The Hierarchy of Human Milk: Supporting Parents, Not Just Feeding Babies
When conversations about infant feeding arise, they often focus on one question:
How do we get milk to the baby?
It's an important question. Babies need to be fed.
But sometimes a second question gets overlooked:
What support does the lactating parent need?
I am strongly supportive of donor milk, milk sharing, and families having access to a wide range of feeding options. Human milk is a remarkable resource, and communities of milk-sharing parents have supported one another for generations.
At the same time, I believe parents deserve more than milk.
They deserve information. They deserve support. And they deserve the opportunity to understand all of the options available to them before deciding which path is right for their family.
The Hierarchy of Human Milk
The World Health Organization and many infant feeding organizations recognize a hierarchy of feeding options that prioritizes human milk whenever possible.
Generally speaking, that hierarchy looks like this:
Feeding directly at the breast or chest
Expressed milk from the infant's own parent
Donor human milk
Infant formula
What's interesting about this hierarchy is that it doesn't place donor milk at the top.
The preferred option, when possible, is a parent's own milk.
Not because donor milk lacks value. Donor milk is incredibly valuable.
But because a parent's milk is uniquely matched to their baby and because feeding is about more than nutrition alone. It is also about relationship, regulation, communication, and the feeding goals of the family.
Support Is Part of the Hierarchy Too
When we talk about feeding hierarchies, we often focus on the milk itself.
But I think there is another hierarchy that deserves attention:
Support.
Before a family decides whether donor milk, formula, exclusive breastfeeding, pumping, or combination feeding is right for them, they deserve access to skilled support and accurate information.
They deserve to know:
Why milk supply may be low
What options exist to increase supply if desired
How feeding mechanics affect milk production
What role birth and postpartum recovery can play
When supplementation is appropriate
How to make feeding decisions that align with their goals
Without that support, families may make decisions from a place of exhaustion, urgency, or incomplete information.
And while those decisions may still be the right ones, parents deserve the opportunity to make them intentionally.
Donor Milk Can Be a Bridge
One of the reasons I value both peer-to-peer milk sharing and donor milk is that they can create breathing room for families. Feeding decisions are rarely made in a vacuum. Sometimes a baby needs additional milk while a parent is working to increase supply. Sometimes donor milk allows a family to continue pursuing their breastfeeding goals without the pressure of feeling that every ounce must come from their own body immediately. And sometimes donor milk becomes the long-term feeding choice because it aligns with a family's values, circumstances, or needs.
The problem is not donor milk. Donor milk is an incredible resource. The problem is when the conversation stops there. When we focus solely on finding milk for the baby, we can miss opportunities to support the parent, understand the challenges they are facing, and help them make informed decisions about where they want their feeding journey to go from here.
Feeding Goals Matter
One of the most important lessons I've learned in this work is that every family defines success differently. Some parents hope to exclusively breastfeed. Others plan to combination feed from the beginning. Some want to provide as much of their own milk as possible, while others are looking for the feeding approach that feels most sustainable for their family's overall wellbeing.
Because of that, I don't believe support should be measured by whether it leads to a particular feeding outcome. The goal of good support is not to convince families to breastfeed, supplement, pump, or use donor milk. The goal is to provide accurate information, thoughtful guidance, and compassionate care so that parents can make decisions that align with their own values and circumstances. When families understand their options and feel supported in their choices, they are far more likely to feel confident and at peace with the path they choose.
The Best Feeding Choice Is an Informed One
I believe deeply in milk sharing. I believe deeply in donor milk. I believe deeply in formula when it is needed or desired. Most of all, I believe in making sure families have access to the information and support necessary to understand those options.
Too often, feeding conversations become focused on what milk a baby receives, when the more important question may be whether the family was truly supported in making that decision. Parents deserve to know why challenges are occurring, what options are available, and what support exists to help them meet their goals. They deserve the opportunity to make feeding decisions from a place of knowledge rather than urgency.
When families are informed, supported, and empowered, they are able to choose the feeding path that works best for them. Whether that path includes breastfeeding, donor milk, formula, or some combination of all three, the goal should never be a specific outcome. The goal should be a family that feels confident in the choices they have made and supported throughout the process of making them.
