Are you really eating what’s best for your baby?

Pregnant and expecting soon, we dream of the best for our baby. But … what if we are approaching our maternal diet with a complete misunderstanding of what is best for our baby’s health? What if we are relying on outdated medical information? What if we are eating in a way that could hinder our baby’s healthy future? 

Some facts:

  • Clinical food allergies among children are on the rise, with an approximate increase of 50% from 1997 to 2011.
  • There is a misconceived notion, stemming from previously published guidelines by the American Academy of Pediatrics that allergy avoidance during pregnancy and breastfeeding reduces risk.
  • New research indicates that not only is an allergy potentially determined from birth, but a varied maternal diet may help reduce the risk of allergy development.
Xtend-life.com conducted a study on 400 mothers to understand common misconceptions around allergy development. 

Picture this future

For millions of people, a simple dinner at a restaurant is fraught with dangers, some of them fatal. And they could be lurking anywhere.

Think about it

Just a trace of a peanut in a bread or snack, or a bit of cheese falling into a sauce could cause a serious life-threatening allergic reaction. Those of us without allergies can hardly imagine a life where every morsel we eat could be a hazard.

Studies show that 10% of children under the age of one and 4-8% of children up to the age of five have clinical food allergies. And it doesn’t affect just them and their lives, it affects their whole family. Everyone has to remain vigilant about food at all times. It’s like standing guard 24/7, for life.

Daycare, school, sports and yes birthday parties or trick-or-treating can be perilous. Often as parents we are faced with big choices in how we will live, work and play for the rest of our lives.

The Xtend-life.com study takes a close look at pregnant women’s behavior, the beliefs held about diet during pregnancy and delivers compelling evidence-based results that debunk myths about diet, allergies and babies.

Read the study results here

By Laurel Wilson and Tracy Wilson Peters

         If you ask a random group of people when mothering begins, most will say it starts when the baby is born. Ask any woman who has given birth and she will likely give you a very different answer. For some it was when they first learned of their pregnancy. Others say mothering began when they felt their baby move for the first time, heard the heartbeat, or saw their baby on ultrasound.  There are those who felt the stirring of mothering begin when they held their baby for the first time. There are even women who did not feel truly like mothers until their baby was days or even weeks old. 

“I have a very difficult time wrapping my mind around the very idea of pregnancy - even as I feel my little one moving around. I can't say that I really felt bonded with my babies until the moment of birth- and then it was immediate and incredible.”~Emily

         While it is normal to begin to “feel” like a mother at different stages, new evidence shows that in fact mothering in a biological sense begins at the moment of conception. In fact, the motherbaby bond occurs often before a mother may feel an emotional connection.  In her book, The Tentative Pregnancy, Barbara Katz Rothman discovered that some women prevent themselves from connecting to their baby until after all the early pregnancy tests have gone well and they enter in to the second trimester. Whether the mother’s emotional connection starts early on or much later, there is an amazing bond beginning between her and her baby from the earliest point of pregnancy.

         A global understanding of what this mother baby bond truly means to the health and happiness of children could change how society begins to think about the role of mothering. What the world needs is a pregnancy paradigm shift. Cutting-edge research has discovered that the experience in the womb and the early moments of birth and early infancy are the most formative moments in our lives (Hobel,Marsh, O’Railley, Simmons). These quantum moments shape all that we become. Everything from what a mother eats and drinks, to the relationships she has during pregnancy, to her stress levels are influencing her developing baby. If the definition of mothering is the nurturing of a child, a pregnant woman is literally mothering from the time of conception.  

         It has become exceedingly difficult for mothers to have the opportunity to truly connect with their baby’s during pregnancy. Today’s millennial families are experiencing more stimulus than ever. They are constantly connected to data, information, texts, e-mail, phone calls, messaging literally everywhere. The pace of life has sped up significantly, and what is expected of a pregnant mother today, the literal demands on her time and energy, has increased exponentially. It is easy for pregnant women to begin to live on auto pilot, which means they are more susceptible to media and other external messages, and less able to connect with their own thoughts and feelings. Pregnant mothers who take the time to become aware of their thoughts, feelings and actions begin to become more conscious of their behavior.

In this technology-obsessed world of ours, it is easy for mothers to forget that the most important knowledge comes from within. In our society, it is rare that women listen to their body’s cues and respond to them.  How many pregnant mothers nap during the day when they are tired? They avoid listening to their body because they feel rushed and don’t honor the body’s signals as actual communication. The pregnant body is communicating what it needs all the time, and believe it or not the unborn baby is too.  All mothers have to do is learn to listen, give themselves the permission to trust the connection and take the time to respond.

