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Series: Building Your Birth Business: Online Marketing for Birth Professionals – A Beginner’s Guide

December 11th, 2014 by avatar

By Janelle Durham, MSW, LCCE

As we move into the new year, you may be considering starting your own independent childbirth education or birth related business.  Maybe you already have such a business already established but are looking to take it to the next level. Today’s post is part of a new series: Building Your Birth Business.

 Perhaps the organization you work for would like to grow their offerings geared toward families in the childbearing year.  Janelle Durham, a birth and parent educator, working for several programs in the Pacific Northwest has put together this beginner’s guide for the options available to reach your target audience of expectant parents through online marketing.  This resource can help you to get started in designing and placing ads and then tracking your success. – Sharon Muza,  Science & Sensibility Community Manager

Introduction

This guide is designed for non-profit organizations or individuals that serve expectant parents or young families (though other programs may also find it useful). I know there are a lot of folks doing great work, but we all have limited advertising budgets, and it’s hard to get the word out sometimes. We try things like a print ad in the newspaper once a year for $250 and hope that gets us some people.(But ask today’s parents if they read the newspaper.. I’m guessing the answer will be no. Most of the people who see your newspaper ad will be past the age of child-rearing. They’re not your target audience.)

social-media-marketingWith today’s online marketing, there are much more effective ways to spend your ad dollars that allows you to put your ad in front of a very targeted audience of young parents in the places where they look everyday (Facebook, online search engines, and YouTube. To see statistics on who uses social media, click here.)  Here’s an overview of your options, with links to more details. (And, of course, once you have the basic vocabulary and ideas I share here, you can do online searching to learn lots more about all these topics.)

Facebook Ads

71% of people who use the Internet use Facebook. 63% of Facebook users visit Facebook every day. (source) This is where parents’ eyes are looking!

Facebook ads allow you to place an ad right on the user’s “feed” – not off on a sidebar that they’ve learned to ignore. They can just read the ad, or they may choose to click on it. (You choose what happens when they click – they could click to like your Facebook page, or the click could link to your website.) You only pay if they click on your ad.

Facebook ads let you target your preferred customer or cient. For example, I can target my ad to people that Facebook has determined are: women, 24 – 44 years old, living in Bellevue, WA or within a ten mile radius (but excluding Seattle) who have purchased baby food, toys for young children, or clothes for young children. Facebook says that’s a possible audience of 5800. For $10, I put an ad in front of 995 of those parents, 23 clicked through to our website to learn more. That’s 43 cents for each person who came to our site to learn more – good bang for your buck! How to place ads on Facebook.

Facebook Boosts

Facebook also allows you to “boost” a post. So, you write a regular post on your business page and all your page followers see it. Then you pay for a boost to put it on the feeds of people who don’t yet follow your page. For $10 I boosted a post about local classes to local parents. It displayed to 1745,  and 36 clicked through. Cost 28 cents a click. How to Boost.

Your ability to target your demographic is more limited with boosts than with Facebook ads, so I prefer ads. I do like using boosts to promote a link to a video. (see below)

Google ads and Bing ads

The big picture is: you create a short ad. You choose whether it will display on search networks, display networks, or both. Then you define what kinds of people to show it to (geographic region, etc.). Then you define “keywords.”

For “search network advertising”: When someone in your region searches for those keywords, then the ad will display. For “display network” your ad will appear when people are looking at related content, even if they didn’t use your search terms to get there. When I ran ads on Bing, for $10, the ad would display to about 500 people, and about 25 would click through. On Google, $10 would display to about 1500 people, but only about 9 or 10 would click through. If you were just trying to get your name out there, Google may be a better bet, because there’s more “impressions” (times your ad is shown.) If you really want people to click to your site to learn more, Bing may be a better bet, because more will click through. Or, you may choose to run a low budget ad on both networks to reach the widest variety of users.

I personally prefer Facebook ads to search engine ads, because as a user, I find I read Facebook ads, and I totally ignore search engine ads. Also, Facebook allows me to target more specifically. However, if you think people will be actively searching out programs like yours and you have a really good sense of what keywords they would use, search engine ads are certainly worth doing. Learn how to place ads on Google and Yahoo Bing.

