MILK DONATION AND SHARING
Whether you are someone who produces more milk than your baby needs, or you’re someone who is unable to produce as much as you’d like for your baby or cannot nurse your baby for other reasons, you may have considered milk donation or milk sharing. Either way, you should be aware of some potential risks. Research has shown that the “perceived risks and benefits of feeding milk from another mother may not align with actual risks and benefits”[i][ii]. However, milk sharing and donation are perceived differently in different cultures around the world; what one country and culture sees as potentially risky may be a long-standing and widely accepted tradition in another country and culture. Hence, we are not here to make any judgment about these practices. Instead, we simply hope to offer information that will allow you to make an informed decision that is right for you, your baby, your family, and your location.
As per our milk donation policy, La Leche League International cannot facilitate milk sharing. You may be wondering why. You can read our policy at the end of this post.
First, our focus is on helping parents to nurse their own babies to the fullest extent possible. This mission takes many resources, and we do not want to dilute our ability to help parents all over the world achieve their goals by trying to engage in other activities, even when they seem so closely related. If difficulties with milk production have brought you to these FAQ, we encourage you to read through our resources on building your own milk supply and talk with a Leader prior to seeking milk from others, because your own milk is uniquely designed for your baby at his or her current stage of development and meets your baby’s changing needs. In most cases, inadequate milk supply results from lack of information about supply management and lack of support. Whenever possible, we always want to provide information and support to help you improve your supply. However, we also know that not everyone is able to produce adequate milk for their babies and that there may be medical reasons for not breastfeeding. We hope you will find some answers to your questions about obtaining human milk for your baby from other sources here.
Second, there are excellent milk banks and many other resources available for parents who want to donate milk. As a result, these FAQ will simply share some basic information and questions parents may want to consider in order to make informed decisions about donating human milk. The first set of questions is written to assist those interested in donating milk.
Third, keep in mind that La Leche League International is not affiliated with any milk bank or any informal milk-sharing organization or network. La Leche League International does not endorse any of these organizations, and La Leche League cannot be held liable for any risks that may ensue from your choice to engage in milk sharing either as a donor or as a recipient. It is entirely up to you to determine whether the benefits outweigh the risks in your situation. We are simply offering information to help anyone interested in donating milk or in receiving milk make an informed decision, and this information should not be considered to be complete or final. We encourage you to seek more information from other credible sources in order to make a fully informed decision. In addition, La Leche League encourages anyone interested in obtaining human milk for their baby to discuss their options with their baby’s doctor or health care provider before proceeding. If you decide to participate either as a donor or as a recipient, you assume all liability for your decision.
Information and answers to questions for both donors and recipients follow.
Donor Information & Questions
Q: I LOST MY BABY, AND I WANT TO HONOR HER/HIS SHORT LIFE BY DONATING MILK TO HELP ANOTHER BABY SURVIVE. WHAT ARE MY OPTIONS?
A: Our hearts go out to you as you grieve your loss; losing your baby is one of the most devastating experiences a parent can have. While it can seem unfair that your body is making milk for a baby who is no longer there, it is the normal physiological process that occurs after a pregnancy. Each person and each situation is unique, and not every person can or may even wish to donate their milk after such a shattering loss. However, some people have found that donating milk can be a very special way to honor their baby as well as to help others, and many people have found that donating helps with their grief. It is truly a wonderful gift, and we laud your willingness to help other babies in this way.
A local hospital, a nearby milk bank, or an IBCLC may be able to help you find a way to donate your milk. Some hospitals have established perinatal bereavement programs that facilitate milk donation after the loss of a baby[iii]. For example, in California, the Mothers’ Milk Bank, which is part of the Human Milk Banking Association of North America (HMBANA), a network of not-for-profit milk banks with standardized practices and procedures, offers bereavement support while assisting people like you to gain some measure of comfort by sharing their milk with other babies[iv]. The Advocate Lutheran General Children’s Hospital in Illinois also supports grieving mothers in breast milk donation[v]. If you are not located in California or Illinois, ask your NICU staff or contact the nearest milk bank to enquire about this possibility. Some other countries, such as Australia, may also offer donation opportunities to bereaved families[vi]. Please see the question, “Where is the nearest milk bank?” for links to find any other milk banks that may be near you.
