Jones says that, thankfully, "I have never had a patient suffer a bad outcome related to donor milk from any source." Even so, he advises patients to avoid unnecessary risk and use banked milk that has been tested for contamination, pasteurized, and appropriately stored.
"The notion of 'informed choice' is at the heart of this set-up," Kwasnica explains, adding that, to the best of her knowledge, no babies have been harmed through milk-sharing in the HM4HB community. Kwasnica acknowledges that there is a level of risk involved, but she believes that families can make their own informed choices about whether the benefits of milk-sharing outweigh the risks. HM4HB doesn't mention the specific risks on its website, though it does encourage each recipient to screen donors, ask for copies of the donors' medical records, and consider pasteurizing the donated milk at home.
After doing her own research on donor milk, Conley decided to take what she describes as a "calculated risk." Although her pediatrician counseled her to obtain donor milk through a bank, Conley still needed a way to feed her son during the months it took her insurance company to authorize payment for the cost of banked milk. Through her lactation consultant, Conley was introduced to her first donor.
Conley's method of finding a donor is typical: Women rarely seek out milk from complete strangers, according to Beatriz Reyez-Foster, an anthropologist at the University of Central Florida who specializes in donor-milk research. Mothers who share milk through these less formal networks primarily use the honor system to vet potential donors, relying on word of mouth from acquaintances.
"Usually the donor and recipient move in the same social network," she says. "If they don't know each other, they at least have people they know in common." Many donors, she explains, feel that this acts as a safeguard against some of the risks inherent in milk-sharing.
Erika Gebhart, a doula and mother of five from Michigan, chose to use donor milk for her youngest child when her own milk supply tanked after gastric-bypass surgery in 2008. Gebhart didn't want to use formula, so she turned to social media, reaching out to other mothers she knew—ones with chubby babies and a surplus of breast milk—to help her. "I was really plugged into the birth community, and I knew a lot of people who were militant breast-feeders," she says. "I knew a lot of people with extra milk."
Over the next 12 months, Gebhart received free breast milk from around 15 different donors, reaching out through places like Craigslist and parenting support groups on Facebook. Gebhart relied on an honor system from her donors, who, at her request, disclosed their medications and dietary habits before donating. "I took milk from donors who used Zoloft, because I had used Zoloft and nursed my own baby," she says. "Hopefully they weren't shooting heroin, but I chose to believe that if they're taking time out of their day to pump extra milk, they have the children's best interests at heart."