Eats on Feets' Four Pillars cited in American Academy of Nursing - "Position statement regarding use of informally shared human milk"

"Hey, why don't we just become wet-nurses? Instead of Meals on Wheels, we can call ourselves Eats On Feets."
~ Shell Walker Luttrell, 1991.

Out of these words blossomed the network that we know today as Eats On Feets. We call the milk sharing that happens on our network community breastmilk sharing.

Community breastmilk sharing works because mothers, fathers, professionals, communities, caring citizens and people just like YOU are joining together to help ensure that babies have access to commerce-free breastmilk. Babies need breastmilk to maintain optimum health. Parents and professionals know this! Every day, women from around the world selflessly donate thousands of ounces of breastmilk directly to babies. With Eats On Feets, these donations are commerce-free, just as nature intended, and they are making a huge difference in the lives of babies and their families.

Eats on Feets is proud to be a leading resource for community based breastmilk sharing.

By designing the original working model for running a Facebook based milk sharing network, creating original documents, compiling and making accessible extensive research, we have influenced milk sharing policy and have become known as the go-to organization for information regarding the safety, mechanisms and informed choice process of community based milk sharing.

By maintaining a global network, supporting families, reaching out to local communities, policy makers, professionals and again, people like YOU, it is our goal that community based breastmilk sharing continues to grow and be recognized as a normal and vital part of human life.

If, you too, believe that babies deserve access to healthy, commerce-free breastmilk, please join us! Have a look around our site, use our resources, get involved, send us your success stories, join our Facebook page and help spread the word:

Community based milk sharing is normal!

Q: What is Eats On Feets?

A: Eats On Feets and Eats on Feets Facebook pages facilitate a world-wide network of parents, guardians and professionals who have made the informed choice to share or support the sharing of breastmilk. The Facebook pages provide a commerce-free space where families can share their milk in a safe, ethical manner.

Q: How was Eats On Feets started?

A: Shell Walker Luttrell, a Phoenix, Arizona midwife started the original Eats On Feets page in late July of 2010. She thought that 'Eats On Feets' would be a fun and lighthearted name for the page.

From Shell's original Eats On Feets Facebook page: "I started this page after receiving a phone call from a mom who was desperate to find breast milk for her newborn. I posted her needs on Facebook and the response was immediate and fantastic. I thought it would be awesome if there were a page dedicated to milk sharing and tribe nursing. So, this is a networking page for moms to share and receive milk when needed. I am not responsible for milk sharing results or content shared by other posters. And a note of caution: KNOW THY SOURCE. While it is true that tribe feeding offers MANY benefits, there is ALWAYS the risk of disease/contamination. I support many causes and movements but in the spirit of keeping the site as focused as possible status updates are specific to milk sharing."

Q: What is informed choice?

A: Informed choice is a choice made based on all the available information and options.

Q. Why choose Eats On Feets?

A. Eats On Feets is uniquely dedicated to safe, ethical, and informed breastmilk sharing between families. Eats On Feets also fervently opposes the selling of breastmilk. It is our firm belief that the selling and buying of breastmilk carries undue medical and ethical risks.

In order to provide the breastmilk sharing community with current research and information, Eats On Feets created and maintains the "Resource for Informed Breastmilk Sharing" and "The Four Pillars of Safe Breast Milk Sharing." We consider the latter to be fundamental for all individuals and entities involved in the safe use of donor milk. These resources are under regular scrutiny from members of the medical and research community, and concerns are immediately addressed (and welcomed!) to ensure the accuracy of this resource.

Eats On Feets is also dedicated to the informed private arrangement of breastmilk sharing. Our administrators work diligently to protect the right to harassment-free, commerce-free, ethical arrangement of milk sharing. Even when anonymity is needed on Facebook, Eats On Feets administrators can accommodate arrangements that still support the integrity of direct contact between the donor and recipient is honored.