         Why Does Mothering Begin at Conception?

         Nature is impressive in its design and is preparing babies in the womb from the moment of conception for the new world they will encounter beginning at birth. All babies are born into a different environment. They must prepare during pregnancy to survive and thrive in their specific community. The information babies receive from their mothers in utero teaches them to adapt to their new world. The mother is constantly communicating all that she knows about her world to her baby throughout pregnancy, via special messenger molecules. This is one her early mothering abilities, to share her feelings with her baby. The baby communicates back to the mother through the placenta with his own set of messenger molecules.   Mom and baby are sharing information during each and every moment of pregnancy. This mother baby bond is the foundation of all mothering.

         Mothers and babies communicate via the placenta with messenger molecules known as neuropeptides.  When a mother has “feeling”, emotion pulses through her body as messenger molecules that deliver signals to the body’s systems.  For example, if a mother smells smoke, she begins to worry.  Her body starts to release adrenaline, to pump blood to her limbs so she can get her baby to safety. Her perception of the world (smelling smoke) created a thought (“I smell smoke”) and emotion (worry/fear), which then signaled her body to prepare to rescue her baby from a fire (blood pumping to her arms and legs).

         This biological communication between a mother and her baby is how the baby’s emotional intelligence is created. He experiences the world of emotions through his mother.  He begins to become aware of his mother’s world based on how she feels about her world.  When she has a loving thought, he experiences love. When she is stressed, he becomes stressed.  This process designed to give babies the opportunity to experience an array of emotions and develop a healthy emotional life that matches the emotional tone of his new family. This emotional tone is his way of coping with his world, known as the EQ, or emotional quotient.  New research has shown that a healthy EQ is much more important for long-term happiness in adults than a high IQ.

         If mothers were aware of their early mothering role, they would likely spend more time doing things that they enjoyed instead of focusing on less important tasks like worrying over what color to paint the nursery.  Dr. Frederick Wirth, neonatologist and expert in the prenatal period referred to this as being a “brain architect.”  Dr. Wirth taught that when mothers focused on creating healthy, happy babies in the womb, it led to happier, healthier children and families. The role of mothering includes with it an amazing superpower - the power to build a baby’s brain.

Mindful Prenatal Mothering

         Awareness of this mother baby bond is critical for creating a more peaceful society. Pregnancy is when conscious mothering begins. When babies are conceived and developed in a trusting, peaceful, loving state they are literally formed in love. Early pregnancy is an ideal time for mothers to contemplate their relationship with themselves and the world around them. This involves moving into a state of observation and awareness, becoming mindful. Jon Kabat Kinn, author of Everyday Blessings, and known as the modern day guru of mindfulness defines mindfulness as the following, “Mindfulness means paying attention in a particular way; On purpose, in the present moment, and nonjudgmentally.”

What we think about, we bring about.  Therefore, it makes sense to move through this world intentionally, especially when it’s known that a mother’s experience impacts the health and personality of her baby. Mothers can make decisions that are truly in their best interest by being in conscious agreement. What is conscious agreement? Conscious agreement is the act of making decisions based on deep inner listening and coming to an intuitive mind/body/spirit agreement. It is making decisions that feel good at a gut level. Conscious agreement occurs when you are in collaboration with your inner wisdom, when every part of you says “YES!” The word agreement literally means being in harmony with one’s feelings.

Before pregnancy, a woman’s consciousness mainly affects her own life. Once she conceives, she must acknowledge that her consciousness impacts her baby’s development and emotional health. Therefore, all of her choices impact her baby. Life is full of choices, from what she eats, to what she does, to who she allows in her life (co-workers, healthcare providers, friends, and partners). Every moment in her life affects her emotional states. Being in a state of conscious agreement during pregnancy (and even while trying to conceive) becomes crucial to the motherbaby connection.

         Easy steps for conscious agreement are:

·      Separate from external influences – to make a decision based on conscious agreement it is sometimes necessary to remove yourself from environments or people that may be distracting. This can be as simple as closing your eyes and taking a moment to connect to your inner wisdom.

·      Get quiet and pause – take a few deep breaths, allow your thoughts to calm and connect to your source. Your source can be defined as that which guides you - God, the universe, your spirit, your intuition, etc.

