Internet access provides convenience but carries real risks.
Before commercial infant formula became available in the early 20th century, it was entirely acceptable to have one's baby nursed by another woman—a wet nurse. Although the practice had largely disappeared in the United States and other Western countries, it seems to be making a comeback—albeit in an updated, technology-driven form: Internet milk sharing. Women looking to donate or even sell surplus breast milk can now advertise on a growing number of popular Web sites, including Facebook and Craigslist. And women unable to breastfeed or produce enough milk and who would prefer to avoid formula can now conveniently search online for donors or sellers.
Figure. Suzanne Terr...Image Tools
CONVENIENCE AND RISK
In 2004 Kelley Faulkner, who was unable to produce sufficient milk for her baby because of a congenital breast abnormality, searched in vain for a way to obtain breast milk online. She ended up founding her own Web site to make the process easier for others, MilkShare, an Internet home for women looking to donate or find breast milk. Faulkner has received milk from more than 30 donors. Eats On Feets, a site similar to MilkShare, launched in 2010 and became another online resource connecting new mothers needing human milk with those willing to share their supply.
Figure. The milk roo...Image Tools
Experts caution, however, that sharing milk outside the safety of established milk banks carries very real dangers, and nurses should emphasize that to women wishing to go that route.
Carol A. Ryan, MSN, RN, IBCLC, FILCA, clinical manager of Perinatal Education and Lactation Services at Georgetown University Hospital in Washington, DC, has a clear opinion on the subject: “I do not recommend obtaining milk from an unknown source,” she said. “It may not be as free as women think.” Ryan, who has 45 years of nursing experience and has been certified by the International Board of Lactation Consultant Examiners for 23 years, emphasizes that Internet milk sharing is quite different from employing a wet nurse. “There was a time for wet nurses, but they were usually employed by a family for all the children within a family,” she said, adding that “the source was a known entity. Online sources aren't known. The health of the donor is neither an absolute nor traceable.”
A SAFER, IF COSTLIER, ROUTE
The safest route for finding breast milk would be a human milk bank, and there are 11 banks operating in the United States and Canada that are members of the Human Milk Banking Association of North America (www.hmbana.org). Milk banks generally provide milk only to women who have a prescription for it, however, and most of that milk is distributed to hospitals. Because the supply is limited, premature and sick infants take priority and a healthy infant without a medical need would be last on the list.
The cost of banked milk is another consideration, even when it's available. Milk banks charge anywhere from $3 to $5 an ounce; an average eight-pound baby may drink 20 ounces per day, which would cost between $60 and $100 a day. That translates to between $1,800 and $3,000 a month, an amount that would grow as the baby grows. Milk sharing may, therefore, be a woman's only affordable way to obtain breast milk.
But women may also be unaware that not all milk offered online is free of charge. Although buying milk from a private seller is less expensive than a milk bank, it can still cost hundreds of dollars a month. Sallie Page-Goertz, MN, APRN, IBCLC, clinical associate professor at the University of Kansas Medical Center in Kansas City, found that prices from private sellers, women who claim to be healthy, can range from $0.50 to $2 an ounce. And there's no way to know for sure whether they are healthy.
There are real dangers. There are many ways to find breast sharing groups on the Internet, Kristina Chamberlain, CNM, IBCLC, a member of the adjunct faculty in the midwifery program at Bastyr University near Seattle pointed out, but for a health care professional to recommend them poses a number of ethical and liability concerns. In theory, she said, donor breast milk should be a better choice than formula because it comes from human mothers and carries a relatively low risk of disease transmission. But Chamberlain, who also runs the Eastside Breast-feeding Clinic in Kirkland, Washington, cautions that with informal milk sharing there's no way to know the milk is 100% safe. She recommends some precautions that can be taken by women who wish to share breast milk despite the warnings. “The donor should be tested and provide documentation that she is negative for HIV, human T-lymphotrophic virus, hepatitis B and C, and syphilis,” she said. “These are the same diseases that human milk banks screen for.”
There's also a risk of contamination if the expressed milk has been left at room temperature for too long. “Breast milk is a perfect environment for bacterial growth,” said Chamberlain. “At a human milk bank, the milk is pasteurized and a final bacterial screening is done before the milk is released. These safety steps aren't taken with informal milk sharing.”
Finally, Chamberlain notes that there's also a risk for donors in these informal situations—the question of legal liability if the infant receiving her milk becomes ill.
FDA AND LA LECHE OPINIONS
It's uncertain just how common milk sharing has become, but it has attracted enough attention for the U.S. Food and Drug Administration (FDA) to come out with a position statement explicitly recommending against feeding a baby breast milk that has been acquired directly from individuals or through the Internet. The FDA also says that if a woman still decides to feed her baby breast milk from a nonbank source, she should only (and after consultation with a health care provider) “use milk from a source that has screened its milk donors and taken other precautions to ensure the safety of its milk.” (To read more from the FDA, go to http://1.usa.gov/eniWFU.)
La Leche League International also takes a lukewarm view of milk sharing, despite its advocacy in favor of breastfeeding. In March 2010 the organization published a policy regarding human milk donation (see http://bit.ly/Jef4Ps), emphasizing that a woman interested in donated milk should speak with “an appropriate, licensed health care provider and contact a licensed human milk bank or other regulated and medically supervised human milk collection center in her country.” If she's interested in a more informal type of milk sharing, the role of her La Leche leader (consultant) is “to provide information about the benefits and risks … including the limitations of home sterilization of expressed breast milk,” so that she can make an informed decision.—Roxanne Nelson
© 2012 Lippincott Williams & Wilkins, Inc.