1. About Eats On Feets
What is Eats On Feets?
Eats On Feets facilitates a world-wide network of parents, caretakers, and professionals who have made the informed choice to share or support the sharing of breastmilk.
Parents and caretakers accept full personal responsibility for their breastmilk sharing experience(s) and outcome(s).
Where did the name ‘Eats On Feets’ come from and how did it all start?
“Hey, why don’t we just become wet-nurses; instead of Meals on Wheels, we can call ourselves ‘Eats On Feets.’” ~Shell Walker (Luttrell), 1991.
Shell Walker Luttrell, a Phoenix, Arizona midwife started the original Eats On Feets page in late July of 2010. She thought that ‘Eats On Feets’ would be a fun and lighthearted name for the page.
From Shell’s original Eats On Feets page:
“I started this page after receiving a phone call from a mom who was desperate to find breast milk for her newborn. I posted her needs on Facebook and the response was immediate and fantastic. I thought it would be awesome if there were a page dedicated to milk sharing and tribe nursing.
So, this is a networking page for moms to share and receive milk when needed. I am not responsible for milk sharing results or content shared by other posters.
And a note of caution; KNOW THY SOURCE. While it is true that tribe feeding offers MANY benefits, there is ALWAYS the risk of disease/contamination.
I support many causes and movements but in the spirit of keeping the site as focused as possible status updates are specific to milk sharing.”
What does Eats Feets believe?
Eats on Feets believes that:
- Breastfeeding is essential for both infant and global health.
- Breastmilk can be shared in a safe, ethical manner, and families are capable of making informed choices.
- Sharing healthy breastmilk is a vital option, when necessary, in order to maintain exclusive breastfeeding.1
- There is enough breastmilk for all the babies who need it.
- Informed use of healthy donor milk is superior to artificial substitutes.
- Wet-nursing is an important part of milk sharing.
- Hand expressing (while maintaining clean technique) of milk does not involve the cleaning of parts and may thus be cleaner and safer than using a mechanical pumping system.
- Breastmilk from a healthy donor that is raw and fresh (not frozen) is closest to its natural state and therefore most beneficial.2
- Detailed health history and blood work can be discussed between donor and recipients in order to come to a mutual agreement for both long- and short-term sharing.
- Proper health screening can be done to reduce the risk of exposure to pathogens (germs).
- When full screening is not available, donor health status is unknown, or to reduce the potential risks of exposure to HIV and other pathogens, breastmilk can be pasteurized.3
- Individual rights should be respected in all decision making and milk sharing interactions. Those who participate in the sharing of breastmilk should be aware of their options so that they can make the informed choices that are best suited to their unique situation.
- Individuals and communities are in a key position to help meet the breastmilk needs of babies.
What does Eats On Feets not do?
- Provide this document as a final research tool for informed choice.
- Support or approve of the selling of breastmilk on our network.
- Match donors and recipients.
- Accept third party offers or requests without direct contact information.
- Allow re-donating donated milk without explicit permission of the original donor and their added contact information.
- Keep track of matches being made on our pages.
- Screen donors and recipients.
- Provide clinical advice/care for breastfeeding difficulties.
- Provide contracts or questionnaires.
- Dictate who should receive breastmilk.
- Collect, store or distribute breastmilk.
- Receive money, payment, donations or funding of any kind.
- Endorse any products for sale.
- Purchase advertising or accept advertising on the chapter pages.
- Reimburse volunteers/supporters.
- Act as mediators or advisors if difficulties or misunderstandings occur between parties.
- Accept liability for the outcomes associated with sharing breastmilk.
- Expect donors to try to increase their supply in order to donate milk.
- Refer to outside networks, groups, organizations, professionals, etc.
Who needs donated breastmilk?