·      Listen in – think about the situation that has presented itself. What is your gut feeling? How is your body feeling? How is your body reacting? Do you feel drawn to the situation or person or do you feel a sense of discomfort? How might your baby feel?

·      Decide and commit – honor the feelings that are coming up for you and your baby. Make a decision that is in harmony with what your body, your baby and your intuition are telling you. This is truly honoring the motherbaby bond.

Today’s mother is bombarded by technology, an endless array of choices and a medical community that has yet to recognize and honor the motherbaby bond. However, it is possible for every mother to tune in to the miracle happening inside of her. She can minimize the influence of her external reality and focus in on the internal world of the motherbaby bond. By moving into the states of Being, Observing, Nourishing and Deciding she has the opportunity to truly BOND.

The Keys to the MotherBaby Bond -  “Being”, “Observing”, “Nourishing”, and “Deciding” and Conscious Agreement are copyrighted concepts within the book, the Greatest Pregnancy Ever: The Keys to The MotherBaby Bond.

1.    Hobel, Calvin and Culhane, Jennifer. Role of Psychosocial and Nutritional Stress on Poor Pregnancy Outcome. Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, The Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048 and Jefferson Medical School, Philadelphia, PA 19107-5587

2.    Marsch R, Gerber AJ, Peterson BS. Neuroimaging studies of normal brain development and their relevance for understanding childhood neuropsychiatric disorders. Journal of the American Academy of Child and Adolescent Psychiatry. 2008;47(11):1233-1251.

3.    O’Rahilly R, Mueller F. Significant features in the early prenatal development of the human brain. Annals of Anatomy. 2008;190:105-118.

4.    Simmons, R. Epigenetics and maternal nutrition: nature v. nurture. Proc Nutr Soc. Nov 29:1-9, 2010.

By Laurel Wilson, IBCLC, CLE, CCCE, CLD

Executive Director of CAPPA’s Lactation Programs

As you may, or may not, know with the passage of the Affordable Care Act (ACA) women now can receive coverage for lactation services through their insurance provider. While the time has come for these services to be seen as preventative and supportive care, the Affordable Care Act unfortunately did not make enough specifications on exactly what should be covered. The law states that “Payers must cover, at no cost to the patient, ‘comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment’. Here is a link to the verbiage on the HRSA website: http://www.hrsa.gov/womensguidelines/

            What exactly does this mean? What does comprehensive lactation support mean? Who qualifies as trained providers? Why only cover rental of breastfeeding equipment?  When was the last time you heard of a mother renting a nipple shield or a Supplemental Nursing System? Must all insurance companies pay for these mysterious covered services? I have been attending webinars and state health department meetings and what I have gleaned from all of the discussion is that the resolution for understanding and interpreting the ACA in terms of lactation is still in its infancy.

            Let’s start with who has to pay for these services. The Affordable Care Act generally covers commercial insurance contracts. Whether Medicaid covers these services or not is basically up to the state. They have to elect to cover USPSF (US Preventative Services Task Force) preventative services. If they have decided to do so, then lactation coverage should be a part of that.  Military services are also exempt from the recommendations in the ACA. Every insurance company also gets to decide how they interpret the ACA language. Many states have decided to create guidelines for insurance payers to use for interpretation on the ACA.  The United States Breastfeeding Committee and the National Breastfeeding Center have created a Model Policy: Payer Coverage of Breastfeeding Support and Counseling Services, Pumps and Supplies. Most states have not modeled this “model policy”. Here is a link to that model policy: http://www.usbreastfeeding.org/Portals/0/Publications/Model-Policy-Payer-Coverage-Breastfeeding-Support.pdf

For insurance payers, the language in the ACA has created significant confusion. There are no clear directives about exactly what services are to be covered, at what rates, or even who should be providing these services. Most of the payers are also unfamiliar with the needs of lactating woman and do not have a grasp on what types of lactation equipment is needed in different circumstances. For example, if a woman has baby that she is exclusively expressing her milk for, she requires the use of a hospital grade breast pump, NOT a double-sided electric consumer pump. Furthermore, payers do not have a clear understanding of the circumstances in which a woman requires lactation services and when.

            Here are some of the challenges that have mothers have been encountering. 

When mothers call their insurance companies to find out how they can access their breast pumps they get the following responses:

·      They must get their pump (of the insurance company’s choice) through a Durable Medical Goods Supply. These pumps often take weeks to be delivered. This is a problem twofold. One: it may be an inappropriate pump for the mother’s situation. Two: They may not get the pump in time for their needs.

