What’s your favourite drink? Let’s imagine for a second that it’s the same as mine; freshly squeezed orange juice. I can’t get enough of the deliciously fresh and zingy nectar, and love the juicy pop of the ‘bits’. Yum.

Now imagine that some sort of disaster has befallen the trees that produce the orange orbs and you just can’t get your hands on the juicy stuff. You’ve visited the local supermarket ten times a day for the past three weeks, you’ve rung umpteen citrus experts for advice, including the man from Del Monte himself, but nothing has helped. You’re juice-less.

To make matters worse, you have a Vitamin C deficiency and orange juice is the best way to get your RDA. With this in mind, a friend suggests drinking orange squash instead. She tells you it’s made from fruit and there’s plenty of Vitamin C in it, but we all know she’s been brainwashed by BigSquashTM marketing and anyway, why would you want to drink artificial orange juice with fortified vitamins when you can drink the real thing, right?

Luckily you spot an advert online: Freshly Squeezed Orange Juice for Sale! A lovely lady that goes by the moniker @juicymama has offered to send you her excess orange juice for a mere £2 per ounce. She states in her advert that she is healthy and clean, cleans her kitchen with Dettol, always washes herDSC_0712 hands before squeezing the oranges and that her juice collection bags are sterile. She has NEVER sneezed while squeezing the juice.  Not even once. Since she has too much juice for her to drink and is having a fridge clear out, she is willing to sell you the excess. She’ll pack it up and send it to you if you can’t make the 80 mile round trip. You reach for your credit card…

And. We’re back in the room.

Would you drink orange juice squeezed by the hand, and in the kitchen of, a complete stranger? Would you trust her when she tells you she’s clean, healthy and hygienic and that there’s nothing in the juice that would make you sick (whether through ill-health or just by giving you the boak)? Do you believe her that she only used organic Valencia oranges and that she hasn’t stretched the volume with water?

I certainly wouldn’t.

This is the reality of informal breast milk sharing. Taking the word of strangers that the product you are buying or being gifted is safe.  Misinformation and shaming of infant formula has led us to a place where we are actually prepared to buy breast milk from complete strangers rather than feed our babies a safe, healthy alternative.

It’s not just hyperbole either. Studies have shown that breastmilk bought online has been found to be contaminated with bacteria1 or diluted with cows’ milk2.  Even in a hospital setting there have been outbreaks of infection with drug resistant bacteria3 following milk sharing, showing the requirement for pasteurisation.

In comparison to breast milk sourced from a milk bank, breast milk bought online had significantly higher counts of bacteria1, and the number of bacteria was specifically related to how long the milk had spent in transit. Furthermore, nicotine and caffeinewere detected in breast milk samples bought online from donors who specifically stated they limited or avoided these substances.

Like other medical products of human origin (MPHO’s), breastmilk can transmit serious diseases, including Hepatitis E5, Hepatitis B6 and many others, so it shouldn’t be seen as a risk-free alternative to breastfeeding or formula feeding.  Indeed, the US FDA specifically recommends against7 using donor milk sourced online and a recent editorial in the British Medical Journal8 concludes that ‘milk bought online is a far from ideal alternative [to using formula], exposing infants and other consumers to microbiological and chemical agents’ and that ‘urgent action is required to make this market safer’.

Here at Infant Feeding Support UK we support all safe infant feeding choices.  However, knowing the risks associated with informal, or peer-to-peer milk sharing it’s difficult to conscionably encourage this practice. However, there are specific cases where it is beneficial to choose breast milk, namely for sick premature infants9. Therefore, in order to mitigate any risk of using donor breast milk, we recommend doing so through a legitimate milk bank.

The UK Association of Milk Banks is a registered charity set up in 1997 to support human breast milk banking in the UK; it promotes the use of safe and screened human breast milk.  Guidelines10 produced by the National Institute for Health and Clinical Excellence (NICE) recommend that all donor milk used by the NHS should be from milk banks that apply strict quality control procedures. In addition, NICE presents guidelines for donors to ensure hygienic milk collection and storage practices and guidance to keep their milk free from unnecessary harms such as medicines, nicotine and alcohol, keeping everybody safe.

So, if you want to use donor milk or donate breast milk yourself, it’s best to do so via a legitimate milk bank.

I’m off for a glass of orange juice. Care to join me? I squeezed it myself 😉

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REFERENCES:

1. Keim SA, Hogan JS, McNamara KA, Gudimetla V, Dillon CE, Kwiek JJ and Geraghty SR. (2013). Microbial Contamination of Human Milk Purchased Via the Internet. Pediatrics, 132(5):e1227-e1235.

2. Keim SA, Kulkarni MM, McNamara K, Geraghty SR, Billock RM, Ronau R, Hogan JS and Kwiek JJ. (2015). Cow’s Milk Contamination of Human Milk Purchased via the Internet. Pediatrics, 135(5):e1157-62.

3. Nakamura K, Kaneko M, Abe Y, Yamamoto N, Mori H, Yoshida A, Ohashi K, Miura S, Yang TT, Momoi N and Kanemitsu K. (2016). Outbreak of extended-spectrum β-lactamase-producing Escherichia coli transmitted through breast milk sharing in a neonatal intensive care unit. Journal of Hospital Infections, 92(1):42-6.

4. Geraghty SR, Kelly McNamara K, Kwiek JJ, Rogers L, Klebanoff MA, Augustine M and Keim SA. (2015). Tobacco Metabolites and Caffeine in Human Milk Purchased via the Internet. Breastfeeding Medicine, 10(9): 419–424.

5. Antonio Rivero-Juarez A, Frias M, Rodriguez-Cano D, Cuenca-López F and Rivero A. (2016). Isolation of Hepatitis E Virus From Breast Milk During Acute Infection. Clinical Infectious Disease, 62(11): 1464.

6. Pirillo MF, Scarcella P, Andreotti M, Jere H, Buonomo E, Sagno JB, Amici R, Mancini MG, Leone P, Ceffa S, Mancinelli S, Marazzi MC, Vella S, Palombi L and Giuliano M.J (2015). Hepatitis B virus mother-to-child transmission among HIV-infected women receiving lamivudine-containing antiretroviral regimens during pregnancy and breastfeeding. Viral Hepatitis, 22(3):289-96.

7. United States Food and Drug Administration. (2015). Use of human donor milk.

8. Steele S, Martyn J and Foell J. (2015). Risks of the unregulated market in human breast milk British Medical Journal, 350 :h1485.

9. Boyd CA, Quigley MA and Brocklehurst P. (2007) Donor breast milk versus infant formula for preterm infants: systematic review and meta-analysis. Archives of Diseases in Childhood – Fetal and Neonatal Edition, 92(3):F169-75.

10. National Institute for Health and Care Excellence (2010) Donor milk banks: service operation. NICE clinical guideline (CG93).