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Purchased Breastmilk Overflowing with Bacteria? The Facts Behind the Sensationalistic Headlines.

October 22nd, 2013 by avatar

 By Suzanne Barston

Suzanne Barston, author of Bottled Up: How the Way We Feed Babies Has Come to Define Motherhood, and Why It Shouldn’t and blogger on topics related to infant feeding discusses the new study that examines bacterial levels found in breastmilk purchased online.  Did you bother to look beyond the headlines to see what the research showed.  How will you respond to clients, patients and students who ask you what you think and wonder how safe it is to feed their babies purchased or donor milk?  Suzanne points us toward some great information and takes a level-headed look at what this study actually tells us.  To learn more about Suzanne, please read Walker Karraa’s interview with Suzanne for Science & Sensibility here.- Sharon Muza, Science & Sensibility Community Manager.

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As someone who supports formula feeding parents, I’m used to sensationalized media coverage of studies that confuses real risk with relative risk. It’s taught me to look at research with a critical eye, rather than accepting what the reporters (or even the study authors, at times) claim is absolute truth. 

This week’s splashy headlines involved breastmilk, not formula, but the end result has been quite familiar: frightened parents, frustrated advocates, and confused bloggers. Everyone’s talking about a new study published this week in Pediatrics, which according to its authors “documents the potential for human milk shared via the Internet to cause infectious disease by estimating the extent of microbial contamination among samples purchased via a leading Internet Web site.” Some took the findings of this study – the discovery that most of the obtained samples contained pathogenic bacteria – to be proof that milk donation is a risky business. Others insinuated that this was a social problem; that puritanical/paternalistic attitudes towards breastfeeding and feminine bodily fluids cast unwarranted suspicion on milk sharing, and provoked a dire dismissal of relative risk (after all, formula is subject to bacterial contamination as well).

The “absolute truth”, I believe, is floating somewhere in the middle. As Alison Stuebe, MD, points out on her Academy of Breastfeeding Medicine blog, this study was limited by its methodology. The breastmilk samples were obtained through an online site where milk was not “shared” but rather sold per ounce. In order to maintain anonymity, the researchers only corresponded with donors via email, and cut off communication if the seller asked too many questions. Stuebe explains:

 “It’s highly plausible that milk sent with no questions asked, via 2 day or longer shipment, and (in 1 and 5 cases) without any cooling whatsoever, was collected with less attention to basic hygienic precautions. The bacterial load in study milk samples therefore doesn’t tell us about the relative safety of milk obtained following a conversation between buyer and seller about the recipient baby and then shipped overnight on dry ice in a laboratory-quality cooler. Indeed, when the authors compared online milk purchases with samples donated to a milk bank after a screening and selection process, they found much lower rates of bacterial contamination…”

The other important factor to consider is that we can’t know if any babies would’ve necessarily become ill after ingesting this milk; all we can be sure of is that milk transported across the country from anonymous encounters online has a good chance of containing nasty bacteria. This was an in vitro study of a biological substance – not a study that involved actual cases of sickness caused by contaminated breastmilk.

And that is what is so beautiful about it. This was an in vitro study of a biological substance. It looked at breastmilk unemotionally, separate from the individual producing the milk or receiving it. No babies were harmed or even affected by this research. We don’t need to have a defensive reaction to the results, any more than a formula feeding mother needs to have a defensive reaction about a formula recall due to bugs in the powder. 

Food preparation, storage and safety don’t need to be a personal or political issue. I doubt the local grocer feels offended when spinach gets recalled, but she probably feels concerned. Unlike guilt or shame, concern is a healthy emotion, because it allows for a solution to be found. That’s why this study should be viewed as useful information rather than an indictment on milk sharing as a practice. From it, we can learn that more stringent practices are needed to ensure safety – parents can be informed that there are some risks involved in anonymous online purchase of human breastmilk.

