4 Strategies for Increasing The Safety of Shared Breastmilk

donor milk informal milk sharing milk sharing

baby holding a storage bag with breastmilk

"Help! I’m desperate! I can’t find my baby’s formula anywhere. Does anyone have extra breastmilk we can have?”

“Anyone have a breastmilk stash you can share? I am not pumping enough milk for my baby and we need to get some more milk for her”

Is anyone else seeing these kinds of posts in your feed lately? Maybe you have been the one actually posting these messages asking for breastmilk for your baby. Informal sharing of breastmilk is not a new idea. From the beginning of time, other lactating parents have stepped up to provide life-saving breastmilk in times of need. Cultures and communities that participate in the shared parenting of the children often share feeding responsibilities, either from direct feeding at the breast or by providing expressed breastmilk. With the development of infant formula milk, breastfeeding and subsequently informal milk sharing practices decreased across the world. But, informal milk sharing has always been a practice.

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You have probably heard about Donor Milk Banks which use milk donated by breastfeeding parents for premature or sick infants, mostly in the NICU. Informal milk sharing is when breastmilk is shared directly from one breastfeeding parent to another parent to use for their infant. Some ways that parents participate in milk sharing are within families, peer groups, networks that exist for the purpose of connecting parents in need of milk with donors who have extra milk, and through the internet. For example, you might have gotten milk from your cousin or a neighbor or connected with someone on your private social media page who is breastfeeding their baby. Or you may have joined a milk sharing group on FaceBook for the purpose of finding a donor or to offer your extra milk.

(All health care professionals and milk sharing organizations advise against purchasing milk from a stranger on the internet).

With the recent concerns over the safety and availability of infant formula milk, informal milk sharing has increased. Many parents who have relied on infant formula milk as the sole source of their infant’s nutrition have started to consider providing breastmilk as a safer and healthier alternative. Most people don’t realize that the majority of breastfeeding families in the US also rely on some formula supplementation for their babies as well. The search for what to safely feed infants affects nearly every family.

Opinions of the Experts

Yet, even during this current crisis surrounding the scarcity and safety of commercial infant formula, the use of donor milk is rarely mentioned as an alternative in the mainstream media or among health care providers. In fact, informal milk sharing is actually discouraged by the US FDA, the American Academy of Pediatrics, The Human Milk Banking Association of North America (HMBANA), and the European Milk Banding Associations. Only donor milk that is available through an established milk bank that has policies for screening the donors and screening and pasteurization of the milk has been considered safe and acceptable.

But, parents looking for donor milk know that getting milk from a milk bank is not a realistic option for most parents. The majority of donor milk received through milk banks is reserved for premature and sick babies in the NICU. Milk that is available to the public requires a prescription and is cost-prohibitive for most families. These recommendations from those professional organizations don’t leave parents with the option of providing the benefits of breastmilk for their baby.

Alternative Expert Opinions

But, on the other hand, The World Health Organization and The Academy of Breastfeeding Medicine (ABM), along with other professionals, agree that donor milk is the next best option if a parent’s own breastmilk is not available for their infant. The ABM, in their Position Statement on Informal Breast Milk Sharing for the Term Healthy Infant, states that the responsibility of participating in informal milk sharing lies between the parents and the donors. In order to make this decision, they should weigh the benefits of providing breastmilk to their infant with the potential risks that may come with sharing breastmilk. Those risks include potential infection and exposures that the baby could be exposed to through the shared milk. They report that parents should know what these risks are and what the recommended strategies are for limiting these risks before making the decision to use shared milk.

My Thoughts

I believe that providing these guidelines for milk sharing is much safer than just recommending that parents don't do this. In reality, we know that parents are sharing milk and, without having any guidelines to follow, this can be very risky for a baby. But, if parents are aware of the risks and benefits as well as the strategies that make milk sharing safer, then they are in a better position to decide if this is a good option for feeding their baby.

Because of this, I wanted to provide some information for parents to consider. This is not a recommendation for you to start sharing milk on an informal basis. This is to help you have the information you need, to be able to make an informed choice about milk sharing. As the Academy of Breastfeeding Medicine states, It is ultimately a decision between a parent and donor. But, in my own experience, there are parents who don’t realize that safe informal milk sharing is an option for them. And there are parents who are sharing milk without being aware of the strategies to increase its safe use.