·      They have to purchase the pump and submit a receipt. They may or may not receive full reimbursement.

·      They are simply mailed a breast pump from their insurance company. It may be an ineffective hand pump or an inexpensive double electric.

·      Side note: There have also been known cases of insurance fraud. Women requesting pumps and then selling them on EBay and Craig’s List in their unopened packaging

Another challenge mentioned above is determining who is considered a trained provider. Commercial payers must insure that the professionals they pay are credentialed and follow certain rules and regulations. For most insurers this means that they will only cover licensed care providers or create standards for non-licensed professionals. Most insurance companies choose to reimburse (at least at highest rates if at all) their own credentialed professionals or in network providers. These providers must have their qualifications evaluated, meet certain criteria, confirm that they meet professional conduct and competence, and have their training, certification and licensure reviewed. The challenge (and also the opportunity) with this is that many lactation support providers are not licensed.

The International Board Certified Lactation Consultant is an internationally certified professional but not required to get licensure to practice in the 50 states. Many states have been considering licensure for IBCLCs, however at this stage it is not mandatory, nor even possible. The Certified Lactation Educator is also a certified but not a licensed professional.  Many insurance companies have decided to work their way around this by simply contracting with RN/IBCLCs only for all services  (RN’s do have licensure).

However, there are other professionals who are trained and certified to teach breastfeeding classes and run support groups, such as CAPPA’s CLE.  This could potentially mean that professionals like CLEs could finally receive reimbursement for their services! Just as we are finally seeing doula services starting to get reimbursement, now is the perfect opportunity to start inquiring and talking to commercial payers about reimbursement for breastfeeding education services provided by CLEs. As the ACA dissemination is in its infancy, now is the time for breastfeeding professionals to make their voices heard and talk to the insurance company’s and state health departments who are making suggested guidelines.

Let’s look at on commercial payer’s response to the ACA:

Aetna: They are allowing IBCLCs to provide lactation support services and have identified the codes that they can use for reimbursement. They do require the use of in network IBCLCs. They cover the purchase of a pump through Durable Medical Supply and they also cover rental of a hospital grade pump when medically necessary. Below is the policy found on Aetna’s site (http://www.aetna.com/cpb/medical/data/400_499/0421.html )

“Aetna considers rental of a reusable breast pump medically necessary durable medical equipment (DME) when either of the following criteria is met:

  • For the period of time that a newborn is detained in the hospital after the mother is discharged; breast pump rental is not considered medically necessary once the newborn is discharged; or
  • For babies who have congenital disorders that interfere with feeding, a breast pump is considered medically necessary for up to 12 months of age.
Aetna does not cover breast pump purchase under standard Aetna benefit plans that are not currently subject to Department of Health and Human Services (DHHS) requirements for coverage of breast pumps. Non-reusable manual or electric breast pumps that are available commercially are not considered by Aetna to fall within the standard contractual definition of durable medical equipment in that they are normally of use in the absence of illness or injury.

Note: The following policy applies to new health plans and non-grandfathered plans that are currently subject to DHHS requirements for coverage of breast pumps, with coverage beginning in the first plan year that begins on or after August 1, 2012 (please check benefit plan descriptions):

  • Aetna considers purchase of a manual or standard electric breast pump medically necessary during pregnancy or at any time following delivery for breastfeeding.
  • Aetna considers purchase of a manual or standard electric breast pump medically necessary for women who plan to breastfeed an adopted infant when the above listed criteria are met.
  • Aetna considers rental of a heavy duty electrical (hospital grade) breast pump medically necessary for the period of time that a newborn is detained in the hospital.
  • For women using a breast pump from a prior pregnancy, a new set of breast pump supplies is considered medically necessary with each subsequent pregnancy for initiation or continuation of breastfeeding during pregnancy or following delivery.
  • A replacement manual breast pump is considered medically necessary for each subsequent pregnancy, for breastfeeding during pregnancy or following delivery.
  • A replacement standard electrical breast pump is considered medically necessary for subsequent pregnancies, for breastfeeding during pregnancy or following delivery, for members who have not received a standard electric breast pump within the previous three years or if the initial electric breast pump is broken and out of warranty.
  • Aetna considers purchase of heavy duty electrical (hospital grade) breast pumps not medically necessary.”
Here is what our families need to know at this stage. All pregnant women should call their insurance provider early in pregnancy and find out what services are covered for lactation. They want to ask how to access a breast pump and what type of pump is covered. They want to find out if they cover breastfeeding classes and support groups and if there are specific ones they have to access. They also want to find out what type of lactation consulting services and which specific providers they can use. Many IBCLCs, if not in-network with the family’s insurance plan, will ask for payment in advance and then offer to give a superbill so that the family can submit for reimbursement. They should also request that their breastfeeding classes and support groups that are run by CLEs be covered!