The real difficulty, here, is that the issue of breastfeeding balances tenuously between the medical, the personal, and the political. It may be hard to make peace with the fact that obtaining breastmilk might need to become a sterile, regulated activity, prone to corporate involvement (because anytime money is involved we run that risk, especially when it comes to infant feeding), when breastfeeding is such an intimate, personal act. Ironically, the only other solution offered in response to this study is to make milk sharing more personal – that we urge parents to get to know donors, discuss how the milk will be pumped, stored, and transported, and share locally whenever possible. This certainly might cut down on the risks, but the fact remains that unless the donor is a close friend or relative, you are still asking parents to implicitly trust someone they don’t know very well. 

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Rather than angrily striking out at this research, or accepting it as the final word on milk sharing safety, we could simply use it to ask more questions. How, exactly, should milk be pumped, stored, and transported? There’s been some interesting research on how the freezing process affects the antioxidant and vitamin content of expressed breastmilk, for example – should babies fed expressed, donated milk only be given vitamin supplements? How does this affect infant health in the long term? What about ensuring that foremilk and hindmilk are balanced, by giving donating moms guidance on the best pumping practices? Does the milk of a mom nursing a toddler provide the best nutrition for a newborn, or should donations partnerships be based on age?

Lastly, rather than assuming other modes of milk sharing are safer (even if we intuitively believe that they are), can we study samples obtained from other types of donation arrangements, to put parents’ minds at rest? Do women who pump and store their own milk need to be concerned about bacterial contamination? (The lead author of the study, Dr. Sarah Keim, actually did offer some concrete suggestions to Medical News Today on improving the safety of pumped milk – things like sanitizing all containers and pump parts and freezing or refrigerating the milk within 6 hours.)

We cannot be scared of research, and we can’t get angry at it. But we can get angry at a media that grabs sensational headlines and runs so fast with them that we can’t catch up; we can be scared of an atmosphere that makes moms feel that their choices are limited to the lesser of two evils if they are unable to breastfeed. It’s our job, as advocates and care providers, to ensure that women aren’t given false ideas about risk in either direction, so that their “informed choices” can truly be informed.

Suzanne Barston is a maternal health advocate and freelance writer specializing in parenting, women’s interest, and science/health topics. She is the author of Bottled Up: How the Way We Feed Babies Has Come to Define Motherhood, and Why It Shouldn’t and blogs as her alter ego, the “Fearless Formula Feeder”. She’s currently at work on an initiative to improve the perinatal experiences of women by addressing infant feeding intention and outcomes in an evidence-based, holistic manner.

 

Babies, Breastfeeding, Childbirth Education, Guest Posts, Newborns, Research, Social Media, Uncategorized , , , , , , , , , ,

  1. avatar
    Ruth
    October 22nd, 2013 at 16:02 | #1

    Why would you choose a formula feeding advocate who makes her money off formula feeding reassurance , writing books and articles supporting drug industry, she is the wrong person to give this type of information, both because she is inaccurate in her portrayal of the issues (and foremilk and hind milk issue which don’t exist). And like any misinformed formula feeding company shill she has raised red herring issues about breastfeeding in this article that are non issues.

    There are real problems with strangers buying breast milk off the internet.
    , but she missed the mark in investigating them with strangers buying milk off the internet.

  2. avatar
    Ruth
    October 22nd, 2013 at 16:16 | #2

    Can you share a response to this study from a responsible resource where
    mother-2-mother breast milk sharing is going on, and they do list all the warnings and instructions to women who donate or receive milk from each other.
    http://www.eatsonfeets.org/posts/AAPResponse.html

