Earlier this week, news sources all over the United States reported on a new study published by the journal Pediatrics, the official publication of the American Academy of Pediatrics. The study found that most human milk purchased via the internet (74% in the study) was contaminated with bacteria. This, according to the study, puts infants who consume the milk at risk. Popular news sites reported things like the following:
"The results are 'pretty scary,' said Dr. Kenneth Boyer, pediatrics chief at Rush University Medical Center in Chicago, who was not involved in the study. 'Just imagine if the donor happens to be a drug user. You don't know.'" (FoxNews.com)"Of 101 samples purchased anonymously, nearly three-quarters of the samples contained bacteria that could make a baby sick, including three batches that tested positive for salmonella." (U.S. News & World Report)"Nearly 75 percent of breast milk bought through the site... was tainted with high levels of disease-causing bacteria, including germs found in human waste." (NBC News)
So what, exactly, does this all mean? Is all shared breastmilk dangerous? What kinds of risks do bacteria in breastmilk pose? Thankfully, we can turn to helpful responses from experts in this field to better understand the study and what it means for you, if you are seeking to purchase or receive donated breastmilk. Alison Stuebe, MD, MSc, a maternal-fetal medicine physician, breastfeeding researcher, and assistant professor of Obstetrics and Gynecology at the University of North Carolina School of Medicine, wrote a response to the study to help shed light on the its methods and potential for errors. About the sample that was obtained, she explains:
Milk was shipped to a rented mailbox to make the process anonymous. Of the 495 sellers the authors contacted, 191 sellers never responded, 41 stopped corresponding before making a sale, and 57 were excluded because they wanted to communicate by phone or asked about the recipient baby. Another 105 did not complete a transaction, leaving 102 of the original 495 sellers approached who actually shipped milk. Of these, half the samples took more than 2 days to ship, and 19% had no cooling agent in the package.
The sample obtained for the study may be skewed, but the sensational headlines don't key in on this detail. Stuebe says:
Indeed, when the authors compared online milk purchases with samples donated to a milk bank after a screening and selection process, they found much lower rates of bacterial contamination. The authors acknowledge this limitation in the study, but that subtlety has been lost in the media coverage.
And what do we make of the potentially harmful bacteria found in the milk? Suzanne Barston, a maternal health advocate, blogger, and freelance writer, shared her response on Science & Sensiblity. She says:
The other important factor to consider is that we can't know if any babies would've necessarily become ill after ingesting this milk; all we can be sure of is that milk transported across the country from anonymous encounters online has a good chance of containing nasty bacteria. This was an in vitro study of a biological substance not a study that involved actual cases of sickness caused by contaminated breastmilk.
Stuebe talks further about the difference between normal bacteria found in breastmilk and the bacteria discussed in the study. She informs readers:
A growing literature demonstrates that fresh from the tap breast milk contains a wide variety of bacteria, and these bacteria colonize the infant's gut. The study reported in Pediatrics did not distinguish between species of bacteria, nor did they compare the frozen samples with freshly expressed breast milk.
When a mother cannot breastfeed, she must be able to evaluate her options between donated breastmilk and formula feeding. Amber McCann, a board certified lactation consultant and co-editor for Lactation Matters, reported recently on Science & Sensibility:
Is milk sharing risk free? Absolutely not. There are also risks to breastfeeding and formula feeding. Dr. Karleen Gribble and Dr. Bernice Hausman discuss these concerns in their paper Milk Sharing and Formula Feeding: Infant Feeding Risks in Comparative Perspective. In it, they explore the issues of contamination of milk with pathogens, chemicals, concerns with milk collection and storage hygiene. They also discuss the risks to formula use that are not present when feeding human milk.
When working with families seeking shared breastmilk (outside of a milk bank that reserves milk for babies who are in critical need) McCann encourages them to first consider anyone they know who may be willing to share milk, and then to explore local online milk sharing groups, like Human Milk 4 Human Babies and Eats on Feets, and groups that facilitate broader-range sharing and shipping, like MilkShare. When seeking milk, McCann guides families to "thoroughly research what sorts of screening they consider essential (such as blood work from pregnancy and questionnaires about lifestyle choices such as alcohol and medication use)."
The key to making the decision that's best for you and your baby is becoming informed. Learn about all of your options and weigh the benefits and risks. Stay away from popular news outlets and carefully inserted soundbites and instead, look to trusted resources. The decision process may not be an easy one, but it is worth your time to investigate. photo credit: Indrani Soemardjan via photopin cc