Risks Associated With Using Shared Milk

No parent should accept shared milk to use for their baby without first being aware of the risks.

But, parents may be so desperate for milk to provide for their babies, that they may not even think about the risks or know what they are. There are really three main risks associated with informal milk sharing: transmission of viral and bacterial illnesses from the donor to the baby, exposing the baby to chemical substances transmitted through the milk that could be harmful to the baby, and the potential contamination of the milk during or after the collection process.

Formal milk banks were developed because the benefits of breastmilk are so well known for infants but providing breastmilk from a baby’s own parent is not always an option. There needed to be a way to provide breastmilk from a donor while reducing the risks of exposure to the infant that came from using milk from a non-biological parent. These milk banks developed processes and policies for limiting exposure to tiny infants. These processes include medical and lifestyle screening of the donors, processing the milk safely, and pasteurizing the milk before use. They use a model similar to how blood banks screen their donors.

Milk that is shared informally has those same risks of exposure. But, is possible to use similar strategies that the formal milk banks use to make sharing breastmilk in the community a safer option for infants.

increasing the Safety of Shared Breastmilk

The Academy of Breastfeeding Medicine, in their position statement on milk sharing cited earlier, recommends that parents should be well informed about the risks and benefits of sharing milk before they begin a milk sharing relationship. They advise that screening the donor’s health and using safe milk handling practices are two strategies for maximizing the safety of shared milk. They also recommend using home pasteurization of the milk to further decrease the risk of transmission of illness and contamination.

The 4 Pillars of Milk Sharing

These same strategies, well known as the 4 Pillars of Milk Sharing, are most often recommended when parents wish to use community sources of donated milk for their infant. These 4 Pillars were developed by Shell Walker, a midwife and founder of the milk sharing exchange, Eats on Feets, and Maria Armstrong, a founding member of that organization. They developed this document because of their own concerns for the safety of sharing milk. They did an extensive review of available research on the topic of milk sharing and then put together these recommendations. These pillars are informed decision-making, screening of donors, safe handling of milk, and home pasteurization. Before participating in informal milk sharing, it is recommended that parents become familiar with these strategies. Parents and donors can then decide how they want to include these actions in their own milk-sharing relationship.

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4 Strategies for Increasing the Safety of Shared Breastmilk

Using recommendations like those of the Academy of Breastfeeding Medicine and the 4 Pillars of Milk Sharing, parents can increase the safety of the use of shared breastmilk. These strategies are discussed in detail below.

1. Informed Choice

Any choice that parents make about the health and safety of their child

should be made after reviewing accurate information available on the risks and benefits. This is especially true about the decision to milk share. But, it is often hard to find the right information, especially when so much parenting information is available online and on social media. Be careful to separate the personal recommendations that you hear from the information that comes from reputable sources. Personal opinions help you to know what other families' experiences are like and that is very important to most parents. But, it’s easy to confuse experience with factual information about the risks and safety. We know that every baby and every family have different circumstances and needs, so you will want to discuss your decision-making with your lactation consultant and health care provider to help decide how best to use milk-sharing recommendations for your own baby. Sharing the 4 Pillars of Milk Sharing document or the ABM position statement with your health care provider may help guide the discussion for you. Ultimately, the decision lies between you and the donor.

2. Donor Screening

The safest and most important way to safely provide shared breastmilk to your baby is to make sure that the breastmilk is coming from a healthy donor. Breastmilk is made from blood and so any communicable illness that the donor may carry could potentially be passed along to an infant through their milk. Formal milk banks perform extensive screening of donors like a blood bank does, for risks for the following communicable illnesses: Hepatitis B and C, HIV, and HTLV as well as for active illnesses the donor may currently have to protect babies from viruses and bacteria that could potentially be passed through the milk.

They also screen the donor for some lifestyle choices that may impact the quality of the milk including smoking or smoke exposure, and medication use. herbs and recreational drug use, caffeine and alcohol consumption, and even certain dietary choices, for example.

