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.

 

 

 

 

 

 

A couples therapy session for Science and fed-up parents

You know how I’m always harping on and on about how we could be doing studies that actually help us protect infant health, rather than guilt-tripping mothers? My fairy godmother must’ve been listening, because today I stumbled upon an interesting article, courtesy of Mammals Suck (maybe she is a fairy godmother? Scientists can be fairy godmothers, can’t they?)

Featured on Nature.com, the article described two findings about the sugars in breastmilk. The first discovery was that one of the human milk oligosaccharides (HMOs) – the sugar molecules present in breastmilk –  can actually increase the chance of mother-to-child HIV transmission.

The molecule, called 3′-sialyllactose (3′-SL), is found in varying concentrations in the milk of different women. In a study in Zambia, HIV-negative newborns breastfed by HIV-positive mothers are twice as likely to catch the virus during their first month of life if the mother’s milk has an above-average level of 3′-SL1.

Doesn’t sound like the most positive news, but wait: only certain women’s milk contains significant enough levels of the sugar to place their babies in danger. Plus, other sugars have a positive effect:

The same study in Zambia found that five more of the 150-odd complex sugars in breast milk seem to have a protective effect. HIV-negative infants who consumed these sugars had a better chance of reaching their second birthday than did HIV-negative babies who drank breast milk lacking those sugars irrespective of their mothers’ HIV status. (Once a baby had caught HIV, however, breast-milk sugars had no influence on survival.)

 

The second part of the article described research into why some babies are not able to fight off necrotizing enterocolitis (NEC), despite being fed human milk. Breastmilk contains oligosaccharides that fight off this deadly infection – but as it turns out, not all women produce these sugars:

 (A team) reported an association between a dangerous gut disease in babies called necrotizing enterocolitis (NEC) and the inability of affected infants to secrete a suite of oligosaccharides in their mucus. These babies are considered particularly likely to benefit from drinking the sugars via breast milk, but about 10% of European women cannot make them in their milk…

 

Okay, so this is where it gets really interesting. Both of these examples suggest that depending on the composition of a particular woman’s milk, the health benefits of breastfeeding may not be identical across populations. A researcher quoted in the article hypothesized that “(t)he often confusing literature on breast feeding’s impact on disease will be largely explained by this underestimation (of the variation in human milk).” The article also explains how “(s)everal labs are trying to identify how variation in the prevalence of the large sugar molecules in breast milk… influences infant health. Once clear links are established, clinical trials to test HMOs as health-boosting additives in infant formula milk can be drawn up.”

Say WHAAAAAAAAT??

Yep, you read it correctly, FFFs. And I think we can all take a moment for a collective sigh of relief. Not all researchers are so entrenched in their  public policy advocacy efforts that they forget to see the forest for the trees! Not all lactation scientists are lactation consultants! Some are – dare I say it – scientists.

I fear that this is the type of research that gets pushed under the rug, because it requires critical thinking. There isn’t an easy soundbite that can appeal to the masses – in the first example, the answer is not to tell HIV+ women in developing countries to use formula until they are tested for the specific HMO, because formula feeding in resource-poor countries with contaminated water is a high-risk activity. But perhaps more research could lead to some sort of treatment which would help these women lower their levels of 3′-SL and increase the beneficial HMOs.

Similarly, what if a preemie’s mom wanted to get her breastmilk tested to see if it contained the necessary HMOs to protect her baby? And if she found that she was part of the 10% who didn’t produce these beneficial sugars, perhaps that could allow her to make an informed decision about using donor milk, while either pumping to keep up her own supply, or deciding to switch to formula once the baby was older.

Research like this allows for progress. It allows us to understand exactly what it is about breastmilk that makes it so beneficial, which might lead to better, more biologically “equivalent” options for women who can’t or choose not to breastfeed. But even taking it away from the infant feeding choice powderkeg for a minute, I think it’s an interesting thing to ponder why certain people are so uncomfortable with the suggestion that not all breastmilk is perfect milk. I mean, I understand it – who the hell is science to tell a woman that her milk isn’t “good enough”?

