The Academy of Breastfeeding Medicine issued in Jan 2018 another one of their generally excellent position papers, this one on cooperative infant feeding arrangements (a.k.a. “informal milk sharing”). This one is a great addition to the growing body of research about the importance of human milk use, and the need to increase accessibility to it for use in supplementary feeds (in lieu of infant formula). http://online.liebertpub.com/doi/pdf/10.1089/bfm.2017.29064.nks
The overall guidance is that sharing of human milk (something humans have been doing since time immemorial) is worthy of a good, old-fashioned, risk-benefit discussion with a skilled healthcare provider, so the family using/offering the milk can make a well-informed decision regarding the parent’s and the child’s health. Hear, hear! Isn’t this how every healthcare- or public health-related decision is supposed to go? I like to say: (1) It’s all about parent empowerment, (2) information never hurt anyone, and (3) parents by-and-large wanna do right by their kids. Give ’em the evidence-informed info they need, so they can decide what to do.
There are some health risks to consider for the infant/child receiving the milk. But there are also feasible ways to identify and reduce risks. Suggestion is made for common-sense precautions. Get medical screening of the milk provider, for contraindicated illnesses/medications. Consider stove-top home pasteurization (instructions included!) of the milk, if the family desires, knowing that it will also eliminate some of the good components and protections of the milk. Note, though, that any infant formula commercially available today has exactly zero such anti-infective and anti-bacterial elements.
I wish consideration had been made, in creating this policy, of some of the excellent research out there about how cooperative infant feeding arrangements are really made, by the families who actually provide/need the milk, using reliable and speedy resources for information, including (gasp!) social media platforms. There are citations below for several of those studies, if you are inclined to learn more on your own.
Added September 2018: I have long advised that IBCLCs and other healthcare providers (HCPs)s should *never* be placed in the position of serving as a “broker” or middleman for the collection and distribution of milk. I don’t CARE if you know Parent A with too much milk, and Parent B with not enuff, and you are hankering to make magic by connecting the two. EVEN IF both Parents have declared an interest in sharing.
And it has NOTHING to do with my view of cooperative infant feeding arrangements. A well-informed decision by two adults/families to collect, distribute and receive human milk is A-OK by me. There are plenty of websites out there that serve as “yellow pages” for such activity (if folks even remember what the yellow pages were ….), and as ABM suggests, this is the kind of risks-benefits discussion well within the purview of IBCLCs and other BFg specialists.
The reason I caution against serving as a broker is that our current systems of law and professional discipline do NOT have any mechanism to account for such activity. And enuff people will be “grossed out” by milk exchanges that a lawsuit or disciplinary action could well be filed. And even though the IBCLC/HCP may well come out vindicated … it will be after 2-3 years of a long, grueling, expensive, not-covered-by-your-professional-liability-insurance process.
I caution against it because of the very tangible legal risk to the IBCLC/HCP … not because of the inherent risk of anything in anyone’s milk.
Akre, J., Gribble, K., & Minchin, M. (2011). Milk sharing: from private practice to public pursuit. International Breastfeeding Journal, 6(8). http://www.internationalbreastfeedingjournal.com/content/pdf/1746-4358-6-8.pdf
Gribble, K. (2012). Biomedical ethics and peer-to-peer milk sharing. Clinical Lactation, 3(3), 109-112. http://media.clinicallactation.org/3-3/CL3-3gribble.pdf
Gribble, K., & Hausman, B. (2012, September). Milk sharing and formula feeding: Infant feeding risks in comparative perspective? Australasian Medical Journal, 5(5), 275-283.
Gribble, K. (2013). Peer-to-peer milk donors’ and recipients’ experiences and perceptions of donor milk banks. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 42(4), 451-461. http://dx.doi.org/10.1111/1552-6909.12220
Palmquist, A., & Doehler, K. (2014). Contextualizing online human milk sharing: Structural factors and lactation disparity among middle income women in the U.S. Social Science & Medicine, 122, 140-147.
Palmquist, A., & Doehler, K. (2016). Human milk sharing practices in the U.S. Maternal & Child Nutrition, 12(2), 278-290. https://doi.org/10.1111/mcn.12221
Perrin, M., Goodell, L., Allen, J., & Fogleman, A. (2014). A mixed-methods observational study of human milk sharing communities on Facebook. Breastfeeding Medicine, 9(3), 128-134. http://dx.doi.org/10.1089/bfm.2013.0114
Perrin, M. T., Goodell, L. S., Fogelman, A., Pettus, H., Bodenheimer, A. L., & Palmquist, A. (2016). Expanding the supply of pasteurized donor milk: Understanding why peer-to-peer milk sharers in the United States do not donate to milk banks. Journal of Human Lactation, 32(2), 229-237. https://doi.org/10.1177/0890334415627024
Reyes-Foster, B., Carter, S., & Hinojosa, M. S. (2015). Milk sharing in practice: A descriptive analysis of peer breastmilk sharing. Breastfeeding Medicine, 10(5), 263-269.
