Milk-sharing misgivings

SEATTLE – When a blood clot in her brain prevented Jesi Paschen from nursing her second daughter, she turned to what she believed was the next best thing: breast milk from another mother.

The 27-year-old mom wanted newborn Radlee, now 7 months, to glean the same benefits as sister Hinlee, 2, including all the nutrition, antibodies and other disease-fighting properties found in human milk. So Paschen, like growing numbers of mothers who can’t nurse their own children, turned to online sources, including the Facebook site for the Washington state chapter of Human Milk for Human Babies, or HM4HB.

“I believe that breast milk is best for my child,” said Paschen, who still takes medication that could be harmful if transmitted to the baby.

But a study by researchers at Nationwide Children’s Hospital in Columbus, Ohio, is raising new doubts about the safety of milk-sharing, including breast milk bought and sold on the Internet through various sites.

An analysis of more than 100 samples purchased in 2012 found that more than 10 percent of the human milk for sale had been mixed with cow’s milk – and at high enough levels to indicate the adulteration was intentional.

“I was surprised that it was that many samples,” said Sarah Keim, principal researcher at Nationwide Children’s. “Even a small amount of cow’s milk could be harmful to a baby with cow’s milk allergies.”

Keim suggested that sellers may have been adding the cow’s milk to the human milk to boost volume – and income. Breast milk typically sells for about $3 an ounce. Keim wasn’t able to test donated milk because of confidentiality issues.

The results follow a 2013 study by Keim and her colleagues that reported that nearly 75 percent of the samples for sale through the site OnlyTheBreast.com were contaminated with disease-causing bacteria.

OnlyTheBreast officials said in a statement they urge sellers to follow “best practices” for expressing, handling and storing human milk, including steps for shipping, freezing and peer-to-peer screening of donors.

“We believe most OTB donors are honest, abiding by OTB terms and are simply looking to provide safe milk for babies in need,” the statement said.

But Keim said her results show that women seeking breast milk can’t always trust the providers.

“Even when women feel like they’re doing a thorough job of choosing the best milk provider, you don’t know,” she said. “People aren’t often very open about their lifestyle or their health behaviors.”

More families are turning to online sources for breast milk, which are far different from the network of organized milk banks that typically provide screened and pasteurized donor milk to hospital neonatal units and via prescription to babies with medical needs.

In 2011, there were about 13,000 postings to the top four sites that broker milk sales and donations, Keim said. By last year, that number had grown to 55,000.

In Seattle and Washington state, posts to such sites are popular, too. There are nearly 5,000 “likes” for the Washington HM4HB Facebook page. Recently several classified ads on OnlyTheBreast.com offered milk for sale from area mothers.

“Seattle sweet cream supplier look(ing) for a buyer, $15/5oz bag,” reads one entry by a seller known as “Sparks.” She did not reply to requests for comment.

Of course, women have been milk-sharing for millennia, experts note. Before the advent of manufactured infant formulas, wet-nursing was the only way to make sure babies were fed if their mothers couldn’t produce, noted Dr. Isabella Knox, a neonatologist and breast-feeding expert with Seattle Children’s.

“I am a proponent of milk-sharing,” Knox said. “But I would not buy it on the Internet from a stranger. I think it’s really unsafe.”

Without proper screening, there’s no way to know whether the breast-milk supplier has diseases such as HIV or tuberculosis or whether she’s taken prescription or illicit drugs.

About 20 percent of the milk samples in Keim’s previous study were positive for cytomegalovirus, or CMV, which can cause serious illness in sick or premature babies, often the target market for milk donations and sales. More than 20 percent of requests for milk online are for babies with health problems.

That troubles donors such as Mariesa Rice, 27, of Whidbey Island, Wash., who found herself with ample supplies of milk after the birth of her son, Brian, two months ago. She has about 150 ounces of milk stored in her freezer and decided to offer it on the HM4HB site to help other new moms.

“I didn’t just want to throw it all away,” she said. “It was a lot of hard work to pump it and freeze it, and breast milk seems like a hot commodity right now.”

Rice said she’s healthy, avoids nicotine and alcohol and is scrupulous about cleanliness. She wouldn’t offer milk that she wouldn’t feed her own baby, she said, but she knows that’s just her word.

“They would have to be very confident in me,” she said. “It’s another one of those honesty and trust things that they’re going to trust that it’s OK.”

That’s not enough for health experts such as the federal Food and Drug Administration and the American Academy of Pediatrics, which frown on the process, advising women to never use milk bought or donated from strangers. Tamara Wescott, a lactation specialist at Swedish Medical Center, typically directs women with the greatest need to sites such as the Northwest Mothers Milk Bank in Portland, which provides breast milk to babies by prescription.

“We have to ensure that babies are given milk that has been assessed and treated,” Wescott said. “I cannot advocate for passing milk between mothers without having it being professionally evaluated.”

No question, breast milk is best for babies, Knox said. But if it’s a choice between unscreened breast milk from strangers or formula, she’d choose formula.

“Formula is not the devil when you need it,” she said.

However, she added, if mothers who need milk seek donors they know – and the women are willing to provide prenatal screening records – that may be a different story.

For Jesi Paschen, it is important to know the women who provide milk for her baby. She gets some milk for Radlee from two local women who are regular donors and insists on meeting other women before she accepts their supplies. And she has asked donors to sign a form that attests that they’re HIV-free, monogamous, free of sexually transmitted diseases, and that they don’t smoke or use drugs.

It’s not a formal medical record, but Paschen said she feels comfortable that her donors are safe. These are women she sees every week, she said.

“If I just say that breast milk is what’s best for my child and if I just generally think about it that way, I’m perfectly OK with it,” she said.