Q: I PRODUCE MORE THAN ENOUGH MILK FOR MY OWN BABY, AND I WANT TO DONATE MILK TO HELP ANOTHER BABY. I HAVE SOME QUESTIONS ABOUT DONATING.
A: This is a wonderful gift! There are many premature or otherwise fragile babies whose parents struggle with the challenges of producing or finding enough human milk, yet human milk is critical to preventing necrotizing enterocolitis[vii], [viii], [ix] in premies as well as in supporting their optimal development and health. There are also many sick babies who could benefit from receiving the gift of your milk, and there are families who are unable to provide adequate human milk for their babies for a variety of reasons. Here are some questions you may want to consider as you decide whether donating is right for you.
Q: WHAT ARE THE LIABILITIES?
A: If you choose to donate through a milk bank, have been through the screening process, and have been approved to donate, the milk bank is responsible for protecting your confidentiality and privacy and, in general, assumes the risks after approving you for donation. There are differences from one milk bank to another in actual practice. While milk banks that participate in HMBANA are guided by an overarching set of principles and approved practices, actual practices may still vary across jurisdictions[x]. In addition, each individual donor is always responsible for withdrawing either temporarily or permanently from donating if they become aware of anything that may adversely impact the safety and suitability of their milk at any time (e.g., their own or their baby’s illness). For more details, ask the milk bank near you.
If you choose to engage in informal milk-sharing, you may have some degree of risk depending on the agreement you reach with the recipient of your milk, on your own health and risk behaviors, on the care you take in collecting, storing, and transporting your milk, and on any applicable laws or regulations in your state or country. Most of the organizations engaged in facilitating milk sharing encourage donors and recipients to sign an agreement to protect both. If you are considering informal milk sharing, we encourage you to read the information offered by the well-known milk sharing networks carefully and do additional research in order to create a strong agreement for your own protection.
In either case, careful preparation for collecting, storing, and transporting milk is key to reducing your liability when engaging in informal milk sharing, and it is required by milk banks. Milk banks will offer you specific guidelines and protocols for collection and storage. Some of the informal milk-sharing organizations provide information as well. We encourage you to research current guidelines for each step in the process to ensure your milk is safe for another family’s baby if you are considering donating through informal channels.
Also, we encourage you to keep in mind that your baby’s needs should always come first and that your baby’s needs will change depending on her or his growth and other factors. Expressing or pumping your milk to offer another baby should never lead to your own baby not getting enough.
Q: HOW DO I DO IT?
A: Anyone who chooses to engage in informal milk sharing is urged to learn about the most current collection, hygiene, handling, labeling, storage, and transportation procedures in order to ensure that your precious milk is safe for another person’s baby. Milk banks and the most well-known milk sharing organizations offer information about these procedures. By following up-to-date procedures for hygienic and safe collection, storage, and transportation, you not only ensure the safety of your milk for the baby you want to help, but you also help protect yourself from any possible adverse outcomes.
Q: WHAT ARE THE DIFFERENT OPTIONS FOR DONATING?
A: How you choose to donate will depend partly on you and partly on your location. Many people choose to donate to a milk bank such as those that participate in HMBANA. Donating through a milk bank will ensure that your milk goes to help babies who are truly in need, for example, premature babies or seriously ill babies who are in a NICU. Because these are not-for-profit milk banks, recipients are not charged for your gift; the only fees, covered by most people’s insurance, are processing fees.
If you find that you are not located near enough to a milk bank or if donating to a milk bank is not for you, another option may be informal milk sharing. There are several well-known milk-sharing networks on the Internet that have some established protocols to help donors connect with those who are in need of milk, such as EatsforFeets, Human Milk 4 Human Babies (HM4HB), and MilkShare. We do not recommend any particular group; instead, we encourage you to research what is available in your location as well as what may suit your circumstances best.
Q: WHAT ARE THE REQUIREMENTS FOR DONATING, AND HOW DO THEY DIFFER BETWEEN A MILK BANK AND INFORMAL MILK SHARING?
A: For a milk bank, at minimum, milk donors must be in good health, taking no medications or herbal supplements, and nursing an infant less than 1 year old. More details about requirements are given below.
