Is donor milk dangerous? Not as dangerous as hypocrisy.

Those of you who have been reading this blog long enough are probably well aware that I hate hypocrisy. I mean, I hate it. I hate it in politics, I hate it in religion, I hate it in the spats I have with Fearless Husband, and of course, I hate it in the breastfeeding/formula feeding debate.

But most of all, I hate it in myself.

That’s why I’m sitting here agonizing over how to report on a study that hit the news cycle tonight. According to NBC News,

…a new study finds that human milk bought and sold on the Internet may be contaminated — and dangerous…Nearly 75 percent of breast milk bought through the site OnlyTheBreast.com was tainted with high levels of disease-causing bacteria, including germs found in human waste…That’s according to Sarah A. Keim, a researcher at Nationwide Children’s Hospital in Columbus, Ohio, where her team purchased more than 100 samples of human milk last year, compared them to unpasteurized samples donated to a milk bank and then tested them for safety…what the researchers found was worrisome: more colonies of Gram-negative bacteria including coliform, staphylococcus and streptococcus bacteria in the milk purchased online, and, in about 20 percent of samples, cytomegalovirus, or CMV, which can cause serious illness in premature or sick babies. The contamination was associated with poor milk collection, storage or shipping practices, the analysis showed.

Here’s the problem: I look at articles which report on the dangers of formula with an intensely critical eye. It would be horrendously hypocritical for me not to do the same in this case – and I’m especially worried, because the people purchasing donor milk are in the same boat as many FFFs – people who wanted to breastfeed and couldn’t. I don’t want to turn my back on my audience and be a hypocrite in one fell swoop.

And yet.

Obtaining milk online is a new construct. We do not have several generations of humans raised on donor milk to examine and rely on for (admittedly insufficient, but oddly comforting) anecdata. We can’t define “donor milk” as clearly as we define commercial formula, because it isn’t a static product. Formula does not change based on a baby’s needs and age, or based on the diet or environment of the woman producing it; breastmilk does. There is not the issue of online, anonymous dealings when we discuss formula (well, unless you count the 16 cans of Alimentum my husband purchased on Ebay…I know, I know, but it was sealed. And that shit’s expensive if you buy it retail).

Discussing donor milk and the safety thereof is not the same as discussing formula, because there are so many more issues at play. This study is not about whether donor milk can nourish an infant better than formula can. This is about the biology of a live substance, and what happens to that substance once it leaves one person’s body and is transported to another’s. This is about body politics, and e-commerce. It is so much more complex than breast versus bottle.

So I hope I’m not being hypocritical when I look favorably at this study, because I do think it’s one worth taking seriously, as long as we acknowledge the limitations. Let’s review those, first:

1. It was a singular study. ONE study. Which used donor milk from one specific organization.

2. As the study is not yet available online, there’s still a lot we don’t know. NBC reports, “Of the 101 samples analyzed, 72 were contaminated with bacteria and would not have met criteria for feeding without pasteurization set by the Human Milk Banking Association of North America, or HMBANA.” I’m not sure how these criteria are set by HMBANA, and I don’t know exactly what the dangers of these bacteria are.

3. We don’t know that any of the babies who would have received this milk would necessarily have gotten sick. (This is one of the things we discuss with formula feeding studies, remember? For example, many people worry about the GMOs in formula. And yeah, most formulas contain ingredients derived from genetically modified corn, soy, and other foodstuffs.  But we have no evidence that babies fed these formulas suffer any ill effects from these tiny amounts of GMOs.)

Now, let’s talk about why this study is a little different than most of the breastmilk vs. formula studies we encounter.

1. The results were in vitro – aka, found in a lab. These were not observational or self-reported or marred by recollection bias. These were findings that were discovered from looking at samples under a microscope, in a controlled environment.

2. We do know that some of these bacteria are dangerous to babies.  20 % of the collected donor milk samples contained cytomegalovirus, which according to NBC “can cause serious illness in premature or sick babies.” 20% is a substantial amount.  The article didn’t give numbers for the samples which contained other disease-causing bacteria like coliform and staphylococcus, nor do we know if the amount of bacteria was sufficient to cause illness. (Please note: I think we do need to approach this with caution until we see more information, because there’s a chance the amount of bacteria wasn’t clinically significant.)

