Donor Breast Milk: History, Where To Get It, and Safety Considerations

As the formula shortage continues, families are turning to donor milk. The centuries-old practice can sustain a baby, but safety is essential and not always easy to verify. Here's what parents should know.

Updated on September 8, 2022

Medically reviewed by Yamel Belen, R.N., CLC

Lactation specialist at Maine Med — Photo: Getty

The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for the first six months of life. But not every family can follow those guidelines for various reasons. Unless an adoptive family member chooses to induce lactation, the child will need other food. Some lactating people have low or no milk supply. Others simply do not want to breastfeed. For more than a century, infant formula has provided a nutritious alternative to human milk. But amid a nationwide formula shortage, families are desperately seeking other options.

Donor breast milk has emerged as one.

"Many parents who have been using formula to feed their children are in a scary, uncertain position right now due to the formula shortage," says Dr. Sharifa N. Glass, MD, IBCLC, owner of The Vine Pediatrics and Lactation. "If their preferred formula is not available or the infant cannot tolerate alternative formulas that are available in this country, then parents have turned to milk sharing."

Milk sharing involves feeding an infant human milk from someone other than the child's parents. Leigh Anne O'Connor, IBCLC, a New York-based lactation consultant, said she used to get one call every two to three months from someone looking to donate or receive donor milk. Now, she gets two to three per month.

Though interest in how to get donor breast milk is on the rise, it's nothing new. The practice of sharing milk has existed for centuries and has a complicated history, particularly within the Black community.

O'Connor explains there are two forms of milk sharing: Formal from milk banks or hospitals and informal between friends or strangers on the internet. The Food & Drug Administration advises against the latter, but some families are out of other options. Here's what to know about both types of milk sharing and how to obtain donor milk as safely as possible.

A Brief History Lesson on Donor Milk

Before breast pumps, families sometimes used wet nurses, or a person who breastfed someone else's child. But Dr. Glass says the practice was often forced on enslaved women.

"African Americans [who were enslaved] were forced to breastfeed the infants of slave owners first before feeding their own infants," says Dr. Glass.

Dr. Glass says this history, along with formula companies targeting marketing toward Black families, has contributed to racial disparities in breastfeeding and milk sharing. The Center for Disease Control and Prevention (CDC) reports that Black women have the lowest rate of breastfeeding initiation (73.6 percent) and are less likely to be still breastfeeding at six months (44.7 percent) compared to white women (62 percent). Paid leave is another barrier and something Black women have less access to than white women.

In other words, since Black families are less likely to breastfeed, they are more likely to be impacted by the formula shortage. But a negative connotation of milk sharing may dissuade them from participating.

How to Get Donor Breast Milk

Families can obtain donor breast milk formally or informally. Experts discussed the pros, cons, and considerations of both.

Formal Milk Sharing

Hospitals sometimes have free donor milk on hand for infants in the newborn intensive care unit (NICU). But families who wish to find donor breast milk formally typically go to a milk bank. The Human Milk Banking Association of America has a directory. Dr. Glass notes that not every milk bank is listed here and suggests families use a search engine like Google to see if there are others in their town.

O'Connor says Mothers' Milk Bank of Northeast also has listings.

At a bank, the donor breast milk criteria are strict. People willing to donate must go through a rigorous screening process, including:

Blood work to test for diseases such as HIV, which are transmissible through breast milk.
A detailed medical history, including information on medication or supplements the donor is taking. Some medicines and supplements are deemed unsafe for lactating.
A letter from the physician verifying the donor's health and medical history.
Information on drug, tobacco, and alcohol use that could disqualify a donor.

The process helps ensure donor breast milk safety.

Though human milk is donated for free, families must pay for it. To be blunt, it's not cheap. Dr. Glass says donor breast milk costs about $3 to $5 per ounce. Babies can drink 24 to 32 ounces per day or more. Therefore, families may have to fork over $72 to $160 or more simply to feed an infant for 24 hours, a barrier for many, particularly underserved communities.

Dr. Glass notes that insurance may cover the cost if an infant has a documented medical need. Other milk banks may offer financial assistance. Suzanne Juel, IBCLC and owner of Bayou City Breastfeeding, notes others are giving small amounts of breast milk to families impacted by the formula shortage for free, typically about 40 ounces.

Juel and Dr. Glass recommend reaching out to a local milk bank or searching its website to see what assistance it offers.

Informal Milk Sharing

The rise of social media and the internet have made it easier for people to donate or receive donor milk. Human Milk for Human Babies and Eats on Feets have local chapter pages where individuals can request or offer milk.

Juel says the milk is typically free, though families who receive the donor milk often offer to pay for supplies, such as storage bags.

Though significantly cheaper and potentially more accessible than milk banks, receiving donor milk through informal means is not without risks.

"The biggest risk has to do with the transmission of certain pathogens and contaminated breast milk," says Juel. "There is a potential of passing HIV I and II, HTLV I and II, HBV, HCV, Syphilis, Rubella, and other serious diseases, and breast milk can be contaminated by bacteria during the collection or storing process."

A 2013 study found that milk purchased from the internet contained high amounts of bacterial growth that posed a risk to infants, particularly preterm or medically frail ones.

"There is a sort of leap of faith people have to take because you are going to expect honesty," O'Connor says.

How To Make Donor Breast Milk Safer

The safest way to receive donor milk is from an accredited bank or hospital. But that isn't feasible for many families. Juel suggests adhering to the four pillars of safe milk sharing.

Make an Informed Choice

Research the benefits and risks of milk sharing before using this option to ensure it's something you are comfortable doing for your baby.

"Make sure you know who you're getting the milk from," Juel says.

Dr. Glass and Juel note that the Academy of Breastfeeding Medicine recommends caregivers obtain breast milk from a trusted friend or family member.

Ask for a Lab Screening

Juel says it's reasonable to ask a donor to undergo a screening.

"This should include communication about the donor's lifestyle and habits and diet," Juel says. "It can also include lab tests to screen for HIV I and II, HTLV I and II, HBV, HCV, Syphilis, and Rubella."

Some babies have dairy or egg allergies and need a donor adhering to a diet that excludes these types of products.

Typically, the person receiving the milk will pay for the screening.

Understand How the Milk Was Kept

The 2013 study that found high bacteria levels in milk purchased on the Internet cited poor storage as a potential reason. Juel recommends parents ask about how the milk was handled and stored. The CDC states that breastmilk can be stored:

At room temperature for up to four hours
In a refrigerator at 40 degrees Fahrenheit or colder for up to four days
In a freezer at 0 degrees Fahrenheit or colder for up to 12 months (six months preferred)

Breastmilk should never be refrozen once thawed.

This part of the screening process will be a simple—hopefully honest—conversation.

"Unfortunately, there is no way for parents to actually test the milk to make sure that it was handled properly," Juel says.

Pasteurization

Pasteurizing, or heating, human milk can eliminate bacteria and harmful pathogens. Juel says the process takes five minutes, and caregivers can feed the baby the milk within six hours. Eats on Feets has resources on how to flash heat milk.

Benefits of Donor Milk

Human milk and formula are both nutritious ways to feed an infant. But the AAP states that safely stored and prepared breast milk has its share of benefits, including: