Got Breast Milk?

by Amy Spangler
January 20, 2011

Intent on giving their babies what every baby needs most—human milk—mothers are bypassing milk banks and going directly to the manufacturer—breastfeeding mothers.

Unable to produce enough milk due to a congenital breast abnormality, but determined to feed her baby human milk, Kelley Faulkner, founder of MilkShare, accepted breast milk donations from 30 different mothers, enabling her to breast-milk-feed her son for two years. Since its launch in 2004, MilkShare has made it easier for thousands of mothers to share their milk with other mothers through peer-to-peer sharing.

Similar to MilkShare, Eats On Feets, which was launched in 2010, is an online resource that connects mothers needing human milk with those mothers willing to share. A growing awareness of the importance of human milk for babies and moms (not to mention the environment) has accelerated the demand for human milk at a time when processed donor milk is scarce and costly. There are currently only 10 public milk banks in North America (six more are in development). Given the limited availability of human milk, babies with serious medical conditions such as prematurity are given priority, leaving healthy babies with few options aside from infant formula. Although some insurance companies will cover the cost of human milk when there is a documented medical need, mothers of babies without a medical condition must pay $3 to $5 per ounce to cover collection, processing, and distribution costs. An 8-pound baby consumes approximately 20 ounces of milk a day. At a cost of $60 to $100 a day, it’s easy to understand why mothers without enough milk for their babies are turning to those mothers with milk to spare.

Why is milk sharing a concern?
The sharing of human milk is viewed by some as a moral imperative, by others as a generous gift, and by still others as a means for spreading disease. Recent media coverage of organizations such as Eats On Feets caught the attention of the Food and Drug Administration (FDA). The agency responded with a warning about the potential risks of milk sharing, including contamination, disease spread, and transfer of harmful medications, and later convened a meeting of its Pediatric Advisory Committee to explore regulatory issues.

The Human Milk Banking Association of North America (HMBANA) and the FDA currently have written guidelines (click here to read the HMBANA guidelines and here to read those from the FDA) for the sharing of human milk. Both advocate for human milk feeding with a mother’s own milk or human milk processed by established milk banks, but neither endorses the peer-to-peer sharing of human milk between mothers. Although peer-to-peer milk sharing isn’t controlled by a third-party, it isn’t completely casual or uninformed either. Donors are typically screened, and recipients make an informed decision to accept donor milk believing it to be a better option for their child than infant formula.

Why do mothers share milk?
There is no substitute for the sensory stimulation that breastfeeding provides, something every bit as beneficial as the milk itself. But if circumstances such as previous breast surgery, insufficient glandular tissue, serious illness, or maternal death prevent a mother or baby from breastfeeding, parents must identify an alternative food source. At the same time, parents need to recognize that each option has distinct disadvantages compared to direct breastfeeding.

• Expressed mother’s own milk. Babies fed express milk from their own mother have less skin-to-skin contact, which means they miss out on all the benefits skin-to-skin contact provides. Mothers also experience less suckling time, which affects fertility and child spacing. Collection and storage of milk, even for a brief period of time, alters the composition of the milk.

• Expressed milk from another mother. A mother’s own milk contains antibodies tailored to her baby’s needs, a unique quality that is lost when a mother’s own milk is given to another mother’s baby. A mother’s milk also changes to meet the distinct needs of her growing baby, not those of the baby receiving her donated milk.

• Processed donor milk. Pasteurization (heat treatment) and storage (freezing/thawing) affects the ingredients in human milk.

• Infant formula. Infant formulas contain no active ingredients—no enzymes, no living cells, no antibodies, and no means for preventing disease.

Are there risks associated with milk sharing?
Despite human milk’s many benefits, casual sharing is cause for concern for a variety of reasons:

• Disease transmission. Human milk can be a source of infection such as HIV/AIDS, HTLV I/II, and CMV. To minimize risk: Screen all donors and pasteurize all milk. A simple low tech form of pasteurization known as “flash-heating” can be used to kill bacteria and viruses such as HIV, yet preserve important ingredients in human milk. (See video on “flash-heating” here.)
• Transfer of drugs or medications. Human milk can be a vehicle for transferring drugs from donor to child. Although most medicines are safe for breastfeeding mothers and babies, some medicines can be harmful, even in small amounts. To minimize risk: Screen all donors.
• Contamination. When human milk is collected and stored there are many opportunities for contamination. Even when the utmost care is taken, bacteria and viruses can get into the milk. To minimize risk: Teach mothers how to express, collect, and store their milk safely. Also instruct mothers in “flash-heating” milk to kill bacteria and viruses.
• Poor growth. There is some evidence to suggest that babies fed pooled donor milk may not grow as well as babies fed their own mother’s milk. To minimize risk: Encourage mothers using donor milk to monitor their baby’s growth. Unlike infant formula, which contains required amounts of vitamins, minerals, and nutrients, ingredients in human milk vary widely from mother to mother, day to day, even morning to night.
• Fewer mothers breastfeeding. Breastfeeding requires time and energy on the part of mothers. If donor milk is readily available at low cost or no cost, mothers may be inclined to forgo breastfeeding altogether. To minimize risk: Give mothers the support needed to breastfeed their child for at least the first year, including extended maternity leave, worksite pumping stations, and affordable child care.

Renewed interest in milk sharing
While the benefits of breastfeeding and human milk have been thoroughly investigated, much of the data have been harshly criticized. Which is not surprising given that mothers breastfeed in a variety of ways—exclusively, almost exclusively, partially; that breastfeeding’s benefits, particularly those pertaining to intellectual and emotional wellbeing are difficult to measure; and that factors thought to influence infant growth and development are difficult to control for. Until recently, use of infant formula was widely accepted, and use of donor milk for healthy, term infants was rarely discussed. As mothers’ understanding of the importance of human milk for human infants has increased, so too has their interest in milk sharing. And while renewed interest brings with it renewed concerns, as discussed above, rarely is there a concern that can’t be managed.

Milk-sharing mothers, donors and recipients alike, are united by a common goal—ensuring that all babies have the opportunity to realize their potential. Considering the barriers to obtaining milk from a public milk bank (e.g., high cost, limited availability, need for prescription, existing medical condition), it’s easy to see why mothers are turning to other mothers for the milk their babies need.

Knowing that individual circumstances vary widely, health authorities (clinicians and politicians alike) should neither endorse nor condemn milk sharing. Instead, they should take steps to ensure that mothers have access to the knowledge needed to make informed decisions that are in the best interest of their child—including knowledge of the risks of peer-to-peer milk sharing and steps to ensure its safety.