  3. October 22nd, 2013 at 16:27 | #3

    Does anyone know the answers to these questions? If the milk was purchased, how do the researchers know if the samples were 100% breast milk? (people will do anything to increase profits, dontcha know?) Did the study go through an ethics review? Did they avoid having to go through an ethics review by eliminating any of the donors who wanted to engage in proper communication? Did National Children’s help to fund/support this study? Did Nationwide partner with Grant Medical Center to help found the Mothers Milk Bank of Ohio? How does this study help those using donor milk? Who regulates the Mothers Milk Bank? Is the milk tested for non-pathogenic contaminants such as nicotine or alcohol? Does the researcher who designed this study work at Nationwide Children’s? Does one of the other study’s other researchers work with a strategic collection spot for the milk bank? Doesn’t Nationwide frequently requests for donations on behalf of the milk bank, claiming that supplies are critically low? Did they isolate the specific pathogenic species? Do not the authors themselves state that “the presence of bacteria is not predictive of infant health risk”? And lastly, why would they point such scandalous arrows at families who are just trying their best to take care of their babies when really all this study seems to be saying is “So… People, uh… our study indicates that you shouldn’t purchase liquid being sold as cow’s milk from strangers trying to make a buck, improperly pack it, have it shipped to a P. O box, leave it sitting there and then feed it to your kids. Yeah, we dont suggest that you do that.”

  4. October 22nd, 2013 at 16:58 | #4

    Thank you for inviting Suzanne to engage with this community on this issue.

  5. October 22nd, 2013 at 18:46 | #5

    @Ruth I believe (with the exception of the comment on foremilk and hindmilk) that Suzanne wrote an accurate and balanced review of the study (which it is clear is useless and not applicable to most donor milk situations in our communities) and provided additional links that also clearly support her view that the leap from the study results to actual milk sharing situations is a big one. Suzanne did not write this as a “formula feeder” but as an informed consumer capable of reviewing this poorly done study. I am appreciative of her time and perspective.

  6. October 22nd, 2013 at 20:28 | #6

    The link to the study is provided. Perhaps reading the study will answer your questions about it…just a thought.

  7. October 22nd, 2013 at 20:31 | #7

    @Ruth

    Ruth:

    1. Oversupply (often referred to colloquially as foremilk/hindmik imbalance -http://www.llli.org/faq/foremilk.html) is a very real possibility when dealing with someone who is pumping a great deal of milk, rather than simply feeding their own infant. These imbalances are often discussed in exclusive pumping websites – a population I’m very familiar with, having been one myself. I don’t think it’s unreasonable to wonder if the milk supplied by an anonymous donor who makes a profit on said milk might be vulnerable to some imbalance in fat content, but as I said, these are just questions. I’m not a researcher nor an IBCLC, so perhaps I missed the mark on that one. However, I don’t think it was outlandish enough to warrant such vitriolic accusations as the ones you’ve made here.

    2. I do not only support formula feeding mothers, but also pumping mothers and a fair amount of moms who engage in milksharing relationships or who purchase donor milk. In other words, anyone who falls outside of the exclusive breastfeeding category. This study probably affected my audience just as much as many breastfeeding communities. I’ve done quite a bit of reading on donor milk as it can and should be a viable option for women who cannot or choose not to breastfeed.

    I’m happy to discuss the finer points of this study or my own thoughts, but not if you are going to stoop to unfair, unfounded accusations. I do not make money off of my work. I don’t get paid for speaking engagements, I don’t charge for the many consultations I have via email or phone with struggling moms, and I don’t even have advertising on my blog. I’m an advocate because I care deeply about these issues. (And I actually am employed in my “day job” by a website that is associated with many “big names” in the natural birth/breastfeeding movement, so if anything, I think it would be more fair to accuse me of being a shill for Big Home Birth. :)

  8. October 22nd, 2013 at 20:35 | #8

    Dear Ruth…I know Suzanne Barston as a friend and colleague. I a I so know she makes no money much less “earn a living” from her blog. It is completely voluntary and she works full time at another job and raises 2 children. Pretty impressive if you ask me. I wish you had read more of her work prior to getting the attitude. This claws out kind of stuff is outdated and been outclasses by true advocates like Suzie and Sharon who bring divergent perspectives to the table for the benefit of women…not personal agendas. I thi k that has a lot to do with the sensibility of science. @Ruth

  9. October 22nd, 2013 at 20:35 | #9

    @Shell Walker

    I think your last comment hits the nail on the head, Shell. This was my biggest frustration about the study and the coverage it received (because I do think we have to remember that the media coverage is typically far more sensationalistic than the studies themselves). How many parents are really buying milk this way? Most of the moms I know who use donor milk either get it from a milk bank or engage in a peer-to-peer sharing arrangement. I wish they’d looked at these types of donor arrangements to get a clearer picture of the risk scenarios in this method of infant feeding.

  10. October 22nd, 2013 at 20:36 | #10

    @Suzanne Barston

    Also, I do have the full study – if you’d like to see it, shoot me an email and I’ll send it to you. sbc323 and gmail. :)

  11. avatar
    Ella
    October 22nd, 2013 at 20:49 | #11

    @walker karraa

    This seems like an unfortunate passive aggressive response to some intelligently raised questions. Just a thought? Why even respond?

    I agree that asking the Fearless Formula Feeder about a study on breastmilk seems to be out of line with good common sense. If this is Science and Sensibility where is the sensibility to not publish a breastfeeding piece by someone with a vested interest in formula? She is, after all, selling books in support of formula feeding as you linked to in the piece.

    I am sure Ms. Barston can and does take a balanced approach to many things, and this isn’t a commentary on her mothering or abilities. It just plain makes no SENSE to enlist her write this specific article, when there are many other people who could have done so. It seems like an err in judgment.

  12. avatar
    Kristine Keller
    October 23rd, 2013 at 09:21 | #12

    The foremilk/hindmilk thing is a myth. Studies have been done Austrailia that show snackers often get the same amount of fat as babies that take in full feedings. Also, age appropriate milk has nothing to do wth this conversation as formula contents dont change daily, weekly or monthly. They are the same from day 1 to day 365…

  13. October 23rd, 2013 at 09:58 | #13

    Thank you for writing this piece, Susanne. It is more balanced than I have seen and I appreciate the angle that S&S is trying to bring to the discussion.

    That said, I have a few comments that unfortunately due to time constraint will not be well worked out but here goes: I think the hind/foremilk argument is incorrect. I also think that there is plenty of official storing and shipping breastmilk info online. The Eats On Feets Resource links to some main ones.

    I disagree that the only solution offered is making milk sharing more personal. “Know Thy Source” is critical in milk sharing, yes, but it is not all that is stressed. There is much information offered on the Eats On Feets resource for example on how to share breastmilk safely. Our 4 pillars of breastmilk sharing are not based on getting more personal, they are based on informed choice, proper screening, proper handling and pasteurization if those criteria are not met, with all the research and information to support these pillars.

    As we know, the study is also not about milksharing, but about purchasing from unknown donors. Susanne perpetuates this convolution of terms in this sentence:
    “Rather than angrily striking out at this research, or accepting it as the final word on milk sharing safety…” I believe that this does no one any good. The differences between sharing and buying/selling should have been acutely stressed imo as they have vast ramifications, not just for the quality of the milk but also for the baby whose biological milk it could be. It goes beyond sharing the extra milk a mother may have.

    And of course, while I assume you write this theoretically, I strongly disagree with this:
    “It may be hard to make peace with the fact that obtaining breastmilk might need to become a sterile, regulated activity, prone to corporate involvement”
    That to me seems to be sensational in the sense that it refers to a result down the road because of what the study is showing, and it is not showing much of anything. If that makes sense.

    Sincerely,
    Maria.

  14. October 23rd, 2013 at 10:15 | #14

    @Maria
    My apologies for spelling your name incorrectly!

  15. October 23rd, 2013 at 10:38 | #15

    @Maria

    Thanks, Maria, for actually commenting on the piece.

    I agree with you that I should’ve watched my language with the “milk sharing” reference – what I was trying to say is that the general public might assume this is the final word on milk sharing since that’s what the study was reported as being about (obviously a problem). But I can see how that could be taken out of context and it is extremely important that we get the word out that this study was not about milk sharing, but milk buying.

    I’m so glad that there are resources out there like Eats on Feets, and you’re right – there is a middle ground that I failed to acknowledge here. Thanks for pointing that out.

