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Monday, November 28, 2011

Responsible Milk Sharing

Sometime ago, I shared a program of UP-PGH Milk Bank - Operation Foster Milk and a human milk sharing page on Facebook known as Human Milk for Human Babies - The Philippines.  Advocates have been divided and have mixed reactions to this informal milk sharing.

Donor moms are receptive to the idea of having donee-moms get the milk directly from them while moms who are looking for breastmilk usually find it difficult to get pasteurized milk from human milk banks and find the informal milk sharing network more accessible.

I was a donor to both milk banks and individual moms at the height of my milk-making career.  I donated to PCMC (a representative from the bank picked it up) and UP-PGH (I had to drop off the milk) and to individual moms who pick-up the milk from my place.  Honestly, I preferred to donate milk to individual moms as they do so at my own convenience e.g. they bring their own coolers and pick-up from my place.  Whereas donating to UP-PGH was so cumbersome since I had to pack up the milk in the cooler, look for parking, pay for parking and bring the milk up - with their elevators usually jampacked.  Although now,  PGH has volunteers to pick-up the milk upon schedule. Plus, the thank you that you receive from individual moms is much more satisfying.

That said, I am still writing this post because I want both donor moms and donee moms to be AWARE and INFORMED of the risks of informal milk sharing.   In early 2000, La Leche League printed some guidelines on how to become a donor to a human milk bank and identified several risks involved in informal milk sharing:
The screening process for becoming a donor is a two-stage procedure. First the donor answers a detailed health history questionnaire. An additional form goes to her primary care provider to verify the accuracy of her health self-assessment. Potential donors may be excluded for the following reasons:
  • receipt of a blood transfusion or blood products within the last 12 months.
  • receipt of an organ or tissue transplant within the last 12 months.
  • regular use of more than two ounces of hard liquor or its equivalent in a 24-hour period.
  • regular use of over-the-counter medications or systemic prescriptions (insulin or thyroid replacement hormones and progestin-only birth control products are acceptable).
  • use of megadose vitamins and/or pharmacologically active herbal preparations,
  • total vegetarians (vegans) who do not supplement their diet with B-12 vitamins.
  • use of illegal drugs.
  • use of tobacco products.
  • a history of hepatitis, systemic disorder of any kind, or chronic infections (eg., HIV, HTLV, tuberculosis).
  • had a sexual partner in the last 12 months who is at risk for HIV, HTLV, or hepatitis (including anyone with hemophilia, or who has ever used a needle for prescription or non-prescription drugs, or who has taken money or drugs or for sexual favors).
Once the prospective donor has completed the health history, she then enters stage two of the donor process and is tested serologically (through blood tests) for HIV-1 and HIV-2, HTLV, Hepatitis B, Hepatitis C, and syphilis. New tests may be added to this screening panel as new viruses emerge which could create potential problems for recipients. Milk banks will cover the cost of the serological screening. Repeat donors are treated as new donors with each pregnancy and must undergo screening again.

The informal milk sharing network boomed in mid-2010 and was further aided by easy access through Facebook pages.  Thus, in March 2011, the La Leche League released its position on informal milk sharing. Salient points below:
When a mother contacts a Leader seeking donated human milk, the Leader shall respond with information and support. This shall include information about induced lactation and/or relactation. The Leader shall also suggest the mother dialogue 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. The Leader shall inform any mother interested in using donated human milk for her baby, whether on an occasional or on a long term basis, of the documented benefits and risks connected with this form of infant feeding. x x x 
If a mother is interested in donating her milk, a Leader shall provide contact information for licensed human milk banks or other regulated and medically supervised collection centers. A Leader shall never pressure a mother to donate or to continue donating her milk. All identifying information concerning the donors and recipients shall remain confidential. A Leader shall remind a potential donor mother that her own baby has a natural priority to her milk. x x x 
A Leader shall never initiate the suggestion of an informal milk-donation arrangement or act as an intermediary in such a situation. If a mother wishes to discuss these options - which may include donating expressed milk, wet-nursing or cross-nursing - the Leader's role is to provide information about the benefits and risks, as mentioned above, including the limitations of home sterilization of expressed breastmilk. 
If you prefer to read a scientific journal on the risks of informal milk sharing, you can check this link.   Meanwhile, LATCH has taken a stand on how to respond to requests of milk donors/recipients.  Please see the slideshow below:
Handling requests for bm donations

LATCH is not against milk sharing. However, there are indeed risks which cannot be ignored.  Plus, we have noticed that there are moms who seek donor's milk simply because they simply cannot be bothered to express and save milk for when they need to go on a planned trip.  Granted, there are emergencies that lead moms to request for donor's milk but it must be emphasized that requests for donor's milk should only be made one time and is really not a sustainable practice.  Moms need to learn that they are responsible for their own babies' consumption and not to rely on other moms' milk.