Those seeking milk through an informal milk-sharing network may request information similar to that requested by a milk bank. However, donors may not wish to enter into milk-sharing agreements if recipients ask for so much information. On the other hand, if someone has been donating to a milk bank and decides to engage in informal milk sharing instead, they will already have been screened thoroughly and can offer that information to a recipient as evidence of the safety of their milk. Hence, the amount of information you share in an informal milk-sharing arrangement is up to you, though of course recipients will want to be assured that your milk is safe for their baby.
The following information for milk bank requirements was obtained from the HMBANA website in February 2018. Please check there for the most current information pertaining to donating milk to a milk bank.
Requirements for donations to milk banks include, but may not be limited to:
Donors must be in good health
Donors’ own infants must be less than one year old (unless they have experienced a loss, in which case the requirement may be within one year postpartum)
Donors will be screened (via blood tests) at the milk bank’s expense for:
Human Immunodeficiency Virus (HIV-1, HIV-2)
Human T-lymphotropic Virus (HTLV-I, HTLV-II)
Hepatitis Viruses B and C (HBV, HCV)
Donors must be willing to donate at least 100 ounces of milk; some banks may have a higher minimum requirement
Those interested in donating to a milk bank may be excluded if they:
Regularly take any medications or herbal supplements other than prenatal vitamins, human insulin, thyroid replacement hormones, nasal sprays, asthma inhalers, topical treatments, eye drops, progestin-only or low-dose estrogen birth control products, or other exceptions as listed at the milk bank to which you apply
Use illegal drugs
Smoke or use other tobacco products
Have received a blood transfusion or blood products (except Rhogam) within the past 4 months
Have received organ or tissue transplants within the past 12 months
Regularly have more than 2 ounces of alcohol per day
Have a positive blood test for any of the above-named diseases
Have a sexual partner at risk for HIV
In addition to the above exclusions, US donors may be excluded if they:
Spent more than 3 months in the United Kingdom between 1980 to 1996
Spent more than 5 years in Europe between 1980 to the present
Q: WHAT ARE THE DIFFERENCES BETWEEN DONATING TO A MILK BANK AND INFORMAL MILK SHARING?
A: When you donate to a milk bank, you will be helping premature babies or very ill or fragile babies in a NICU. If you choose to donate through an informal milk-sharing network, you may select from babies in a wider variety of circumstances for your donations. For example, you may choose to help families with older babies who are not seriously ill but whose parents are unable to produce enough (or any) milk for their babies for a variety of reasons, or you may donate to babies with allergies that prevent them from being able to eat formula.
Some donors prefer to donate to a milk bank because they feel fulfilled knowing that their milk will go to help a premature or fragile baby in deep need of their life-giving fluid. However, donors will rarely know about a specific baby they may have helped through a milk bank. Some donors may choose to engage in informal milk sharing, because it can offer an opportunity for them to learn about a specific family and their baby. They find gratification in knowing about the specific baby they are supporting with their milk[xi]. In addition, families that are Muslim may prefer obtaining milk through an informal milk-sharing arrangement because they need to know the donor; in Islam, sharing milk establishes a relationship between the donor and the baby that would prevent the baby of the donor and the baby receiving the donated milk from marrying[xii].
Q: WHERE IS THE NEAREST MILK BANK?
A: As of February 2018, there are 26 HMBANA milk banks in North America[xiii]. There are also milk banks in Australia, Brazil, India, Italy, Norway, Sweden, South Africa, and the United Kingdom, as well as in some other countries—the list grows every year7. The International Milk Banking Initiative lists milk banks in countries all over the world. According to UNICEF, in 2013, Brazil had the most extensive milk banking network in the world[xiv], and researchers were exploring how mothers were being encouraged to donate milk[xv]. Researchers in Turkey are exploring the ethics, religious aspects, and options for milk banking there, and researchers in Russia are investigating attitudes toward milk donation in that country[xvi]
If you are searching for information about donating, HMBANA, the International Milk Bank organization, or your own NICU staff may have information to offer. Here are links to find milk banks around the world:
Q: WHERE CAN I SHARE MY MILK WITHOUT HAVING TO GO THROUGH EVERYTHING REQUIRED BY A MILK BANK?
