Donor Breast Milk

Dr. Tafadzwa Kasambira, M.D., M.P.H. is a pediatrician who received his undergraduate training at McGill University in Canada, and graduated in 2002 from Tufts University School of Medicine, where he also completed a degree in public health. He completed his pediatric residency training at Harvard University in 2005, and completed a fellowship in infectious diseases at Johns Hopkins University in 2008. He has been a medical officer at the FDA for the last six years. He and his husband are the proud fathers of three children.

There is little argument in the medical community that breast milk is the best nutritional option for newborn infants. Besides situations in which breast milk is contraindicated (e.g., inborn errors of metabolism, such as galactosemia), nearly all pediatricians and family medicine physicians would advise that infants be initially fed with breast milk when they are born.

What are the options, however, for gay fathers who want their newborn infants to gain from the benefits of breast milk? My husband and I were two such fathers who considered the option of donor breast milk after our son (whom I will call Spiderman) was born. Our first child, Wordgirl, suffered terribly from milk-soy protein intolerance (MSPI), as I discussed in my previous blog post, and we felt that many of her problems stemmed from the formula that she was taking. We wanted to avoid that issue with our second child by providing him with donor breast milk.

The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for the first 6 months of an infant’s life, followed by continued breastfeeding as complementary foods are introduced, with the continuation of breastfeeding for one year or longer (1). The reasons for this strong recommendation are the numerous advantages that breast milk provides for an infant.

The risk of hospitalization for lower respiratory tract infections in the first year of life is reduced by 72% if infants are breastfed exclusively for more than four months (2). The severity (in terms of duration of hospitalization and oxygen requirements) of respiratory syncytial virus (RSV) bronchiolitis is reduced by 74% in infants who breastfed exclusively for 4 months, compared with infants who never or only partially breastfed. Any breastfeeding, compared with exclusive infant formula feeding, will reduce the incidence of otitis media (OM) by 23%. Other conditions that are reduced in incidence and/or severity with breastfeeding include serious colds and ear and throat infections, pneumonia, nonspecific gastrointestinal tract infections, asthma, atopic dermatitis, and eczema, as well as the risk of sudden infant death syndrome (SIDS), obesity, and diabetes (2).

With so many proven advantages of breast milk, it is not surprising that gay fathers have been among those interested in finding ways in which their own infants can gain the same benefits. The issue of donor breast milk is a controversial one, and the pros and cons are many. While breastfeeding is relatively free from bacterial contamination of the actual breast milk, transmission of infections can be an issue with banked human breast milk that is improperly processed. Some infectious agents that can pass into breast milk may potentially cause significant disease in infants, such as human immunodeficiency virus 1 (HIV-1), human T-cell lymphotropic virus 1 (HTLV-1), and cytomegalovirus (CMV).

The collection, processing and storage of human breast milk is usually conducted to meet the needs of low-birth-weight (LBW) infants, of full term newborn infants who temporarily cannot breastfeed, or of ill infants with intractable diarrhea, with short-gut syndrome, or intolerance to milk or soy proteins (3). Donor human milk banks have been established in the United States to provide safe, processed human milk from milk that is donated by healthy lactating mothers who have undergone a rigorous screening process. These nonprofit milk banks, operating under the auspices of the Human Milk Banking Association of North America (HMBANA), obtain, process, and dispense human milk under strict guidelines set by the association (4).

HMBANA does not charge for the milk itself, but rather for its processing (donor blood testing and tracking, pasteurization, and testing and analysis of the milk) and the overhead involved. The milk is expensive to purchase, costing as much as $4 an ounce or more. Given how much milk a growing infant requires, especially if taking breast milk exclusively, one’s bill can easily run into the thousands of dollars fairly quickly. When purchased for infants in the hospital or with medical insurance, the costs can be covered or defrayed to some extent.

Due to the demand for breast milk and the exorbitant costs for this “liquid gold,” an alternative market for the milk has arisen. There are websites online where donors can sell their breast milk to parents who are willing to buy it. There are also websites, such as Milkshare, that help those in need of breast milk for their babies to learn about milk donation and connect families who can assist each other in that endeavor (5). Such resources do not support the selling of breast milk, and establish distinct criteria for interacting with mothers and those who are looking for breast milk. All the interactions are carried out at one’s own risk, with the assumption that one’s child is of the utmost importance, and all parties know and respect that fact. Donors are often very willing to undergo all the necessary lab work to ensure that the milk they donate (always given also to their own babies, or now, children) is safe, and that the recipient families are secure in that knowledge.

This was our experience when we decided to take this route to provide our son with donor breast milk. We were something of a novelty: a gay couple seeking breast milk on Milkshare, which only had women communicating with other women. It did not take long, however, before we were contacted by a mother who lived in the state next to ours. She was a young, married attorney, who was still breastfeeding her nine month old daughter, and had a freezer-full of stored breast milk that was only increasing in volume, as her supply was excessive. We spoke on the phone, and she told us that her sister was lesbian, and that was the reason why she wanted her excess breast milk to go to gay fathers. She was friendly and motivated, had a good health history, exercised regularly and had a great diet. She immediately sent us a copy of recent extensive blood tests that that showed that she was very healthy and free of any infectious diseases. We met in person soon afterwards, where she gave us two coolers full of her breast milk, with more to come in the next few weeks. Her happiness at doing so equaled ours.

It is difficult to express enough gratitude for such a gift that is given so graciously and at no charge. This all happened while we were matched with our son’s birthmother, before he was born, and when we got the call that he had arrived, another mother in the state of his birth provided us with enough breast milk to last us for the two weeks we spent there, waiting to bring him home. She, too, was a married mother, very healthy (as evidenced by her labs), who had three older children and a baby who could not keep up with her milk supply. We could tell that she was not entirely comfortable with our being a gay couple, but her concern for the health of our child superseded these feelings, and she kept in touch with us for a long time after we met her, offering us more of her milk if we needed it. We were also helped by another two mothers several months later. Our son ended up consuming breast milk exclusively for the first six months of his life, and only breast milk with solids until he was nine months old. He never had any gastrointestinal issues, and his growth and health have always been superb.

The choice to use donor breast milk is a very personal one. Most non-breastfed babies do well on commercial infant formula. For those who make the choice to seek out donor breast milk, the risks and benefits must be weighed carefully, particularly in the non-regulated market that exists for this precious infant nutrition source. While trusting that a donor mother would not place another person’s child at risk is probably a safe bet, assumptions should not be made, and everything should be done to ensure that the milk one gives one’s baby is safe and not contaminated. Having a discussion with one’s pediatrician about the most appropriate source of nutrition for your infant is essential.

 

Legal Disclaimer: This article is designed to provide general information related to pediatric care. The information presented in this article should not be construed as formal medical advice, nor is it intended to create a doctor-patient relationship. The content is intended solely for informational and not for treatment purposes.

This article is not a substitution for professional medical diagnosis or treatment.

 

REFERENCES

  • Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics 2012;129;e827
  • Ip S, Chung M, Raman G, et al; Tufts-New England Medical Center Evidence-based Practice Center. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (Full Rep). 2007;153(153):1–186
  • Barness LA, Dallman PR, Anderson H, et al. Human Milk Banking. Pediatrics 1980;65(4):854-857
  • Upedegrove K. Nonprofit Human Milk Banking in the United States. J Midwifery Womens Health 2013;58(5):502-508
  • Milkshare. https://milkshare.birthingforlife.com/ (Accessed September 15, 2014)
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