Once again, the media has reported on the risks of donor breastmilk sharing.
This time, a BBC reporter posed as a father of a 6 month old baby, and purchased donor milk from 12 different mothers.
Then, each of these milk samples was analysed: one third reportedly contained E.coli and one sample contained a particularly dangerous bacteria, called Pseudomonas aeruginosa.
So, what should a mother who has sourced donor milk or is thinking of doing so take from this?
Is donor milk sharing really as risky as the media makes it out to be?
Is it riskier than using formula?
Here are 11 things you need to know about sharing donor milk:
#1: Human Milk Is Designed For Human Babies
There’s no question: human milk is uniquely suited to human babies. There’s really no comparison between formula and human milk. See a list of what's in breastmilk and what's in formula.
It has been well established that not breastfeeding is linked with many poorer health outcomes such as increased risk of infection, obesity, lower intelligence, SIDS etc.
Therefore it’s no surprise leading health organisations recommend exclusive breastfeeding for 6 months and then breastfeeding along with suitable solid foods for at least one year.
It’s also not surprising some mothers seek to source donor milk, particularly if they don’t have enough of their own to give to their babies.
But what are the risks of donor milk sharing and how can they be minimised?
#2: Donor Milk Can Be Contaminated With Viruses
There are a number of viruses which can get into breastmilk.
The viruses known to be able to get into breastmilk if the mother is infected include: Human Immunodeficiency Virus (HIV); Hepatitis B and C; Human T-Cell Leukaemia Viruses (HTLV1 and 2); Cytomegalovirus (CMV); and Epstein-Barr Virus.
However, only HTLV, CMV and HIV are known to be able to be transmitted via breastmilk. In other words, although bits of the above viruses have been found in breastmilk, these three are the only known viruses which are confirmed to have been passed on to a child via breastmilk. And CMV in breastmilk is only a problem for premature babies.
Although HIV and HTLV can be transmitted via breastmilk, it doesn’t happen easily. In fact, many repeated exposures, over a long period of time, are needed before infection occurs.
As Doctor Karleen Gribble and Bernice Hausman point out in their paper, ‘Milk sharing and formula feeding: Infant feeding risks in comparative perspective?’:
“While a single transfusion with HIV positive blood will infect 89% of receiving individuals, only 0.6 – 4% of infants who are exclusively breastfed from birth to six months by HIV positive mothers will contract HIV, despite potentially receiving many thousands of doses of HIV-infected breast milk.”
You should also know, in countries like Australia, HIV is extremely rare. HIV is also routinely tested for, pre-natally, meaning 98% of HIV positive women are identified before their babies are born. The national recommendation for HIV positive women in developed countries such as Australia is not to breastfeed. In Australia, fewer than one child per year is exposed to HIV in the perinatal period. That means the risk of an Australian woman not knowing she has HIV and then donating her milk is extremely small.
#3: Donor Milk Can Be Contaminated With Bacteria
Research has shown that the type of bacteria and amount of bacteria in breastmilk vary greatly between individual mothers.
The bacteria generally found in breastmilk are harmless (e.g. bacteria from the skin). In fact, much of the bacteria (probiotics) in breastmilk are helpful in establishing a healthy gut microbiome. There are significant differences between the bacteria in the gut of breastfed babies and the bacteria found in formula fed babies.
Other potentially dangerous bacteria have been found in some mothers’ breastmilk.
However, despite this, it has not been established whether their presence is harmful or not.
It’s important to understand that breastmilk, unlike other milks, contains antibacterial elements (many of which withstand various storage conditions). It’s possible the antibacterial properties of breastmilk might to some extent offset any potentially harmful bacteria that might also be there.
#4: Formula Can Be Contaminated With Bacteria
Powdered formula can also be contaminated with a range of harmful bacteria.
In fact, formula is not sterile, which is why it needs to be made up with boiling water, to kill off any potential bacteria.
Despite the range of bacteria which have been found in powdered formula, Cronobacter sakzakki and Salmonella are the only bacteria which have been shown to have infected babies.
Health authorities insist on testing formula for the presence of Salmonella, but outbreaks still occur. A certain amount of contamination of Cronobacter sakzakki is allowed in powdered formula, with 3-14% of formula tins having been found to contain it.
