Milk Donation Dilemma - Part III

Bodily Fluids

This is part III in my discussion of problems faced by the milk donation community in response to the replies I received when posing a question about moms' opinions of the use of donated human milk. In this portion, I will discuss the repeated concern expressed (no pun intended, or maybe it was) regarding milk as a bodily fluid.

Many mamas on the mom networking site where I posed my inquiry that did not nurse their child(ren), responded that they were not interested in donated milk because they didn't want to be handling someone else's bodily fluid. In today's society, there is a concern about diseases passing via bodily fluids such as urine and blood. To a lesser extent, there seems to be a mild concern with saliva as well. And feces certainly can be a source of disease and contamination, though not typically a fluid. I apologize if this is taking a rather unsavory turn. In any case, it stands to reason that along with other body fluids that are known or suspected to be of concern, breastmilk would fall into that same category causing concern for many moms.

Here's the thing though. Breastmilk is not considered a bodily fluid. This may come as a surprise to many, but it's true. Here is a response taken from the CDC (Center for Disease Control and Prevention) website's Frequently Asked Questions regarding the handling of breastmilk:

Are special precautions needed for handling breast milk?

CDC does not list human breast milk as a body fluid for which most healthcare personnel should use special handling precautions. Occupational exposure to human breast milk has not been shown to lead to transmission of HIV or HBV infection. However, because human breast milk has been implicated in transmitting HIV from mother to infant, gloves may be worn as a precaution by health care workers who are frequently exposed to breast milk (e.g., persons working in human milk banks).

For additional information regarding Universal Precautions as they apply to breast milk in the transmission of HIV and Hepatitis B infections, visit the following resources:

• Perspectives in Disease Prevention and Health Promotion Update: Universal Precautions for Prevention of Transmission of Human Immunodeficiency Virus, Hepatitis B Virus, and Other Bloodborne Pathogens in Health-Care Settings. MMWR June 24, 1988, 37(24):377–388.
• CDC. Recommendations for prevention of HIV transmission in health-care settings. MMWR1987, 36 (supplement no. 2S):1–18S.

The full list of FAQs can be found here (though they are not all concerning the handling of breastmilk).

So, what does this tell us? Well, healthcare and daycare workers don't need to worry about special handling of breastmilk. Gloves can be worn, but it is not necessary in most cases, when preparing and feeding breastmilk. The bottom line is that breastmilk does not fall into the same category as other bodily fluids as many may believe.

Despite the status of not being a bodily fluid, there still is the possibility of transmitting disease as discussed by the CDC's website. Because of this, many health professionals would recommend that if you do use donated human milk, it is best to obtain that milk via a milk bank where the donors are screened for transmissible diseases and the milk has been pasteurized. This is one way to ensure that disease is not passed along to a young infant. Many moms do take comfort, however, in using milk donated privately if they know the donor personally. In such cases, they are likely aware of any health concerns there may be in regards to the donor and their decision to use the milk. While it does pose risks not seen when milk is obtained via a milk bank, there is less uncertainty in regards to knowing exactly from whom the milk is coming. Either way, the milk certainly is not a bodily fluid.

Continue on to the next part of the Milk Donation Dilemma Series:
Part IV - Safety and Nutrient Content of Donated Milk

If you missed previous entries, they can be found here: 

Part I - The Importance of Breastmilk     

Part II - The Availability of Donated Milk

Milk Donation Dilemma - Part II

The Availability of Donated Milk

"I didn't know donated milk was available./I didn't know that people did that./It wasn't available back when I had a baby."

I mentioned before that I recently put up a post on a mom forum inquiring about milk donation and what mamas thought about it. This is Part II of a series of discussions about responses and why we have a lot of work to do when it comes to donating milk.

One of the big problems surrounding milk donation is lack of knowledge and education about it's existence. Many mamas responded in one of the ways listed above. It appears, we aren't talking about it enough.

I'm not sure how to get the word out other than how I'm doing it. I talk about it, I blog about it, I have a Facebook page about it. I think if people who know about it talk about it, the word will spread. We have to share our experiences though. If we don't, no one will hear about it.

