Family Matters

Milk Banks vs. Milk Swaps: Breast Milk’s Latest Controversy

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Breast-feeding is a demanding undertaking. It takes time, and lots of it, and some mothers are barely able to produce enough milk. But others find themselves with milk to share, and these days, they’re being wooed by two very different potential recipients: official nonprofit milk banks that supply nutrient-laden breast milk to preemies and sick infants for a fee, and milk-sharing groups that may help feed the baby next door free of charge.

The breast-feeding community has historically been tightly knit, united in their belief that “breast is best.” But it’s increasingly facing off over where to direct the bounty, with each side publicly raising eyebrows over the other side’s practices. (More on Pumping at Work: The Government Asks Working Moms How They Do It)

The dozen or so breast milk banks across the country recently issued a press release containing an “urgent call” for donations. Milk banks that are part of the Human Milk Banking Association of North America (HMBANA) provide premature babies and sick infants with breast milk, which is easily digested and conveys immunologic protection to at-risk babies and healthy ones too.

Banks intensively screen donors via multipage questionnaires and pay to get them blood-tested; they also underwrite the cost of shipping frozen milk to the milk banks, where it’s pasteurized to kill bacteria, processed and triaged to those most in need. But all these steps cost money; as a result, many milk banks charge $4.50 an ounce. Some would-be donors are put off by the blood-testing and the strict rules about how to pump and freeze the milk; the expense, which is not typically covered by insurance, makes others recoil.

“There are moms who are going to say, Gee, I don’t really want my milk to go somewhere where it’s charged for,” says Naomi Bar-Yam, executive director of the Mothers’ Milk Bank of New England. “But no milk banks are getting rich off this.”

The milk banks’ supply, according to the press release, has reached “critically low” levels, in large part because more and more hospitals are starting to rely on breast milk as standard of care for premature babies. Mothers of preemies may not be able to produce enough milk; in other situations, mothers may be seriously ill themselves and unable to breast-feed.

But milk bank directors also attribute the slowdown to the increasing popularity of online milk-swapping, via groups such as Eats on Feets or MilkShare, which help link those who need milk with those who’ve got it.

In the past, breast milk has been offered for sale — and subsequently pulled — on Craigslist and eBay. But milk-swappers don’t charge. To them, sharing breast milk is the modern-day equivalent of wet nursing, where mothers who’ve got a freezer full can browse the Internet in search of mothers who need extra.

Eats on Feets, with groups in at least 10 countries, maintains a Facebook page that has accounted for hundreds of milk swaps since it launched in July 2010. For the most part, the women live near each other, although in some instances where moms need specialized milk — nut-free or dairy-free — donors may ship. Many women seeking milk online have experienced a sudden health crisis; in other situations, they might have trouble making enough milk to feed their baby.

Eats on Feets doesn’t act as a go-between, but it does provide links to screening questions that a mother looking for milk might want to ask a donor. “We support an ideal of informed choice,” says Shell Walker, the founder of Eats on Feets, who says she’s received no complaints about unsafe milk. “I know that to some of the milk bank health professionals it might seem women are doing this irresponsibly. But we need to give a little more credit to moms and understand they are taking measures to keep this safe.” (More on Longer Pregnancy + Breast-Feeding = Bigger Brains, Longer Life)

Knowing that a woman is nursing her own baby should reassure recipient moms, says Sally Stevens, a volunteer with Eats on Feets. “There’s some amount of common sense that she wouldn’t be feeding her baby her milk if it were laden with yuck,” says Stevens.

But Kathleen Marinelli, a neonatologist and medical director for the Mothers’ Milk Bank of New England, says that logic doesn’t stand up because donor moms may have infections they’re unaware of. You can feed your own baby breast milk if you have hepatitis B, for example, but it’s not okay to feed another baby. “The biggest risk is you have no idea what you’re getting,” says Marinelli. “You want to believe every woman out there is giving it for altruistic reasons, but you just don’t know. It’s scary to me.”

In November, the U.S. Food and Drug Administration advised parents against using milk-sharing groups: “When human milk is obtained directly from individuals or through the Internet, the donor is unlikely to have been adequately screened for infectious disease or contamination risk. In addition, it is not likely that the human milk has been collected, processed, tested or stored in a way that reduces possible safety risks to the baby.”

Despite the warnings, many women seem to like the idea of connecting with other mothers in need. I really wanted to know who received my milk when I donated to a milk bank several years ago, but my milk, once processed, was tagged only with a number. Fans of milk-sharing, on the other hand, say it can strengthen community ties, and in some cases, has led to friendships. (More on Time.comBreast-Feeding: It Takes a Village to Help Moms Succeed)

After Angie Bond gave birth to a daughter in January, she found herself with much more milk than Vivinee drinks and decided to give the excess away, finding recipients via Eats on Feets. She considered milk banks but was deterred by the price tag. “I couldn’t justify turning around and charging mothers upwards of $4 an ounce when I could turn to my own community and help a local mom,” says Bond, whose mother donated milk to other premature babies on the ward when Bond was born.

Bond has donated more than 250 ounces of breast milk to four babies. All of the recipient mothers conducted their own screening, asking Bond if she smokes or does drugs. For those moms interested, Bond, who lives in Chandler, Ariz., presented the results of blood work done during her pregnancy.

Pros and cons aside, it’s worth asking — as Bar-Yam does — why so many women of healthy babies need donor milk. It’s one point on which both sides can agree: women are not getting enough support to make breast-feeding always possible. “That’s not getting addressed,” says Bar-Yam, who notes that a woman who works 50 hours a week might be eager to accept donor milk from another mom.

“We are not asking the harder question of why we as a society are not supporting these women,” she says. “Someone else’s milk is always second best to nursing your own baby.”