The first line of safety would be that donors exclude themselves from donating if they have any of these known risk factors. Donors should also exclude themselves if donating could put their own mental or physical health or that of their baby in jeopardy. A breastfeeding parent should not donate milk if their own infant is in need of that milk. A parent who is donating milk should never feel pressured to donate milk if this is not the best choice for their family. That sounds simple, but it could be difficult for a breastfeeding parent to say no to a plea from a family member or friend who is in need of milk.

The next step is typically some type of conversation between the donor and recipient about the history of any communicable diseases and illnesses, and lifestyle choices. This can be done through an in-person conversation or through the use of a questionnaire you develop. This is a good time to get to know the potential donor more and get a feel for how a milk-sharing relationship would work between your families.

Once you feel comfortable with the results of this informal screening, then you can request that the donor share results of previous lab tests that they may have taken during pregnancy or request updated testing if these results are more than 3 months old.

This step may feel uncomfortable for a lot of parents, but this is actually a critical step in the decision-making process. Reviewing lab results is an important part of increasing your comfort level about providing shared breastmilk for your baby. Some parents may not actually be aware that they have been exposed to an illness without this testing.

Lifestyle and Habit Screening

Whether you use a personal conversation or a questionnaire, you can include screening for lifestyle choices and habits too. These might include drug and medication use, alcohol use and frequency, smoking and smoke exposure, and dietary restrictions of the donor, just to name a few. Individual lifestyle choices and habits might be more important to some families than others. You may want to pay more attention to these with a younger baby, or for a baby who will be needing the donor milk for the majority of their feedings. If your baby is receiving the majority of their milk from your breastmilk and you just need a small amount of supplement, for example, then you may feel more comfortable with some habits.

Some choices are more important to a baby’s wellbeing, such as if the baby has a cow’s milk protein allergy and requires dairy-free milk, for example. Another parent may have special cultural dietary restrictions that make this particular screening more important to them. . Some parents have a lower tolerance level for medication use in their potential donor. It is important for you to think about what habits are important for your baby and then screen for these in advance or choosing your potential donor.

Screening Might Feel Uncomfortable

You might wonder how you can ask such personal questions of someone who is offering you their valuable milk without feeling awkward about it. That is a very good question. Keeping your goals in mind of providing safe quality your baby above all else is a good start. Remember that, without the use of safety screening questions, you may accidentally provide milk to your infant that could cause harm. It may be easier to ask these questions after getting to know the donor first, either through phone conversations, talking online, or checking out their social media pages. You may then feel more comfortable moving forward in the screening process. Another way to feel more comfortable is by using a screening questionnaire format to allow donors to exclude themselves or provide you with information that you can screen on your own. Some parents find it easier to request milk through a milk sharing network with guidelines such as these so that all donors and recipients understand that these questions are a natural part of the safe milk sharing process.

You can share resources like the 4 Pillars of Milk Sharing document from Eats on Feets (linked below) or even this blog post, for example, to anyone you are considering going into a milk sharing relationship with so that they are aware of the recommendations.

Another way to allow donors to exclude themselves is by being specific in wording your request for milk. For example, you might say something like “I am looking for milk from a donor who has recent lab testing, who is dairy-free, and is alcohol free” This will allow a potential donor to say “Oh that is me” or to not respond to your request. Having a prepared response might help this all feel easier for you. You might say something like “We ask everyone who is donating milk for our baby to answer a questionnaire for us. If you don’t feel comfortable doing this, I understand, but for our peace of mind, we feel this is important”.

It is ultimately up to you to decide how important each of the suggested screening criteria is for your own baby.