Reyes-Foster, B., Carter, S. K., & Hinojosa, M. S. (2017). Human milk handling and storage practices among peer milk-sharing mothers. Journal of Human Lactation, 33(1), 173-180. https://doi.org/10.1177/0890334416678830
Smith, J. (2015). Markets, breastfeeding and trade in mothers’ milk. International Breastfeeding Journal, 10(9), e1-e11. https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-015-0034-9
Tomori, C., Palmquist, A., & Dowling, S. (2016). Contested moral landscapes: Negotiating breastfeeding stigma in breastmilk sharing, nighttime breastfeeding, and long-term breastfeeding in the U.S. and the U.K. Social Science & Medicine, 168, 178-185. https://doi.org/10.1016/j.socscimed.2016.09.014
Baumgartel, K., Sneeringer, L., & Cohen, S. (2016). From royal wet nurses to Facebook: The evolution of breastmilk sharing. Breastfeeding Review, 24(3), 25-32. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5603296/
revised 7 Sept 2018
Liz, the one thing I don’t appreciate is that it talks about internet milk sharing as if it is some type of anonymous and unscreened wasteland. I’d like to think that families that make contact via internet milk sharing pages later on go to make human contact and do the screening questions that are necessary.
You are correct. When my daughter needed milk for her twins, she connected online with a mother several states away. Three years later, on a trip across the country, my daughter and her family stopped to spend time with the donor and her family. The twins are almost 6 and these moms are still friends.
Agree, Lourdes! Hence those links to research that refutes the notion that Internet = bad. I think those studies *do* support the notion that families make personal connections, learn a lot about the donor/receiver, and have altruistic motives.
But I will also say that the ABM position statement, written by-and-for physicians, and asking for an honest risk-benefit discussion in aid of informed healthcare decision-making, is a better approach than some of the alarmist policy statements about milk-sharing, from other professional organizations and governmental entities out there ….
This paper addresses healthy babies. Is there e bough milk in the hmbana system for all hospitalized babies to receive donor milk? What about cost involved? What system would be best for shared milk in this situation, if any?
You are correct, Judy, that it is something of an apples-and-oranges comparison to talk about human milk offered to sick infants in highly-medicalized Neonatal Intensive Care Units (NICUs), and milk arranged between parents for full-term, strappingly-healthy babies and toddlers.
But thanks for asking about the Human Milk Banking Assn of North America (HMBANA), on whose board I sit (through Aug 2019). Concerns have been raised, primarily by for-profit milk processors who are in competition with HMBANA (that sound you heard was my eyebrow, severely arching), that there is a “shortage” of human milk from HMBANA banks. Just not true. 5.2 million ounces of human milk were distributed by HMBANA non-profit member milk banks in 2016. https://www.instagram.com/p/BTuGaWPjaHH/
BUT.
There is always a need to do more, and do better. Some hospitals do not provide HMBANA or *any* human milk to families. I find that shocking, since it is associated with such a huge reduction in the risk for deadly necrotizing enterocolitis (NEC): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025624/. Families and hospitals obtain HMBANA milk **at no charge** with a doctor’s order, paying a processing/shipment fee only (about $4-5/ounce), compared to for-profit companies that charge more that $14-30/ounce for milk on top of processing/ shipment and up to $300/bottle for human-milk-based fortifier. It is a huge barrier that Medicaid does *not* now routinely reimburse the cost of providing human milk in the NICU, nor do most private insurers. On the justification that milk is a food, not a medicine — hair-splitting in the extreme, if ya ask me, when we are talking NICU care.
We know that an environment within the NICU that promotes and supports the provision of human milk by the parent — especially in a hospital that is Baby-Friendly-designated — fosters longer breastfeeding (BFg), more BFg by other families in the NICU, and better rates of continued BFg. The National Assn of Neonatal Nurses has a nice position paper that covers this, along with a helpful bibliography: http://nann.org/uploads/About/PositionPDFS/1.4.3_Use%20%20of%20Human%20Milk%20and%20Breastfeeding%20in%20the%20NICU.pdf.
Even when routine provision of HMBANA milk is happening, many NICUs have policies that promote excellent risk-benefit discussion, and informed decision-making, for families bringing in milk from a known donor. The California Perinatal Quality Care Collaborative’s Toolkit for Very Low Birthweight Babies has, within its Appendix IV, all manner of BFg-promoting information, including information and consent forms for just such situations. https://www.cpqcc.org/qi-tool-kits/nutritional-support-vlbw-infant