In the March/April 2016 issue of Maternal-Child Nursing, Diane Spatz, PhD, RN-BC, FAAN presents a well-written opinion piece on families in the NICU at Children's Hospital of Philadelphia (CHOP) participating in an informal sharing of breast milk. She reports that among the reasons mothers choose to share human milk are HIV-positive mothers, maternal deaths, adoption, glandular hypoplasia, and those with breastfeeding challenges who do not want to expose their children to artificial infant milk.
Dr. Spatz and her multidisciplinary team developed a waiver which was reviewed by CHOP legal advisers, and implemented within the CHOP system. She stresses the availability of donor human milk from an HMBANA milk bank whenever possible, but acknowledges that informal milk sharing can easily be found within the local community as well as through social media.
A 2016 position statement from the American Academy of Nursing points out, "It is an ethical and responsible role of care providers to have patient-centered, evidence-based, and resource-focused discussions of benefits, risks, and goals in providing human milk without endorsing the practice or incurring legal liability" (AAN, 2016).
Gribble and Hausman (2012) discuss milk sharing and formula feeding in a comparative perspective, concluding that, "Health authorities have warned parents against peer-to-peer milk sharing networks, stating that sharing breast milk is dangerous. However, analogous and additional risks exist for using infant formula...instead of proscribing peer-to-peer milk sharing, health authorities should provide parents with guidance on how to manage and minimize the risks of sharing human milk."
Currently available on the internet and through social media, two organizations assist with informal milk sharing: Eats on Feets (www.eatsonfeets.org) and Human Milk 4 Human Babies (www.hm4hb.net). Both sites promote informed choice, screening of milk donors, safe expression, handling and storage of breast milk, and home pasteurization.
Whether we as health professionals approve of informal milk sharing or not, the age-old practice will continue. I have recently experienced multiple clinical situations where milk sharing is occurring. I am in full agreement with Diane Spatz, in that we need to provide research-based information on reducing the risks involved in milk sharing without formally condoning the practice. Even in my hospital, we acknowledge the practice but RNs and IBCLCs are not to participate in the handling of or feeding of the infant with shared milk.
Do any of you have a written policy or protocol which you would be willing to share on this forum for others to adapt to their settings? Do you have a strict practice, one way or the other, on the use of informally shared human milk in your facility? Let's discuss this issue!
American Academy of Nursing. (2016). Position statement regarding use of informally shared human milk. Nursing Outlook, 64(1); 98.
Gribble, K. D, and Hausman, B. L. (2012). Milk sharing and formula feeding: Infant feeding risks in comparative perspective? Australasian Medical Journal, 5(5):275.
Spatz, D. L. (2016). Informal milk sharing. MCN, March/April; 125. www.mcnjournal.com
Walker, S. and Armstrong, M. (2012). The four pillars of safe breast milk sharing. Midwifery Today, Spring;34.
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