As a dedicated group, we routinely reassess our goal and purpose: providing space and support to the families and professionals who choose informed milk sharing guided by the Four Pillars. This is our commitment to our communities and to the right of every baby to have biologically normal nutrition.

Q. Who needs donated breastmilk?

A. Eats On Feets focuses on the breastmilk needs of babies and young children. All children have a right to breastmilk. There are many situations wherein a child or baby would need donated breastmilk, including but not limited to: death of mother, adoption, foster care, guardian care, low milk production, no milk production, mother’s health. Eats On Feets does not endorse any order of priority for the sharing of breastmilk with babies and young children.

Although Eats On Feets focuses on breastmilk for babies and young children, sometimes medical needs arise for older children or adults. Eats On Feets does not put an age range on pediatric needs, and reposting these needs will be up to the discretion of our admins.

A strong case can be made for the medical use of breastmilk by adults. Eats On Feets supports informed choice and a woman’s right to share her breastmilk with whomever she chooses. Adult needs are welcome on our Wall, but will not be reposted by our admins. Please contact your local page with any questions.

Regarding adults requesting milk for non-medical reasons, please see this site for more information. Eats On Feets administrators will delete these types of requests. Eats On Feets encourages families to practice safe social networking.

Q: What does Eats On Feets NOT do?


  • Support or approve of the selling of breastmilk on our network.
  • Match donors and recipients.
  • Accept third party offers or requests without direct contact information.
  • Allow re-donating donated milk without explicit permission of the original donor and their added contact information.
  • Keep track of matches being made on our page.
  • Provide medical advice or clinical care.
  • Screen donors or recipients.
  • Provide contracts or questionnaires.
  • Decide who should receive breastmilk.
  • Collect, store or distribute breastmilk.
  • Receive money, payment, donations or funding of any kind.
  • Reimburse volunteers/supporters.
  • Act as mediators or advisors if difficulties or misunderstandings occur between parties.
  • Accept liability for the outcomes associated with sharing breastmilk.
  • Expect mothers to try to increase their supply in order to donate or receive milk.

Q: What may be expected of me as a donor and/or recipient?

A: Expectations will vary depending on the individual donor and recipient. Full disclosure from all parties is important.

Q: What if I am unable to reach an agreement with my donor/recipient or I don’t feel comfortable receiving/giving milk?

A: If a recipient or a donor does not feel comfortable or is unable to reach an agreement, (s)he is under no obligation to participate in milk sharing with the other person. Please repost the offer/request in order to find a more suitable arrangement. Eats on Feets, or other Eats on Feets page is not responsible for the outcome of any milk sharing arrangements.

Q: What can I do to provide to my baby the safest possible breastmilk?

A: Full disclosure reduces risk. Suggested points of discussion can include medications, alcohol and drug use. Consult a health care provider in order to obtain testing if desired. Some diseases to consider are HIV, hepatitis B and C, syphilis, HTLV, Rubella, as well as cytomegalovirus (CMV) and tuberculosis. Many free clinics will provide testing. If you cannot get a complete picture of the health of your donor, one option is to look into at-home pasteurization. Please see our Resource Guide for more information.

Q: How (and for how long) can milk be stored?

A: Expressed milk can be stored in various breastmilk containers following the manufacturers' instructions. Noting the date on the container will make sure it is consumed within a safe time frame. Storage times will vary based on where it is stored. See this link and this one for more information.

Q: What can I do to reduce the risk of contamination?

A: Whether you are using hand expression or a pump your hands and supplies should be clean and dry and your breasts should also be clean and free of sores or blisters (this last point also applies to wet nursing). Your pump manual will have information about how to properly use and clean it. For more information on hand expression technique, see this video. Also, this page may be useful.

Q: My baby is healthy, can I still ask for donor milk?

A: Absolutely. There does not need to be a medical reason for your baby to have breastmilk. Human milk is for human babies and children. Eats On Feets does not prioritize recipients, but simply offers an online space where families can connect and make informed choices about milk sharing. You can ask for milk for your child at any time and for any reason, regardless of age.

