Milk sharing: the expert verdict

The benefits of feeding your baby donated breast milk generally outweigh the risks. By Amie Larter

The age-old tradition of wet nursing is once again in the spotlight, as the growing demand for human breast milk rises.

Human Milk 4 Human Babies, an international online milk-sharing site, is growing in popularity, with more than 4000 Australian members. The group uses Facebook "to make real-life connections and come together as sustainable milk-sharing communities where women graciously share their breast milk".

However, with health officials continuing to warn about the risks, Nursing Review spoke to three experts for their insights on the issue.

"Risks are minimal"

Dr Jennifer James, lecturer and course coordinator, Division of Nursing and Midwifery, RMIT University, Melbourne

"The risks are absolutely minimal - that's the bottom line. Very little gets transferred across in breast milk, regardless of whether it is from the mother or another mother.

"The risks of transmitting if you are sharing milk via a wet nurse or a banked product are quite minimal. There is a slight risk, but it has been blown out of all proportion.

"Informal milk sharing goes on in our community and it just doesn't get talked about - sisters, cousins and aunties breastfeed nieces and nephews.

"As nurses, we need evidence-based practice. As you look at the evidence, then you soon realise that risks of transmission are tiny, and as health professionals it is our responsibility to impart that information to women.

"Our biggest challenge is to get breastfeeding to be the norm in our culture. If we can do that then no-one is going to bat an eyelid and the media will have to look for something else to talk about."

"Screening is needed"

Kerre Willsher, lecturer in the Centre for Regional Engagement at the University of South Australia, Whyalla, registered midwife and maternal and child health nurse

"I believe that proper screening of mothers wishing to donate milk should be carried out. Mothers can be excluded if they have poor health, smoke, take certain medications, are taking illicit drugs, or [have] HIV, CMV, hep B or hep C.

"I would consider that healthy shared breast milk is superior to formula. A good deal of my experience as a maternal and child health nurse has taken place in remote areas of Australia and in developing countries (PNG). In scenarios where literacy and numeracy is poor, there are few chances to practise good hygiene and there is no income to purchase formula, wet nursing is superior. In natural disasters, mother's own milk or wet nursing may be the only options. In countries like Australia, formula may be safer, but on the other hand some babies may have allergies.

"If there are concerns about the adequacy of the mother's own supply, we could explore ways to increase it. I would hand out evidence-based literature to the parents to allow them to make an informed choice - literature that explains to parents what to look for would be helpful if they wish to go online."

"Milk banks have limits"

Ben Hartmann, manager of the Perron Rotary Express Milk Bank, King Edward Memorial Hospital, Perth

"Certainly milk sharing is uncontrolled so there is an element of risk. In that situation, if a parent and a consenting adult are making a decision about the care of a baby, then they have to be aware they are taking the responsibility for those risks.

"Babies' nutritional needs need to be supported, and unfortunately in Australia there are not a lot of options for mums. Donor milk banks are only available for preterm babies in hospital, so milk sharing and artificial formula are the only other options [for mums who can't breastfeed].

"I don't see donor milk from a human milk bank sitting in that space [of future options for breastfeeding mums] because I think it's unrealistic. If you look at our breastfeeding rates, we are great at convincing mums to breastfeed, but we don't do that well in meeting longer-term targets of four to six months exclusive to two years.

"The volumes of donor milk we would need to fill that gap would be just enormous and I can't see that being a practical way."

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