Is any breast best?

Every two weeks or so, Stefanyie Hamilton announces to her husband, Elliott: “I’m going to the store to get milk.” She loads her three kids — Corban, almost three, and 10-month-old-twins, Aviyah and Elijah — into her minivan, along with her trusty blue Coleman cooler. Sometimes the “store” is in her hometown of Hamilton, Ont., other times it’s in Buffalo, NY, or the Ontario towns of London, Woodstock, Thorold or Welland. When she gets to her destination, she meets with a mom she has previously only corresponded with on Facebook. After a bit of chit-chat, Hamilton loads up her cooler with breastmilk, sometimes as much as 300 ounces, and hits the road.

She is one of a growing number of parents who, faced with a low milk supply or factors that make breastfeeding difficult or impossible, go to great lengths to feed their babies donated breastmilk. While the concept of feeding an infant another woman’s milk isn’t new (wet-nursing was a common practice before the 1950s), the Internet has given it a modern-day twist, and raised new questions along the way.

Proponents say it’s a centuries-old practice that brings families together. Others say it’s a scary proposition that puts babies at risk. So if you can’t feed your baby your own milk, is donated breastmilk a viable option?

How online milk sharing works

Several websites and Facebook pages, including Human Milk 4 Human Babies Global Network (HM4HB) and Eats On Feets, connect parents in need of breast milk with moms who have extra.

The Canadian-founded HM4HB is the biggest network of this kind, with more than 130 HM4HB community Facebook pages in more than 54 countries.

A Facebook page is established for an area and is overseen by several administrators. Donors and recipients post information about their available milk and needs, and make their own connections and arrangements. The goal, says Vancouver-based founder Emma Kwasnica, is for parents to support one another in their own communities. “With mom-to-mom milk sharing, you know who you have helped. It’s about human connection.”

Donating vs. selling bodily fluids

In Canada, it’s illegal to sell bodily fluids, including breastmilk. In the United States, where selling is legal (with some stipulations from state to state), one ounce of milk can go for three dollars on the for-profit website onlythebreast.com. Since a one-month-old drinks about 36 ounces a day, the costs can add up. Actor Neil Patrick Harris, on The Late Late Show with Craig Ferguson in 2010, recounted how he and his partner bought breastmilk to feed their daughter. “They charge a fortune! It costs more for breastmilk than sushi!” he joked. But to some of the most devoted Canadian breastmilk donors and recipients, putting a dollar value on mom’s milk isn’t a punchline, it’s simply vulgar.

"That's gross!"

Regardless of the benefits or the source, there is still squeamishness around a baby drinking another woman’s milk. Mom Dani Arnold-McKenny of Brantford, Ont., one of the administrators of the Southwestern Ontario HM4HB page, admits she often gets a “that’s gross” reaction. Her response? “A hundred years ago, there was no ‘ick.’ It was just done. Women nursing each other’s babies was how babies survived.” And wet-nursing is still practised in certain parts of the globe, such as China and Indonesia.

Why donate breastmilk?

Amanda Grady has two children, two-year-old Xander and nine-month-old Rohan. While she struggled with low supply with her first, it’s a different story the second time around. “I have enough to feed two babies. I’m never going to use it all, so I might as well do something good with it.” Grady now pumps about 15 ounces a day, which she stores in her basement freezer. She checks her local Facebook page daily to see if she can make a “milky match” and has donated as much as 360 ounces at a time. “I watch my youngest grow in leaps and bounds thanks to my milk. If I can pass that on to someone else, that’s great.”

Why use donated milk?

Parents who use donated milk cite the proven benefits of breastmilk, including boosted immunity and nourishment tailor-made for human babies. “There’s so much value in breastmilk,” says Hamilton. “That’s why I drive all over the place to get it.”

What the experts say

Many medical experts aren’t swayed. The Canadian Paediatric Society (CPS) doesn’t endorse milk sharing outside of a milk bank setting, where donors are screened and the milk is tested and pasteurized. Like any bodily fluid, breastmilk can carry contaminants, infections and diseases, including HIV and hepatitis C.

“Non-milk-bank milk sharing makes me nervous,” says Sharon Unger, a neonatologist at Mount Sinai Hospital and co-author of the Canadian Paediatric Society’s position statement on human milk banking. “Mothers’ own milk is best for babies but formula is safer than informally shared milk; there are so many unknowns.”

Availability of accredited milk banks

Access to accredited milk banks for all parents who want to feed their babies breastmilk isn’t realistic. Back in the 1980s there were 23 banks in Canada. All but one, BC Women’s Milk Bank in Vancouver, were closed that decade amid fears of HIV contamination. Currently, only the sickest babies get the small supply that’s available. Toronto’s Mount Sinai Hospital, The Hospital for Sick Children and Sunnybrook Hospital have been working together to try to develop a milk bank. “In an ideal world, wouldn’t I love it if there was a huge milk bank that could provide milk to all the most vulnerable babies who really need it?” says Unger.

Screening processes

What “screening” means varies widely. In mom-to-parent milk sharing, the onus is on the parents to ensure the safety of the supply. “It’s up to parents to make the best decision for their babies,” says Kwasnica. “Women are capable of screening other women.” For some parents, simply seeing a donor feeding her own baby is enough to convince them to accept the donor’s milk. Others ask for medical records and blood tests. Hamilton, who estimates she has fed her twins breastmilk from 50 different women, asks donors if they smoke, drink or take medications, and has declined donations. Her friends have asked her if she’s worried about giving her babies food from virtual strangers. But she isn’t. “Donors aren’t out to hurt children,” she reasons. “They know the benefits of breastmilk.”

HM4HB posts detailed information on safe handling of breastmilk and information about potential risks, as well as how to pasteurize milk on a stovetop, which has been proven to kill HIV and certain bacteria. But this still raises red flags with Unger. “You don’t know if you’ve heated it enough or too little. The food that we consume has to go through rigorous protocols, and the only way that you can do that with breastmilk is through an accredited milk bank.”

Donor milk vs. mother's milk

Unger says there’s limited research on donor milk and that the exact benefits, particularly for older, healthy babies, have not been adequately studied. (She and her colleagues at Sunnybrook, SickKids and Mount Sinai are currently conducting a study to compare the long-term health benefits of donor milk versus formula on preterm babies.) For one thing, another mother’s milk is not the same as the mother’s milk. Milk from a baby’s own mother changes every day based on her baby’s needs and the environment shared by both mom and baby. Donated milk won’t have the same antibodies.

Not everyone can breastfeed

"The answer isn’t donating milk," says Unger, "it’s supporting moms. Why is it that 90 to 95 percent of new moms say that they want to breastfeed, but the rates of moms actually breastfeeding dramatically drop off?”

Teresa Pitman, a long-time La Leche League leader and former executive director of the group’s Canadian affiliate, agrees: “It’s not true that everyone can breastfeed. But before turning to donor milk, the question needs to be asked: Has everything been done to get breastfeeding working?”

That means access to breastfeeding information and assistance before the baby is born, and in the weeks and months after. But those resources — access to public health nurses, peer support, lactation consultants and hospital-based breastfeeding clinics — are shrinking. “There needs to be more professional help available,” says Pitman.

But for now, parents like Hamilton will continue to take to the Internet — and in her case, the road — to get breastmilk for babies. “If I can give the twins breastmilk until they’re two, I will.”

A version of this article appeared in our April 2012 issue with the headline "Is any breast best?," pp. 95.

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