Eats On Feets focuses on the breastmilk needs of babies and young children.4 All children have a right to breastmilk. There are many situations wherein a child or baby would need donated breastmilk, including but not limited to: death of lactating parent, adoption, foster care, guardian care, low milk production, no milk production, health of lactating parent. Eats On Feets does not endorse any order of priority for the sharing of breastmilk with babies and young children.
Although Eats On Feets focuses on breastmilk for babies and young children, sometimes medical needs arise for older children or adults. Eats On Feets does not put an age range on pediatric needs,5 and reposting these needs will be up to the discretion of our admins.
A strong case can be made for the medical use of breastmilk by adults. Eats On Feets supports informed choice and a person’s right to share their breastmilk with whomever they choose. Adult needs are welcome on our Wall, but will not be reposted by our admins. Please contact your local page with any questions.
Regarding adults requesting milk for non-medical reasons, please see this site for more information. Eats On Feets administrators will delete these types of requests. Eats On Feets encourages families to practice safe social networking.
2. The 4 Pillars of Safe Milk Sharing
- Informed Choice
- Understanding the options, including the risks and benefits, of all infant and child feeding methods
- Donor Screening
- Donor self-exclusion for, or declaration of, medical and social concerns
- Communication about lifestyle and habits
- Screening for HIV I and II, HTLV I and II, HBV, HCV, Syphilis and Rubella
- Safe handling
- Inspecting and keeping skin, hands and equipment clean
- Properly handling, storing, transporting and shipping breastmilk
- Home pasteurization
- Heat treating milk to address infectious pathogens
- Informed choice of raw milk when donor criteria are met
For more information on these 4 pillars, please see the full article here.
3. What should I know about appropriate (online) social networking? Is it safe?
|Eats On Feets is not responsible for the outcome of donor/recipient arrangements.|
Potential risks of social networking can be avoided by following these guidelines.
Successful milk sharing relationships between donors and recipients are based on mutual understanding, informed choice and respect. This process is best done by starting with corresponding via private messages or private email.
If, for any reason, someone does not feel comfortable pursuing or continuing a donor/recipient relationship, they are always free to withdraw from it, regardless of the situation.
If undesired contact keeps occurring, please know that FB has a ‘blocking’ feature. Please also notify the local chapter page and/or a forum administrator via email. Part of safe networking includes keeping your location, and information that could disclose your location (such as digitally uploaded photos), private. Trust your gut feeling!
Some adults might request milk for non-medical reasons. Please see this site for more information. Eats On Feets administrators will delete these types of requests.
4. What are the benefits of community-based milk sharing?
Some benefits are:
- Normalizes breastmilk as the primary food source for babies, wet-nursing and the sharing of breastmilk.
- Rapid response in acute situations,
- Control of the pasteurization process,
- Likelihood of obtaining age-specific milk,7
- Opportunity to meet donor(s) and verify lifestyle and health habits,
- Provides parental and caretaker autonomy,
- Builds community with other parents and caretakers,
- In some cultures: extends family to include ‘milk-brothers and -sisters,’8
- Key placement of those whose knowledge, assistance and networks could be imperative during a state of emergency,9
5. Are there risks to using donor milk?
There are always risks associated with feeding a baby anything other than his or her own parent’s or caretaker’s healthy breastmilk via direct nursing.10 When considering (private) donor milk, parents and caretakers are balancing the benefits of optimal nutrition and immunity against the risk of disease transmission. Some argue that even after donors are screened, a small amount of pathogens can still remain in the milk and that therefore raw donor milk is never safe.11 However, when considering pasteurized milk, there are also risks that need to be evaluated, and in situations where donor milk has been pasteurized, pathogens can (re-) contaminate milk (see below).
Informed milk sharing12
To our knowledge, there are no documented cases of disease transmission or bacterial infection associated with informed milk sharing at this point.
Milk sharing is also not considered to be a pressing public health risk according to Dr. Chessa Lutter, Regional Advisor on Food and Nutrition for the Pan American Health Association (Regional Office of the WHO) on ‘The Current.’ From the interview:
Q: “Is Eats [on] Feets (sic) safe in the opinion of the World Health Organization? Are they a credible alternative?”