Promoting a video

You may choose to make a video to promote your program. If you do, then upload it to YouTube, then embed it somewhere on your website (check the help info in your website tool to learn how to do this.) Then promote it.

On Facebook, you can put a post with a link to the video, and then boost that post. (My $10 test ad displayed to 1700, and 62 clicked through.) On Google Ads, you can create a “video campaign” (learn how and learn more). Ads display on YouTube. (My test ad displayed to about 950 people, 24 clicked through.) Or you can set up your ad (“promote your video”) on YouTube directly. (Learn how.)

Check your web presence

When you spend money on internet advertising, most of those ads will take people directly to your website to learn more about your program. PLEASE make sure your website is the best it can be, free of grammar and spelling errors, graphically pleasant  and contains all the essential info they would need! Learn more here.

Is it working?

When you spend money on an ad in traditional media (newspapers, mailings, radio ads), it can be hard to tell: how many people saw the ad? How many were your target demographic? Did they take any actions after seeing the ad?

It’s easier to get those answers for online advertising. All the services listed above will give you all sorts of statistics (analytics) on how many people saw the ad, how many clicked through, what portion of the video they watched, and so on. This helps you decide whether the ad was money well spent.

It’s even better if you can take this to the next level. Many websites allow you to see your statistics. So, for example, on a day you ran an ad, you can see not only how many people clicked in from your ad, but what they did once they got to your site. Did they click on links on the page? Did they look at other pages? How much time did they spend on your site? There are also some external tools that can track statistics, like Google Analytics.

It’s even better if you can do “conversion tracking” which shows more specifically what a user did on your site after clicking through from an ad. These articles might be helpful to you: How to Track Facebook Ad Conversions and Understanding Conversion Tracking.

Staying up to date

The world of internet advertising is always changing, so if you want to be effective, update your website and your marketing strategy on a regular basis.

In this overview, I’ve shared what I learned this summer about online marketing. I need to say that the online world changes very quickly, and the processes might not be the same and you might not get the same results in September 2015 as I got in September 2014.

Have you had any experience with online marketing for your childbirth education or other birth business?  Please share your successes and learning moments with us in the comments section. – SM

About Janelle Durham

Janelle headshotJanelle Durham, MSW, LCCE. Janelle has taught childbirth preparation, breastfeeding, and newborn care for 14 years. She trains childbirth educators for the Great Starts program at Parent Trust for Washington Children, and teaches young families through Bellevue College’s Parent Education program. She is a co-author of Pregnancy, Childbirth, and the Newborn and writes blogs/websites on: pregnancy & birth; breastfeeding and newborn care; and parenting toddlers & preschoolers. Contact Janelle and learn more at www.janelledurham.com

 

Childbirth Education, Guest Posts, Lamaze International, Series: Building Your Birth Business , , ,

Tweet with Us! – Share & Experience the 2014 #LamazeDONA Confluence on Twitter

September 11th, 2014 by avatar

 By Robin Elise Weiss, PhDc, MPH, CPH, ICCE-CPE, ICPFE, CLC, CD(DONA), BDT(DONA), LCCE, FACCE

lamaze twitter 2014The 2014 Lamaze International/DONA International Joint Confluence in Kansas City is scheduled to convene in just one week and the excitement is palpable!  Bags are getting packed, presentations finalized and birth professionals of all backgrounds are getting ready to meet old friends and make new ones.  The content and information that will be covered in the plenary  and concurrent sessions will be new and exciting.  Today on Science & Sensibility, Lamaze International’s incoming president, Robin Weiss, a leader on our social media team, shares all the “need to knows” for getting the most out of the conference via Twitter. – Sharon Muza, Science & Sensibility Community Manager

The past few years the idea of using social media in conjunction with the conference has grown. And the 2014 Confluence with Lamaze International and DONA International is no different. Using the hashtag #LamazeDONA, you will be able to find a treasure trove of information about the conference, and even learn from the sessions – even if you aren’t in Kansas City.