3. A large part of my ennui with formula studies is that most tell us the same thing: breastfeeding mothers are associated with healthier children. There’s not much variance in the theme of the research, or what can be done about it. This study is nothing like that. It is giving us actual information about the actual risk of bacterial contamination through donor milk. This is exactly why I started taking formula preparation rules so seriously when I saw in vitro studies on bacteria found in infant formula. It’s hard to argue with cold, hard science that has removed the human condition from the equation.

More importantly, this study offers us an opportunity. Not only does it allow us to improve milk sharing – something that can and should be a choice for moms who cannot or choose not to breastfeed – it reminds us that cold, hard science can be translated into better feeding options for families. Donor milk can and should be tested, to see how it needs to be stored and transported and screened. Formula can be compared with donor milk so that parents can understand the risks and benefits to both scenarios. Since one of the advantages of breastmilk is its ever-changing, adaptive personality, we could look at how the donor milk from a mom nursing a toddler might affect a newborn. We could even see if, say, the milk from women with higher IQs equates to higher IQs in babies fed their donor milk (oy, can you imagine the eugenic excitement over a finding like that? ::shudder::). You see where I’m going with this. When we’re discussing the substance rather than the behavior, a whole world of research will open up – research that can ultimately lead to improved formula, improved donor milk, and improved options for both babies and parents.

Lastly, it seems that defensiveness about negative press for one’s feeding choice is not exclusive to formula feeders. NBC quotes one milk sharing network’s founder as accusing the research of being “A blatant attack on women attempting to feed their babies”:

“..(It) is cruel and you should feel ashamed of yourself for spreading misinformation,” Khadijah Cisse, a midwife who founded MilkShare, a portal for connecting women cited in the new research, said in an email to NBC News. “Anyone can type up any bit of lies they want and make claims. Breast milk is supposed to contain bacteria.”

I feel bad for Cisse, as I know what it feels like to read research that denies my own lived experiences, or makes me feel judged for feeding my child in a specific manner. In her defense (and mine), it’s really hard to keep a lid on one’s anger when the media takes a 5k story and runs a marathon with it, without any consideration for context or nuance.

Imagine how much easier it would be to keep that proverbial lid tightly locked, if feeding choices were supported and respected. If the dialogue didn’t always involve universal bests. If we could make choices armed with more cold, hard science so that the choices themselves didn’t have to so damn cold and hard.

There’s a lot we could learn from this study.

Or, you know. It could die in an avalanche of hypocrisy.

 

 

 

 

 

 

About the Author:

Suzanne Barston is a blogger and author of BOTTLED UP. Fearless Formula Feeder is a blog – and community – dedicated to infant feeding choice, and committed to providing non-judgmental support for all new parents. It exists to protect women from misleading or misrepresented “facts”; essentialist ideals about what mothers should think, feel, or do; government and health authorities who form policy statements based on ambivalent research; and the insidious beast known as Internetus Trolliamus, Mommy Blog Varietal.

Suzanne Barston – who has written posts on Fearless Formula Feeder.


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18 thoughts on “Is donor milk dangerous? Not as dangerous as hypocrisy.

  1. An additional area in which we could learn from this is how there really is no training for new moms on pumping. I was given nothing. The only thing I knew about pumping after my pre-natal classes was the impression I got from the breastfeeding educators: it was inferior to the breast. Some women had to do it, but there was a sort of disappointment in them, like “why were they leaving their babies?” Pumping didn’t solve anything, so ladies, don’t think you’re getting more sleep if you pump so your spouse/partner can give a bottle in the middle of the night. That sort of thing.

    The only information I got about how to clean parts, how to store the milk, how to thaw it if it was frozen, how long it was good for, etc. was from the internet. And some of that advice was contradictory, even among pro-breastfeeding websites that were at least somewhat supportive of pumping. Some said breastmilk could be left at room temperature for hours because of its antibacterial properties (but wait, according to Khadijah Cisse and so many others online, it’s supposed to contain bacteria…). Some said pump parts didn’t have to be washed every pump. And forget advice about storage or transport–it was all over the map.

