Mum-to-mum breast-milk sharing on the rise despite risks, new study

Photo: Getty Images
Photo: Getty Images Photo: Getty Images/iStockphoto

More and more mothers are turning to other mums for breast milk when they can't produce enough for their babies, but many remain unaware of the safety risks. That's the key finding of a new preliminary study, which highlighted that almost 80 per cent of mums didn't screen milk donors, "because they trusted them".

"Informal milk sharing is becoming increasingly popular and widespread," said researcher Nikita Sood. "It is therefore crucial that physicians become aware of this practice and the associated risks so that they can educate patients and address this growing concern."

As part of the research, which was presented at the American Academy of Pediatrics 2019 National Conference and Exhibition in New Orleans, 650 mothers were surveyed about their use of donor milk from breast milk banks and more informal mother-to-mother sharing. Over 50 per cent of the anonymous respondents said they didn't have any safety concerns about informally donated breast milk, despite the practice being discouraged by the American Academy of Pediatrics (AAP). The AAP note that these sources of human milk "carry the risk of bacterial or viral contamination, or exposure to medications, drugs, herbs or other substances."

Over half of the survey respondents who did not use a milk bank, raised concerns abut the cost,  26 per cent said they were concerned that pasteurisation would affect the milk's quality and 13 per cent were worried about not being able to get the right quantity. Survey participants listed drug and alcohol transmission, potential disease transmission and bacterial contamination as their main concerns around using milk sourced informally.

"Most respondents who reported obtaining donor breast milk did so informally and the majority indicated they did not have concerns or take measures to reduce risks associated with informal milk sharing," Ms Sood writes, adding that it is clear that mother-to-mother sharers "underestimate" the risks.

In Australia six milk banks provide human donor milk to hospital neonatal intensive care units (NICUs). Only the Mother's Milk Charity provides screened milk to mums in the community.

When it comes to informal milk-sharing the Australian Breastfeeding Association (ABA) notes:

"The Association believes that a mother's own milk is the ideal food for her baby and child, and with the right information and support, most mothers can produce enough breast milk for their babies. In cases where mothers do not have enough breast milk to nourish their babies, or where breastfeeding is not possible, the Association believes that human milk from another woman is the next best alternative, and supports women to make informed choices about the available alternatives, including donor milk.

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"The Association also recognises that some mothers will choose to source human milk from private donors (informal milk sharing arrangements). There are risks involved in using privately-sourced donor milk. The Association strongly encourages mothers to ensure that they are well informed of the potential risks and benefits of donated human milk, methods available for minimising risks, and to make decisions based on their own individual circumstances."

On their site, the ABA links to two resources "as a service to the community and to assist parents to make an informed decision," adding that the Association "does not necessarily endorse the information available from these resources and makes no representations as to their accuracy."

Human Milk 4 Human Babies (HM4HB) is one such network for milk-sharing, with Facebook pages around the world. Mothers can can both share and seek milk in private groups.

"We respect the right of families to make informed choices and we expect our members to take full responsibility for those choices," HM4HM state on Facebook. "It is up to the participants to get to know each other, to ask questions, and to continue talking and engaging directly with one another until a relationship of trust is established. 

When it comes to reducing risk, they recommend, "full disclosure". "Suggested points of discussion can include medications, diet, alcohol and drug use," they note. 

A spokesperson from Human Milk 4 Human Babies told Essential Baby: "We are strictly facilitating peer to peer milk sharing. We're not a bank, rather a means for communication for recipients to find donors. It is up to individuals to perform screening and make their own informed decisions.

Ultimately, they noted, "HM4HB means more babies have access to breast milk."

 
Professor Lisa Amir of La Trobe University tells Essential Baby that we know mothers are increasingly using milk sourced from other mums. "The internet has facilitated this since many new mothers belong to neighbourhood Facebook groups, and they are made aware of the online sites for milk sharing." In addition, she says, in Australia, milk banks almost always restrict their processed milk for the use of very pre-term infants at certain hospitals.
 
With the practice becoming more widespread,  just how risky is mum-to-mum sharing? Dr Amir says there are risks of blood-born viruses in the milk, for example HIV, but notes this is "very uncommon in Australia." "Families can ask if the donor has been screened for these as they would be before donating blood."
According to Dr Amir, risks from medications and illicit drugs or smoking are low - and families can seek more information. "It's very unlikely that women are willing to donate milk (i.e. go to the trouble of expressing and giving it away - not selling) are using illicit drugs/ or even smoking," she says.
Dr Amir explains that the main thing is to be aware of hygiene practices in expressing, storing and transporting milk.  "If the donor has expressed milk to give to her own child, but now doesn't need it, it is likely to collected appropriately," she says, adding that care needs to be taken in transport.
And banning it isn't the answer.
"The danger is that if health professionals try to ban the practice, then people will do it and just not tell them," she says. "So, it's better to discuss the pros and cons as you would for any other practice."