If you are new to Twitter, you will simply need to sign up for a free account. This handy guide will help you to get started in five easy steps.  You can search for the #LamazeDONA hashtag.  Using this hashtag helps twitter users sort a specific conversation that is focused on the confluence and just our users.  Simply read and interact with the people who will talk on this search.

You will want to join in the discussion, tweet and retweet your favorite snippets of wisdom from the fabulous speakers.  If you are not attending, you will want to follow the #LamazeDONA hashtag as attendees tweet live from the sessions they are participating in.

Back this year is the fabulous Tweet Up! We are going to try to do two this year. The first is scheduled for Thursday at 4p.m. Meet by the registration desk. @RobinPregnancy and @KKonradLCCE will be there to walk you through a few things if you have questions or just say hello! @KKonradLCCE will also host a simple social Tweet Up, watch #LamazeDONA for specific information to join – all are invited, no personal invitations needed.

We will also have prizes for your participation when you watch the hashtag, including some for those joining in at home, so be sure to watch #LamazeDONA for directions.

A great article on Twitter etiquette for you to review prior to the confluence

You might also want to consider reading Birthswell’s helpful three part series: Twitter 101 for Birth and Breastfeeding Professionals if you are new to this fast moving and captivating social media platform.

Check out Facebook, where it is possible to follow the same hashtag, #LamazeDONA for updates as well.  Many Facebook users use the same hashtag system to share information on that platform.

 People to Follow

@LamazeOnline (Lamaze for parents)

@LamazeAdvocates (Lamaze for educators)

@donaaintl

@RobinPregnancy (Robin Elise Weiss, social media team for Lamaze International and incoming President)

@KKonradLCCE  Kathryn Konrad (preconference and concurrent presenter)

@ShiningLghtPE Deena Blumenfeld (concurrent presenter)

@Gozi18  Ngozi Tibbs  (plenary speaker)

@Christinemorton  (concurrent presenter)

@mariajbrooks Maria Brooks (Lamaze Board Member)

@jeanetteIBCLC Jeanette McCulloch (concurrent presenter)

@doulamatch Kim James (concurrent presenter)

@douladebbie Debbie Young

@mldeck  Michele Deck (plenary speaker)

@pattymbrennan Patty Brennan

@doulasrq Patti Treubert ‏

@babylovemn Veronica Jacobson

@tamarafnp_ibclc &  @storkandcradle Tamara Hawkins (S&S contributor)

@thefamilyway Jeanne Green & Debbie Amis

@gilliland_amy  Amy Gilliland (concurrent presenter)

@yourdoulabag Alice Turner (concurrent presenter)

Are you going to be live tweeting from the confluence?  Share your Twitter handle in the comments section and we can add you to our list.- SM 

About Robin Weiss

robin weiss head shotRobin Elise Weiss,  PhDc, MPH, CPH, ICCE-CPE, ICPFE, CLC, CD(DONA), BDT(DONA), LCCE, FACCE, is a childbirth educator in Louisville, KY. She is also the President-Elect of Lamaze International. You can find her at pregnancy.about.com and robineliseweiss.com

2014 Confluence, 2014 Confluence, Childbirth Education, Confluence 2014, Continuing Education, Guest Posts , , , , , ,

Copy Right! Using Images in Your Presentations and Teaching Materials Appropriately

December 3rd, 2013 by avatar

Today on Science & Sensibility, contributor Andrea Lythgoe, LCCE, birth doula and photographer shares information about using images and text in your work as a birth professional – for teaching, marketing or other purposes.  Using images and other works responsibly is the right thing to do, but you may be confused on how to go about it.  Today’s post will help and on Thursday I share information on how to locate materials that you are free to use. – Sharon Muza, Community Manager

Image Source: http://www.flickr.com/photos/horiavarlan/

Image Source: http://www.flickr.com/photos/horiavarlan/

When you are a childbirth educator or other birth professional, you may find yourself teaching a class, giving a presentation, designing a website or making attractive handouts and marketing materials. You take great pains to make sure that your work is visually pleasing and attractive.

