Michelle Angeletti, MSW, Ph.D. Professional Liaison Research Associate for the LLL Alliance for Breastfeeding Education Area Network and Mary Francell, Area Professional Liaison for LLL of Georgia, USA.
In recent years, there has been a proliferation of social media and Internet sites where breastfeeding mothers can informally share breast milk. Mothers today tend to be web savvy and even if they are not involved in milk-sharing activities, probably most are aware of them. They may also be aware that the World Health Organization1 refers to “breast milk from a healthy wet-nurse” as an alternative to a mother’s own breast milk. As a Leader, you may have been approached by a Group member wondering how she can become involved in informal milk sharing—either to donate or receive milk. You may wonder whether it is even appropriate to discuss informal milk sharing with mothers. In this article, Michelle and Mary discuss the role of the LLL Leader and La Leche League International’s revised policy on this issue from a US-perspective.
In March of 2015, the LLLI Board of Directors revised the LLLI policy regarding the sharing of human milk. The Milk Donation policy states;
When a mother contacts a Leader seeking to acquire donated milk or to discuss personal options, the Leader’s role is to respond with information and support about the benefits and risks of such practices of induced lactation, relactation, wet-nursing, or cross-nursing.
When a breastfeeding mother asks for information about milk sharing, she may have a large milk supply that she would like to share or she might want to seek milk from other mothers. If the latter, a Leader can explore whether the mother could provide her own milk to her child with information about how to increase her milk supply or relactation. As with any other type of situation, our goal as Leaders is to help the mother make the best decision for her family based on the options available to her.
Increasing a mother’s milk supply
The mother may not be aware that simple measures, such as putting her baby to the breast more frequently, improving the latch, or trying breast compressions, often help to increase milk supply. A Leader can also explain that providing donated milk to her child can interfere with the mother’s natural supply-demand function that regulates her milk production. Like formula, providing donated milk can have the unintended consequence of decreasing a mother’s own supply.
The policy also states that a Leader can offer information about induced lactation, which is the initiation of milk production in a woman who has never been pregnant, or relactation, which is defined as increasing milk production in a woman who has been pregnant. Information on these topics is available in The Womanly Art of Breastfeeding, 2010, pages 354–362. If a Leader feels as though this is beyond her area of expertise, her next step would be to contact the Professional Liaison (PL) Department2 for support or to refer the mother to a lactation consultant.
The policy goes on to state:
If a mother is interested in donating her milk or in receiving donated milk, the Leader should urge the mother to investigate various ways of donating and acquiring human milk. The mother should be encouraged to make an informed decision that is best for her and her baby and meets cultural expectations. A Leader may provide contact information for non-profit human milk banks, other regulated collection centers, and formal/medically supervised or informal milk-sharing networks. Protocols for the careful and safe collection and handling of human milk are the responsibility of milk banks and networks, and the Leader should encourage the mother to evaluate these protocols. It is not the responsibility of LLL Leaders or LLLI to license, recommend, or assess milk banks or networks, but to share information with mothers.
Leaders can help parents become aware of the myriad options regarding informal milk sharing. Some mothers (or adoptive fathers) work out an arrangement with one or more donors they know personally. Some use milk-sharing websites such as Human Milk 4 Human Babies or Eats on Feets. Some flash-heat donated milk at home and some choose to use it raw. It is important to inform parents of various possibilities and encourage them to research each option thoroughly before deciding what to do. Among other things, parents need to be aware of the possibility that milk that is purchased from an unregulated source (rather than donated) may be “made to go further” with ingredients other than human milk.
If a mother is interested in donating milk, the Leader might point out that in addition to various forums for informal milk sharing, many countries have regulated milk banks (where most human milk goes to premature or sick babies). Some countries organize their milk banks into milk banking associations eg the Human Milk Banking Association of North America (HMBANA) or the European Milk Banking Association (EMBA). In countries such as Brazil, France, and Germany, banked human milk has been incorporated into public health policies.
Questions to ask
It can be useful to provide parents with questions to help them evaluate an informal milk sharing arrangement, particularly if the mother is considering obtaining milk through classified ads or other anonymous donation sources.
How will the milk be collected and stored, what containers will be used, and will the containers be dated so the age of the milk can be determined? What hygienic practices will be involved in the expression, storage, and overall handling of the milk? If the baby receiving donor milk is preterm or ill, are special collection protocols required? If the baby is preterm or ill, are they aware that donor milk from a licensed milk bank may be covered by their health insurance? Will the milk be received fresh or frozen and how will it be transported or shipped? Does the donor smoke, drink alcohol, use recreational drugs, over-the-counter preparations or take prescribed medications?
Does the donor’s diet include potential allergens? Has the donor had her blood tested recently for HIV, HTLV, Hepatitis B and C, CMV, and sexually transmitted diseases? Can the donor provide documentation of such testing and a letter from her doctor about her general health (perhaps including a medical history) and ability to provide milk while breastfeeding her own baby? Has the donor been diagnosed with any other illnesses or has she had any tattoos or body piercings in the last 12 months?
The list of questions to ask (above) does not cover all eventualities. For a thorough list of screening questions, parents can contact a human milk bank or blood screening facility. Some of the online milk sharing sites may also include donor screening tools. There is a sample donor medical history screening form on the informational website Milk Share. In the UK, NICE3 guidance can be found in Donor breast milk banks: the operation of donor milk bank services. In the US the Leader could share that the US Food and Drug Administration (FDA) advises against informal milk sharing due to concerns that the milk will not have been adequately screened for infectious disease or contamination. The FDA’s Use of Donor Milk is available online. Leaders can share official recommendations in their part of the world and discuss the importance of screening milk donors, including family and friends, who may be unaware of or too embarrassed to reveal personal health information that could affect the safety of their milk for another baby. Infectious agents, like bacteria or viruses, can be found in the milk of seemingly healthy, asymptomatic4 women. Not every country will have official recommendations. In that case, the Leader can contact the PL Department of her Area.
Medications in mothers’ milk
An important risk involved in accepting donor milk is the possible transfer of medications into milk. Leaders can encourage a mother to consult her baby’s health care provider about the safety of a medication for her baby. See Breastfeeding and Medications for a summary of books, reputable websites, and international helplines for checking the compatibility of medications during breastfeeding.
Handling discussions on social media
You wake up one morning to find that mothers have been happily sharing websites such as Eats on Feets and Human Milk 4 Human Babies on a Group Facebook page. What’s a Leader to do? Share information, of course!
First, it’s important to state that La Leche League Leaders are not allowed to facilitate a milk-sharing network and will need to ask the mothers to please move such a discussion to another forum. However, LLL Leaders are able to provide information and support to mothers who wish to explore this option. Be sure to inquire why milk sharing is being suggested and, if appropriate, share information on breastfeeding management or induced lactation.
Next, discuss the risks and benefits5 of donor milk. In addition to the FDA’s Use of Donor Milk, one useful resource on the risks might be: Milk sharing and formula feeding: Infant feeding risks in comparative perspective? Another helpful source of information on minimizing the risks of peer-to-peer milk sharing is the Four Pillars of Safe Breast Milk Sharing by the founders of the U.S. based organization, Eats on Feets.
Informal milk sharing can be controversial. However, without being involved in any milk sharing in practice, Leaders can still do what we do best: provide information and support to mothers.
The LLLI policy also says
It is always important for the Leader to encourage the mother to talk with her own and the baby’s health care providers about their particular situation.
If a Leader knows that a mother plans to participate in an informal milk sharing, cross-nursing, or wet-nursing arrangement, she can encourage the mother to work with a health care provider who is knowledgeable about screening and testing milk donors to confirm a donor’s physical health.
Importantly, the LLLI policy states that:
A Leader should never use her position as an LLL Leader to set up any type of milk-sharing network.
While Leaders should provide information and support to a mother about informal milk sharing, Leaders must not be involved in linking mothers willing to donate with mothers requesting milk. This statement serves as the proverbial “line in the sand” that Leaders do not cross.
As Leaders, LLLI liability insurance covers our volunteer service only while operating in accordance with the policies and guidelines of LLLI. In the case of informal milk sharing, our role is to provide information and support. If we facilitate informal milk-donation arrangements or act as an intermediary, we may not be covered under LLLI liability insurance, as these practices are not in compliance with LLL policies and guidelines. For example, if a mother shares milk at a meeting (or in the meeting location before or after a meeting) and it results in harm to a child, it is possible that the Leader could be named in any lawsuit that resulted from the situation. In this type of case, it is unlikely that the LLLI attorneys and insurance company would conclude that they are responsible for the Leader’s defense. Leaders are encouraged to consider these types of situations from a risk management perspective before making a decision. Your local Professional Liaison Department is available to help with these situations as well.
While working with mothers, remember to focus on supporting the mother and her breastfeeding relationship. Also remember that our goal is to offer information and options, not advice and recommendations. By providing multiple perspectives on the topic, parents will be empowered to develop their own conclusions and make decisions that are best for their family. Leaders have a unique opportunity to support mothers with a variety of problems. We can help mothers identify challenges and develop creative plans to avoid or overcome them.
Michelle Angeletti is a La Leche League Leader, Area Professional Liaison (APL) for LLL of Florida and Caribbean Islands, USA, and Professional Liaison Department Research Associate (PLDRA) for the LLL Alliance for Breastfeeding Education Area Network. She is an Associate Professor of Health Services Administration at Florida Gulf Coast University.
Mary Francell is the mother of three breastfed children. She has been a La Leche League Leader for 20 years and is currently Area Professional Liaison for LLL of Georgia, USA. Mary is studying to take the International Board of Lactation Consultant Examiners (IBLCE) exam this summer and plans to open a private lactation practice.
1WHO, UNICEF. Geneva: WHO; 2003. Global Strategy for Infant and Young Child Feeding.
2The PL Department serves as a resource for Leaders working with mothers. It is important to remember to contact the PL Department yourself and then relay the information to the mother. This procedure allows the mother to stay connected to you, her local Leader, and allows you to gain new knowledge and skills.
3National Institute for Health and Care Excellence
4Showing no symptoms of disease.
5See The Science of Human Milk and Kellymom have a number of resources discussing the benefits of breast milk.
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