Q: My baby is 4 months old, can I receive milk from a donor whose baby is 12 months old?

A: As babies grow and mature, their nutritional needs also change. It is therefore ideal for donor breastmilk to either come from a mother whose baby is around the same age or from a mother who pumped when her baby was around that same age. However, as per the World Health Organization's guidelines, in most circumstances human milk is preferable to milk substitutes, even when there is a difference in age.

Q: Do I have to use a bottle to feed my baby donor milk?

A: No, many mothers use an at-the-breast system to feed their babies. This device includes a container attached to a small feeding tube that is either taped to the breast or placed inside the baby's mouth while the baby is latched onto the breast. This allows the baby to receive the donor milk while still stimulating the mother's breast and taking in any milk she is making. While this device can be purchased, you can also make your own. Some families also use a small cup, a spoon or other methods. Please see this page for more information.

Please see the Resource for Informed Milk Sharing for additional information, including information on Pasteurizing breastmilk

Please contact the page administrators with any questions you may have.

The Four Pillars of Safe Breast Milk Sharing

Download the PDF version

The use of healthy, commerce-free, donor milk is a natural option when a mother cannot provide her own milk to her baby. However, there are risks associated with feeding a baby anything outside of the closed bio-system of mother-child, including breastmilk. It is our mission to provide evidence based information for the safe sharing of human milk.

These four pillars form a foundation from which parents can learn how to safely share breast milk. The four pillars are not only useful to parents, but also to pediatricians, midwives and those active in birth and parenting communities.

By understanding these easy to implement principles, they too can help babies in their communities by supporting safe breast milk sharing.

The Four Pillars of Safe Breastmilk Sharing

  1. Informed Choice
    • Understanding risks and benefits, of all infant and child feeding methods and knowing thy source
  2. Donor Screening
    • Donor self-exclusion for, or declaration of, medical and social concerns
    • Communication about lifestyle and habits
    • Screening for HIV I and II, HTLV I and II, HBV, HCV, Syphilis and Rubella
  3. Safe Handling
    • Inspecting and keeping skin, hands and equipment clean
    • Properly handling, storing, transporting and shipping breastmilk
  4. Home Pasteurization
    • Heat treating milk to address infectious pathogens
    • Informed Choice of raw milk when all donor criteria are met

1. Informed Choice

An informed choice is made by examining all credible, verifiable and relevant information available and using it to carefully and objectively weigh options as well as potential consequences. When parents or professionals look for information in order to safely share breast milk or support breast milk sharing, it is important that ALL of the information is taken into consideration, (not just those which supports personal dogma in regards to breastfeeding), in order to make truly informed choices. To date, milk banks have set the standard for milk sharing. Unfortunately, these standards are based on blood bank safety protocols, as breast milk is considered a potentially infectious bodily fluid. In certain situations or “non-normal” circumstances (such as cultural or religious need for donors to be identified, or for special dietary considerations), informed parents may choose to deviate from the milk bank standards in order to provide breast milk in such a way that will allow them to maintain their beliefs or to suit their unique circumstances. For example, it is common for breast milk donors who have spent time in Great Britain to be excluded from milk banks due to a concern for exposure to Creutzfeldt-Jakob disease, which upon investigationmany recipients may not find to be a cause for donor exclusion. Informed health care providers should support and respect the individual rights of parents to make their own decisions about milk sharing. Deviation from the standard is and should be a matter of personal and informed choice.

2. Donor Screening

Donor screening is based on three elements: donor self-exclusion, health and lifestyle communication and blood testing. Proper donor screening reduces exposure to potential disease- and non-disease causing contaminants in breast milk.

