I’ve been trying my hardest to avoid tackling the hot topic of milk sharing (or milk banks), but it seems to be the issue of the day. Hell, even Wired got in on the action. Typically, I’d take the fact that breastfeeding was discussed in Wired as a sign of the Apocalypse, but since the whole May 21 thing turned out to be a bust, I’m not banking on it. (Ha. “Banking”. And we’re talking about milk banks. Get it? That’s the extent of my wit when I’m all doped up on Tylenol Severe Cold.)
The reason I haven’t wanted to touch this topic with a ten-foot pole is that I’m honestly not sure what to think about it. My whole m.o. is wrapped up in this live-and-let-live mentality; it shouldn’t matter that I personally would be skeeved out to feed my baby milk from some random other mama, as long as you’re comfortable with it. I think informal milk sharing between friends or relatives – like my good friend, who donated some of her enviable freezer stash to her sister-in-law – is pretty awesome. But I do have an issue with how a misrepresentation of risk is deluding women into thinking that buying breastmilk off the internet is “safer” than using formula. And since, according to Wired, breastmilk is turning into quite the commodity, I think its time we had a little talk about some harsh realities.
First of all: breastmilk and breastfeeding are two separate concepts. I have seen these two terms being thrown around as if they are interchangeable, and that is just. not. true. Frequent readers of this blog know that one of my biggest complaints about breastfeeding medicine is that we spend so much time, money and energy on (mostly flawed) studies “proving” the superiority of breastfeeding over formula feeding, rather than performing more interesting, controllable, and ultimately helpful studies on the properties of breastmilk that are performing these magical feats. For example, there is strong and ample evidence that breastfed kids have a lower risk of ear infections. But what is providing this benefit? Is it something in the milk itself, or is it simply the delivery system? Is there a study comparing kids fed breastmilk out of bottles to those breastfed, in the most literal sense? And if it is indeed the milk, then wouldn’t it be cool to know what constituent of the milk is protecting little baby ear canals?
This is relevant to the topic of milk sharing, because until we understand the benefits of breastmilk versus breastfeeding, we can’t know the benefits of giving our kids donated milk. And for parents shelling out $32-60 a day to feed their babies human milk, I’m assuming these benefits matter. Even for those who have managed to find generous donors and are getting the milk for free, the potential health costs of unmonitored milk need to be weighed against the benefits.
Speaking of health costs… this is a sensitive subject. But just as I will freely admit that there are risks to formula feeding if one does not handle the formula properly, or uses bad water, or dirty bottles; or a company allows bug parts to get into their supply or what have you, I think we also need to be realistic about consuming a bodily substance from a stranger. Says Wired:
Screening milk donors turns up a surprising number of infectious agents—pathogens that could be passed on to a baby. A 2010 Stanford University study examined data from 1,091 women who applied to donate milk to a bank in San Jose, California. It revealed that 3.3 percent were rejected after their blood samples tested positive for at least one of five serious infections: syphilis, HIV, hepatitis B, hepatitis C, and human T-cell lymphotropic virus. And if these pathogens are in a donor’s blood, they can be present in the milk, too.
This doesn’t even begin to explain the potential risks of OTC and prescription medicines, herbal supplements, and diets – things that are considered “irrelevant” in much of the breastfeeding literature, despite a mind-boggling lack of evidence to back this “irrelevancy” up. For example, nicotine does get secreted into the breastmilk of smokers; so do some antidepressants, painkillers, etc. It is up to every mom to decide if the benefits outweight the risks when breastfeeding their own child, but just because I feel that taking Prozac while nursing is cool, it doesn’t necessarily mean you do. And if someone feels that it is perfectly safe to smoke, drink, or take certain meds because Kellymom or LLL or a message board tells them that it is, chances are they won’t think its worth mentioning in a Craigslist ad hawking their own breastmilk. This is not to say that milk donors aren’t altruistic – I would bet that most really are, that they truly want to help babies deprived of breastmilk… but even the milk of human kindness can be tainted with things that we might not want our kids ingesting.