A: Some people may feel comfortable engaging in informal milk sharing. Even there, though, for your own safety as well as for your recipient baby’s safety and well being, some degree of screening is probably wise. Some well-known informal milk-sharing organizations are EatsonFeets[xvii] and Human Milk 4 Human Babies[xviii], both of which have groups or chapters in various parts of the world, and MilkShare[xix]; there are many more. La Leche League is not affiliated with any of these organizations; we are simply offering information to help you get started if you think this is for you. We encourage you to research these or any other group you find, read through their guidelines and procedures carefully, and consider the risks they discuss in order to make informed decisions that will protect yourself and others.
Q: WHAT ABOUT WET-NURSING, CROSS-NURSING, CROSS-FEEDING, OR CO-NURSING? AND WHAT ARE THE DIFFERENCES?
A: Historically, wet-nursing has been the complete nursing of someone else’s infant. The wet-nurse was often in an unequal, nonreciprocal relationship with the baby’s family, and it was often a form of employment[xx], [xxi]. Wet-nursing is no longer commonly practiced in middle-income countries.
Cross-nursing, cross-feeding, or co-nursing occurs when friends, sisters, or others in a relationship of equality choose to share breastfeeding duties by nursing each other’s babies (this article does not discuss two parents in a same-sex relationship nursing the same baby, as that is a very different situation). This often informal activity is practiced by people in countries all over the world for a variety of reasons; for example, it may be used as a means of helping stimulate milk production, in a baby-sitting arrangement, or as an expression of friendship. In some Muslim societies, cross-feeding may be formalized and used to establish a sibling relationship known as “milk siblings;” by Islamic religious laws, milk siblings are forbidden to marry[xxii].
Some experts discourage the practice of cross-feeding/co-nursing, citing a variety of risks for both sets of parents and their infants who are involved in the relationship. Risks to consider include transmission of infectious disease from one parent to the baby and other parent, decrease in one parent’s milk supply due to inadequate suckling, milk composition differences when babies are not the same age or close to the same age, emotional reactions of either parent or baby (e.g., inability to let down for another’s baby or baby’s refusal to nurse from someone not his or her own parent), and possible negative reactions by other family members20. However, recent research shows that cross-nursing does occur in the U.S. as well as other parts of the world21, [xxiii], [xxiv], [xxv].
For those in other countries, such as countries where famine, war, or other events impact food supplies adversely, the World Health Organization (WHO) first recommends that in cases when a baby is severely malnourished, the parent of the baby should be supported in improving breastfeeding management or in relactating. If that is not possible, the WHO recommends wet-nursing by a healthy wet-nurse, followed by supplementation with human milk. WHO recommends formula only when an infant has “no realistic prospect of being breastfed”[xxvi].
La Leche League International cannot recommend wet-nursing, cross-feeding, cross-nursing, or co-nursing due to the potential risks involved. Unlike donor milk obtained from a milk bank, which is pasteurized and pooled to minimize risks, and unlike donor milk you might obtain from an informal milk-sharing arrangement, which can be flash-heated or home pasteurized to reduce risks of transferring infections from the donor to your baby, there are fewer ways of mitigating the risks when feeding someone else’s baby or allowing someone else to feed your baby directly from their own body. We encourage anyone interested in cross-nursing or wet-nursing to thoroughly investigate the potential risks and consider them carefully in relation to the benefits they perceive in order to make an informed decision.
Q: WHAT ARE SOME THINGS I CAN DO AS A DONOR TO MAKE MY MILK AS SAFE AS POSSIBLE FOR DONATION?
A: The act of expressing or pumping milk and transferring it into storage containers always entails a risk of contamination[xxvii]. The most important thing any donor can do is to practice hygienic collection (washing both your hands and your pumping equipment), use appropriate short- and long-term storage measures, and use safe transportation procedures[xxviii]. The Academy of Breastfeeding Medicine (ABM) has recently revised their protocol for safe expression and storage[xxix]. Milk banks will provide information and training to all approved donors. Informal milk-sharing groups often offer practical guidance on collection, storage, and transportation as well. Rather than rely on any one individual organization to stay up to date on current practices, research the Academy of Breastfeeding Medicine protocol, which is updated every five years or earlier if significant new information comes out, to find the most current, evidence-based information to assure that you are protecting your milk and the recipient infant to the fullest extent possible.
In general, while human milk contains antibacterial properties that help prevent bacterial colonization after pumping even when left at room temperature for a few hours, it is known that the cleanliness of the milk expression technique may reduce the safe time period. Hence, milk should be refrigerated as quickly as possible after pumping, then frozen at or below -20 degrees C (-4 degrees F) in appropriate containers until time for shipping or transporting to the recipient.