You may be inclined to find images for your work by quickly searching online for exactly the right picture to get your message across.  It’s easy, it’s quick and free.

Photographs, drawings, paintings, music, writing and all other artwork are protected by copyright laws, and you cannot use them without the permission of the artist. Ever. It does not need to say “copyright” in order to be copyrighted. It does not need to be watermarked. It does not need to say “All Rights Reserved.” The copyright exists the moment the work is created. There are serious consequences for taking others’ work without permission.

When you are producing something that will be used for educational purposes, you might wonder if the laws allow you to use copyrighted images under those circumstances. There is an exception to the copyright law called “Fair Use” where it might be acceptable to use them without permission or payment. But what exactly constitutes “fair use” can be very complicated and hazy. I’m not an attorney, but I do have some suggestions to keep you firmly in the realm of safe use.

Don’t use images without permission for commercial use

Don’t use images without permission for anything remotely commercial, unless they are images you acquired under a Creative Commons license.  (See this Thursday’s post for more on Creative Commons.)  If your web site, blog or social media site is promoting your childbirth classes, you’re advertising a commercial venture. If your handout is used during classes that you’re being paid to teach, that’s profit making and probably not OK. If you’re presenting at a conference and being paid to present – ask permission. Even if you are not being paid, check to see if the conference is going to be selling a recording of your presentation. At the most recent Lamaze International conference, a company recorded audio that was synced to the presenter’s Powerpoint, which was then made available for purchase. Any images in those presentations are therefore being resold for profit. This means you need permission for commercial use of those photos, diagrams, and graphics.

Don’t modify anything without permission

Modifying includes cropping, removing a watermark, turning it black and white, making it part of a collage, adding text to turn it into a meme, or anything else you might be tempted to change. As a birth photographer, I am very careful of my client’s privacy and want to make sure that their family’s personal moments are only used in the ways they are comfortable with. I may turn down a request to use a photo in a meme because the parents declined to allow me to give third parties a right to use it. I might not allow you to use it in a poster because the parents would prefer limited exposure. Imagine how upset the parents could be to come across it somewhere they did not expect it. Consider the difficult position that puts me in – it appears that I have violated their trust in allowing me to share their images at all.

Credit appropriately

When you are using images with permission, inquire from the photographer or artist how they would like to be credited.  Most people will be happy with their name and website (linked if possible) near the picture, so people are aware of the source.  Find out how to type the “©” symbol for your particular keyboard/computer/software and use it. Alternately, in your presentation, be sure that the owner of the image is credited on the slide where the image is placed.  Printed marketing materials can include information close to the image or in a discreet location at the bottom if appropriate.

Share on social media appropriately

When you see something you want to share on social media, make sure you share rather than download and post as if it were your own. If sharing is blocked, there’s likely a reason! Don’t share from someone who has obviously uploaded other’s content as their own already, either. As a photographer, I’d love it if my images are seen by a wider audience, but I want that audience to be able to know who created the work. I often see beautiful paintings or photos shared without that connection to the artist maintained.

Do not copy and paste text

When it comes to text, don’t ever copy and paste. Writing your own content is crucial to having your own voice. Plagiarizing content is not a victimless offense. I will never forget an experience I had earlier this year when a woman I had been mentoring posted a link to her new web site asking for feedback on the template she used. The wording was mine. It was the wording I’d spent weeks working on to get just right. And just when I thought I had it perfect, I’d had friends and family read and give me feedback. This triggered another round of edits.

And with a simple copy and paste, this woman had stolen my hard work. I must be honest and tell you that it hurt.

Even if you plan to change a few words here and there, that is probably not enough to make it your own. If you’re using enough of someone else’s words that you need to copy and paste, it’s likely too much.

You can quote someone – no more than a paragraph or two – but it needs to be clearly attributed as a quote and should be in the context of your own writing. The OWL (Online Writing Lab) at Perdue University suggests:

“Use quotes that will have the most rhetorical, argumentative impact in your paper; too many direct quotes from sources may weaken your credibility, as though you have nothing to say yourself, and will certainly interfere with your style.”