    I think there’s a lot to be learned from this, and you’re right FFF–if this doesn’t devolve into bickering, it could be a very good chance for women of many stripes to learn the safest practices for pumping, whether it’s for their own babies or others’.

    • Not to mention, it also begs the question of should you borrow your friend’s pump (even if you replace all the tubing) that she swears she sterilized every single time she used it? I was offered a pump when I breastfed my 2nd to help increase my supply. I was tempted, but turned it down because I had already decided to wean to formula if the Reglan she loaned me didn’t work.

  2. Pingback: Motherlode Blog: Is Breast Still ‘Best’ When It’s Another Mother’s Milk? | Cliff Jordan Films

  3. Thanks for your take on this. I fed my baby donor milk from three trusted sources (two friends and a friend-of-a-friend) before switching to formula. I also know others who have accepted donor milk from a multitude friends and strangers. It’s a calculated risk and I have not seen evidence of harm. BUT I agree with you that this study holds some potential. I often hear the oft-repeated WHO recommendation that women should seek out donor milk before considering formula. The implication is that breast milk’s magical healing powers should overcome any potential risks. this proves that this is not true. And I agree that there is a dearth of information out there about safe breast milk storage, pumping, etc …

  4. Pingback: Motherlode Blog: Is Breast Still ‘Best’ When It’s Another Mother’s Milk? | test site

  5. Adoptive mom here. I fed a combination of formula and milk donated through Human Milk for Human Babies, a connection developed through a mutual friend that created a friendship. I was blown away by my donor-friend’s extensive knowledge of safety protocols for storage and feeding of donated milk, and she kindly shared very detailed instructions with me. Another area of hypocrisy surrounding this article is that some of these problems may be in improper storage and use, something that can be overcome by education. The source I read had NO INFORMATION about safe procedures, and that struck me as revealing more interest in shaming or criticizing choices than in actually helping people stay safe. Of course, different articles/sources may have included that information, and I hope they do!

  6. I agree…I think donor milk can and should be a valid choice, except that in its current form, it is not safe enough. Breast milk is a bodily fluid and should be treated like blood…screened, stored and transported safely for the safety of everyone involved. I don’t have the answers for how this could be done in an affordable way but perhaps some women are willing to pay for the option of breast milk, and wouldn’t be bothered by the cost, I don’t know.

    • I also agree with AmyM. I’ll admit that this topic is particularly frustrating for me because of the drive bys and trolls telling formula feeders to just get breastmilk from a stranger on the internet rather than use (regulated, tested) formula. That alternative is unacceptable to me. And only magical thinking that exaggerates the benefits and properties of breastmilk justifies this behavior. When truly, many of the benefits are lost when the milk is frozen and reheated, when it is pasteurized properly, when it is fed in a bottle (which to my knowledge is the real risk factor for ear infections). We also hear how the mother’s milk changes to accommodate her baby’s needs, which is another benefit that is lost for donor milk. So these benefits are lost, but for informal milk sharing, additional risks are taken on, particularly the transmission of disease. Donor milk banks mitigate these risks. They should be supported and expanded so all preemies and medically fragile babies have access to breastmilk. But this will never be an affordable and practical solution for those who have no medical need but simply want their babies to never be exposed to a drop of evil formula.

  7. I agree with AmyM. Donor milk in theory should be a choice but at present it just isn’t safe enough. There was a woman in the article who fed her child milk from 30 different donors. To me this is analogous to having unprotected sex with 30 different men, especially since HIV can be transmitted through breast milk. Milk banks that properly screen donors are wonderful, but buying milk from strangers on Craigslist when you have no idea of their HIV status, drug/alcohol history, whether they are properly storing milk, etc. is scary.

