Monday, October 21, 2013

Something smells off and it's not the milk!

We learn at a pretty young age that milk left out on the counter, or too long in the fridge, goes off. I don't have a single child that doesn't eyeball the carton before they pour milk onto their cereal, and they give it a sniff if they're not sure. And if it's been sitting out? Nope, they're not touching it. In fact, my kids are very likely to go "eww" if a carton of yogurt has gone past its best before date, despite my protests: "It's yogurt, it's supposed to be full of bacteria. It's healthy bacteria! That's a BEST BEFORE date, it doesn't automatically go bad at midnight. Gaah!"

Yet, apparently, when my children become adults, and then parents, they will have lost every bit of wisdom they've learned growing up and they'll become incapable of determining how to safely feed their babies. They will have no capacity to distinguish between borrowing a cup of milk from the neighbour, and grabbing a carton that's open and been sitting in a dumpster.

At least, that seems to be the conclusion drawn by some after reading a new study published in Pediatrics today out of the Nationwide Children's Hospital in Ohio. Researchers looked at several hundred classified ads listing human milk for sale and offered to buy. They responded only "to ads from sellers who did not ask about the infant receiving milk and who did not require a phone call before a transaction was made" and directed sellers to ship the milk to a PO Box in Ohio. Some of the milk was shipped in a liquid state, some frozen milk wasn't protected during shipment and thawed before arrival, and it appears that some sat for as long as six days before being tested. Nobody knows how the milk was collected or stored. It's not clear if they even checked to be sure it was human milk as advertised. The study concludes the purchased milk:
"exhibited high overall bacterial growth and frequent contamination with pathogenic bacteria, reflecting poor collection, storage, or shipping practices. Infants consuming this milk are at risk for negative outcomes, particularly if born preterm or are medically compromised. Increased use of lactation support services may begin to address the milk supply gap for women who want to feed their child human milk but cannot meet his or her needs."

The results are not revolutionary. The milk of any species will rot if it's left to sit around in the heat. The study is meaningless when applied to the real world of moms who don't have enough breastmilk to feed their babies, unless we needed someone to tell us not to drink milk left lying around, or that shady characters = shady behaviour = increased risk.

I saw a copy of this study before it was published and it frustrated me greatly that the authors' conclusions were applied to peer-to-peer milksharing, even though the study has nothing to do with milksharing. Concerns expressed prior to publication have resulted in some wording changes and the final news release is clearer. Still, some people are pointing to this study and warning families not to purchase milk via the Internet, even though the study's methodology is hardly what families unable to access donor milk and turning to riskier milk purchase would employ. Others are saying milk that isn't from a milk bank is dangerous and are urging families to feed infant formula if they can't get screened milk. That is sound advice - but it ignores that families are quite capable of screening and even processing milk on their own.

These warnings may be well-intentioned, but they are incredibly disrespectful. Do families really need to be warned about this? Do families actually feed their children unscreened milk purchased from shady characters who ship to anonymous PO boxes? Of course not.

Researcher Karleen Gribble recently wrote:
"research by Thorley (Thorley, 2011) and myself (as yet unpublished) supports the proposition that recipient mothers of peer-to-peer shared milk take enormous care in deciding to feed their child the milk of another, and in managing the risks involved. Despite the absence of institutional involvement, there is nothing casual about the process. Mothers, however, would benefit from greater support from health workers in assisting them in their decision-making."

It would be much more valuable for researchers to explore how families who seek human milk for their children actually behave. How do they screen their sources? What kind of hygiene guidelines are out there for mothers who express their breastmilk for their own babies (because that is how most milk that winds up being made available for someone else's baby - it starts as a freezer stash intended for mom's own baby.)

And yes, families who have problems breastfeeding need greater support from health workers. Those health workers in turn need greater support from their guiding bodies. And Health Canada and the FDA and the like to get off the pot and adopt harm reduction strategies if they want to address concerns about feeding human milk that doesn't come from from a mother's breast directly to her baby's lips, and doesn't come from a milk bank.

If we're going to get all excited about milk selling, how about looking at the growing number of for-profit corporations out there offering to buy milk from moms so they can create highly formulated human milk products for sale to hospitals.
US company Prolacta milks donors, charity partners

Because that's what stinks about this whole issue. Some would have you believe that milk from the mom-next-door is "dirty" and not fit to be fed to babies. But at the very same time, slick marketing campaigns are convincing the same mom that her milk is a scarce and precious commodity that will save the lives of babies.

Same moms. Same milk.

A selection of news coverage:

Breast intentions? New study spurs debate over online breast milk sales --, Oct 21, 2013
Is it really possible to purchase breast milk online? - Huffington Post, Oct 21, 2013
Breast milk donated or sold online is often tainted, study says -- New York Times, Oct 21, 2013
Online milk sharing carries health risks from bacterial contamination: study -- New York Daily News, October 21, 2013


Audrey T. said...

Excellent points. Well written. And sensible too.

Alison Sauer said...

Good article. Thank you

Alison Sauer said...

Good article. Thank you

Murielle said...

Once again, your post is right on, Jodine ! Thanks for staying on top of these topics.