dear ann, i was hoping that you were not being perhaps naive about this, and
i see by your post that maybe that is a good way to describe your position
right now about the milk exchange. here are some thoughts on the subject; i
do various things for the local milk bank, but i am not a spokesperson for
them. what i know is just my interpretation of various aspects of the milk
donation concept.

some of the problems with accepting donations of milk from someone you do not
know is that it could be adulterated, contaminated, or from a non-healthy
person, and you would have very little effective means of determining this.
you want to avoid introducing dairy products into your baby's life before a
certain age? your child is sensitive to dairy? if what is sent to you as
human milk contains cow's milk to add to the quantity, you may be endangering
your child.

if someone feels a need to "help others" by producing milk, that is
wonderful. however, in some situations, such as when a group decides that it
would be great for all its members to donate milk for a needy mom, there may
be someone in the group who knows that they are unsuitable to donate (perhaps
due to a medication), but this information is something they would rather not
share with the group. they are put in the difficult position of refusing to
donate without being willing to share the reason. sometimes someone might
donate anyway, in desperation.

a mother might not know that a health practice or drug use is a risk for the
potential recipient of the milk. healthy full term babies can often tolerate
items in their mother's milk that an ill or otherwise compromised baby
cannot.

while you can certainly test a mother to be sure that she is not unknowingly
suffering from any dread diseases, there is no way to insure that this means
continual freedom from infection. that is, a mom who tests negative to
"everything" today may be exposed next week. we have to admit that in this
not so perfect world there are relationships in which both partners are not
completely honest with each other. also, the cost of testing a donor is not
small, and milk banks could not possibly do this for informal donors. most
milk banks are supported by a lot of donations and support from institutions
that house them and provide a lot of their equipment. its definitely not a
money making proposition, or an organization that can do any extra work.
whether a doctor could adequately screen someone to be a donor? sure, but
there are the other considerations.

how do milk banks get around this problem? testing, personal interviews, and
pasteurization. that includes testing of donors and testing of the treated
milk. i have seen pasteurization being done; the highest standards are
adhered to.

we have plenty of scientific evidence to show that communicable disease
agents are  killed by pasteurization (NOT boiling as another post described).
but, there are still these many other factors to be considered.

that is not to say that there is no place for private donations. i have had
patients who chose to accept private donations of untreated milk. this takes
places more frequently than many people might believe. many mothers feel the
risk of using the alterntive is unacceptably high, and will use private donor
milk as the alternative. when i am involved in this situation, i make sure
that everyone involved is quite clear about the possible liability issues. i
am not sure that it is possible for a document to "absolve" everyone involved
from liability. legal opinions here? ann, you should have a better idea than
me about this. its probably a sticky situation with many ugly possible
repercussions.

particularly with the new information about using breastmilk to treat cancer,
there is interest in using it despite the lack of real data about how to use
it. there is nothing wrong with this, but i think it will increase the demand
for milk. everything that we do to increase the awareness of the benefits of
breastfeeding and the risks of ABM mean there is more of a demand for
breastmilk. there are also probably a certai population of what i might
politely call unusual persons who want breastmilk for reasons that fall into
what my husband calls the category of "that's more than i wanted to know."

so that means that, along with the heightened awareness of mothers that what
they have frozen is "liquid gold" and is something not to be wasted, we are
going to continue to have this informal exchange of human milk. whether you
can put up a website to facilitate this without causing more problems than it
is worth, is unknown, and probably will be the case. that's too bad, it is a
beautiful idea. this just means that we need more milk banks, and more
support for the milk banks that we have (usually meaning we need more
opportunities to dispense the milk, rather than more milk. very few doctors
are aware of the possibilities of using this milk).

and maybe we need some better ideas of how to improve this informal exchange,
since it is not going to cease. providing instructions on how to do home
pasteurization? i always discuss this with patients.

everything in life involves a risk of some kind or other. i hope some of the
other milk bank "moms" that are on the list will add some to these items i
have mentioned. my hope is that by talking about the difficulties, we can
come up with some solutions.

my motto, "there is no such thing as too much breastmilk, its just in the
wrong place,'" still stands. its just difficult to figure out the logistics
of the transport.

carol brussel IBCLC

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