Here is what lactation professionals need to know. Encourage your families to communicate early on with their insurance companies. Get actively involved in your state breastfeeding coalitions and work with state health department to ensure that access to lactation services is reasonable and include support professionals who are certified for those services. Finally, let mothers know that services are covered and be proactive in gaining access to these services.

While the ACA provide far from perfect lactation support, it is a step in the right direction in recognizing the fact that lactation support is PRIMARY preventative healthcare. It is also an amazing opportunity for lactation professionals to have their voices heard. Commercial payers are ready to listen and they need guidance. It is time to build some bridges and make your voices heard!

Too Stressed to Be Grateful?

November is the month when most of us begin to focus in on what we are grateful for. It is a month that marks the beginning of the holiday season for many, and while we wish to express gratitude, it can also be a time of intense stress and exhaustion.  This can be intensified for expectant families, as they are not only preparing for the holidays but also for the arrival of a new baby. It is very difficult to experience gratitude when you are stressed out. Stress can be caused by many factors and unfortunately its impact is felt not only by the pregnant mom, but also the developing baby.  

            When a pregnant mother experiences stress, hormones such as cortisol pulse throughout her bloodstream and are sent to the placenta. Those same stress hormones are then shared with the baby via the placenta.  This fascinating pregnancy messaging system is designed to help the baby become aware of and adapt to its mother’s environment.  No one can avoid stress. The good news is all humans have a built in stress management system, they just need to know how to turn it on. 

            When a mother has a stress response the vagus nerve is stimulated which causes such effects as heart palpitations and sweaty palms.  This nerve can be calmed through the effects of deep breathing. When a mother breathes in deeply it stimulates her diaphragm, located under the lungs. This action sends messages to the vagus nerve that all is well. Breathing is one way to reboot oneself after a stressful situation.  This stress-relieving technique can help get you back into a state of gratitude.  When a mother feels gratitude, her baby experiences those same emotions.

A great technique helpful for pregnancy, labor and throughout life is Belly Breathing. To do this, place your hands on your chest and inhale as you normally breathe.  Notice how your lungs expand. Now place your hands on your diaphragm, just above your abdomen. If you do not notice your hands moving with your breath here, you are using shallow or backward breathing.

Now inhale deeply into your abdomen feeling your belly bulge out under your hands. As you exhale, notice how your hand moves inward toward your spine. Practice this deep breathing, trying to keep your exhale approximately twice as long as your inhale. Some people use a 4/6 count when first practicing deep breathing, inhaling to the count of 4 and exhaling to the count of 6.

As you practice deep breathing, imagine your breath first filling your lungs, then your abdomen, then your pelvis, and the rest of your body, all the way down to your toes.  With your exhalation, pay attention to your breath as it leaves the body.  Imagine breathing into the space where your baby lies, filling your baby with oxygen, and exhaling any tension that you or your baby may have. It is as simple as that.

            To ensure a gratitude filled holiday season for you and your unborn baby, follow this simple three-step process:

1.     Become conscious of when you feel stress

2.     Take a few deep breaths

3.     Focus in on what you are grateful for

For more stress reduction and deep breathing techniques, check out the book the The Greatest Pregnancy Ever.

By Laurel Wilson and Tracy Wilson Peters
For more information on stress and pregnancy and having a healthy pregnancy visits 
6 Keys to Reducing Stress in Pregnancy

Every expectant mother experiences stress at times throughout her pregnancy.  This is a normal part of pregnancy and, in fact, even prepares your little one for his journey into your arms. However, there are times when regular every day stress can move into overdrive. Especially when mothers see their To Do lists getting longer instead of shorter.  There are so many things they want to accomplish before the baby arrives and it seems as though there is so little time.

It is important for mothers to pause, take time to reassess what is necessary and what they can let go of. Creating some breathing room during pregnancy can actually contribute to a healthier mom and baby. 

