The Casual Sharing of Human Milk

on March 18, 2014 in Breastfeeding, Casual Sharing of Human Milk

You may know a mother whose milk supply is low or that her milk supply has dried up for reasons in or out of her control.  Maybe you are blessed with an abundant supply and think that your extra milk will be just the thing to share.

Maybe you are a mother who had breastfeeding difficulties that lead to a low milk supply or perhaps you weaned prematurely and now have regrets.  Your baby may or may not have trouble with infant formula but now wish you had a full milk supply for your baby. Maybe you know of a mother who has a freezer full of milk that she expressed for her baby in preparation for her return to work or just for a “rainy day”.  Or maybe you know of a mother who boasts she could “feed the neighborhood”!

But is casual milk sharing safe?  Is it okay to post a need for milk on Craig’s list or some other on-line Facebook page?  Is it right to donate to another mother that you know or have heard about?  What about selling your milk to a for-profit company that sells milk to needy infants?

As a health care provider, it is my responsibility to follow the rule of “First, do no harm”.  Non-malfeasance, is one of the principal precepts of bio-ethics that all healthcare students are taught in school and is a fundamental principle throughout the world. Another way to state it is that, “given an existing problem, it may be better not to do something, or even to do nothing.  It reminds the health care provider that they must consider the possible harm that any intervention might do.

I am obliged to disclose to women if there is a possible risk or harm in anything that they do while breastfeeding.  As an example, that might include using a medication or herbal supplement that could cause harm to the mother or her infant.  Another example is not feeding a baby when the baby has lost an excessive amount of weight or who is failing to gain weight as expected and needs more calories to thrive.  Casual peer-to-peer sharing breastmilk is another example of a practice that could cause harm to the baby receiving milk that has not gone through the process of maternal screening, and culturing and pasteurization of the milk.

This does not ignore the possible risks and safety associated with feeding of infant formula.  The literature certainly has documented the risks of tainted formulas worldwide and even the practices of unsafe feeding of infant formulas.  And of course, there are a multitude of studies showing the numerous associations of formula feeding with infant sickness and other health and developmental issues.

But widespread casual milk sharing is also experimental and the practice of infant formula can be argued is monitored more closely.  How can we be sure what the white fluid in the bottle really is?  Is this milk from a healthy mother?  Were the collection techniques hygienic?  Many milk banks find that donated milk is contaminated with bacteria from lack of cleanliness and must be discarded.  Are mothers always honest about their intake of tobacco, illegal drugs, and medications?  Are all mothers aware of their health history or that of their partners?  There is some evidence that this is not always the case.

By donating milk to an accredited milk bank, certain safeguards are in place.  The baby’s doctor must confirm that the woman’s own baby is thriving.  Mothers are screened to make certain that they are disease-free.  It makes little sense that these safe guards are not important for any infant being fed donated breastmilk.

Social media may give the illusion that mothers know one another, in reality they may not.  Even when relatives have feelings of obligation donate blood or organs, they must be interviewed in private away from sick family members by blood banks or transplant teams so that any issues can be brought out for the issue of safety.

It is hard to know if this unmonitored practice is entirely safe, however there have been cases in the world where infants have contracted HIV.  In a study done by the San Jose, California Milk Bank, they found that of the 1,000 mothers who passed the lifestyle and health history questionnaire, 3.3% went on to have viral diseases, including syphilis, hepatitis B, hepatitis C, HTLV and HIV.  And it is thought that the incidence of these diseases may even be higher among unscreened donors.

Mothers who donate milk may do so because of the belief that acting for the benefit is right and good.  But, this feeling of wanting to be a part of something seemingly important may affect the truthful disclosure of their personal health issues.  This can be seen on Mother-to-Mother websites on a near daily basis. Some mothers see selling of their milk for profit.  You can probably find breastmilk for sale on Craig’s List on any day in a large city!