Milk donation has changed a lot over the years, and yes, it's been around a while. I can't say for how long, but certainly most of us have heard of wet nurses - women that nursed other women's babies for a variety of reasons. I can't say for sure how long donation of expressed milk has been happening. What I do know is that my mom donated when two of my sisters were babies. The older one is now 37 years old, so at least for that long. Probably longer. My mom said bottles were dropped at her house and she'd fill them up. Opposite of the milk man, is how she describes it. They'd pick up the full bottles and leave the empty ones.

Back then, they approached my mom about it. She hadn't heard of it before that point either. I'm not sure that nursing was any more popular in those days, but now, if you want to donate, you have to seek out the information. And to do that, you have to know about it first.

So, for all you expectant moms. Yes, donated milk is available. There are a couple different channels you can go through, but it is there. Yes, people do it. They do it out of the kindness of their own hearts. For many it's a matter of not wanting to waste or throw out a stash of milk they no longer need that is taking up freezer space. For others, it is a labor of love as they take the time to pump extra milk specifically for the purpose of donating. Finally, yes, it was available "back then." Though this time period is vague, it is likely that many mamas that have children over the age of 37 may not be as internet savvy, and perhaps don't have accounts on mom forums; but, that means that the majority of moms that responded probably had babies in a time period where I know for a fact milk donation was available.

Please spread the word. Let mamas know they have options.

See the next post in this series, Part III - Bodily Fluids

If you missed Part I of this series, it can be found here.

Milk Donation Dilemma - Part I

The Importance of Breastmilk

There exists such a thing called the "Infant Feeding Hierarchy" that lists the preferred methods of infant feeding in order based on how suitable the feeding method is to feed and nurture an infant optimally. Interestingly enough, there seem to be multiple lists available. Here are a few examples:

The one most commonly listed is cited as the World Health Organization Hierarchy of Infant Feeding and is as follows:

1. Breastfeeding directly from the mother

2. Expressed milk from the mother

3. Expressed, screened/pasteurized human donor milk from a milk bank

4. Formula

Other lists are available too. Here are a few:

1. Breastfeeding directly from the mother

2. Expressed milk from the mother

3. Wet nurse/cross-nursing

4. Expressed milk from another mother

5. Formula

1. Breastfeeding directly from the mother

2. Expressed milk from the mother

3. Expressed human donor milk from another mother

4. Formula

There are many considerations when looking at these lists that may need more attention and could be the source of varying the list depending on your angle. Given that breastmilk changes according to the baby's needs when they are feed directly at the breast, it could be argued that a wet nurse is a better choice than mama's expressed milk. Some argue that since pasteurization destroys many nutrients in milk, that raw milk is superior. Still others will tell you that screened and pasteurized donor milk is safer if the mom is unable to breastfeed because there is more assurance that the baby will not contract illnesses from another mother. In reality, the discussions can go back and forth and the exact order of the list can vary, but in the end, one fact remains the same:

Breastmilk. If not, formula.

But in seeing that, this is where we run into trouble. Most people think it looks like this:

Nurse. If not, formula.

And in that, we have an error.

The bottom line is that scientifically, breastmilk is superior to formula, no matter the source. Mothers need to know that breastmilk is the best choice. Sure, nursing is ideal, but if you can't nurse, breast milk. From you, from someone else, whatever. Breastmilk. If you feel more comfortable about screenings and pasteurization or if you feel more comfortable about fully intact nutrients (taking into account that regardless of being raw, storage - ie. refrigeration/freezing - can have an effect on nutrient content), breastmilk. Donor milk is available, no matter where your comfort level lies. We need to spread the word.

In the next few posts in my series, Milk Donation Dilemma, I will address many responses given to me when I inquired on a mom forum about knowledge, education, and thoughts on donated milk. Some answers surprised me. At times it was the percentages of moms that responded in particular manners. Either way, I feel the responses need to be addressed. So, here goes...

Continue to Part II in this series.