Human Milk Sharing: Formal and Informal

Formal Human Milk

Formal human milk sharing (sharing of breast milk between mothers and lactating parents) happens through Human Milk Banks. There are over 30 nonprofit milk banks now operating in the United States. Some examples include:

• The New York Milk Bank
• The Human Milk Bank of North America
• Medolac
• Prolacta

The milk from these milk banks is pasteurized (heated to kill harmful bacteria) and tested for diseases and is generally used for sick or premature infants. Families with healthy children can sometimes purchase donor milk from a milk bank with a prescription. However, supply is limited, and insurance does not cover the cost, which ranges from $4 to $5 per ounce.

At Strong Memorial and Golisano Children's Hospital, we will only use:

• Your own expressed milk (breast milk that has been pumped out)
• That of a co-lactating parent (another parent who is also breastfeeding)
• Human milk from a milk bank

Informal Human Milk Sharing

American Academy of Pediatrics (AAP) does not recommend informal milk sharing because there is no way of ensuring the shared milk is safe. However, The Academy of Breastfeeding Medicine (ABM) acknowledges that while it can be risky, medical screening of the donor and safe milk handling practices can improve safety (https://www.bfmed.org/resources). Both the MP and ABM recommend against purchasing milk online.

Recommendations for Informal Milk Sharing

If you choose to use informally shared human milk, here are some recommendations to reduce risks:

• Do not buy human milk from anyone other than a milk bank. Milk purchased online has been shown to be mixed with cow's milk or rice milk. It may also be contaminated with bacteria and cotinine, a chemical from cigarette smoke.
• Know that informally shared milk is not pasteurized or tested. It is often donated by mothers or other lactating parents who have stored extra milk in their freezer and are willing to help those in need. It is up to the recipients to determine the safety of these donors through careful screening.

Reducing Risks

One key to reducing the risks of informal milk sharing is open communication between the donor and the recipient about their medical history and lifestyle habits to ensure the milk is safe and free from medications, drugs, alcohol, and infectious diseases that can harm your baby. Many parents who participate in informal milk sharing either ask that their donor provide copies of test results showing they are free from infectious diseases or review the requirements to pasteurize the breast milk just before the baby's consumption.

Questions to Ask a Potential Donor

Collection of Milk:

• When was the milk collected and how old is their infant or child?
• How is the milk handled? Do they wash their hands before handling and pump directly into a sterile container?
• How quickly do they refrigerate or store the milk after pumping?
• Will the milk be transported on ice?

Donor Health:

• Do they have any medical conditions, recent illness, or infection?
• What medications, supplements, or herbs do they take?
• Do they use recreational drugs or alcohol? (If yes, which drug, how much, and how often?)
• Do they have any cigarette or marijuana exposure in the home?
• Are they willing to share the results of their prenatal labs (medical tests done during pregnancy), such as for HIV, Hepatitis B, and C (liver infections caused by viruses)?
• Have they had any rashes on their breasts, chest, or nipples, such as Herpes (a viral infection causing sores) or Impetigo (a skin infection)?
• Have they recently traveled?
• Have they had any recent tattoos (since delivery, due to risk of Hepatitis or HIV transmission)?