Mothers Search for New Sources of Breast Milk

After San Diego mother Sarah McNeill researched the health properties of breast milk, she wanted those benefits for her baby. "Just because he was adopted, my little one should not have to miss out on the antibodies and the health that breast milk provides," she said. But McNeill wasn't producing her own milk, so two months before her adopted baby was born she began searching for an alternate supply.

Many mothers such as McNeill with physical barriers to supplying milk for their child (for example, adoptive parents, whether male or female, or women who have undergone mastectomies) are turning to other sources of human milk rather than using infant formula. This comes as new studies show the unique health properties of human milk, along with increased funding for government-led programs encouraging women to breast-feed. Studies in recent years have touted breast milk's role in everything from lowering infant risk of respiratory illnesses to boosting immune systems and IQ numbers. "Women are starting to get the message that mother's milk is really important," says Nancy Mohrbacher, a board-certified lactation consultant and coauthor of Breastfeeding Made Simple: Seven Natural Laws for Helping Mothers.

Milk banks are one place parents turn for supplemental milk. (Estimates of U.S. mothers who cannot physically produce enough milk for their offspring vary. Many women lack support for breast-feeding after they leave a hospital, so it is difficult to know whether those who report insufficient milk are unable to produce, or need help increasing production). Banks take donations from mothers who have pumped extra milk, and combine and pasteurize it to provide milk for babies in need. The banks rigorously screen donors because human milk, like blood, is living tissue, and can transmit diseases such as HIV, hepatitis B, cytalomegalovirus, and bacterial infections. They test donor blood and review health histories, including donor medications, alcohol and tobacco consumption, and lifestyles.

The 10 Human Milk Bank Association of North America (HMBANA) banks saw a nearly fourfold increase in milk distribution from 2000 to 2009. "Demand is far outstripping supply," says Pauline Sakamoto, a registered nurse and executive director of the nonprofit Mother's Milk Bank in San Jose, Calif. Much of that growth is due to an upswing in physician acceptance of donor milk—doctors requested more than half of the milk distributed by HMBANA banks for preterm infants in neonatal intensive-care units. (Mothers whose babies are born prematurely often don't yet have their own milk supply).

But without a prescription and generous health coverage, milk from a bank is out of reach for many parents. Shipping and screening milk is expensive, and prices can reach more than $3 an ounce. An infant may drink 30 ounces a day. "It was out of the question, too expensive for me," after the cost of adoption, says McNeill. Her search for alternatives led her to the Milk Share Web site, where mothers post notices offering their milk (free donation only), and those looking for milk post requests. For the past six months, McNeill has fed her son exclusively with milk from donor mothers she found on the site. Other parents locate donors through neighborhood moms' groups, friends, or other online parenting forums.

Donors are often grateful to find someone who wants what many mothers call "liquid gold," milk that might otherwise go to waste. "I'm a bit of an overproducer," says Lynne Feldman, a mother in western Massachusetts who has FedEx'd 250 frozen ounces of her own milk on dry ice to another mother in California. Feldman learned about sharing through her own problems nursing her newborn. (Breast-feeding was so painful for her she compared it to "extending out your arm for someone to put out a cigarette on it repeatedly.") She solved her issues by pumping milk and bottle-feeding her child, but wanted to share what quickly became an excess supply. "I feel quite lucky I've been able to do this," she says.

Still, many medical and breast-feeding professionals express concern at the risks of using unregulated donor milk. The screening process suggested on Milk Share encourages parents to follow the same procedures as milk banks, but not all do. Milk can also be tainted during the transfer from breast to bottle or storage bag, or if it is stored improperly. Some recipients hesitate to probe into the personal lives and hygiene of their donors, and many are specifically opposed to pasteurization, which may also reduce beneficial bacteria in milk. "Pasteurization defeats so many of the purposes of getting breast milk," says McNeill, who says her donors have been quite open about tests, medications, and diet, and that meeting the mothers and their children is an important part of her screening process.

In an effort to learn to gauge the safety of informal breast-milk sharing, a study by Mother's Milk Bank in San Jose and Dr. Ronald S. Cohen at Stanford University tested the blood of mothers who had already undergone rigorous screening as potential donors by the bank and found that 3.5 percent of blood samples tested positive for viruses. (Milk banks conduct such tests on all mothers and refuse donations from those who test positive). Pauline Sakamoto, who worked on the study, adds that the tests hadn't even looked for bacteria, only viruses. "The risks of milk sharing are real," she says. "These are things we can't necessarily treat and cure."

Mohrbacher says most lactation consultants won't recommend milk sharing, because of the risks. "Milk-bank milk would definitely be the better choice," she says. La Leche League International (LLLI), which helps mothers with breast-feeding support, forbids LLLI group leaders from suggesting "an informal milk-donation arrangement, including wet-nursing or cross-nursing," though if a mother asks they can "provide information about the risks and benefits" of these practices.

Mohrbacher believes improving institutional support, such as free postpartum health care and paid maternity leave, is the best solution for getting safe milk to all children. And Sakamoto points out that increasing the number of banks could significantly lower costs, since shipping of milk is one of the largest milk-bank expenses. "It shouldn't be women pitted against women," says Mohrbacher. "It should be women working together to change the system."