There can be serious health consequences (e.g. meningitis, even death) if a baby is infected with Cronobacter sakzakki, although there is low risk and cases are rare. Making up formula with water that is at least 70 degrees∘Celsius, a practice recommended by the World Health Organization, deactivates Cronobacter sakzakki.
#5: Donor Milk Can Be Contaminated With Drugs
Many drugs can enter a woman’s breastmilk. Typically only about 1% of the maternal dose reaches the baby through breastmilk, and most drugs women take have not been shown to harm their babies via breastmilk.
Evidence-based and up-to-date information about drugs and breastfeeding is available via the Lactmed Database.
#6: Donor Milk Can Be Contaminated With Environmental Toxins
This is another topic the media reports on from time to time. You can read about toxins in breastmilk here.
#7: Formula Can Contain Other Harmful Substances
Formula can also contain other substances that can be harmful to babies. For example, in 2008, some batches of formula in China were contaminated with the industrial chemical melamine. This caused thousands of babies to become very ill, and several died.
Formula has also been contaminated with things such as glass, PVC plastic and beetle body parts. Environmental toxins such as perchlorate have also been found in formula.
#8: Formula Ingredients Might Have Deficiencies And Toxicities
Various deficiencies and toxicities in formula ingredients have occurred through history. For example, the US issued recalls for formula deficient in protein and vitamin C, and in Israel, formula deficient in thiamine resulted in brain damage and deaths.
For a detailed insight into the history of formula, read Maureen Minchin’s book Milk matters: Infant Feeding and Immune Disorder
#9: Poor Hygiene And Incorrect Storage Of Donor Milk Can Increase Contamination Risk
Suboptimal hygiene when expressing milk, and incorrect storage of breastmilk can increase the risk of the milk being contaminated with bacteria.
There are guidelines for the safe storage of expressed breastmilk, which are detailed here. Obviously, it’s up to each individual to be aware of these guidelines, and follow them.
When expressing, good hygiene practices are recommended, such as good hand washing practices and thorough cleaning of all items.
#10: Poor Hygiene And Incorrect Storage Of Formula Can Increase Contamination Risk
Likewise, suboptimal hygiene in preparing and storing formula can increase the risk of contamination. Particularly when formula is reconstituted, it’s a great environment for bacteria to multiply.
Research has often shown that recommendations for safe formula preparation in the home are often not followed. One UK study found that 60% of bottles parents thought were clean were in fact contaminated (including cases involving Staphylococcus aureus).
As well as bacterial contamination, formula might also be made up with too much water, resulting in over-dilution or with too much powder, resulting in under-dilution. Both under-dilution and over-dilution can result in health problems.
#11: Peer-To-Peer Milk Sharing Is Different From Donor Milk From A Human Milk Bank
On the other hand, donor breast milk from a human milk bank goes through a rigorous screening process from sourced donors (mothers) and has usually been pasteurised. Typically, human milk use a pasteurisation method known as the ‘Holder’ pasteurisation method, which destroys all pathogens known to infect babies via breastmilk. Breast milk from human milk banks is typically reserved for very sick or premature babies.
5 Safe Milk Sharing Tips
With all the above information in mind, here are some tips to minimise risks associated with peer-to-peer donor milk sharing.
#1: You Could Meet The Donor
Sometimes, it might be possible to meet a potential donor before deciding whether to accept her milk or not. This can help you feel more confident about the decision you make.
#2: You Can Screen The Donor
Potential donors can be screened using criteria similar to those used by blood banks.
#3: You Can Provide The Donor With Information Or Question Her About Proper Hygiene And Storage Practices
To help ensure the donor milk has been handled and stored correctly, you could provide a potential donor with guidelines on the best practices or even ask her questions about practices she implements when expressing and storing breastmilk.
#4: You Can Pasteurise The Milk
Freezing breastmilk can deactivate any HTLV present.
HIV can be deactivated using flash heating. This involves placing the breastmilk in a glass container, which is then placed in water. The water should be heated to boiling point before the container is removed and allowed to cool.
#5: Don’t Buy Breast Milk
And finally, it’s important to not buy the milk. Whereas the altruism in peer-to-peer milk sharing is protective, profit motives can undermine quality – the very reason why we don’t pay for blood donations.
When it comes to milk sharing, it’s up to you to weigh up the risks versus the benefits. You can’t do this effectively unless the risks associated with the use of formula are also taken into account. There are ways to minimise the risks of milk sharing and many parents have found the benefits of human donor milk outweigh the risks.