In addition, the shorter the time after pumping and freezing your milk that a baby is able to use it, the better the quality. Research has shown that fats, other macronutrients, and energy concentrations decrease over time when frozen at or below -20 degrees C (-4 degrees F); significant decreases occur by 3 months[xxx].
Current LLLI information on collecting and storing human milk can be found in our Pumping and Milk Storage posts.
At minimum, shipping human milk requires an insulated container in which to pack the milk along with ice, dry ice, or frozen gel packs to keep it frozen. There should be no extra space in the container, as a fully packed container will stay frozen longer than one will empty space. Donors are encouraged to use the fastest shipping method possible in your state or country to ensure milk arrives frozen.
Keep in mind that ice and frozen gel packs will not last as long as dry ice, particularly when the shipping distance is long or outside temperatures are high. For long shipping distances or in the summer, dry ice may be the only reliable means of ensuring that your milk stays frozen all the way to your recipient. In addition, it is important to enclose adequate quantities of ice, frozen gel packs, or dry ice to maintain the appropriate temperatures until the milk arrives at its destination. Please ensure you seek the most current information possible on safe transportation of frozen human milk.
Q: ARE THERE LAWS REGULATING MILK DONATIONS OR MILK SHARING?
A: In the US, there are currently (as of February 2018) no federal laws regulating the use of donor human milk or milk sharing. Milk banks that are part of the HMBANA network are governed by the protocols and regulations HMBANA has developed to ensure the safety of the milk offered to babies in NICUs; other milk banks in other countries have also developed stringent protocols for milk banking and use. Though some health care professionals have called for the FDA to establish regulations for milk sharing in the U.S.[xxxi], the FDA has chosen not to do so[xxxii]. In addition, though a few states in the U.S. have enacted laws regulating milk banks, few laws regulate informal milk sharing.
Currently, the Food and Drug Administration (FDA) simply counsels parents not to feed their babies human milk acquired directly from individuals or through the Internet. The FDA offers some cautions about potential risks:
Donors may not have been adequately screened for infectious diseases or other risks of contamination
Donors may not be fully informed of or practice safe, hygienic milk collection, storage, or transportation procedures
Hence, the FDA encourages parents to use human milk obtained from a source where careful screening and training of donors have been conducted, such as a HMBANA Milk Bank, which has established standards to which all participating milk banks must adhere. Families that decide to participate in informal milk sharing are encouraged to consider the potential risks carefully and to research the laws in their state or country.
Outside of the U.S., some countries have established some regulations or guidelines. Canada and France strongly discourage the practice[xxxiii], and some researchers note that as increasing commodification (sales of breastmilk) occurs, national and international governments will be required to enact regulations to protect breastfeeding[xxxiv]. Parents living outside of the US are encouraged to search their own government’s websites or regulations to determine what laws may apply in their situation.
Q: WHICH BABIES QUALIFY FOR MILK FROM MILK BANKS?
A: Milk banks prioritize babies by medical need. Milk goes first to very premature, fragile, or ill infants in NICU settings. If milk is available after babies with the most critical needs have been supplied with donor milk, it may be released to healthy babies. Milk banks may continue to supply milk for premature infants or infants who were hospitalized for illness after they are released to a home setting. Decisions about recipients are generally made by the milk bank director in discussion with a baby’s health care provider[xxxv].
Q: HOW MUCH MILK DO I NEED TO PUMP IF I WANT TO ENGAGE IN INFORMAL MILK SHARING?
A: Most people who choose to engage in informal milk sharing will be providing milk for a full-term baby or one who is older. Older babies may need 250 mL or more milk for each feeding. Most babies need about 25 ounces of milk per day on average between the ages of one and six months[xxxvi].
Q: I MAKE PLENTY OF MILK—MORE THAN ENOUGH FOR MY BABY—AND I’D LIKE TO EARN SOME EXTRA MONEY. IS THERE A WAY FOR ME TO SELL MY EXTRA MILK?
A: Some people do choose to sell their milk. This can be done either through Prolacta, a for-profit milk bank[xxxvii], or through other, less formal groups, such as Only the Breast. As for anyone interested in providing human milk to others, please do ensure that you meet your own baby’s needs first. Your baby’s needs may change from day to day as he or she grows and, hence, may impact the amount of milk you have available to sell.