Summary

As you create your web sites, presentations, class materials, marketing pieces and illustrate your own writing with visuals, please remember that artwork, including photographs, is still work, and that the artists have families to feed and clothe as well. They deserve the respect of honoring that work with a respect of their copyright and payment if they request it.

Please don’t look at copyright law as “Can I rationalize this as an acceptable use?” but instead think in terms of “How can I make sure I am using this appropriately?” – As an artist, my livelihood depends on it.

When in doubt, leave it out!

Check back on Science & Sensibility on Thursday, when Sharon Muza will share information and resources on how to find and access Creative Commons images and other works that you might be able to use freely or even modify if needed for your purpose. Let us know in the comments section what challenges you have faced in creating your own presentations and teaching materials, and any solutions you might have found.

 

Childbirth Education, Continuing Education, Guest Posts, Science & Sensibility, Series: Finding and Using Images and Copy, Social Media , , , , , , ,

Insta-gram or Insta-gasp? The Ethics of Sharing on Social Media for Birth Professionals

October 24th, 2013 by avatar

Attorney and Lactation Consultant Liz Brooks, President of the International Lactation Consultant Association, takes a look at the issues that childbirth professionals might want to consider before sharing information on a social media platform like Facebook, Twitter, Instagram, Pinterest or others.  Do you follow the HIPAA guidelines, even if you are not bound to do so?  What has been your experience?  Please share your thoughts and experiences in our comments section. – Sharon Muza, Science & Sensibility Community Manager.

By Liz Brooks, JD IBCLC FILCA

Is it ever ethical for a healthcare provider (HCP) to post a photograph or video of a patient on a website or Facebook page? My first reaction is “Heck No!,” but the question deserves a deeper look, especially since social media platforms serve as a predominant means of communication, marketing and information-sharing. It is the way we can speak to today’s mothers, and it is the way they insist on reaching us. 

Privacy and confidentiality are hallmarks of the traditional healthcare professions. I am an International Board Certified Lactation Consultant (IBCLC), and right there, in my ethical code (called the IBLCE Code of Professional Conduct for IBCLCs, or CPC), it says at Principle 3 “Preserve the confidentiality of clients.” Further, I am required under the CPC (a mandatory practice-guiding document) to “Refrain from photographing, recording or taping (audio or video) a mother or her child for any purpose unless the mother has given advance written consent on her behalf and that of her child.” 2011 IBLCE CPC, 3.2. Translation: If I want to take a picture of a mother for any reason at all (to document healing of a damaged nipple, perhaps), even if I drop it into a patient folder only I will ever see, and which I lock away in a file cabinet, I had better get the mother’s written consent first. 

But what about a doula or childbirth educator? Are doulas or educators considered “healthcare providers” in the way a doctor, nurse, midwife or IBCLC would be? Or are they removed from the rules in healthcare?

The Childbirth and Postpartum Professional Association (CAPPA) describes the doula as an important informational and emotional link between the pregnant/laboring woman and her healthcare providers … a part of the birth team. DONA International, another doula organization, describes the role as “a knowledgeable, experienced companion who stays with [the mother] through labor, birth and beyond.”

This is what else we learn from CAPPA and DONA International: It is clear that privacy of the mother is paramount. Any person who is certified through CAPPA is expected to follow a Code of Conduct that is quite plain in its requirement to protect privacy: “CAPPA certified professionals will not divulge confidential information received in a professional capacity from their clients, nor compromise clients’ confidentiality either directly or through the use of internet media such as Facebook or blogs.” (Page 1, Bullet 4, CAPPA Code of Conduct.) The Code of Ethics from DONA International echoes this requirement: “Confidentiality and Privacy. The doula should respect the privacy of clients and hold in confidence all information obtained in the course of professional service.” (DONA Int’l Code of Ethics Birth Doula, 2008.)

Childbirth educators are held to a similar standard. Lamaze International, which offers an international certification for those who are working with pregnant women and their families, has a Code of Ethics for its Certified Childbirth Educators. That Code indicates “Childbirth educators should respect clients’ right to privacy. Childbirth educators should not solicit private information from clients unless it is essential to providing services. Once a client shares private information with the childbirth educator standards of confidentiality apply.” (Standard 1.07, 2006 Code of Ethics, Lamaze International.)