Here’s a confession: I have found all four of the incredible babysitters I’ve used in the past 2.5 years through Craigslist. My friends think I’m nuts, but meanwhile, I have managed to find some of the best, most loving, educated and responsible women around to care for my kids. Sure, I had to interview a lot of duds, but even that wasn’t too arduous a process. But many of my friends feel, understandably, that trusting someone you find on Craigslist with their babies would be utter stupidity. I think that’s probably a common belief. (Yet, how many women would take donated breastmilk from the same site with nary a second thought?) My point, again, is that many people may have great luck getting milk through a free internet site. But we shouldn’t make women feel that they are better mothers because of it. Just because I had a good experience on Craigslist finding childcare doesn’t mean that there aren’t baby snatchers scouring that same site. I felt comfortable with the candidates I found, but that’s partly because I can work from home and keep a close eye on what’s going on, sans teddy-bear nanny cams. I would never tell another mom to use this method of finding a sitter because it was “perfectly safe”, because my situation is a unique one.
Another issue we have to think about is that breastmilk straight from the tap differs from breastmilk that has been stored for days or weeks. Studies (controlled, in vitro studies, not observational ones like the kind most breastfeeding-related beliefs are based on) have shown that certain vitamins and antioxidants do not hold up well when breastmilk is frozen (although in the case of antioxidants, the frozen breasmilk still beat formula. You listening, Enfamil? Similac?). So unless you’re able to afford an actual wet nurse, your baby may not be getting the 24-karat liquid gold. Maybe more like gold-plated.
Now, obviously, one could argue that even gold-plated is better quality than the sterling silver that is infant formula. That’s absolutely your call. I personally like the look of sterling silver, and think it holds up better in the long term, but its a matter of preference. I definitely don’t think the government has a right to interfere in milk donation; parents have a right to buy and sell (or donate and accept) breastmilk just as much as I have a right to choose to formula feed. But I do worry about the repercussions of a formula-is-poison atmosphere as this breastmilk “niche industry” develops. Eavesdropping on a popular adoption baby board recently, I saw a disturbing discussion about donor breastmilk which completely misrepresented/misunderstood the risks of milk sharing, and could easily lead to adoptive mothers feeling derelict for not seeking out a source of breastmilk rather than formula feeding.
All I’m saying is that we need to approach these decisions realistically, with bifocals rather than blinders on. Someone recently commented on the FFF Facebook page that while breastmilk is a nutritionally superior substance, its not a morally superior one. I love this. But when it comes to donor milk, I also want to make sure that parents are fully informed and 100% sure that breastmilk is, actually, the nutritionally superior product – or more accurately, the overall superior product, with all the risks of human-derived bodily substances factored in. I suspect that processed, screened breastmilk from a reputable bank, as described in the Wired piece, is indeed superior to formula. But that still involves quite a bit of scientific intervention (and cost):
Collecting the milk is just the beginning of a lengthy process that also involves analyzing, purifying, and standardizing the product. Once a donation has been tested for microbes and found to be pure, a small sample is analyzed by a machine called a MilkoScan FT 120. It looks like an espresso maker and uses an interferometer to scan the milk. The result is a readout showing the proportion of protein, fats, lactose, and calories, which can vary from 12 to 38 per ounce. To sell to hospitals, banks must provide milk with a specific, consistent balance of nutrients and calories. To achieve that, the banks use a technology called target pooling—blending donations with various nutrient profiles until the optimal caloric value (around 20 calories per ounce) is achieved. Finally, they pasteurize the milk with a special technique that heats it to about 144.5 degrees Fahrenheit, minimizing the destruction of antibodies while killing viruses and other pathogens.
In sum, I think milk sharing is none of my business, or the governments, and is probably totally safe and fine for the most part. Which is what I think the attitude towards formula should be as well. Both are just food. Both need better science and better jurisdiction to make them truly safe and superior products. Neither make you a better parent for using them.
And frankly, I’m all for a breastmilk “market”. I imagine that if it is profitable, companies will start analyzing the constituents of breastmilk and discovering exactly what’s in the stuff that makes it so amazing. Considering the breastfeeding experts seem to have little interest in doing so (and would rather keep churning out poorly-designed studies that just provide fodder for lactivist blogs), I’m just glad someone will be performing these studies – even if its for profit-driven reasons. Just like that song in Cabaret says, money makes the world go round – and you know what? I’m fine with it.