The Four Pillars of Safe Breastmilk Sharing

The use of healthy, commerce-free donor milk is a natural option when a baby cannot receive milk from their own lactating parent. However, there are risks associated with feeding a baby anything outside of the closed bio-system of mouth-to-nipple. This includes storing and feeding expressed milk to one’s own child, donating expressed milk that will not be used, and storing and feeding donor milk. From expression to feeding, and especially in the context of donating since the intended recipient baby may not have the same antibodies as the donor, steps can be taken to reduce the exposure to pathogens. Both donors and recipients can screen each other using this document and The Four Pillars of Safe Breastmilk Sharing.

The Four Pillars of Safe Breastmilk Sharing came out of the extensive research that is compiled in this document and they form the foundation from which families can learn how to safely share human milk. These four pillars provide evidence-based information for the support of safe community-based and private arrangement milksharing. The Four Pillars of Safe Breastmilk Sharing are not only useful to parents and caretakers, but also to pediatricians, midwives, and those active in birth and parenting communities.1 By understanding the easy-to-implement principles of the Four Pillars of Safe Breastmilk Sharing, they too can help babies in their communities by supporting safe community-based and private arrangement milksharing.

The Four Pillars of Breastmilk Sharing

Informed Choice

  • Understanding the options, including the risks and benefits, of all infant and child feeding methods
  • Know thy source

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

Are there risks to using privately arranged donor milk?
Some argue that even after donors are screened, a small number of pathogens can still remain in the milk2 and that therefore raw donor milk is never safe.3 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.

Informed milksharing4

To our knowledge, there are no documented cases of disease transmission or bacterial infection associated with informed milksharing at this point.

The article The Four Pillars of Safe Breastmilk Sharing was published in Midwifery Today. Spring 2012. The photo was taken at our very first Eats on Feets gathering in Arizona where donors and recipients could meet and share milk!

Next: Who needs donor milk?

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  1. Eats on Feets – Safe Milksharing ↩︎
  2. Ronald S. Cohen, et al. 2009. Retrospective review of serological testing of potential human milk donors.pdf image 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, they tend to be higher in those who are pregnant or were recently pregnant. From the perspective of a milk bank that 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 those screened but, even per the most optimistic values, it is quite likely that many did not in fact have any current infections. ↩︎
  3. 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, they can occur more often during pregnancy. From the perspective of a milk bank that 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 the subjects but, even per the most optimistic values, it is quite likely that many did not in fact have any current infections. ↩︎
  4. 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 milksharing are minimized. To suggest that this milk is not safe for sharing is to suggest that it is not safe for parents to feed their own babies with their expressed milk. We question this line of logic. ↩︎