A: “We don’t have a position on this. We focus our efforts on what we consider are the most pressing public health concerns. This has not made it to the top of the list. What I would like to share…”
Dr. Chessa Lutter goes on to describe a pediatrician’s positive donor breastmilk experience.
For a podcast of this interview, please go here.
There may be concern regarding the spread of infectious diseases through breastmilk, in particular HIV. The CDC states: “HIV and other serious infectious diseases can be transmitted through breast milk. However, the risk of infection from a single bottle of breast milk, even if the mother is HIV positive, is extremely small. For women who do not have HIV or other serious infectious diseases, there is little risk to the child who receives her breast milk.” Please see ‘How can breastmilk be pasteurized at home?’ for more information on mitigating the risk of exposure to HIV and other pathogens.
Risk from handling
Some of the risks associated with donor milk are caused by the method used to feed the milk to the baby.13 There have been documented cases in hospitals where newborns developed bacterial infections after receiving milk obtained from milk banks and delivered via feeding tubes or artificial nipples. For instance, “one outbreak of F. meningosepticum was not from milk, but was located on milk bottle stoppers and ‘cleaned’ teats, as well as the ward environment.” La Trobe Table #5 identifies four related deaths as a result of contaminated breastmilk in hospitals. Some of these infections appear to have been associated with a single donor, which indicates that there was some cross contamination that occurred with that particular batch of donor milk. The infections linked to contaminated breastmilk were generally caused by normal bacteria that live on human skin and are by definition not isolated to babies in hospitals. Sick and premature infants are more at risk for these infections. Please see ‘Handling of breastmilk’ for more information on proper handling techniques.
While there is risk of disease transmission, there are other, theoretical, risks of informed milk sharing:
- Unwanted contact from adults who seek milk for non-medical needs,14
- Harassment by donor/recipient,
- Possible sabotage by recipient or donor,
- Transmission of pathogens that could cause a baby to become sick or die,
- Legal action, founded or unfounded, in case of bad outcome.15
Risk of pasteurized versus raw breastmilk
Sick and premature babies are at risk for neonatal hospital acquired infections. The lack of anti-effective properties in pasteurized milk can put a baby at risk, especially when a baby is sick or premature. Please see ‘What about premature babies?’ for more information about the effect of heat-treating on breastmilk.
In this previous but valuable study on the effect of routine screening of raw breastmilk and donor milk for premature babies, the authors discuss that while the data clearly document that premature infants fed raw expressed human milk are frequently exposed to large numbers of bacteria, no adverse events directly related to consuming this milk were documented.
The lack of anti-effective properties in pasteurized milk can put a baby at risk, especially when a baby is sick or premature. Please see ‘What about premature babies?’ for more information about the effect of heat-treating on breastmilk. Please see ‘Why breastmilk?’ for more information on the benefits of breastmilk.
6. Breastmilk in a state of emergency
In an emergency situation, whether a natural or man-made disaster, breastfeeding is an important strategy for increasing infant and child survival. “Appropriate and timely support of infant and young child feeding in emergencies (IFE) saves lives.”
In this WHO podcast on ‘The importance of breastfeeding during emergencies,’ Dr. Veronica Riemer says: “Infants who are not breastfed are vulnerable to infection and to developing diarrhoea. Following an emergency, one of the first things that is donated is breast milk substitute – often done with the best of intentions, but this can have a negative impact on the health of mothers and children.” IFE states: “In emergencies, donations of BMS (Breastmilk Substitutes) are not needed and may put infants’ lives at risk [bold –ed.].”
Identifying key decision-makers at household, community and local health facility level who influence infant and young child feeding practices is crucial information when determining the priorities for action and response in emergencies. A community based milksharing network can be vital for a fast mobilization of aid when and where needed.
