的“药物”。Mauss（1925）将礼物理解为创造和维持社会关系。捐赠的母乳是作为礼物赠送的体液，这凸显了这些社会团体之间存在的漏洞。本博士将提供一种新的母乳民族志方法，通过跟踪母乳从捐赠母亲家中的私人领域流向母乳库，再流向新生儿重症监护室的接受母亲/婴儿，并探索围绕母乳的信念、实践和过程。建立在礼物和商品的人类学理论基础上，捐赠的牛奶将作为两者进行探索，并有助于更细致入微地理解这些关键的人类学概念。本博士将探讨在苏格兰的新生儿重症监护病房中，捐赠母乳作为体液的使用，渗透到身体和国家、亲属关系和母亲、营养和医学的界限。这是一个及时的问题，因为尽管苏格兰的母乳喂养率仍然是世界上最低的，但苏格兰新生儿重症监护病房的母乳捐赠增加了三倍（联合国儿童基金会）。这个博士学位将为苏格兰生殖人种学提供新颖的见解。要问的首要问题是：1。牛奶作为礼物：为什么苏格兰的母亲会捐赠母乳？这包括什么？作为药物的牛奶：在将捐赠的牛奶转化为NHS药物和商品的信念、做法和过程是什么？对于参与这一过程的人来说，捐赠的母乳意味着什么？3. 母乳和另一位母亲：在苏格兰的新生儿重症监护病房接受捐赠的母乳意味着什么？供体母乳对供体母亲和受体母亲的“母性工作”有什么贡献？作为NHS的一名注册助产士，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，并作为“在家的民族志学家”。由于要求在6个月内使用供体奶，多个人种志工作地点将在12个月内分成重复的阶段（NICE, 2010）。多方法方法将利用参与者观察、实地考察笔记、访谈和文献分析等关键人类学研究方法来三角测量和背景化研究结果。第一阶段：参与者观察和采访苏格兰各地的捐赠母亲，探讨捐赠意味着什么，如果她们认为母乳流向谁，以及这如何与她们自己的“母亲工作”相匹配。还将邀请妇女记录她们表达做法的图片和录音，以便在传播过程中为调查结果提供视觉和基于感官的内容。第二阶段：参与者观察运输到牛奶库和储存，巴氏消毒和牛奶转化为“药物”的细菌测试。对母乳银行工作人员和志愿快递员的采访将使他们了解捐赠的母乳对他们意味着什么。第三阶段：位于格拉斯哥和邓迪两个确定的新生儿重症监护病房地点，选择这两个地点是因为它们的社会剥夺率高，种族多样性大。参与观察新生儿重症监护室工作人员将了解涉及储存，处理，管理捐赠母乳的做法。对政策的书面分析，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工作人员、母亲和伴侣的访谈将把这些观察到的数据置于背景下，并探讨它与新生儿重症监护室自己的母亲身份工作的关系。最后，新生儿重症监护病房的家长将在采访中被邀请帮助共同创建一个信息指南，为未来的新生儿重症监护病房的父母提供进一步的背景研究结果，并提供一个切实的结果进行传播。

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.