Crying over shipped milk

When Kendall Chase of Shoreline, Wash. gave birth last June, she planned to breast-feed, but two weeks in, her son Parker was losing weight and milk supply appeared to be faltering. When her pediatrician suggested supplementing with donor milk — breast milk from another lactating mother — as an alternative to formula, Kendall and her husband Craig were receptive.

With support from Parker’s doctor, they found a healthy local donor right away and picked up the first milk donation that very night. Within two days, they were in contact with a long-term milk donor.

Kendall did what she thought was best for Parker, and she took precautions, selecting healthy donors that her pediatrician knew and trusted. But according to the American Academy of Pediatrics, this type of informal milk sharing — milk shared mom-to-mom instead of through a milk bank — puts babies at risk.

The Academy and Food and Drug Administration both discourage mom-to-mom milk sharing, and a recent study published in Pediatrics [i] found high levels of staphylococcus bacteria and a few instances of salmonella in samples of breast milk sold online.

At press time, New Jersey legislators are due to vote on a bill [ii] that would create a campaign to “warn parents about the dangers of casual milk sharing.”

Human milk is ‘liquid gold’

Human milk is widely acknowledged as the safest, best food, and an immune-booster for infants, offering protection against a host of diseases and conditions, from bacterial infections and respiratory illness to diabetes and obesity [iii]. When a mom can’t produce enough milk on her own, the Academy’s 2012 policy statement, “Breast-feeding and the Use of Human Milk [iv],” recommends only pasteurized donor milk (generally, milk obtained from a milk bank that’s been treated with heat to kill any pathogens) to fill the void.

But many parents can’t get the pasteurized donor milk available from reputable non-profit milk banks like Northwest Mother’s Milk Bank in Portland [v], because it’s reserved mainly for premature or vulnerable infants and available by prescription only. And banked milk is spendy: a $3- to $4-per-ounce price tag puts this “liquid gold” out of reach for many families, since an infant can drink 30 to 40 ounces of milk per day.

The highly restricted market for banked milk forces parents to look elsewhere, and the world of e-commerce is eager to fill the burgeoning demand. A number of websites enable parents in need of milk to browse through classified ads and purchase breast milk for as low as a dollar per ounce.

This type of anonymous transaction — buyers and sellers don’t know each other and milk is often shipped long-distance — is the kind of sharing critiqued by Pediatrics.

With good reason, says breast-feeding expert Dr. Isabella Knox, associate professor of pediatrics at University of Washington Medical Center. This type of sharing does pose risks to the baby receiving the donated milk.

The risks go beyond the bacterial contamination referenced in the Pediatrics study. The study’s results weren’t surprising, says Knox, because the type of milk studied — unrefrigerated, unpasteurized milk shipped long distance — starts to break down quickly.

“Rotted human milk is dangerous in the short run, with the chance of introducing a serious infection, not to mention the deteriorated nutrients, such as rancid fat,” she says. (Unpasteurized, refrigerated breast milk can remain fresh for 96 hours, but like any milk, it deteriorates quickly when at room temperature.)

Certain viral infections like hepatitis B, HIV, and cytomegalovirus are also passed into breast milk, says Knox. And there’s the question of the milk’s true source.

“When milk is purchased, who says it’s breast milk?” says leading breast-feeding researcher Dr. Jack Newman, a Toronto pediatrician and author of “The Ultimate Breast-feeding Book of Answers.”

Safe sharing is a worthy goal

Despite these risks, donated milk is still superior to infant formula, says Knox, which makes safer milk sharing a worthy goal.

Human milk contains minimal proteins from other species (for example, cow’s milk protein) that could potentially cause allergies in an infant, she says, and many substances in human milk are uniquely suited to protecting the infant from infections. A great example: oligosaccharides [vi], complex carbohydrates in breast milk that block the attachment of bacteria to the intestinal wall.

When it’s stored and transported properly, donated breast milk isn’t all that different from a mother’s own milk, says Newman.

“It may lose some of the antibodies and probably all of the white cells [in storage], but it’s essentially the same as the milk a mother expresses and stores for her own baby.” And, he notes, formula contains no infection-fighting white cells at all.

And according to the Human Milk Banking Association of North America, there has never been a documented case of death or even disease transmission resulting from donated milk [vii].