Some women also receive pay for wet-nursing another person’s baby. While rare in the U.S. and other middle income countries, it is fairly common in some countries and is recommended by the WHO as a good alternative when the mother of a severely malnourished baby is unable to nurse. Due to the risks, La Leche League cannot recommend wet-nursing; please see the question, “What about wet-nursing, cross-nursing, cross-feeding, or co-nursing? And what are the differences?” for more information about the risks. Again, we encourage anyone who may be considering this practice to research information thoroughly in order to protect themselves and their own baby as well as other babies and parents.
Recipient Information & Questions
Q: WHEN THE MILK IS PASTEURIZED AT THE MILK BANK, HOW DOES THAT AFFECT QUALITY?
A: Pasteurization is used to eliminate or deactivate unwanted or dangerous (pathogenic) bacteria and viruses that may be present in donor milk. Any method used in this endeavor will impact the quality of the donated milk to some degree. Research efforts continue in efforts to find treatment methods that will do the necessary job with as little adverse impact as possible. International guidelines for milk banks currently recommend using a method of pasteurization known as Holder pasteurization, which involves heating the milk at 62.5 degrees C for 30 minutes. Holder pasteurization serves to eliminate pathogens while retaining the quality of the milk. Research suggests that modern pasteurizers likely do a better job of reducing degradation compared to older ones, and a review of the research indicates that many of the important qualities of the milk, particularly those necessary for central nervous system development, remain after Holder pasteurization[xxxviii]. Overall, the Holder pasteurization method is considered to be “extremely effective” in eliminating dangerous pathogens while impacting quality as little as possible.
Q: WHAT ARE THE RISKS OF USING DONOR MILK FROM A MILK BANK?
A: Milk banks have developed strict protocols to minimize the risks of using donor milk, to ensure both donor and recipient safety, and to protect the quality of the milk provided to the infants they serve. The risk of highest concern is interfering with a lactating parent’s own milk supply by unnecessary supplementation; hence, it is important for each parent to be supported in breastfeeding their own baby with information to help them maximize their milk supply. La Leche League Leaders are available to help parents with breastfeeding management information to increase their milk supply to the fullest extent possible; please see “Get Help” on our website to find a Leader near you.
I don’t produce enough milk for my baby, but I can’t get human milk from a milk bank because my baby isn’t in the NICU, the milk bank says she/he is no longer in the right priority level, and/or the doctor will no longer write a prescription. I don’t want to use formula. What can I do?
Following are a series of questions to help you make an informed decision about feeding your baby.
Q: WHAT SHOULD I CONSIDER BEFORE USING MILK SOURCED THROUGH AN INFORMAL MILK SHARING GROUP?
A: All human milk contains good bacteria as well as bad bacteria. Good bacteria help inoculate the baby’s gut, prepare it for future digestive work, and help inhibit the growth of unwanted bacteria. However, human milk may also contain undesirable or bad bacteria and viruses, [xxxix], [xl], [xli], [xlii]
As the safety of human milk obtained from another person can be affected by many factors [xliii], [xliv], there are important considerations related to this method of feeding or supplementing your baby. Some of the specific diseases that can be transmitted via human milk include cytomegalovirus (CMV), human immunodeficiency virus (HIV) [xlv], and papillomavirus. In research conducted on human milk obtained via the Internet other bacteria were also found; the most common were Gram-negative and coliform bacteria, Staphylococcus sp., and Escherichia coli (E. coli)[xlvi].
While CMV is not of particular concern for a full-term, healthy infant, premies and fragile or ill infants are susceptible to CMV infections. In addition, even full-term, healthy babies may be susceptible to staph infections and HIV, so parents considering using milk obtained via the Internet are encouraged to consider the risks carefully.
Another issue to consider is how long the milk has been stored and at what temperature. Freezing at or below -20 degrees C (-4 degrees F) in the back of a home deep freezer is recommended for best storage. In addition, the shorter the time after pumping and freezing that your baby receives it and is able to use it, the better the quality. Research has shown that fats, other macronutrients, and energy concentrations decrease over time when frozen at or below -20 degrees C (-4 degrees F); significant decreases occur by 3 months.