Possible Screening Suggestions

Verbal "get to know you" interview with donor
Written questionnaire that may include:
Blood testing for HIV, Hepatitis B and C, HTLV, and syphilis
General physical and mental health
Active illness or exposure, fever, open sores on the body, or open wounds
Questions about social habits such as smoking and alcohol consumption, recreational drug use
Regular medication use ( not all medications are unsafe for breastfeeding infants - multivitamins, iron, human insulin, thyroid replacement hormones, anti-anxiety and depression medications, Ibuprofen, Tylenol, nasal sprays, asthma inhalers, topical treatments, eye drops, progestin-only and low-dose estrogen birth control products might be considered safe for donation. It is best to discuss individual medications with your healthcare provider or lactation consultant to determine safety for your infant.)
Use of Multivitamin/herb combinations, herbal teas, herbal supplements, and high dose multivitamin use. These may not necessarily be considered unsafe but you will want to review these with your lactation consultant or health care provider
Special diets - such as dairy-free, vegan, or elimination diets for example

These are just general questions. There may be others you want to add, or some you don’t feel are necessary. The younger and more fragile a baby and the more milk you will need, the more important some questions are.

3. Safe Handling of Breastmilk

If you have pumped breastmilk for your own infant, you are very aware of the process involved in expressing and collecting breastmilk as well as the safety recommendations. If this is not something you are familiar, you might not be aware of the ways that breastmilk can become contaminated.

Breastmilk can become contaminated during the process of collecting the milk through the donor's hands, through the pump parts, or through the containers, the milk is pumped into or stored.

It is very important that any collected milk, from a parent or a donor, be collected using safe practices to decrease any risk of contamination along the way. Infants have immature immune systems which make them at very high risk for illness.. The milk handling process must be done safely to protect the baby.

The CDC published these guidelines (see below in the resources) or the safe handling of breastmilk so that contamination risks are decreased. Asking questions about how a donor collects and stores the milk will help a parent to get a better understanding of what this risk would be for their child.

Here are some other questions you might want to include in your screening:

How old is the milk?
How has the milk been stored ( refrigerator, freezer, deep freezer)
Is the milk dated? ( expiration date is important)
Has the milk ever been frozen?
Has the frozen milk ever been thawed?
Has the milk been heat treated?
What is your process for keeping milk from becoming contaminated while pumping?
What is your process for cleaning your pump parts?
Do you clean your pump parts after every use?

Keeping Milk Safe During Transportation

Milk can also be contaminated during the transportation of the milk from the donor to you. Fresh milk can overheat, sit out too long, or even spill during transport. Frozen milk can unexpectedly thaw out during the transportation process and become contaminated. A plan should be developed for transporting the milk to make sure that the milk does not become contaminated. It is for these reasons that finding a local breastfeeding parent to receive shared milk with is an easier and safer option.

If you are a parent who expressed milk for your own child, you will know what questions you want to ask the donor. If you have not pumped and stored breastmilk, you can look to the CDC guidelines or ask friends who are pumping to help you evaluate this. It is common for parents to have different comfort levels when adhering to milk collection and storage guidelines. Part of informed choice is knowing the guidelines and then deciding your comfort level around this.

4. Home Pasteurization

The 4th strategy for safely participating in milk sharing is home pasteurization of the donated milk. Even after thorough screening, using shared milk can still have a risk of transmission of viruses or illnesses that could be harmful to your baby. Home pasteurization of the milk can destroy some potential viruses, bacteria, and contaminants that could be transmitted in the milk. The Flash Heating method of pasteurization is an easy process that requires no special equipment and takes about 4 minutes but maximizes the safety of the shared milk your baby will take in.

The simple process of pasteurizing milk with flash heating could make the difference in your child being exposed to harmful pathogens in milk. Flash heating was originally developed for use by mothers with HIV in areas where lack of clean water sources made formula use very risky for infants. This was a way of providing breastmilk safely to their own infant. The pasteurization was found to kill the HIV virus while still preserving the nutrient properties of the milk. Flash heating is quick and simple to perform at home and takes no special equipment.

Other Methods of Pasteurization of Milk

Flash pasteurization (not to be confused with flash heating) is a home method that requires special equipment. The Holder Method is the method used in milk banks. This method keeps the milk at a high temperature for an extended period of time, which is very hard to achieve at home. This method also destroys more of the nutrient quality of milk, although it is still very beneficial for babies.