But people – this is exactly why we can’t be wishy-washy about whether breastfeeding is a personal act or a monitored, medicalized event. If we are going to pitch it to women based on statistics, telling parents that science has proven the medical necessity of nursing our young, then we must accept the risk that science could turn around and say “erm, you know what? I messed up. That’s only true for some women. Some gals just produce inferior milk.” While we might want to say screw you, science, and the horse you rode in on, we can’t. Because we used science in some very dirty ways when it suited our needs, and now it is hanging around like a rebound boyfriend who just doesn’t take a hint.

On the other hand, if we don’t allow medical authorities to lay down moral indictments based on the way we feed our babies, then we can easily kick science to the curb when it tries to tell us that our milk may not be all it’s cracked up to be.

Personally, I don’t think either scenario is great. As that Facebook group with the funny memes says, I f**king love science. Because I don’t think it’s true science that is messing things up for women. I think it is zealotry dressed up as science – people who are so committed to a cause that they are unable to come into research with the open, curious mind so integral to the scientific process.

So, I think as women, as mothers, it is safe for us to applaud research like this. We have to trust that knowledge can be power, as long as it is handed to us free of extrapolation. It’s not scary to hear that formula fed babies aren’t protected from NEC if donor milk is made available to preemie parents, or if we know that good old science is doing its best to create a supplement that could offer our tiniest babies protection regardless of the quality or quantity of a new (and often highly stressed, given the circumstances) mother’s pumping efforts. It’s not guilt-inducing to hear that breastfed babies have a higher IQ if we know exactly why this is – if it is an association, or something about the physical closeness during the act of nursing (which could easily be recreated by a bottle-feeding parent using a bit of imagination and less clothing) or something specific in the milk (in certain milk? Do some women increase their baby’s intelligence, and some women decrease it? Who the heck knows until we look into it?).

We can’t be scared of science, and we can’t abuse it. And scientists can’t be scared of staying neutral, and can’t abuse their power. If we can give each other this mutual respect, maybe we can turn this into a beautiful relationship. Even if it did start out as a rebound…

 

 