Time to relax and slow down reduces stress. Here are just a few ways lowering stress levels can be of benefit during pregnancy:

·      Healthier sex drive and fertility (important if you are trying to conceive)

·      Reduced risk of preterm birth

·      Reduced risk of baby born small for gestational age

·      Reduced risk of depression in the mother

·      Developing a mature hippocampus in your baby (the emotional hub of the brain)

·      Promotes healthy physical development in early infancy

·      Increased cognitive scores for your infant

·      Normal stress threshold for your baby (babies become stressed less often)

·      Reduced risk of your baby’s brain becoming habituated to stress hormones, which makes her feel unsafe and scared

·      Reduced risk of neurodevelopmental disorders (such as autism and schizophrenia)

·      Higher IQ

·      Decreased behavioral problems in childhood and adolescence

With all of these benefits, stress reduction should be at the top of the To Do list! Start with simple things that are scientifically proven to reduce stress:

1.    Smile. Schedule time to do activities that increase your joy. Hang out with girlfriends who make you laugh. Surround yourself with people who make you feel good.

2.    Yawn. Repetitive yawning actually helps reset the brain and allows you to refocus.

3.    Meditate or Pray. This can be accomplished in many ways. You can simply find a quiet space, close your eyes and think about the

people and things in your life that you have gratitude for. You can also participate in activities that help you to feel calm and centered, like walking in nature, gardening or swimming.

4.    Move Your Body. Movement is one of the best ways to remove stress from your body. Take a walk. Go swimming (also great to line your baby up for birth). Take a belly dance class. Try prenatal yoga. 

5.    Practice Deep Breathing Techniques.  Slow your breathing. Try and count to four while you inhale and count to 8 as you exhale.  Do this for several minutes when you feel stressed.

6.    Take a Daily Nap. Yes, it’s true, you should lie down. Cuddle with your partner, your dog or your teddy bear.  Napping for just 15 minutes a day has direct health benefits and reduces stress levels immensely!

While it is impossible to avoid stress at time, it is possible to help your body manage stress. Take some time every day to practice stress reduction and you and your baby are sure to he happier and healthier. Want to learn more about ways to de-stress and bond with your baby prenatally? Read best-selling book The Greatest Pregnancy Ever, available on Amazon and Kindle.

By Laurel Wilson and Tracy Wilson Peters


Milk Sharing Conundrum

Milk Sharing and Perinatal Professionals
Reposted from CAPPA Connection

by Laurel Wilson, IBCLC, CLE, CCCE, CLD

CAPPA Executive Director of Lactation

All human babies have the right to breastmilk exclusivity. This can be accomplished in a variety of ways - exclusive feeding at the mother’s breast, exclusive mother’s expressed breastmilk delivered to the baby via a feeding device, or pasteurized donor human milk delivered via a feeding device.(1) However, there has been a new form of delivering breastmilk to newborns, older children, and adults that is getting more attention, even in publications such as TIME magazine.(2)  This is the concept of milk sharing. Milk sharing is when women provide breastmilk directly to another family in need, without going through the donor milk bank process. 

This type of milk delivery system has been increasing since the rise of social media, making it easier for families and the lactating mother to connect virtually.  Examples of organized milkshare sites include the following:

•   Eats on Feets  http://www.eatsonfeets.org/

•   Human Milk for Human Babies http://www.hm4hb.net/

•   Milkshare http://milkshare.birthingforlife.com/

•   World Milk Sharing Week, Last week in September http://www.facebook.com/WMWeek

Human milk banking in the United States is managed through eleven human milk banks that are part of the Human Milk Banking Association of North America.(3) The banks are located in California, Colorado, Indiana, Iowa, Michigan, Missouri, Massachusetts, North Carolina, Ohio, and Texas. The donors are thoroughly screened through a detailed questionnaire, blood test, and finally testing the milk.  Once donors are approved, they donate their milk which is then mixed with the milk of several other mothers’ milk, pasteurized, and tested again. It is then sealed and prepped for delivery.  For a family to gain access to donor human milk, the patient must get a prescription from a doctor. Milk banks require a prescription to ensure that the neediest patients have access to the donor milk, as donor milk is in limited supply and they must distribute the limited resources.(4) Babies who are sick or premature have the first priority to obtaining donor human milk. These babies need milk that has been thoroughly screened, tested, and pasteurized to ensure minimal risk. The donor milk costs between $5-$8 per ounce. If the individual has a demonstrated medical need for the breastmilk, such as a baby in the NICU, often health insurance will pay for the donor milk. Due to this limited availability and screening, donor milk is not available to many families who desire breastmilk exclusivity for their babies and cannot personally provide that resource, mainly due to medical or physiological issues.

