ABM Milk Sharing Position Statement: Instead of Just Say No, Just Ask How

The Academy of Breastfeeding Medicine issued in Jan 2018 another one of their generally excellent position papers, this one on cooperative infant feeding arrangements (a.k.a. “informal milk sharing”). This one is a great addition to the growing body of research about the importance of human milk use, and the need to increase accessibility to it for use in supplementary feeds (in lieu of infant formula). http://online.liebertpub.com/doi/pdf/10.1089/bfm.2017.29064.nks

The overall guidance is that sharing of human milk (something humans have been doing since time immemorial) is worthy of a good, old-fashioned, risk-benefit discussion with a skilled healthcare provider, so the family using/offering the milk can make a well-informed decision regarding the parent’s and the child’s health. Hear, hear! Isn’t this how every healthcare- or public health-related decision is supposed to go?  I like to say: (1) It’s all about parent empowerment, (2) information never hurt anyone, and (3) parents by-and-large wanna do right by their kids.  Give ’em the evidence-informed info they need, so they can decide what to do.

There are some health risks to consider for the infant/child receiving the milk. But there are also feasible ways to identify and reduce risks.  Suggestion is made for common-sense precautions.  Get medical screening of the milk provider, for contraindicated illnesses/medications.  Consider stove-top home pasteurization (instructions included!) of the milk, if the family desires, knowing that it will also eliminate some of the good components and protections of the milk.  Note, though, that any infant formula commercially available today has exactly zero such anti-infective and anti-bacterial elements.

I wish consideration had been made, in creating this policy, of some of the excellent research out there about how cooperative infant feeding arrangements are really made, by the families who actually provide/need the milk, using reliable and speedy resources for information, including (gasp!) social media platforms.  Here are citations for several of those studies, if you are inclined to learn more on your own.

Akre, J., Gribble, K., & Minchin, M. (2011). Milk sharing: from private practice to public pursuit.  International Breastfeeding Journal, 6(8). http://www.internationalbreastfeedingjournal.com/content/pdf/1746-4358-6-8.pdf

Gribble, K. (2012). Biomedical ethics and peer-to-peer milk sharing. Clinical Lactation, 3(3), 109-112. http://media.clinicallactation.org/3-3/CL3-3gribble.pdf

Gribble, K., & Hausman, B. (2012, September). Milk sharing and formula feeding: Infant feeding risks in comparative perspective? Australasian Medical Journal, 5(5), 275-283.

Gribble, K. (2013). Peer-to-peer milk donors’ and recipients’ experiences and  perceptions of donor milk banks. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 42(4), 451-461. http://dx.doi.org/10.1111/1552-6909.12220

Palmquist, A., & Doehler, K. (2014). Contextualizing online human milk sharing: Structural factors and lactation disparity among middle income women in the U.S. Social Science & Medicine, 122, 140-147.

Palmquist, A., & Doehler, K. (2016). Human milk sharing practices in the U.S. Maternal & Child Nutrition, 12(2), 278-290. https://doi.org/10.1111/mcn.12221

Perrin, M., Goodell, L., Allen, J., & Fogleman, A. (2014). A mixed-methods observational study of human milk sharing communities on Facebook. Breastfeeding Medicine, 9(3), 128-134. http://dx.doi.org/10.1089/bfm.2013.0114

Perrin, M. T., Goodell, L. S., Fogelman, A., Pettus, H., Bodenheimer, A. L., & Palmquist, A. (2016). Expanding the supply of pasteurized donor milk: Understanding why peer-to-peer milk sharers in the United States do not donate to milk banks. Journal of Human Lactation, 32(2), 229-237. https://doi.org/10.1177/0890334415627024

Reyes-Foster, B., Carter, S., & Hinojosa, M. S. (2015). Milk sharing in practice: A descriptive analysis of peer breastmilk sharing. Breastfeeding Medicine, 10(5), 263-269.

Reyes-Foster, B., Carter, S. K., & Hinojosa, M. S. (2017). Human milk handling and storage practices among peer milk-sharing mothers. Journal of Human Lactation, 33(1), 173-180. https://doi.org/10.1177/0890334416678830

Smith, J. (2015). Markets, breastfeeding and trade in mothers’ milk. International Breastfeeding Journal, 10(9), e1-e11. https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-015-0034-9

Tomori, C., Palmquist, A., & Dowling, S. (2016). Contested moral landscapes: Negotiating breastfeeding stigma in breastmilk sharing, nighttime breastfeeding, and long-term breastfeeding in the U.S. and the U.K. Social Science & Medicine, 168, 178-185. https://doi.org/10.1016/j.socscimed.2016.09.014

Baumgartel, K., Sneeringer, L., & Cohen, S. (2016). From royal wet nurses to Facebook: The evolution of breastmilk sharing. Breastfeeding Review, 24(3), 25-32. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5603296/

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