Mammary Mania: Podcast approaches lactation science as the science it should be

I just listened to a podcast of a fascinating interview about breastmilk, courtesy of Skeptically Speaking. Interviewer Desiree Schell spoke with Dr. Katie Hinde, an Assistant Professor of Human Evolutionary Biology and the Director of the Comparative Lactation Laboratory at Harvard University. The newest of my internet crushes, Hinde offers a unique perspective on the science behind breastmilk with a level of sensitivity and realism that is unparalleled, as far as I’m concerned.
Take a listen for yourself – it’s well worth the 15 minutes. But in case you just want the Cliff’s Notes, here are the FFF-related highlights:
  • Hinde points out that while there is a good deal of lactation research going on in the world, much of it is agenda-driven. The science is mainly coming from three areas: breast cancer research (which tends to focus on rats, who have similar mammary development to humans), the dairy industry (fixated on how to maximize milk production in cows) and from the infant feeding world (looking at tiny humans and their mothers).  Within the last category, Hinde notes that both sides have clear agendas – one is trying to increase formula sales, and the other has “anti-formula aspects, that no matter what, breast is best.”  “Both ends of these spectrums are limiting,” she says. (To which I say, word. WORD.)
  • Research has shown that milk varies dramatically between women. Some mothers make high fat, low sugar milk; some have more cortisol (a beneficial hormone) in their milk; and so forth. Hinde explains that our milk is affected by what we’ve eaten and been exposed to for years prior to pregnancy and actual lactation, and that these lifestyle factors may create these differences in milk. Even the lactation process can vary across populations – Hinde notes that in America, studies have shown that many women do not have “copious milk production” until 72 hours postpartum, whereas in the less-developed world, the average time is much shorter. Considering doctors often step in at that 72-hour mark and recommend formula supplementation due to fears of dehydration or neonatal weight loss,  it would be highly beneficial to find out why this delay occurs. Hinde questions why there hasn’t been more research on these differences in lactation process and milk constituents among women.
  • While Hinde speaks about the power of breastmilk (and gives a really interesting explanation of just why breastmilk is so miraculous, absent of the usual hyperbole and backed by actual science), she also acknowledges that the decision to breastfeed is not made in a vacuum. And in what is probably one of the bravest statements I’ve ever heard made in a public forum about these issues, she argues that by finding out more about breastmilk, we can then create a better formula. “This is an important goal,” she states, because if women are unable to lactate, or have contraindications like HIV, “we need to make sure that the intervention (formula) is as representative as it can be for what (babies would be) getting from their mothers.” Now, obviously Hinde would argue that breastmilk is a superior nutritional choice, but the fact that she acknowledges the reality that some women are going to need formula, and that we owe these women and their children a better product…. well, let’s just say it made me tear up.
  • On the topic of breastfeeding support, Hinde muses that there is this idea that because lactation has evolved over millions of years, it should be effortless and natural. But “so is sex”, she says, and a lot of us aren’t so great at that to begin with, either. She suggests that by openly discussing the physiological problems so many mothers face when attempting to breastfeed, we could actually increase the amount of women successfully meeting their breastfeeding goals, because we would feel less overwhelmed and lost when these issues arise. (I like to think all of your FFF Friday stories are doing this, in some small way; that they not only make formula feeding moms feel more empowered, but also help women dealing with breastfeeding challenges find answers, solace, and community, as well.)

Dr. Hinde is exactly what is needed in the world of lactation science – a true scientist, able to approach her research with nuance and a wider perspective.  Check out her blog, Mammals Suck…Milk and take a listen to the Skeptically Speaking podcast (Schell, the interviewer, is also pretty darn rad, and manages to guide a potentially science-y interview into a very accessible and entertaining listening experience) to gain a far more thorough understanding of mother’s milk that makes you think instead of wanting to hurl your computer at the wall.
Speaking of thinking, this interview made me ponder about the types of studies that would be truly helpful for infant feeding research. How about a large study examining differences in children of non-breastfeeding mothers, randomly and blindly assigned only expressed donor breastmilk from bottles or a DHA/ARA containing, partially hydrolyzed formula (since this type seems to be the one that fares best in the studies which have been done), essentially ruling out all confounding factors? Or, what if we did intensive interviews and examinations with women who suffer from insufficient milk or delayed milk production, compared to controls that have no problems? Looked into their social, emotional and physical histories, and tried to find a common thread. I’d also love to see studies of breastmilk composition from women on severe elimination diets compared to those with healthy diets. And the list goes on…
So, let’s play scientist. What types of studies would you like to see in the field of lactation science? What do you think would actually help women to breastfeed, or to make formula a better substance?

Dirty Milk

FFF Sarah, who is currently trying to induce lactation for her upcoming adoption, emailed me this afternoon with an interesting question:

So, I’m pumping all of this crap into my body in an attempt to see if I’m able to lactate.

Today, I was telling my husband why I buy x-type of dairy milk (b/c it doesn’t have rBGH)…I read him this tidbit from the dairy’s page:

rBGH is “recombinant bovine growth hormone” and also known as recombinant bovine somatotropin (rBST). Developed by Monsanto Corporation, rBGH is an artificial hormone that causes cows to artificially increase milk production.

We love our cows and believe that pure, natural milk tastes best and is healthiest for you. Here at Brown’s, our cows are not treated with artificial growth hormones like rBGH.

He said…”um…isn’t that what you’re doing? Taking stuff to artificially increase milk production? How is that good for a kid then?” I said I thought the ingredients were better, but honestly…I don’t know. Is it better? Do we know the danger of Reglan or Domperidone or Fenugreek or Blessed Thistle or any of the other crap we take in order to make milk or more milk for our babies?

