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 breastmilkmight 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), whenbreastfeeding 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.

Published: October 21, 2013

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