In the United States, there are four main ways a family may access human milk for their child. The first and best method is that a mother breastfeeds her own child. Ideally, all women will be given the opportunity to make an informed decision to both start and continue to breastfeed their child at least through the first year of that child's life. In the absence of a mother being able to breastfeed or provide milk for her own child, a family must access milk from another source and there are three options: pasteurized donor human milk from a nonprofit milk bank governed by the Human Milk Banking Association of North America (HMBANA), pasteurized donor human milk from a for-profit company, or through informal milk sharing. Why might families opt to or need to access human milk informally and why must nurses and healthcare providers have knowledge of informal milk sharing?

As a nurse researcher and director of the lactation program at the Children's Hospital of Philadelphia (CHOP), my role is to ensure a culture where human milk is valued and that healthcare providers understand the critical role that human milk plays in ensuring optimal health and developmental outcomes of hospitalized infants (Froh & Spatz, 2014; Spatz, 2015). We have been using donor milk purchased from an HBMANA milk bank for over 10 years and have pastuerized donor human milk kept stocked in house since 2006. Even with families at CHOP having access to donor milk, we experience families who participate in informal milk sharing.

Martino and Spatz (2014) report that families choose to informally milk share because they are not eligible to access milk from an HMBANA milk bank, as milk banks prioritize milk to the most critically ill hospitalized infants. Examples of why families informally share milk include but are not limited to HIV-positive mother, maternal death, adoption, women with glandular hypoplasia, and women with breastfeeding challenges who do not wish for their child to be exposed to infant formula.

Knowing that informal milk sharing does occur in the community and in our institution, we developed a waiver for informal milk sharing to be able to have a transparent conversation with families. This waiver was developed through a multidisciplinary team and reviewed by our legal counsel. One HMBANA milk bank reported a 3.3% positive rate on screening tests (RPR, HIV, HTLV 1 & 2, hepatitis B & C); however, they did not report their confirmatory rates, which are likely to be much lower based on research from the blood and tissue banking (Cohen, Xiong, Sakamoto, 2010). Further, it is essential to acknowledge that there are risks to infants when they are not fed human milk (Froh & Spatz, 2014). At CHOP, families have access to pasteurized donor milk from an HMBANA milk bank if maternal milk supply was insufficient, but this is not the case in many institutions. As healthcare providers we have the obligation to help families make informed decisions about all aspects of their child's care, thus having an understanding of informal milk sharing is essential. This website has helpful information for clinicians. http://www.fda.gov/ScienceResearch/SpecialTopics/PediatricTherapeuticsResearch/u

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