Concerns about Pasteurization

Some parents have concerns about pasteurizing milk because they have been told that heating breastmilk will destroy its benefits. It is true that freshly expressed breastmilk provides the most beneficial milk for babies. The more processed the milk is, the more of its benefits are decreased. Even refrigerated and frozen breastmilk lose some properties over time. That is why direct nursing provides the most benefits to a baby. But, even if milk is heated, it still has the most nutritional and immunologic benefits for babies. The loss of a small amount of nutrient quality is an acceptable loss compared to the risk of exposing a baby to illness or contaminants in the breastmilk. If a parent chooses not to use home pasteurization, it is recommended that they have a personal relationship with the donor and that the donor has had a thorough and recent screening, including lab testing.

Flash heating Pasteuirization Method (according to the Academy of Breastfeeding Medicine):

Put 50 - 150 ml of the breastmilk you want to pasteurize in a heat-resistant glass jar.

(if you have more than 150ml of milk, divide it into separate jars)

2. Place the jar of breastmilk into a small pan of water. Make sure that the water level is about two finger levels above the milk so that all the milk is heated well.

3. Heat the water on a very high hot fire or at the highest level on your stove until the water around the jar of milk reaches a rolling boil (when the water has large bubbles).

4. Stay close by because this should only take a few minutes. If you leave the water to boil for too long, this will damage more of the nutrients in the breastmilk.

5. Immediately after the water comes to a boil, remove the jar of milk from the boiling water (using tongues or gloves).

6. Place the jar into a container of cool water to quickly cool it or let it stand until it is room temperature.

7. Place a clean lid on the jar when cooling and storing, to protect it from being contaminated.

8. Once milk is cooled to room temperature, you can feed the milk to the baby, place the milk in the refrigerator or freeze it.

(If the milk was previously frozen, you can freeze it again after pasteurizing. Or you can keep the milk frozen until ready to use and then pasteurize it so that you do not need to freeze it again.)

Using these 4 strategies, making an Informed decision, screening for a healthy donor, making sure that the milk was collected using safe milk handling and collection processes, and pasteurizing the donor milk at home before feeding it to the baby will help make sure that you are providing the safest milk possible to your baby.

FAQ’s about milk sharing?

There are so many questions related to milk sharing and they can't all be covered at one time. But here are a few frequently asked questions about using milk from a donor.

Where can I find donor milk?

Parents often receive milk from family members or friends who are currently breastfeeding their own child, or who have recently breastfed a child and have a stash of milk that they aren’t going to use.

Parents will often put out a request for breastmilk on their own personal social media pages or will see an offer of breastmilk from a friend on their page.

There are Milk Sharing Networks specifically developed as a place for donors and recipients to connect. for safer sharing of breastmilk. Two such groups are Eats on Feets (the 4 Pillars of Milk Sharing originated here) and Human Milk 4 Human Babies. (Both of these are linked in the resources below) You can also do a search for donor milk-sharing networks for your own state.

Local social media groups that you belong to, such as parent groups or breastfeeding groups, are other places that parents often connect for milk sharing.

*IMPORTANT POINT* Complete screening and testing are recommended in order to make sure that shared milk is safe for your baby. The farther away you get from your own personal peer group, the more closely you must follow screening recommendations. For example, if the donor is your sister, you may not need to do as much screening as someone in a milk-sharing group or in a social media group.

*ANOTHER IMPORTANT POINT* Receiving or Purchasing milk from a stranger is always discouraged. The risks associated with milk sharing, including contamination of the milk or even altered milk ( breastmilk that has had other ingredients added to it to increase the amount) rise significantly with receiving milk from a stranger. There have been reports that breastmilk purchased from the internet had been altered with cow’s milk or other substances to increase the amount. There are also reports of contaminated milk purchased through the internet. Health care professionals and the milk-sharing groups listed above do not advise receiving milk from the internet or paying for breastmilk.

Should I pay my donor for their milk?

Paying breastmilk donors for their milk is a controversial subject, However, most supporters of milk sharing - including the ABM and the two milk-sharing groups listed above, strongly advise against paying for breastmilk. Overall, this is a much less safe practice. Some opponents of paying a donor say that adding a financial incentive for providing milk can place an unexpected burden on the breastfeeding donor to provide the agreed-upon amount of milk in order to receive payment. This could potentially lead to additional stress for a breastfeeding parent and impact her personal relationships or the health of the donor's infant by prioritizing the pumped milk for the recipient.