There are very few times that an infant would be better off to have artificial milk. As per the World Health organization, these rare instances include the following:(5)

•   Infants with classic galactosemia: a special galactose-free formula is needed.

•   Infants with maple syrup urine disease: a special formula free of leucine, isoleucine, and valine is needed.

•   Infants with phenylketonuria: a special phenylalanine-free formula is needed (some breastfeeding is possible, under careful monitoring).

In all other situations, human milk is considered the best food for human babies. Perinatal professionals should be well-versed in the risks associated with artificial milk feeding. Providing education on these risks is an important part of informed consent/refusal for families needing to consider supplementation for their child.

While peer to peer milk sharing is gaining popularity among families, finding policy and recommended practices can be difficult. The Academy of Breastfeeding Medicine only references mothers own expressed milk, donor human milk, or hydrolyzed or standard infant formulas for breastmilk feeding in regards to supplemental feeds. The World Health Organization, states in its Global Strategy for Infant and Young Child Feeding, “for those few health situations where infants cannot, or should not, be breastfed, the choice of the best alternative – expressed breast milk from an infant’s own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breastmilk substitute…depends on individual circumstance.”(5) Most milk share organizations recommend the practice of using The Four Pillars of Safe Milk Sharing.(6) These are informed choice, donor screening, safe handling, and home pasteurization.

What are the concerns perinatal professionals have with peer to peer milk sharing?

There is serious risk of exposure to pathogens, bacteria, viruses, drugs, and chemicals. 

However, new research suggests that most of the pathogens of concern can be killed by flash-heating at home.(8) Holder pasteurization and flash-heating are both processes that can be accomplished when milk sharing to provide protection against most illnesses.

What do families need to know?

Families considering using peer to peer milk sharing should follow the “Four Pillars of Safe Milk Sharing” (6)

•   Informed Choice

•   Donor Screening

•   Safe Handling

•   Home Pasteurization

The family receiving peer to peer milk should should fully educate themselves on the benefits of using human milk as a supplement, as well as the potential risks. These include: (6)

•   Pathogenic transmission to a baby, causing illness or even death

•   Potential sabotage or harassment by donor

Families should strongly consider screening potential donors:

•   Ask to see pregnancy blood tests or pay for blood tests to be done. Screening should include  HIV I & II, HTLV, HBV, HCV, Syphilis, and Rubella. CMV, TB, and WNV.

•   Use a questionnaire for the donor that request information about lifestyle and medication use.

•   Make sure milk is handled and transferred in an optimal hygienic environment.

•   Flash-heat or Holder pasteurization methods should be used on the milk before the baby receives it.

The family donating milk also has a few considerations. They have the option to donate to an organizational member of the Human Milk Banking Association of America or directly to a peer. Families can facilitate their donation by either contacting HMBANA directly, in the case of milk bank donation, or by utilizing the peer milk sharing organizations online. All donors should consider the benefits as well as potential risks of donation. The risks vary, but can include issues such as litigation in the event of a bad outcome and potential, though unlikely, harassment by recipient. Donors should expect to fill out a screening form and provide a blood sample at the expense of the person receiving milk. Donors also have a responsibility to follow proper storage and transfer guidelines for breastmilk. http://milksharing.blogspot.com/2010/12/freezing-breastmilk.html

The Four Pillars article suggests that families first self-screen. Self exclusion should include the following: (as per Walker and Armstrong) (6)

•   “Health

•   Poor general health

•   Suffering from severe psychiatric disorder(s)

•   Confirmed positive for HIV I, HIV II, HTLV I, or HTLV II

•   At-risk for HIV (including sexual partner)

•   Current outbreak of herpes or syphilis lesion

•   Current open sores, blisters, and/or bleeding cracks on the skin

•   Undergoing chemotherapy or radiation treatment

•   Receiving radiation treatment or thyroid scan with radioactive iodine

•   On medication contraindicated for breastfeeding

•   In the fever stage of chicken pox or shingles

•   Lifestyle

•   Currently abusing drugs, alcohol, or OTC medicines

•   When donating to a premature or critically ill baby: drinking, smoking, using certain herbal supplements, or taking megavitamins

•   Social

•   Feeling coerced

•   At risk due to religious/social conventions”

After doing the research, CAPPA strongly feels that the perinatal professionals role at this time regarding peer to peer milk sharing involves acting as an educator, not a facilitator. While it is the decision of every perinatal professional to make their own judgments regarding milk sharing, it is important that all professionals carefully consider all aspects of milk sharing and provide balanced and evidence based information to all clients when  asked.