While there are for-profit milk banks that purchase milk from mothers and then prepare the milk to sell to hospitals, they exist to make a profit for the company. SourceURL:file://localhost/Users/kathleenhuggins/Desktop/NMCtext.doc

While there are for-profit milk banks that purchase milk from mothers and then prepare the milk to sell to hospitals, they exist to make a profit for the company and are not associated with non-profit HMBANA,  milk banks in the U.S. and Canada.  There are several milk depots across the United States that call themselves milk banks, but these “milk banks” are NOT affiliated with HMBANA milk banks at all. These “milk banks” don’t actually distribute milk to babies in need of breastmilk. These so-called “milk banks” are collection depots, sometimes freestanding, sometimes found inside hospitals or birthing centers, taking in milk to sell it directly to a company called Prolacta Bioscience (the price Prolacta pays for the raw milk ranges from $.50-$2/ounce). To all outward appearances, these milk depots look and sound like a real milk bank, but they do not distribute any milk to any babies, which is what non-profit milk banks do.

Prolacta Bioscience, is the only for-profit human milk processing company in the world. It processes donated breast milk and turns it into human milk fortifier, which is meant to be added to human milk, for preemies. What Prolacta doesn’t make clear is that this human milk fortifier carries a price tag $185.00 per ounce! And because Prolacta is a for-profit company, if a family with a critically ill baby can’t pay or doesn’t have health insurance or Medicaid, they don’t get the human milk fortifier, even if their baby needs it. HMBANA milk banks already can provide preemies with higher-calorie milk, and preemies have already been known to thrive off of the HMBANA-provided milk, so the necessity of Prolacta’s human milk fortifier is questionable. Furthermore, if people donate to a Prolacta “milk bank” and give their breastmilk to Prolacta Bioscience instead of a HMBANA milk bank (both organizations have very similar screening criteria and thus receive donations from the same pool of donors), this depletes the supply going into HMBANA banks which means fewer preemies get the milk they so desperately need at a price that can be more affordable.

The 17 not-for-profit milk banks in North America (Canada and the U.S.) provide the necessary safegards that protect their most vulnerable infants.  In these milk banks, no one is paid which helps eliminate the risk of taking advantage of the donors.  The cost of the milk goes to the screening of donors, bacteriologic testing of the milk, pasteurization of the milk, and chain of control monitoring the milk to the receiving infant protect recipient infants.

Not-for-profit milk banks do not sell their milk but they must charge a fee for the milk in order to keep the banks up and running.  Private insurances and some states pay for this milk when a baby is covered through government insurance.

There is usually a shortage of milk from not-for-profit milk banks meaning that there is always a certain priority that is in place for needy, sick, vulnerable infants who are mostly in hospitals.  If the current casual milk sharing movement were to support the non-profit milk banks, there could be a large surge in the number of milk banks and more needy infants could be saved.

According to Barbara Wilson-Clay, IBCLC, peer-to-peer milk sharing provides a wonderful way to manifest great generosity.  And the act of sharing milk may have the best of intentions, but with that being said, we must continue to discuss the ethics and safety of this sharing of a human bodily fluid.

If you want to provide your baby with human milk and you struggling, work with a lactation consultant.  Consider frequent pumping, using herbal remedies and even medications to bring in your milk.  See if your baby’s doctor will write a prescription for banked breastmilk if medically necessary and contact a nearby milk bank for the possibility of having milk sent to you.

If you are blessed with an abundant milk supply, keep in mind that a day may come when your own baby needs it.  If you are being asked to give your milk to another mother, think about your baby first.  Or consider donating some of your milk to a not-for profit milk bank.  Know that most milk banks are very often, like blood banks, are all too often experience serious shortages of human milk.  Not-for-profit banks send milk most often to who are medically vulnerable baby and whose need for your milk could make the difference between life, disability or even loss of life. Visit the The Human Milk Banking Association of North America  at  https://www.hmbana.org. You can be a breast milk heroine!