But, I am so grateful to my milk donor. How can I thank them?

There are so many creative and acceptable ways to thank your milk donor. Here are some common ones:

Provide replacement of the supplies used for milk expression such as milk collection bags, extra flange sets, or pump parts
Some parents offer gift cards or personal gifts to their donors. ( Who doesn’t love getting a gift card to Target?)
Meal Delivery Services might be a welcome and time-saving gift for a parent who is donating milk
Of course, the best gift is to tell your donor how much their breastmilk is appreciated and is helping your family. Most donors love knowing how they are helping you and your baby, so an ongoing relationship is often very meaningful to them.

Ultimately, it's up to the donor and recipient to come to an acceptable agreement about sharing breastmilk. The donor has the right to decide how they would like to be compensated for their time, effort, and the breastmilk they provide. If you're not sure what they prefer, just ask! If you aren’t comfortable with the request, don’t form an agreement with this donor.

What if I don't feel comfortable with the arrangement we have made?

It is really important to come to an agreement prior to milk sharing. If at any time before or after you have developed a donor and recipient relationship, either one feels uncomfortable, the milk-sharing relationship should be stopped.

This is especially true for anyone donating milk. Your reasons for donating are a personal decision and if you are feeling coerced into providing milk or find that donating is impacting your relationships or your own baby's needs or your mental or physical health, it is your right not to share your milk.

The milk-sharing organizations, Eats on Feets and Human Milk 4 Human Babies have resources to help navigate the milk-sharing process in great detail. Use those resources to help you make an informed decision about participating in a milk-sharing relationship.

The value and benefits of breastmilk for infants are well-known. It is recommended that babies receive nothing but breastmilk until 6 months of age and then continue with the introduction of solid foods until they are at least one year old. It is a parental choice to decide how long they choose to breastfeed. Breastmilk is the perfect nutrition for babies except for very rare exceptions. But, in real life, the majority of infants are not provided with breastmilk according to these recommendations.

Traditionally, providing infant formula milk has been the first recommendation when breastmilk was not available for an infant. Now, when the risks and lack of availability of infant formula milk are becoming more widely known, breastfeeding should be encouraged and supported more than ever to both decrease the reliance on formula milk and to increase the health benefits of infants.

When you look at the available information about milk sharing in research, the traditional media , social media, and the infant health organizations, you will find mixed reactions, opinions, and recommendations about informal milk sharing. There is more advice against informal milk sharing than those advocating for and providing guidelines for safe use.

Breastmilk sharing is a practice that is on the rise. Parents should have the guidance and support available to them to help make this decision as safe as possible for their baby.

Disclaimer

The information and resources provided here should not be taken as medical advice or recommendations for your particular situation. Only a health care provider or lactation consultant with a professional relationship with your family has the authority to provide guidance, support, and recommendation about your individual situation related to sharing of breastmilk. The guidelines I have provided here should be considered a starting point to becoming more informed about the risks and benefits and the strategies for safer milk sharing so that you can make the best decision for your baby.

Next Steps

If you have further questions about donating your breastmilk or receiving breastmilk for your child, review this information and the resources recommended with your own personal health care provider or lactation consultant. Whether you are donating or receiving breastmilk, you and your own infant have individual needs that should be taken into consideration. These are best discussed with a professional who is familiar with your own circumstances to help decide if this is the right decision for your family. Your lactation professional can discuss your particular questions about how donating milk may impact you and your infant, or how you might be able to increase your own breastmilk supply to rely less on supplementation. Only someone who is working with you personally will know what your particular needs are. If you do not have a lactation consultant available to you, you can find one through your pediatrician, your insurance company, or through www.ZipMilk,org or you can book a consult or a virtual, home or office appointment here.

The number one priority is for your baby to be fed with the best nutrition available in the safest way possible. Only you as the parent can decide how you do this. The best way to make that decision is by knowing the facts and relevant information about the options available to you. Then you can make an informed choice about what is right for your baby.