Wall Street Journal - January 4, 2005
Sara Schaefer Muñoz, sara.schaefer@wsj.com

Amid mounting evidence of the health benefits of breast-feeding for infants, a movement is quietly growing among parents: sharing or even selling breast milk.

The idea is to provide milk for adoptive mothers and women who cannot nurse because of illness or some other reason. Instead of turning solely to infant formula to feed their children, these women are tapping into informal networks of friends, acquaintances and in some cases strangers found on the Internet.

While there are milk banks where parents can purchase donated breast milk that has been pasteurized and screened for disease, infants who are very sick and cannot nurse get priority. In addition, banks require a doctor's prescription, and the milk can be very expensive -- about $100 a day.

Now more casual, ad hoc agreements are emerging, in which mothers with excess breast milk either donate the milk or sell it for less than a milk bank would charge. Sometimes these pacts are made between friends, family or neighbors. The growing number of parenting Web sites and chat rooms are facilitating these milk exchanges.

Shannon McElearney, a surgery resident at the University of Virginia, was trolling the Web soon after her baby was born 19 months ago and came across a request for milk from a woman who had had a double mastectomy and was unable to breast-feed. Dr. McElearney packed up 150 ounces of unused milk she had frozen and FedExed it overnight to the woman, Jenn Connel in Wilton, N.H.

"I thought it was a great way to use up this milk that otherwise would expire in my freezer," said Dr. McElearney, who donated the milk, though Ms. Connel covered the cost of having it shipped in dry ice.

Some advocates of breast-feeding praise the commitment of parents to get their babies human milk. But many health experts note that the practice can be risky. Many diseases, including HIV , hepatitis and syphilis, can be transmitted by human breast milk. And milk that is improperly collected or stored can harbor dangerous bacteria. The Centers for Disease Control and Prevention has no specific stance on the practice. But the American Academy of Pediatrics, as well as the breast-feeding-advocacy group La Leche League International, say they don't recommend it.

Nevertheless, nurses and volunteers for La Leche League say they have encountered more women seeking human milk during the past two to three years at support groups or on breast-feeding-assistance hot lines. And some individuals are moving to capitalize on the demand. In 2003, a couple put 1,000 ounces of breast milk for sale on the community Web site craigslist.org, for 25 cents an ounce. Craig Newmark, founder of craigslist, says he has seen breast milk listed for sale about once a month during the past two years.

Unregulated breast-milk sharing puts doctors, nurses and lactation consultants in a quandary. In addition to the risk of transmitting disease to a baby, breast milk can contain other contaminants such as drugs, alcohol and mercury that can be dangerous for infants. In at least one state, California, it is illegal to share tissue or bodily fluid without going through a licensed facility. As an alternative, infant formula is still an acceptable choice for babies, pediatricians say.

Interest in milk sharing comes as a growing number of studies show benefits of human milk for babies -- including a reduced chance of respiratory infections and sudden infant death syndrome, as well as possible cognitive advantages. A study published in May in the journal Pediatrics showed that breast-feeding reduced the chances of babies dying in their first year of life, and a British study released the same month showed that babies who were breast-fed had healthier cholesterol as teenagers, decreasing their risk for heart disease. In light of this, many lactation consultants, doctors and nurses hesitate to condemn the practice of milk sharing outright.

Typically, women who wish to share their breast milk use electric pumps that can pump about six ounces in 10 minutes. The milk then is stored in glass or plastic bottles or plastic bags in refrigerators or freezers. If the milk is being shared with someone nearby, it may be transported in a cooler; if it is being shipped far away, it often is packed in dry ice and sent overnight.

The American Academy of Pediatrics says the milk is good for 72 hours when it is refrigerated, and can last at least one month in a typical home freezer and for as long as six months if kept in a deep freezer below zero degrees Fahrenheit.

But if milk hasn't been kept at the proper temperature, bacteria can grow and spoilage can occur, lactation experts warn. And a study published last year by researchers at the Robert Wood Johnson Medical Center discovered that antioxidants drop substantially in breast milk that has been frozen for more than 48 hours. The researchers said more studies need to be done to see whether the reduced antioxidant levels in stored milk really matter for babies.

"I would say that if you are interested in doing this it is important that [the donor] is a not a carrier of something you want to risk your baby with," said Audrey Naylor, a pediatrician speaking for the American Academy of Pediatrics.

Carol Ryan, a nurse and director of parenting and lactation services at Georgetown University Hospital, in Washington, D.C., says casual donors should have the same blood screening that is required for donors to milk banks, which include blood tests for HIV , hepatitis, syphilis and herpes viruses. She also recommends a chest X-ray to rule out tuberculosis, because carriers of the disease could contaminate their donated milk while handling it.

Ms. Connel in New Hampshire, who got milk from various strangers over the Internet in addition to Dr. McElearney, is one mother who asked for copies of test results for HIV and hepatitis.

Some mothers take donations only from women they know. Kim Box, a mother of two from Edgewood, Texas, makes the five-minute drive to her friend Melinda Smith's house and picks up several bottles of breast milk that she stashes in a small cooler for her newly adopted son. Ms. Box, who has known Ms. Smith since high school, says she hopes the antibodies in the milk will protect her 5-month-old son from the ear infections that plagued his older sister.

"At first I hesitated," said Ms. Box, 40. "But I just think it's what's best."

Still, health experts say the safest way to obtain milk is through milk banks. There are eight operating milk banks in the U.S. and Canada and four more in development, according to the Human Milk Banking Association of North America.

The banks are nonprofit organizations that operate much like blood banks, with screened donors and a cold-storage process. The milk is pasteurized before distribution, mostly to babies in neonatal intensive-care units who are too ill to nurse. If the supply is available, banks will provide milk to individual children who have a doctor's prescription.

Frances Jones, president of the Human Milk Banking Association of North America, said demand has grown. Recipients of milk from her bank at British Columbia Children's Hospital in Vancouver, have increased from 50 in 1999 to 230 recipients in 2004, 90 of those who were individual families, not hospitals. During the past several years, she has seen requests for milk from individual families in Canada and the U.S. go from about one a week, to about three or four a week.

One problem is cost. The milk can run about $3 an ounce plus shipping charges. An infant will consume around 30 ounces a day, or more. While some milk banks will negotiate with insurers to help get the milk paid for, many insurance companies don't cover it.

Copyright © 2005 - The Wall Street Journal. Reproduction of this article (other than one copy for personal reference) must be cleared through the WSJ Permissions Desk.

AEGiS is made possible through unrestricted grants from Boehringer Ingelheim, Elton John AIDS Foundation, Bridgestone/Firestone Charitable Trust, the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 2005. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2005. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .