In a pair of studies, researchers delved into the issue of donor breast milk, and how parents are choosing to get it. In one, a survey of 655 parents who used donor milk found that only about 36% got it from official "milk banks" that screen and pasteurize donations.
Most said they'd turned to "informal" sharing, where parents get breast milk either from a nursing mom they know or via the internet. It's a practice discouraged by the American Academy of Pediatrics (AAP) and U.S. Food and Drug Administration due to safety concerns.
There is a risk of dilution, or contamination with viruses or bacteria, particularly with donor milk obtained online, explained Dr. Lori Feldman-Winter, who chairs the AAP's Section on Breastfeeding.
Certain viruses, such as HIV, can also be transmitted through breast milk.
"If you get breast milk from someone you know, it's probably a low-risk situation," said Feldman-Winter.
However, she added, that doesn't mean there's no risk.
Study author Dr. Ruth Milanaik, of Cohen Children's Medical Center/Northwell Health in New York, made the same point. Even when breast milk is given for free, with the best of intentions, she said there could be accidental contamination or temperature instability that causes the milk to spoil.
"The only recommended option for obtaining donor breast milk is through a milk bank," said Milanaik.
That is easier said than done, however.
Right now, there are 28 nonprofit milk banks across the United States that are part of the Human Milk Banking Association of North America. And most of that milk, Feldman-Winter explained, goes to hospitals for preemies whose mothers cannot yet express their own breast milk.
That means little left over for moms of full-term infants who cannot breastfeed, or for adoptive or male gay parents. And even when it is available, there is a steep cost - around $4 an ounce, Milanaik said.
With informal sharing, parents may get breast milk for free - either from a friend or by finding a local donor with the help of social networking. There are also websites that allow women to sell their breast milk - it's not a cheap option, but the prices are typically lower than those of a milk bank, Milanaik noted.
Breast milk is considered the best nutrition for infants. However, it's not clear whether, for most babies, donor breast milk is a healthier choice than formula.
There's proof of the benefits to preemies in the hospital, Feldman-Winter said. But when it comes to healthy, full-term infants, "the science just isn't there yet," she said.
So if breastfeeding or banked milk are not options, the AAP recommends formula-feeding.
The new findings will be presented by Milanaik and co-author and Cohen researcher Nikita Sood on Saturday at the AAP's annual meeting in New Orleans, and are based on two related studies. Such research is considered preliminary until published in a peer-reviewed journal.
In the first study, a survey found that of those who chose informal sharing, 56% said they had no safety concerns, and 78% did not ask for medical information from donors because they "trusted them." More than half said they opted for informal sharing over milk banks due to costs.
In the other study, the researchers looked at 122 parenting-blog posts on donor breast milk. Most, they found, focused on informal sharing rather than milk banks, and most "lacked important discussion of safety concerns."
It's not clear how many parents are choosing informal milk sharing. But the new findings suggest it may be more common than pediatricians realize, Feldman-Winter said.
"Certainly one of the take-home messages here is that doctors should talk about this," she said. "We're missing an opportunity, as pediatricians, to open up a dialogue and help clarify misperceptions."
As for nursing moms who have extra milk they want to donate, Milanaik urged them to give to a milk bank.
Sources: Ruth Milanaik, D.O., pediatrician, Cohen Children's Medical Center/Northwell Health, New Hyde Park, N.Y., and associate professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, N.Y.; Lori Feldman-Winter, M.D., M.P.H., chair, Section on Breastfeeding, American Academy of Pediatrics, and professor, pediatrics, Cooper Medical School of Rowan University, Camden, N.J.; Oct. 26, 2019, presentation, American Academy of Pediatrics annual meeting, New Orleans.
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