  8. As usual, a terrific article and very balanced. I am not anti-milksharing at all and I do think that this study looked at some rather “worst-case-scenaior” samples, but I think that strict rules of hygiene and protocol are essential. Too many people are guilty of thinking that hygiene somehow doesn’t matter when it comes to breastmilk. EBM does have some useful bacteria-zapping capabilities, but it’s still food; if you collect it in grubby conditions, it will spoil and potentially become pathogenic.

    By the way, here is the abstract of the original paper, for anyone who wants to read the original research this was based on.
    http://www.ncbi.nlm.nih.gov/pubmed/23971685

  9. I think donor milk should be an option for parents who prefer breast feeding but do not have their own or not enough milk. But as other people mentioned in previous comments as well, safety is a big concern too. How to collect them, how to store them safely and how to distribute them so other parents can have access to it. Of course it has to be affordable, otherwise, most parents probably just go with formula.

  10. “many people worry about the GMOs in formula. And yeah, most formulas contain ingredients derived from genetically modified corn, soy, and other foodstuffs.”

    So what?

    Many people worrying is not evidence that worry is warranted. That’s an appeal to the masses fallacy. I don’t care if the masses worry about GMO foods. GMO foods are safe. It is a safe process. It is a controlled process that eliminates the needs for potentially thousands of generations of selective breeding to achieve the exact same results “naturally.” We can’t obtain any agricultural specimen via genetic modification that we couldn’t eventually obtain by traditional breeding methods.

    “Many worriers” are less reliable to me than scientific evidence produced by geneticists who use this technology.

    “But we have no evidence that babies fed these formulas suffer any ill effects from these tiny amounts of GMOs”

    Of course we don’t. Why would they? GMO’s are not pathogens. They are not infectious. They do not have the potential to cause disease.

    Gram negative Streptococcus, Staphylococcus and Coliform bacteria are likely to be pathogenic.

    Cytomegalovirus is a pathogen.

    These things all have the distinct potential to cause disease in humans, particularly in human babies.

    This is a poor analogy.

    It is unlikely that the dangerous pathogens originate in the donor breastmilk itself, and more likely that insufficient cleaning of breast pump parts, or inadequate refrigeration during storage or shipping is the source of the contamination.

    • I agree. But there are other things that could originate with the donor like allergens, or drugs (not necessarily street drugs, but prescription drugs the recipient mother would not be comfortable with her infant ingesting, if she knew they were there.)

    • “We can’t obtain any agricultural specimen via genetic modification that we couldn’t eventually obtain by traditional breeding methods.”

      This isn’t true. For example, rice contains no beta carotene, so it’s impossible to introduce it without genetic engineering.. Well, that’s what they say in the article. You could say that in theory it’s possible, but given that over all the time humans have been cultivating rice we haven’t found any variety that produces beta carotene, the chances of getting a beta carotene gene within a reasonable amount of time are very small.

  11. “it’s really hard to keep a lid on one’s anger when the media takes a 5k story and runs a marathon with it, without any consideration for context or nuance.”

    This is a great way of putting it! I may have to steal that phrase…

  12. Have you seen this 2009 study? http://www.ncbi.nlm.nih.gov/pubmed/20231217

    Results: Of 1091 potential donors, 3.3% were positive on screening serology, including 6 syphilis, 17 hepatitis B, 3 hepatitis C, 6 HTLV and 4 HIV.

    Conclusions: There is a significant incidence of positive serology among women interested in donating human milk. This implies that there may be significant risk associated with peer-to-peer distribution of human milk from unscreened donors.

  13. I would only do donor milk if it was from people I knew and trusted. I would definitely be concerned about using milk from strangers. I’m currently formula feeding my fourth baby. I gave her my pumped milk for 3 months, but she got a lot of gas from it despite my doing my best with my diet. So, I weaned to formula. I think you take a risk if you give milk from strangers. It’s like when you do a blood transfusion. You can’t be sure what’s in there and what could be passed on to your baby as far as diseases known or unknown and if it’s done outside of a milk bank, you can’t be sure of the bacteria as this study showed. I won’t judge anyone for their decisions because we are trying our best to care for out children, but that’s my thoughts on this.

  14. Pingback: FFF Recap 2013: What we learned about infant feeding (or didn't) this year - Fearless Formula Feeder

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