Some experts express concern about donor honesty[xlvii]. For example, some research found that milk obtained via informal milk-sharing may have been watered down or mixed with other fluids to increase the volume. Some research found some samples obtained via the Internet were contaminated with cow’s milk[xlviii], so if cow’s milk allergy is a concern, you will want to add that to your list of questions to ask a potential donor.
Some questions to ask the person from whom you are thinking of obtaining milk:
Is the other mother healthy?
What evidence has she shared to indicate she is healthy?
Is the other mother’s milk safe? (Does she smoke tobacco or ingest other unsafe substances? Does she take illegal drugs? Is she on any prescription drugs? Does she drink, and if so, how much?)
How much will it cost to buy the milk? Does this cover shipping?
If shipping costs are separate from the cost for the milk, how much will they be?
How will the milk be shipped to ensure it will arrive still frozen? (Donors should use dry ice or ice gel packs at minimum)
Some questions to ask yourself:
Will the milk benefit my child?
Will the milk harm my child?
How old is the milk (how long has it been frozen)?
Will I use a heat treatment to reduce any bacterial or viral contamination? If so, what method, and how do I do it?
What will my family members think?
What will my doctor or health care provider think?
How will I answer their questions?
Q: HOW CAN I REDUCE THE RISKS FOR USING MILK OBTAINED FROM INDIVIDUALS?
A: First, La Leche League encourages every family considering using milk obtained through an informal arrangement to talk with their health care provider.
After that, the most important step you can take to reduce the risks associated with informal milk sharing is to request health and lifestyle information like that milk banks request from any potential donors; see “What are the requirements for donating, and how do they differ between a milk bank and informal milk sharing?” in the Donor Information section for specific details on questions you may want to ask. Some donors have already been tested and approved to donate to a milk bank, or they will have themselves tested; in such cases, the donor can provide documentation demonstrating that they do not carry any communicable diseases of concern. This will give you a means of making an informed choice regarding the risks and benefits of using their milk.
You will need to learn how to defrost the milk safely. Microwaving is not recommended because the milk heats unevenly, and immunologic properties are significantly impaired, nor should it be left out at room temperature to thaw[xlix], as bacterial colonization can occur at room temperature. According to the Academy of Breastfeeding Medicine, the best thawing methods are:
Set the container in the refrigerator overnight (best for maintaining fats)
Set the container in a bowl of warm water
Run the container under warm water
Use a waterless warmer (not the microwave)
Also, if the milk is raw human milk (i.e., it has never been heat-treated), you may wish to use flash heating to help reduce bacterial and viral contamination and any associated risks. You might also consider using home pasteurization techniques; holder pasteurization is commonly recommended if you feel more comfortable using a full pasteurization process. While flash heating will cause less damage to nutrient components, it also does not do as complete a job on eliminating bacterial and viral contamination. HMBANA and milk banks around the world require holder pasteurization because it is most effective in eliminating viral pathogens (including HIV-1, Ebola, and Marburg virus[l]) and preventing their transmission to a baby fed the milk so treated[li].
Freezing human milk at -20 degrees C (-4 degrees F) for 20 days has been shown to reduce the viral load for cytomegalovirus (CMV) to undetectable levels. It is important to use the milk in less than three months, though, as the nutritional and immunologic properties degrade over time in the freezer.
Q: HOW DO I DO FLASH HEATING?
A: Flash-heaing is done by placing the 120 mL/4 ounces of milk in an uncovered glass food jar, then placing the jar in about 450 mL/2 cups of water in a 1.5- to 2-quart pot. Place the pot on a burner or over a heat source and bring the water reaches a rolling boil[lii]. Remove the jar of milk from the water carefully, using jar tongs or something to protect your hand from the heat.
Q: HOW CAN I DO THE HOLDER PASTEURIZATION TECHNIQUE AT HOME?
