Informal breastmilk sharing currently exists and is in sharp contradistinction to donor human milk banking. Informal milk sharing presents a dilemma for families. They must consider both the known benefits of breastmilk and the possible health and safety risks from exposure to medications or infectious diseases from either community-based or internet-based breastmilk sharing.
Human milk donors are lactating women who have surplus breastmilk after feeding their own infant, have milk they cannot provide to their infant due to infant illness or who have experienced perinatal loss. Human milk donors should have no medical illness where breastfeeding is contraindicated, nor should they be on any medication or herbal preparation that is incompatible with breastfeeding.
Identifying safe human milk donors usually requires a review of the donor’s medical history, including, where possible, a review of her prenatal infectious screening tests (Hepatitis B, Hepatitis C, HIV, HTLV I/II, syphilis) and a review of her social practices (no smoking tobacco products or e cigarettes, no drinking alcohol greater than a small amount daily, no using illegal drugs or marijuana, and no sexual partners within the previous year at risk for HIV.)
Please see Dr. Philipp’s previous post on donor human milk banking.
Informal breast milk sharing has grown increasingly more common. Whether community based or internet based, informal milk sharing can be problematic for the recipient infant. There are multiple websites that describe their mission to provide an avenue for breastmilk sharing without taking money. The responsibilities of this type of donor milk exchange remain with the donor mother and the parent(s) of the recipient infant.
The U.S. Food and Drug Administration, the Human Milk Banking Association of North America, the European Milk Bank Association, and the American Academy of Pediatrics have all discouraged informal milk sharing. Each organization recommends that you consult with a healthcare provider first about using a breastmilk source other than the baby’s mother. The Academy of Breastfeeding Medicine has published a position statement on informal donor human milk sharing.1
Feeding a baby with human milk from a source other than the baby’s mother presents possible health and safety risks for the recipient baby. Because of these risks, any decision to give donated breast milk to your baby should be discussed with your baby’s health care provider in advance.
Peer-to-peer breastmilk sharing is cause for concern for several reasons:
1) Disease transmission. Human milk can be a source of infection such as bacteria, or viruses like HIV, HTLV I/II, and CMV. To minimize risk: All donors should be screened, and all milk should be pasteurized. 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.
2) Transfer of drugs or medications. Human milk can be a vehicle for transferring drugs from the mother donor to your child. Although most medicines are safe for breastfeeding mothers and babies, some medicines can be harmful, even in small amounts. There may be chemical contaminants and some illegal drugs.
3) Contamination. When human milk is not handled and stored properly, it could, like any type of milk, become contaminated and unsafe to drink. During collection and storage there are many opportunities for contamination and some milk can be adulterated with cow’s milk.
Only medical screening of the donor and safe milk handling practices can maximize the safety of community-based breastmilk sharing. Organizations such as “Eats on Feets” have chapters in almost every state throughout the US. Their website describes its mission as supporting the safe sharing of breastmilk with an emphasis on informed choice, donor screening, safe handling, and home pasteurization (if necessary). Recipient mothers are instructed to communicate with donors by asking questions about their health and lifestyle and by requesting blood screen test results from the donor mother.
A recent post on the Eats on Feets website instructs parents about the hazards of being scammed by offers to pay for the shipping of milk, by requests for a large amount of milk (it might signal “milk flipping”), by declining to meet in person or requesting that you drop your milk off or leave it out, by offering to send you bags via an online store directly, by declining to answer your questions or being vague about health, lifestyle, and proper handling of milk. Enough said about a procedure this susceptible to scamming.
Internet-based breast milk sharing is not recommended under any circumstances. Studies have shown that milk sold through the internet is often more problematic than milk sharing on the internet. Breastmilk can be adulterated with other substances or arrive fully thawed out, spoiled, and contaminated with various bacteria. Since the breastmilk that is being sold on the internet is being sold for profit, the donors may not be fully transparent regarding their health histories, medications, and social practices, thereby increasing the risk to the recipient infant.
It is not a safe practice to buy human milk via community-based milk sharing. Some issues of buying human milk from individuals include the milk may be a donation they received from someone else, the milk may not be human at all, the milk may be cut with other liquids, the milk may come from multiple unknown donors. Studies have shown that purchased human milk contains higher levels of bacterial contamination.
There was an excellent article in the NYTimes about milk sharing during the formula shortage of 2022.2 Let me know your thought below.
Academy of Breastfeeding Medicine’s 2017 Position Statement on Informal Breast Milk Sharing for the Term Healthy
What parents need to know about sharing breastmilk.