Guest post: Informal Milk Sharing- Are the concerns justified?

Donna-WHealthy Children Project faculty member Donna Walls, RN, BSN, IBCLC, ANLC, ICCE shares another wonderful guest post. You can find her previous article, Safe use of essential oils during pregnancy and beyond, here

Most resources involved in maternal-child health agree that a mother feeding her baby from her breast is the best feeding choice for both mother and baby. But for some women breastfeeding can be difficult or impossible and they want to supply human milk to their infants, but how?

For centuries mothers have helped other mothers in the feeding of their babies. Wet nursing or casual cross feeding was commonplace and women were not concerned about milk contamination. But there are unique concerns now weren’t present in the past ; infections, environmental toxins, collection contamination or the presence of contraindicated medications or illicit drugs.

The American Academy of Pediatrics does not condone informal sharing of breast milk because of concerns over infection, says Dr. Joan Younger Meek, chair of the AAP section for breast-feeding and chair-elect for the United States Breastfeeding Committee. “In my mind, it’s a risky business,” Meek says. “Even the informal sharing between mom’s sister and the mother’s best friend – there are still risks to that because you don’t know the full health history or if the milk was stored in clean containers.”

LaLeche League International, a well know breastfeeding support organization, does not condone informal milk sharing either via person to person or via the internet for purchase. From their guidelines for human milk sharing, LaLeche League leaders are encouraged to talk with mothers considering milk sharing and provide information including the following:  “Risks can include, but are not limited to: transmission of certain infectious agents, like bacteria or viruses, some of which may be found in milk expressed by asymptomatic women; drugs; possibly some environmental contaminants, and potentially unhygienic storage and handling of unprocessed donated milk. Milk from a qualified milk bank will require donors meet specific health requirements before accepting their donated milk, which eliminates many of those risks.”

Research from the Nationwide Children’s Hospital in Columbus, Ohio,  looked carefully at milk purchased from the internet and found that most (74%) of samples were colonized with gram-negative bacteria, coliform and Staphylococcus Contamination increases were associated with the amount of time since milk was expressed and the number of days it had been transported.

Researchers in another Nationwide study, looked at contents of internet purchased milk and found that 11 of 102 samples contained cow milk which can be of great concern to infants with allergies to cow milk.

The Food and Drug Administration advises mothers to receive milk only from HMBANA (Human Milk Banking Association of North America) or state licensed milk banks. Milk received from these banks has been screened by interview, bacteriology testing and pasteurization of the milk.

Meek says while it’s a good thing that women value breastfeeding and are willing to do whatever they can to provide breast milk to their babies, more lactation support is needed to prevent informal breast milk sharing. “We, as a society, should be more supportive for women to breast-feed their own children and helping them with back-to-work issues; making sure our hospitals are supportive of breastfeeding women.” ​

The European Milk Banking Association and Human Milk Bank Association of North America both issued a recommendation together in January of 2015:

Informal sharing of breastmilk presents health risks to infants receiving the milk and reduces the supply available for milk banks to dispense to very low birth weight and preterm infants. EMBA and HMBANA strongly discourage internet mediated sharing or selling of breastmilk and fully endorse the promotion of breastfeeding and donation of surplus breastmilk to non- profit milk banks. We advise all parents to be aware of the risks involved in feeding a baby with another mother’s milk and before doing so to consult a qualified healthcare professional such as a pediatrician, neonatologist or hospital infant feeding specialist.

The issue of milk sharing can be controversial, but in the larger picture, we need to look at support provided to mothers prenatally, in the birth setting, at home and at work. We need to assure that mothers  will be educated in making an informed decision about breastfeeding and supported in their decision to breastfeed. We need to change the culture of making nursing mothers feel uncomfortable while breastfeeding in public and we need to invest in the education of all healthcare providers to provide accurate, current and evidence-based information to breastfeeding families.

As a culture, if we value the health of mothers and babies, we will find ways to make safe milk available to all families through a community based HMBANA facility for issues ranging from vulnerable or NICU babies, adoptive mothers, military mothers, mothers with milk supply concerns to any infant who cannot receive it’s own mother’s milk.

http://www.llli.org/release/milksharing.html

www.pediatrics.org/cgi/doi/10.1542/peds.2013-1687 doi:10.1542/peds.2013-1687

Click to access EMBA%20HMBANA%20Milk%20Sharing%20Statement%20FINAL%20January%202015.pdf

http://www.cdc.gov/breastfeeding/

Martino K1, Spatz D. MCN Am J Matern Child Nurs. 2014 Nov-Dec;39(6):369-74. doi:
10.1097/NMC.0000000000000077. Informal milk sharing: what nurses need to know.

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