Honestly, I had no idea how to answer this; however, I thought it was one of the most interesting questions I’d ever been asked. Even the mere concept of rBGH-free milk is worth talking about, and I can’t believe I’ve never thought about it before. Of course, we’ve discussed the fact that breastmilk can be a veritable smorgasboard of chemicals; in fact, scientists use this particular bodily substance for bio-monitoring (a way of measuring how many toxins are being stored in the human body). Typically, this concern is squashed by folks telling us not to worry, breastmilk is so amazing that it counteracts or cancels out all the bad stuff, or yelling at us not to peek at the man behind the curtain, like the titular dude in Wizard of Oz. (Read this article from Mothering.com to gain a frustrating, bang-your-head-against-the-wall understanding of why some breastfeeding advocates are fighting the trend of using breastmilk in bio-monitoring.)

So, isn’t it kind of funny that everyone is so concerned with the mercury in fish; the hormones in beef and milk… and not the food our own bodies produce?

There is ample proof that what we eat, breathe and absorb goes through our breastmilk. In fact, the NRDC has an entire website dedicated to the chemicals present in breastmilk, and they admit that “infant formula contains far lower quantities of dioxins, PCBs and organochlorine pesticides than breastmilk”. Of course, they go on to assure mothers that “formula has serious drawbacks that tip the scale against it”, and then list all the “risks” we have discussed on this blog, time and time again. The chemical contamination dangers they cite pertaining to formula are “contamination with substances such as broken glass, fragments of metal and salmonella and other bacteria. The fungal toxin aflatoxin has also been detected in some commercial formulas. Although detected levels were very low, this toxin is known to cause cancer and is not present in breast milk. Infant formulas also may contain excessive levels of metals, including aluminum, manganese, cadmium and lead.” However, many of these contaminants are avoidable if we could improve manufacturing processes; the first few listed, when discovered, led to recalls.

The important message here should not be choose formula over breastmilk, or vice versa. It should be, let’s all become more aware of the chemicals our babies are exposed to. Formula is a product; if we want to discuss the chemical contaminants in formula, we can address manufacturing processes, corporate responsibility, quality assurances, ingredient sources, etc. If we want to discuss the chemical contaminants in breastmilk… well, chances are we won’t be discussing that, because its tantamount to yelling fire in a crowded movie theater. Us girls are, like, panicky and hysterical, dontcha know?

Back to the original question which spawned this post, though. It’s one thing to worry about chemicals we have no real control over; quite another to discuss intentionally ingesting something potentially harmful to increase milk supply or induce lactation in the name of Liquid Gold. But could Reglan, Domperidone, Fenugreek, or Blessed Thistle really be harmful? Doctors prescribe them for nursing women all the time, and these folks would never prescribe something that they don’t know 100% for certain won’t harm a baby, right?

(Pause for diabolical laughter…)

Fenugreek and Blessed Thistle are probably the least concerning of these substances, as they are herbal remedies. However, while NIH’s Medline Plus cites “increasing breastmilk quantities” as one of Blessed Thistle’s uses, they also warn, “Don’t take blessed thistle by mouth if you are pregnant. There is some evidence that it might not be safe during pregnancy. It’s also best to avoid blessed thistle if you are breast-feeding. Not enough is known about the safety of this product” and list “irritat(ion of) the stomach and intestines” as a possible side effect. As for Fenugreek, Kellymom warns that while “(m)ost of the time, baby is unaffected by mom’s use of fenugreek (except that more milk is usually available)”, sometimes “baby will smell like maple syrup…some moms have noticed that baby is fussy and/or has green, watery stools when mom is taking fenugreek and the symptoms go away when mom discontinues the fenugreek. Fenugreek can cause GI symptoms in mom (upset stomach, diarrhea), so it’s possible for it to cause GI symptoms in baby too.” A search on WebMD’s database found that “(s)ome reports have linked fenugreek tea to loss of consciousness in children”.