CAPPA Statement on Milk Sharing

While CAPPA professionals should educate families on the benefits of using human milk versus artificial milk, they should also educate on the potential risks that are involved with informal, non-regulated milk sharing to ensure that families utilizing this form of breastmilk access can mitigate the risk as much as possible.  CAPPA discourages its professionals from acting as barters for milk sharing, and strongly encourages all professionals to consider the implications of acting as a facilitator for accessing shared milk. While it is important to educate families on all of the benefits of human milk exclusivity, CAPPA professionals have a responsibility to confer information about the benefits and risks of all options.

For questions on CAPPA’s position, please email the Executive Director of Lactation at cledirector@cappa.net.

For more on this topic, I offer lectures. Click here for more information about the Milk Sharing Conundrum speaking engagement.


1.) The Academy of Breastfeeding Medicine Protocol. 2009. ABM Clinical Protocol #3: Hospital Guidelines for the Use of Supplementary Feedings in the Healthy Term Breastfed Neonate. Breastfeeding Medicine 4:3, 175-182.

2.) Block, Jennifer. Move Over, Milk Banks: Facebook and Milk Sharing. Web article. November 22, 2010.


3.) Human Milk Banking Association Website. https://www.hmbana.org/

4.) Miracle, Donna et al. Contemporary Ethical Issues in Human Milk-Banking in the United States. Pediatrics 128:6, 1186-1191. http://pediatrics.aappublications.org/content/128/6/1186.full

5.) World Health Organization, UNICEF. Global Strategy for infant and young child feeding. WHO Library. Nutrition. 2003. http://www.who.int/nutrition/publications/infantfeeding/9241562218/en/index.html

6.) Walker, S and Armstrong, M. The four pillars of safe breast milk sharing. Midwifery Today International Midwife. 2012 Spring;(101):34-7. http://www.ncbi.nlm.nih.gov/pubmed/22486021?dopt=Abstract or www.eatsonfeets.org/docs/TheFourPillars.pdf

7.) Walker, Shell. Profiting off of Breastmilk. Eats on Feets Blog. November 13, 2011. http://www.eatsonfeets.org/

8.) Finney, Karen et al. Feasibility of Using Flash-Heated Breastmilk as an Infant Feeding Option for HIV-Exposed, Uninfected Infants after 6 Months of Age in Urban Tanzania. UC Davis Researchers, funded by NIH. To request study: karen.finney@ucdmc.ucdavis.edu

Blogs on Milk Sharing

•   Supporting Families in milk Sharing as an IBCLC - Amber McCann

•   Biomedical Ethics and Peer to Peer Milk Sharing - Dr. Karen Gribble

•   Milk-Sharing: Safe Infant Feeding and Being a Human - Sustainable Mothering - Jake Markus 

•   The Lorax and Other Milksharing stories - MatriciativismoenelsigloXXI Jesusa Ricoy-Olariaga

•   Winning the milk lottery - PhD in Parenting,  Diana West, BA, IBCLC

•   Scared Milk-less - Peaceful Parenting - Lisa Van den Hoven

•   Overcoming Difference Through Milksharing - Milk Junkies, Trevor MacDonald

•   Biomedical Ethics and Peer-to-Peer Milksharing - Human Milk News, Karleen Gribble 

•   A Story of Peace and Healing - Normal, like breathing, Diana Cassar-Uhl

•   Milksharing and La Leche League - Feed the Baby LLC, Laura Spitzfaden

•   Supporting Families in Milksharing as an International Board Certified Lactation Consultant -  Nourish Breastfeeding Support, Amber Rhotan McCann 

•   "I wish I'd Known About Milksharing When..." - Complete Wellness Concept, Dinnae Galloway

•   Waiting for Milk Banks: A Matter of Life or Death - Human Milk News, Jodine Chase 

•   Powerful Images: Supplementing with Donor Milk - DoubleThink, Paa.la, Paala Anderson Secor

•   What is World Milksharing Week - Dinnae Galloway