So it seems that healthcare providers, childbirth educators and doulas alike should NOT be posting pictures of their clients/patients on the Internet. So why are we seeing so many of them?

Because if the mother agrees to have her picture or personal information shared, her informed consent changes everything. The notion of protecting privacy is that the patient or client ought to be in control of whatever information gets shared with the outside world. Anyone who has attended a conference, and benefited from education that included clinical photographs, knows that some clients/patients are willing to allow their images to be seen by others. They may require conditions of use (i.e. do not show the face), but they willingly agree.

“So all I have to do is just ask the mother?” you wonder. Well … not so fast. Some other considerations may (dare I say it?) cloud the picture:

  1. Some healthcare providers, hospitals or birth facilities may have rules of their own affecting whether or not images may be taken, by you or even the family. You will need understandings and consent up front, often signed on forms as proof, before you can whip out the smart phone. 
  2. If the doula or childbirth educator has a professional, business relationship with other healthcare providers, or healthcare facilities, she may well be considered a “business associate” for purposes of the privacy-protecting sections of the Health Insurance Portability and Accountability Act (HIPAA), and its first cousin in enforcement, the Health Information Technology for Economic and Clinical Health Act (HITECH). Under HIPAA/HITECH “business associates” who have ANY kind of access to patient information (like: name and address) are held to the same standard for privacy as the healthcare provider. And if there are breaches of privacy, both the business associate AND the HCP are held liable. Enforcement actions recently have included actions against small practices, including the levying of some hefty fines. The person working with the family, who has a professional relationship with a covered entity under HIPAA, should be certain that her own business associate agreement is up-to-date and signed. It is important that she respect the requirements set by her (probably skittish) business partner, before she seeks the mother’s consent.
  3. Make sure you and the mother are very clear in your understanding of what her “consent” really means. Many a mother has been disappointed that her great and wonderful news announcing her baby came from someone else first … even if the plan all along was to have everyone share the great news once mom revealed it.

Discuss all the possibilities with the patient/client. Who can publicly discuss the pregnancy/birth/sonogram? Who can take and post pictures? What and who can be included in the pictures (faces, body parts, location-identifying background all matter). Who can text? Who can tweet? Is a link back to a website or Facebook page by the mother required? When can all of this take place?

As a savvy advocate for the mother, you may want to suggest that she have these same discussions with her own circle of family and friends. While they will not be held to the legal and ethical standards required of a doula or HCP, the disappointment will be no less acute for the mother if the glorious news of her pregnancy or birth is spilled by a friend, first. 

As doulas, childbirth educators, IBCLCs and HCPs who work in maternal-child health, we are privileged to be willingly called into the intensely personal and life-changing events that pregnancy, birth and early parenting represent. Our need to respect the wishes, dignity and privacy of the family are not diminished because modern technology makes news-sharing so easy.

About Liz Brooks

Liz Brooks, JD, IBCLC, FILCA, is a lawyer (since 1983) and earned her International Board Certified Lactation Consultant credential in 1997 after several years as a lay breastfeeding counselor.  Before she left the practice of law, Liz worked as a criminal prosecutor, a lobbyist and a litigator, with a focus on ethics and administrative law.  That expertise followed her to lactation:  She wrote the 2013 book, “Legal and Ethical Issues for the IBCLC,” and was lead author for one ethics chapter in each of three other books.

Liz is on the ILCA Board of Directors (President 2012-2014).  She was designated Fellow of the International Lactation Consultant Association (FILCA) in 2008. She currently is the United States Lactation Consultant Association Alternate to the United States Breastfeeding Committee and is an Elected Representative on their Board of Directors (2012-14).  Liz can be reached through her website.

 

 

Babies, Breastfeeding, Childbirth Education, Guest Posts, informed Consent, Legal Issues , , , , , , , , , , , , , , , ,

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.

© http://bit.ly/Hc2W86

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.

 

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