More moms are going online to find and donate breast milk, but sharing milk with strangers carries risks, according to a new study that found a high prevalence of disease-causing bacteria in milk purchased online.
With the message that “breast is best” heard loud and clear, thousands of moms are taking to the Internet to seek donated breast milk from other moms who have more than their babies can drink, already pumped and stored in their freezers.
In 2011, more than 13,000 ads were placed on four top milk-sharing websites, according to Sarah Keim, Ph.D., a researcher at the Center for Biobehavioral Health at The Research Institute at Nationwide Children’s Hospital in Columbus, Ohio.
The messages are friendly and upbeat, with donor ads often touting the mother’s health. “Between 300-600 oz. available monthly…plenty to spare but no room to store it!” reads one ad posted on the site Only The Breast. “Large quantity of milk for sale. Pumped since July. NO drugs, alcohol, caffeine, only a BM safe blood pressure medication. Non smoker,” reads another.
But a new study published Monday by Keim and colleagues in the journal Pediatrics questions the safety of online milk sharing, arguing that milk shipped between moms often falls short of the appropriate safety standards and could be putting babies’ lives at risk.
For some moms, the websites have become an alternative for established not-for-profit milk banks, such as those run by the Human Milk Banking Association of North America (HMBANA), the umbrella organization that supplies 75% of its donations to neonatal intensive care units across the United States and Canada, and the remainder to outpatients.
While milk donated to the banks undergoes a rigorous donor-screening process and pasteurization, the milk costs money — around $ 3.50-$ 6 an ounce, depending on location — which insurance may not cover if a baby was not born prematurely or is not facing another health concern. If bank supplies are running low, it’s also possible the mom of a healthy baby might be turned away. Would-be donors are also turned away if they do not meet specified standards, including being on certain medications or drinking alcohol within a 12-hour window of pumping milk.
A doctor checks the quality of donated milk at a human milk bank. Moms who donate their breast milk to milk banks must undergo a screening process and are given instructions for safe milk collection, storing and shipping. Once the milk reaches the banks it is pasteurized before distribution.
The FDA and the American Academy of Pediatrics both recommend against milk sharing via the Internet on the basis that donors may not be adequately screened for diseases like HIV or for prescription drug use that could potentially harm babies. “In addition, it is not likely that the human milk has been collected, processed, tested or stored in a way that reduces possible safety risks to the baby,” the FDA adds.
Keim said her new study lends support to these concerns. Responding to ads on two milk-sharing websites used by U.S. moms, her research team anonymously purchased 101 samples of milk and compared them with 20 samples of milk obtained explicitly for the study from donations to the Human Milk Banking Association of North America. The milk bank samples had not yet undergone the pasteurization process.
After analyzing samples for microbial contamination, they found the Internet-procured samples had greater overall levels of disease-causing bacterial growth compared to the unpasteurized milk bank samples, including strikingly higher levels of gram-negative bacteria, coliforms, staphylococcus and streptococcus. Three percent of Internet samples tested positive for salmonella, while none of the milk bank samples did. Twenty-one percent of Internet samples tested positive for cytomegalovirus DNA, compared to 5% of milk bank samples.
Such bacteria can be responsible for health issues ranging from mild cases of diarrhea, “all the way up to life-threatening infections like meningitis and in some cases even death,” Keim said.
“It’s mostly a concern among babies born prematurely or with a preexisting illness,” she said, “but things like salmonella can be dangerous even for a healthy baby.”
Keim said the discrepancy between the Internet and milk bank samples is likely due to poor storing and shipping practices for the milk, some of which traveled 3-6 days to reach researchers. The study asked mothers in the online ads to choose their preferred shipping method. Twenty percent shipped their samples using freezer ice or gel packs to keep it frozen, while 62% percent used dry ice. “Some people, even though they used dry ice, didn’t insulate it,” Keim said. “If you put dry ice in a cardboard box it’s going to dissipate pretty quickly.”
Courtesy of Jodi Gerstenhaber
Jodi Gerstenhaber of West Haven, Conn., seen breastfeeding her twin girls Emerson and Ellis.
“Some (milk) arrived right above freezing, some was room temperature,” she added. “That’s a recipe for bacterial growth. We also don’t know how cold the milk was when it left the home.”
Informally shared milk is inherently risky because it lacks the formal screening process of milk donated through milk banks, said Kim Updegrove, president of the Human Milk Banking Association of North America and executive director of Mother’s Milk Bank in Austin, Texas. Moms who donate their excess milk through HMBANA must undergo blood work and disease screening, submit a doctor’s statement of their health and their baby’s health, and are given explicit instructions on how to express, store and ship their milk to the banks.
“Even then, when a person is screened or approved it’s not safe to dispense their milk; it’s only safe to bring in,” Updegrove told the Daily News.
“Informal sharers are probably no less compassionate than formal sharers, however they are uninformed about what the risk factors are when sharing a bodily fluid,” she said.
Proponents of peer-to-peer milk sharing disagree that it is always unsafe. Emma Kwasnica of Vancouver, founder of the online network Human Milk 4 Human Babies, took issue with the study’s methods, saying it doesn’t approximate the way most women form milk-sharing relationships.
Courtesy of Jodi Gerstenhaber
Gerstenhaber has donated her breast milk to another local mom she met through a mothers’ group.
The vast majority of posters on HM4HB, she said, use the site’s network of online forums to find mothers in their own vicinity, eliminating the need for long-distance shipping, with an emphasis on building long-term milk-sharing relationships.
“These moms are matching up very locally; they’re meeting face-to-face,” Kwasnica said of the women on her forums, which are active in more than 50 countries and utilize Facebook pages for sharing in the same geographic area. “They’re asking the tough questions. They ask (donors) to get new blood work done, saying ‘Can you get tested today?'”
On its main site, Human Milk 4 Human Babies provides information on safe milk collection as well as tips for safe social networking, but doesn’t actively match up donors and seekers, and declares members take “full responsibility” for their choices. They also actively discourage selling. “When you introduce money, the altruism of community breast milk sharing goes out the window,” Kwasnica said.
Such an altruistic relationship has meant the world to Maria Small of Orange, Conn., and Jodi Gerstenhaber of nearby West Haven. Small, 32, who couldn’t produce enough milk for her 4 ½ month old twin boys, balked at the cost of feeding two infants through an established milk bank.
She was connected with Gerstenhaber, 35, the mother of nearly year-old twin girls, because they shared a lactation consultant. Gerstenhaber had more than 100 ounces of breast milk stored in her freezer that would otherwise have gone to waste.
“I didn’t know anything about (donor milk), but I reached out to Jodi and she was totally onboard,” Small said. “She gave me milk the next day.”
Thanks to Gerstenhaber and six other Connecticut women, some of whom she met through the online milk-sharing network Eats On Feets, Small’s twins were fed exclusively breast milk until they were 3 1/25 months old. Small continues to take milk from Gerstenhaber and supplements with formula.
Small met all her donors face to face, though she said she would have considered having the milk shipped from donors further away. “If there was ever a time I didn’t feel comfortable (with a donor), I didn’t feel bad saying no,” she said.
“I know as a mom I wanted my girls to have breast milk more than anything else,” Gerstenhaber said. “I would happily donate to another mom, whether they were in the next town over or across the country.”