(I feel I should interject here to remind everybody that just like everything else we discuss on here, we should look at these warnings in terms of relative risk. If you read the possible side effects on a bottle of Children’s Advil, it’s a hell of a lot scarier. I’m merely trying to illustrate a point, so bear with me, please, and don’t panic if you’ve been binge-drinking Fenugreek tea.)

Reglan and Domperidone carry more severe warnings. Reglan is one of those drugs that repeatedly come up on litigator’s websites (never a comforting sign), and it has been suggested that it can cause a condition called Tardive Dyskinesia. As one of the litigators explains, “Before Reglan was released, the FDA only approved its use for 12 weeks at a time, which means that women who are breastfeeding are at an even higher risk for developing TD because of the timeframe spent breastfeeding.” (Ironically, I found a really great opinion piece about the relative risks of Reglan on another of these lawyer sites. Go figure.) Perhaps a more real-world concern – and definitely one that worries me a great deal, what with PPD being such a real threat to new moms – Reglan is also linked with depression.

Domperidone, a drug typically used for cancer patients or those with gastrointestinal issues, does seem to be a safer bet, although on a UK site detailing the prescription use of Domperidone, it clearly states that “this medicine passes into breast milk in very small amounts that are not expected to be harmful to a nursing infant. However, the medicine is not recommended for use in women who are breastfeeding unless the potential benefit to the mother outweighs any risks to the nursing infant. Seek medical advice from your doctor.” If that doctor happens to be breastfeeding guru Jack Newman, you’ll be reassured that it is indeed safe (“Worldwide experience with domperidone over at least two decades suggests that long-term side effects also are rare. Some of the mothers in our clinic, breastfeeding adopted babies, have been on the medication for 18 months without any apparent side effects…patients using domperidone for stomach disorders may be on it for many years. I hope you won’t need domperidone for very long, but if it’s necessary and helpful, stay on it,” he breezily suggests, adding links to back him up (nearly all of which are dead links, btw, save for one study which simply proves that Domperidone increases milk supply. Sort of a moot point, don’t you think?)

If a mom needed to take either of these drugs for a medical condition, I would think the benefits absolutely outweigh the risks. Aside from the depression risk, neither seems to be that scary, especially when you consider Reglan was discussed as a potential therapy when my infant daughter was suspected to have delayed gastric emptying (so one would hope it isn’t all that toxic to babies).

But we’re talking about selectively consuming these drugs in order to do something which is often marketed to women as the “natural” choice, the “biological norm”. If a woman wants to breastfeed, I would totally understand her desire to try these drugs, and more power to her. If a woman feels like she has to breastfeed, and has to take these medications in order to fulfill her biological and maternal responsibilities, that’s another story. And regardless, let’s stop the hypocrisy and ignorance so prevalent in the way we view and discuss breastmilk. If it is full of chemicals, the answer is obviously not to discourage breastfeeding, but shouldn’t it also be obvious that we can’t ignore the problem? Likewise, if someone has to take medication in order to breastfeed, we need to support her in her goals in whatever way we can, but we also need to ensure that she has adequate research on her side that proves she is not putting herself or her baby at risk.

Breastmilk, left to its own devices, is one of the most amazing and purest foods in the universe. Unfortunately, we live in a time when pretty much nothing has been left to its own devices. Nobody is saying that breastfeeding isn’t worth it, but in the world we currently inhabit, I don’t think we should view breastmilk as unadulterated, absolute perfection. It can be corrupted, like any biological substance.

So, FFF Sarah’s husband… I’m not sure what the answer to your question is, exactly. But I can tell you that while writing this, this image kept running through my head of one of those “Not treated with rBST!” messages stamped on a nursing bra. Thanks for that, buddy.

Milk sharing, shmilk shmaring

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.

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