Further, moms with premature or sick babies seeking donor's milk need to be AWARE of the higher risks that their babies are facing and must exercise extra caution.  These babies have compromised immune systems and are highly susceptible to viruses - just common viruses can be fatal in these cases. A colleague told me of a story about mom who asked breastmilk from her sister.  They later found out that the sister had Hepatitis B.  Luckily, the baby did not get the virus.  But this story just shows how little we know our own bodies.

In my case during my first pregnancy, I had myself tested for Hepatitis B, HIV, Herpes 1 and Herpes 2 and Syphilis.  For this pregnancy I did all those tests again except syphilis. However, these are not standard tests being required from pregnant Filipino moms.  Plus, these tests for sexually transmitted diseases are highly changeable especially when moms become intimate with their partners again.  Let's face reality - the breastfeeding mom may be monogamous but how about her partner?

In the US, milk banks screen donor moms at their own cost to check for viruses and determine suitability for milk donation.  However, we in the Philippines, do not have this luxury.  Plus these tests are not cheap (you would spend about P5K for all these tests).

Let me emphasize that BREASTMILK (even if donated, unscreened) IS STILL 1000% BETTER THAN FORMULA!  As stated in this post, "When mothers use human milk, they avoid the risks associated with infant formula.  However, they potentially expose their child to a whole different set of risks. " You can read more resources about using donor's milk from Kellymom.  In deciding whether to use donor's breastmilk, this post from the Massachusetts Breastfeeding Coalition is very informative:
There are several considerations to sharing breastmilk, however. The most important risks are HIV and the possibility of transmitting maternal medications in milk that can be unsafe for the baby. HIV can be transmitted in mother's milk, and thus it is recommended that women with known HIV infection in the US should not breastfeed nor share breastmilk. One may not know if source milk may have HIV, and milk at milk banks is routinely pasteurized. HIV is inactivated by heating. There has been research in Africa into using a home pasteurization method known as Pretoria pastuerization, which has been shown to effectively inactivate HIV in breastmilk in one study by Jeffrey et al. Home pastuerization of milk is not routinely done in the US.
There is a theoretical risk of Hepatitis B transmission, but this would occur only if the milk were contaminated by an infected mothers blood (if, for example, she had an abrasion on her nipple). The risk of tuberculosis through shared breastmilk is negligible, unless the mother has a localized tuberculosis infection in the breast itself, which is exceedingly rare. The risk of TB to a nursing infant occurs when an infected mother breathes or coughs infected particles onto an infant, not through her milk.
It is also important to realize that formula may also be subject to contaminants, environmental toxins, and bacterial contamination. Powdered infant formula is not sterile and has been recalled for bacterial contamination on multiple occasions. The cows whose milk provide the basis for making formula are subject to the same environmental toxins as the people who live near them.
There are ways to mitigate the risks of using donor's milk for your child.  You can identify a potential donor and ask that the donor mom for a complete health background or to have herself tested and pay for her tests. You can also have the donated milk pasteurized at one of the milk banks. I know that UP-PGH allows this if they have milk pasteurization run coming up OR if you have been unable to get a complete donor history, then opt to do home pasteurization on the donated milk. 

Here is a video and a slide show presentation on flash heating:
If you are wondering how to cool down milk that has been heated and want to know if you can reuse cooled milk, this resource is most helpful.  For premature babies, special handling is necessary and I suggest you read more about it

As a final word - I am not against milk sharing.  But I would like moms to be AWARE and INFORMED of the risks involved.  Plus, I'd like to ask moms to be responsible!  Please do not email or text me and ask if I can refer you to a milk donor because you are going on a trip next week.  You should've planned for your trip and planned to express enough milk for your baby.  I believe that this is part and parcel of responsible motherhood.

1 comment:

AnneM said...

I didn't even know that we had a milk bank here... It's great though that you shared this article so moms who look for breast milk are aware of the risks involved, so they can make well informed decisions. I hope the screening process is strict and accurate for everyone's sake. 

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