I'm a bad blogger. I'm supposed to be able to respond quickly to things in the news. But I've had to mull over this topic for a while before feeling ready to write about it. So, here goes.
Recently, an Arizona midwife and a Canadian breastfeeding advocate established Eats on Feets, a network of Facebook pages dedicated to mother-to-mother milk sharing. In the blink of an eye nearly 90 chapter pages were set up in 18 countries. The name Eats on Feets is a play on Meals on Wheels.
This is not the first time that the web has been used to facilitate milk sharing. MilkShare, a website which connects donors and recipients through a Yahoo Group, has been operating for some time. What's new about Eats on Feets is the scale and openness of the network.
Not surprisingly, Eats on Feets has gotten the attention of the press as well as at least one national health agency. Time Magazine's blog published a fairly supportive post. In contrast, the Canadian health agency Health Canada responded with a press release warning of risks of potential health risks and stating, "unprocessed human milk should not be shared."
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The one thing everyone can agree on is that mothers should be fully informed of the risks and benefits of milk sharing. Health Canada "advises Canadians to be aware of the potential health risks associated with consuming human breast milk obtained through the Internet or directly from individuals." La Leche League states that "the Leader’s role is to provide information about the risks and benefits so that the mother can make her own informed decision based on her situation." Much of the discussion on Lactnet has focused on whether we are showing disrespect for the wisdom of mothers when we assume that women can't make good decisions for themselves when presented with the necessary information. Eats on Feets states "We encourage milk-sharers to utilize the principles of Informed Choice when establishing milk-sharing relationships."
But what does it mean to be informed when it comes to milk sharing? Everyone probably has a different threshold. I can only say what I would want to know, which might be more or less that you would.
Eats on Feets has a page on "health issues" associated with milk sharing. It discusses some concerns, such as HIV (see my comment below), hepatitis, and sexually transmitted diseases. But I would want to know more. Here are a few additional things I'd want to know (and this is not by any means an exhaustive list):*
- We often assume that women who are nursing their own babies in this country don't test positive for viruses such as HIV. But a recent study which reviewed blood tests for donors to the Mothers' Milk Bank of San Jose (CA) from a six year period found "3.3% were positive on screening serology, including 6 syphilis, 17 hepatitis B, 3 hepatitis C, 6 HTLV and 4 HIV." My understanding is that this rate (3.3%) is similar to the rate found in blood and organ donation. I'd want to know about this.
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- Preterm and immune compromised babies can respond very differently to viruses and bacteria in milk than healthy full term infants. If I had a preterm or immune compromised infant, I would definitely want to know this. At a milk banking conference I attended last year, Lois Arnold told the story of a mother who fed one of her premature twins milk pumped by her sister. The sister's milk exposed the twin to cytomegalovirus (CMV) through her breastmilk. CMV is commonly present in breastmilk, and while it is generally not a problem for full term infants, it can be devastating to preterm infants. While the sister's full term baby was unaffected by CMV, it caused the death of the premature twin.
- Eats on Feets is an international network, and I would want to be aware that the calculus of milk sharing in the developing and developed world involves different risks and benefits. International recommendations also need to be viewed in the context of these differences.
- I would want more information about the risk of HIV transmission than the CDC statement posted on the the Eats on Feets website. This statement was written to apply to a very specific and limited circumstance - when a baby is mistakenly given another mother's milk once in a hospital. This is obviously different than long term exposure. I also think that one could easily conclude from reading the statement in isolation that simply expressing milk kills the HIV virus, and I think that this is a dangerous assumption. The CDC continues to recommend that HIV positive mothers not breastfeed. Similarly, I would want more information than what is presented about medication use on the Eats on Feets website.
Finally, I have to take exception to the implication in the Time Magazine article and other sources that part of the problem is that milk banks aren't meeting the needs of full term, healthy infants. In the article, which is titled, "Move over Milk Banks: Facebook and Milk Sharing," the author states, "Milk banks screen and pasteurize donated milk and give priority to premature and very ill babies, essentially preventing most families from accessing the milk. And for those who can get banked milk, it is often prohibitively expensive: $3 to $5 per oz., upwards of $100 for a day's supply."
The small number of milk banks in this country are struggling mightily to meet their mission of providing safe donor milk to the babies who need it most (very premature and very ill babies), and for whom it is unquestionably life-saving. I recently interviewed the president of the Human Milk Banking Association of North America, who flatly said of efforts to get donor milk to preterm infants, "we aren't meeting the need." She also pointed to a projection showing that, between the rapid growth in the use of donor milk for preterm infants (which has already tripled in the last ten years) and the growth in the rate of preterm birth, the demand can be expected to increase four-fold in coming years. I don't think that milk banks see as their mission to supply milk for very large number of healthy full term babies when there are so many critically ill babies who suffer from lack of access to it now. So, to me, complaining that milk banks aren't meeting this need is a little like blaming a fish for not being a horse.
So, there are my two cents. I'd love to hear yours.
*I'm going to assume that we all know the benefits of breastfeeding/risks of formula, but in case you want a list, here's a good place to start.