7. Resources for support
|These are suggestions only. Eats On Feets cannot recommend any particular organization or person.|
Please find these local resources for obtaining referrals, breastfeeding support and donor/recipient support, blood testing and more. If the professionals on this list cannot directly help you, they will most likely be able to refer you to someone who can.
- Lactation Consultants
- Health Care Providers
- Nurse Practitioners
- Community Nurses
- Breastfeeding Counselors
- Naturopathic Physicians
- Craniosacral Therapists
- Peer-to-Peer Breastfeeding Support Groups
- Parent/foster/adoptive groups
- Others with breastfeeding experience
- In this document Eats On Feets utilizes the WHO definition of exclusive breastfeeding which includes milk from another breastfeeding parent (see ‘WHO guidelines for exercising feeding options’). In support of exclusive breastfeeding, in circumstances where wet-nursing is not feasible, informed milk sharing can be a viable option for families. Milk sharing can be seen as an extension of wet-nursing, and as a safe alternative for infant feeding and successful exclusive breastfeeding. EOF recognizes the benefits that direct breastfeeding from the breast bestows as well as the value of the milk itself. We may therefore use the words breastfeeding and breastmilk interchangeably. [↩]
- Please see ‘Why breastmilk’ for more information on the properties of breastmilk. [↩]
- See ‘How can breastmilk be pasteurized at home?’ for more information. [↩]
- In ‘Global Strategy for Infant and Young Child Feeding,’ bullet 10, p. 14, the WHO states: “Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond.” [↩]
- The FDA has this nonbinding guidance for the use of medical devices:
For purposes of this guidance, we are defining pediatric subpopulations as shown below.
Pediatric Subpopulation Approximate Age Range newborn birth to 1 month of age infant 1 month to 2 years of age child 2 to 12 years of age adolescent 12-21 years of age
“Although the upper age limit used to define the pediatric population varies among experts, including adolescents up to the age of 21 is consistent with the definition found in several well-known sources. The Center for Devices and Radiological Health (CDRH) believes this age range is generally appropriate for the use of medical devices in pediatric subpopulations, but recognizes that there may be cases in which the pediatric population should be defined differently, depending upon the type of device.“ [↩]
- Eats on Feets does not support or approve of the selling of breastmilk on its network. [↩]
- See ‘Can I receive milk from a donor who’s baby is not the same age as mine?‘ [↩]
- According to Islamic law, two babies breastfed by the same milk-providing parent/caretaker automatically become Mahram (unmarriageable kin). This prevents the use of mixed donor milk from milk banks as it would be impossible to know family status. [↩]
- See ‘Breastmilk in a state of emergency’ for more information. [↩]
- Also see ‘Risks and ethics of breastmilk substitutes.‘ [↩]
- Screening tests are designed to have a relatively high incidence of false positives in order to prevent any false negatives. While false positives happen to many people, pregnant or recently pregnant women tend to get them more frequently. From the perspective of a milk bank which will be testing the donors on a regular basis, it makes sense to exclude anyone with a history of false positives since the cost of pursuing confirmations at every testing opportunity is not only prohibitive for a non-profit org, it also can lead to logistical issues with the milk received from the donor. This study does not follow up on the actual serological status of these women but, even per the most optimistic values, it is quite likely that many of these women did not in fact have any current infections. [↩]
- Donated breastmilk is, in most situations, milk expressed and/or stored for her own child. After blood screening of donors and education on safe expressing/handling/storing techniques, the risks to milk sharing are minimized. To suggest that this milk is not safe for sharing is to suggest that it is not safe to feed to one’s own babies with their expressed milk. We question this line of logic. [↩]
- The same potential infections can occur when breastmilk substitutes are used in the same setting. Please also see ‘Risks and ethics of breastmilk substitutes’. [↩]
- Please see ‘Who needs donated breastmilk’ for more information. [↩]
- Donors may request recipients to provide blood and health screening(s). [↩]