    And yes- that last point was totally theoretical, but I actually think that down the line we WILL see corporate involvement in human milk “formulas” or banked human milk, because the more we learn about breastmilk, the more consumer demand there will be for it. I don’t mean that to be sensationalistic, but rather a call to action of sorts – because we need ethical people to be involved in these developments rather than us burying our heads in the sand. My goal is always to get babies fed in the healthiest way possible while still protecting the autonomy, mental and physical health of the mother and other close family members – if banked breastmilk is indeed healthier than formula (and while I intuitively believe it is, I still think we need research to prove this in order for us to provide accurate risk/benefit info to parents), I would like us to be able to meet that demand without it turning into a formula company endeavor.

  16. October 23rd, 2013 at 10:41 | #16

    @Kristine Keller

    Exactly, Kristine- that was my point. Formula is static and does not change; we know what nutrients infants are receiving (or not receiving, as the case may be) every time they swallow a certain amount of formula. But breastmilk changes based on the age of the infant, the diet and environment of the mother, etc… we can’t extol the malleable virtues of breastmilk in one breath and then assume that there is no worth in examining how those changes might affect an infant when we use the product of breastfeeding (breastmilk) a breastfeeding replacement, like formula.

  17. October 23rd, 2013 at 11:00 | #17

    @Suzanne Barston

    Yes, corporate involvement in human milk formulas and banked breastmilk: There already are some corporations, and while they are great for a certain demographic, there are issues with those as well.

    There will always be a big group of community breastmilk sharers, and so the corporate involvement will not be the only way even though I think that many donors will be involved in both.

    I just wanted to make that clear because it sounded like you suggested this to possibly be the only outcome. There is still a big issue regarding the pasteurizing or sterilizing of breastmilk for instance and handling raw milk will probably not be something that a corporation can do. It could be done on the local NICU level though, which to me still is the way to go. But that is another story!

  18. avatar
    Ruth
    October 23rd, 2013 at 14:59 | #18

    I will not defend my dissatisfaction with who was chosen to write an article on this issue. I’m sure she is a lovely woman. But as a professional I feel strongly that Doulas and Lamaze educators who turn to this forum and column professionally deserved to have an IBCLC or a professionally credential lactation expert addressing this very serious health issue facing our clients, I want the “gold standard” of human lactation educators addressing this, not a blogger about formula feeding.

  19. October 23rd, 2013 at 22:04 | #19

    I appreciate your point of view, Ruth, and while I don’t agree with it, I believe there is room for all the conversations at the table. If this was a “serious health issue facing our clients” then yes, potentially another writer with the “gold standard” credentials in lactation research may have been better suited to speak to the science and research. Or maybe a food biologist? But, as has been stated many times, by Suzie and many others, (including credentialed lactation experts) the research study did not replicate how women are more likely to be sharing breastmilk in most communities. Mailing milk to an unidentified PO Box across the country without guidelines, for monetary reimbursement, and a nebulous connection with the receiving party at best is not how most milk exchanges go down. The point of many of the articles, blogs and commentaries we have all read on this study in the past few days all lead readers to the same point. This is not a study that one can or should rely on to make decisions on acquiring milk for one’s newborn. And the links that Suzie Barston shared in her post, further substantiated this and provided additional resources for educators to get more information. I appreciated Suzie’s viewpoint, her time and her perspective. I am sorry that you felt that she was not qualified to write this post. I did and I am glad I ran her post. Again, I appreciate your opinion.

  20. avatar
    Katie
    October 24th, 2013 at 01:15 | #20

    I think Dr Alison Stuebe or Dr Karleen Gribble are just two professionals that come to mind as being more credtionalled to write about this matter.
    The research in question was incredibly badly conducted. It is junk science.
    We need more research into the safety of donor milk. This research has nothing to offer in his regard.

  1. October 22nd, 2013 at 14:42 | #1
  2. October 23rd, 2013 at 04:00 | #2