Withdraw from a bank — or a friend

Safer milk sharing is possible, says Newman, as long as parents follow a few guidelines. First and foremost, parents should never buy milk from an individual. (Not-for-profit milk banks are the exception to the no-buying rule, he says.)

“As soon as commerce enters the equation, you can’t be sure what you’re getting,” he says.

If pasteurized, banked milk is unavailable, friend-to-friend sharing is safer than milk purchased from strangers online, says Newman. (In fact, formula would be preferable to purchasing milk long-distance from strangers, he says.)

“Parents should meet the donor and get information about her and her baby,” he says. “If the donor is healthy and her baby is healthy, it’s likely her milk is safe.”

Online communities Eats on Feets and Human Milk for Human Babies (both have websites and Facebook pages) connect parents in need of milk to moms with milk to spare, nearly always in their local area. Megan Lantz of Redmond, Wash., mom to a toddler, has donated thousands of ounces, free of charge to a handful of moms she met through these groups. She now helps administer the Human Milk for Human Babies Facebook page.

According to Newman, Lantz, and others, “free” is a key aspect of safer milk sharing.

“When you take money out of the transaction, it boils down to pure goodness,” says Lantz. Moms who share this way are motivated to take care of themselves and their milk, because they’re in it for the right reasons: seeing another baby flourish because of their efforts.

There’s a world of difference between anonymous internet selling and face-to-face sharing, says milk donor Allyson Madere, a Shoreline, Wash. mom of two young daughters.

“Establishing a relationship with someone and donating your milk directly to them is very different than buying it anonymously and receiving, days later, defrosted and full of bacteria,” says Madere.

Seattle mom of two Courtney Vowels, who has donated milk to a few friends, says milk-for-sale isn’t as trustworthy as donated milk.

“I’d be more likely to trust freely donated milk than milk someone had been paid for.”

Other safety precautions for milk recipients: ensuring that donors sterilize pump equipment after each pumping session, and making sure that milk is transported and stored safely (see sidebar).

“It would be useful if the donor has had a blood test for HIV and other viruses such as hepatitis B,” says Newman.

Some parents using donated breast milk screen for medications that pass into milk. Colleen Young of Tacoma, Wash., uses milk from five different donors for 8-month-old Nico, and discontinued one donor relationship because the mom used antidepressants.

Parents who want more assurance about milk safety can pasteurize milk at home, says Newman. The World Health Organization recommends killing potentially harmful pathogens in expressed milk by flash-heating, a low-tech form of home pasteurization in which milk is heated to above 160 degrees, though some milk sharing moms don’t perform this step, because it can adversely affect breast milk quality.

Milk donor Shannon Kshywonis of Dupont, Wash., has shared milk with a handful of local moms. She takes safety precautions like frequent hand washing and cleaning pump parts, but she skips the flash-heating (although a recipient could perform this step if desired), in order to protect the integrity of the milk she donates.

“Pasteurization would destroy many of the benefits derived from breast milk,” she says.

Normalizing sharing

Colleen Young would like to see milk sharing become more widely accepted, and for more parents to know about this option.

“One of my donors likened milk sharing to blood banking: we’d never create synthetic blood, and most people don’t think using donated blood is odd. Breast milk is the same concept. There is no substitute.”

Kendall Chase agrees. Donated milk helped her son grow and thrive while she worked on building her own milk supply; at eight months, Parker now drinks just a few ounces of donated milk per day.

“Our donors will always have a very special place in our lives. They helped my son grow strong.”

Malia Jacobson is an award-winning health and parenting journalist and mom of three. Her most recent book is “Sleep Tight, Every Night: Helping Toddlers and Preschoolers Sleep Well Without Tears, Tricks, or Tirades.”

Safely preparing and storing expressed breast milk

(From Centers for Disease Control, American Academy of Pediatrics)

• Be sure to wash your hands before expressing or handling breast milk.

• When collecting milk, be sure to store it in clean containers, such as screw cap bottles, hard plastic cups with tight caps, or heavy-duty bags that fit directly into nursery bottles. Avoid using ordinary plastic storage bags or formula bottle bags, as these could easily leak or spill.

• If delivering breast milk to a child care provider, clearly label the container with the child’s name and date.

• Clearly label the milk with the date it was expressed to facilitate using the oldest milk first.

• Do not add fresh milk to already frozen milk within a storage container. It is best not to mix the two.

• Do not save milk from a used bottle for use at another feeding.