A: Holder pasteurization is accomplished by heating milk at 62 to 62.5 degrees C (145 degrees F) for 30 minutes. While this assures the inactivation of HIV-1, it also reduces immune functions of the milk significantly (IgM, lactoferrin, and iron-binding capacity suffer significant losses, and IgA levels are reduced by 20%[liii]). However, it is still considered the best compromise between inactivation or destruction of pathogens and preservation of immunological and nutritional components of human milk while still being feasible[liv]. You can use a home canning system or purchase a home pasteurization system specifically made for this purpose. Holder pasteurization is more challenging to conduct, as it is critical to maintain the temperature throughout the heating period; if the temperature drops below 62.5 degrees C/145 degrees F, you will have to raise the temperature accordingly and begin timing again.[lv]
Fill glass milk bottles or canning jars no more than 4/5 full of milk
Place canning jars in a rack inside a home canning tub on top of your stove
Carefully pour warm water into the canner (without splashing water into the milk) until the water level is slightly above the level of the milk in the jars
Place an accurate thermometer with a metal probe into one of the jars of milk
Begin heating the canner while a) stirring the milk in each jar to achieve uniform heating and b) watching the temperature
When the milk temperature approaches 62.5 degree C/145 degrees F, cover all milk jars (except for the one with the thermometer) with lids.
Put aluminum foil over the jar with the thermometer. Punch a hole in the aluminum foil to put the thermometer probe through so you can continue to monitor the temperature
Continue heating until the necessary temperature is reached and start a timer
When the correct temperature is reached, adjust the heat to maintain that temperature
Maintain the temperature at the necessary temperature for 30 minutes. If the temperature drops below 62.5 degrees C/145 degrees F, you will have to reheat the milk and reset your timer for 30 minutes again
When the timer goes off, begin gradually replacing hot water with cool water in order to cool the milk without breaking a jar
Bring the temperature down to 26 degrees C/80 degrees F
Once the temperature is at or below 26 degrees C/80 degrees F, you can add ice to the water to speed the cooling process
Once the temperature is at or below 4 degrees C/40 degrees F, remove the temperature probe, cap the jars tightly, and store in the refrigerator until you are ready to use them
Q: HOW IMPORTANT IS IT TO GET MILK FROM SOMEONE WHOSE BABY IS THE SAME AGE AS MINE?
A: While the ideal would be to obtain milk from a donor whose baby is the same age as your baby, that may not be possible. The World Health Organization lists alternative infant foods in order of importance from your own milk, then to donor milk, with formula at the bottom of the list. If you have explored the options thoroughly and are committed to obtaining human milk for your baby, your first priority should be on ensuring the safety of the milk you obtain, then on seeking a donor whose baby is close to the same age. Research shows that significant increases in fat and energy contents of human milk occur when lactation continues past one year[lvi]; however, it is not known what effect this difference might have for feeding a younger infant. While you may want to seek milk from donors whose own infants are under one year of age, a few months’ difference in age is unlikely to be as important as your perceptions of the difference between human milk and formula.
MILK DONATION POLICY
The first priority of LLLI is to help mothers to breastfeed their babies at the breast. A second priority is to help mothers when it is necessary for them to express and safely store and handle their own milk for their babies. When their own mother’s milk is unavailable, babies may need human milk donated by other mothers. According to the World Health Organization, donor milk is the best option following one’s own expressed milk.
It is always important for the Leader to encourage the mother to talk with her own and the baby’s health care providers about their particular situation. If the baby or mother is hospitalized and breastfeeding is not possible, the Leader would recommend that the mother dialogue with medical staff regarding possible hospital policies related to obtaining and using the mother’s own milk or donor milk.
When a mother contacts a Leader seeking to acquire donated milk or to discuss personal options, the Leader’s role is to respond with information and support, including information about the benefits and risks of such practices as induced lactation, relactation, wet-nursing, or cross-nursing. This discussion may include formal, commercial, or informal (peer-to-peer) forms of milk sharing, which are practiced in various ways around the world.
If a mother is interested in donating her milk or in receiving donated milk, the Leader should urge the mother to investigate various ways of donating and acquiring human milk. The mother should be encouraged to make an informed decision that is best for her and her baby and meets cultural expectations. A Leader may provide contact information for non-profit human milk banks, other regulated collection centers, and formal/medically supervised or informal milk-sharing networks. Protocols for the careful and safe collection and handling of human milk are the responsibility of milk banks and networks, and the Leader should encourage the mother to evaluate these protocols. It is not the responsibility of LLL Leaders or LLLI to license, recommend, or assess milk banks or networks, but to share information with mothers.
A Leader should never use her position as an LLL Leader to set up any type of milk-sharing network.
As with other breastfeeding-related topics, Leaders are expected to keep up-to-date with current best practices and information for their locations.
(Aug 76; rev Oct 92, Mar 07, Mar 11, Mar 15)
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