Donor Self-Exclusion Criteria
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 (incl. 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
-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
-Undue stress on herself or her family
Other -Having difficulty meeting needs of her own baby
-Not meeting recipient criteria/request

Health and Lifestyle Communication

The first question that parents usually ask a potential donor is if she has any communicable diseases. Discussing lifestyle and personal history is also a normal part of milk sharing. Some parents may ask to see test results, and others may request screening to be done. Complete and current screening is essential for the safety of breast milk sharing. It is important to know thy source.

For non-infectious contamination of milk, getting to know a donor and building a relationship is an important element in establishing the factor of trust. Milk banks do NOT test donor breastmilk for non-infectious contaminants (alcohol, nicotine and other substances) and primarily rely on self-exclusion and self-reporting to reduce the possibility that of these non-infectious contaminants being present in the milk that they distribute. In their own communities, moms can talk with each other on the phone, chat online, check out each other’s Facebook page, ask for references and meet in person to discuss lifestyle, diet, hygiene habits, use of medication and non-infectious substances (not just recreational substances but also potential allergens or philosophic oppositions such as nuts, diary, eggs and meat). Eats on Feets provides a list of suggested questions for addressing donors.

Donor Blood Testing

Typical blood testing of milk donors includes HIV I & II, HTLV, HBV, HCV, Syphilis and Rubella. CMV, TB and WNV can also be considered for additional screening. Milk banks recommend that screening be done every three to six months. For donors without insurance coverage, free clinics are an option for screening as is becoming a blood donor in most cases.

3. Safe Handling

While some viral diseases, like Hepatitis B (HBC) and HepatitisC ( HCV), are not passed via breast milk, contamination can occur when there are lesions and open sores anywhere on the skin. Breasts and body should be inspected for lesions, infectious blisters and bleeding nipples before expressing milk, and hands should be diligently washed before expressing milk and handling milk, milk collection equipment and supplies. Bacterial contamination of breast milk can occur due to improper handling of pumping and storing supplies and of breast milk. Parents can educate themselves about proper handling techniques and follow generally accepted guidelines for storage, transport and shipping of expressed milk.

4. Home Pasteurization

There are two methods of pasteurization that are safely and easily done at home: Low Temperature Long Time (LTLT) like the Holder method and Pretoria Heating, and High Temperature Short Time (HTST) like flash heating.

Holder pasteurization is the method used by most US milk banks. It can be performed in the home using a marketed single bottle pasteurizer. Pretoria Heating is done on the stove top, and is used in resource-poor areas for HIV positive mothers. These methods have been demonstrated to kill a wide variety of viruses and bacteria. However, they also have been shown to denature the milk of much of its nutritive properties, many of which may be especially beneficial for premature infants.

Flash heating, not to be confused with commercial flash pasteurization, was also developed for use in resource-poor areas for HIV-positive mothers. Flash heating can be accomplished on the stovetop or other direct heat source. Flash heating has been demonstrated to kill HIV, but its effect on other viruses is theoretical. Due to its relatively lower exposure time, this method has been demonstrated to preserve more of the milk's nutritive qualities than the LTLT methods.

Spore Forming Bacteria

It is important to note is that any pasteurizing of breast milk raises the risk of spore release from spore-forming bacteria, like Bacillus cereus (B. cereus). While B. cereus is less of a concern for healthy-term babies, it can pose a significant risk to premature babies or those with gastrointestinal issues. This makes a good case for using raw milk from a thoroughly screened donor, and raw milk should also be taken into consideration for feeding premature or sick infants.

Raw Milk

Many families will prefer to use raw, unpasteurized milk so that their babies receive milk with greatest nutritional value. In the case of using raw donor milk, it is imperative for the recipient-donor relationship to be well established and/or for the donor to be thoroughly and recently screened. If this is not the case, the recipient may choose to pasteurize the milk.

Overview of both pasteurization techniques compared to raw milk

Holder pasteurization Pretoria-heating Flash-heating Raw (fridge) Raw (frozen)
Temperature 62.5°C (144.5°F) 62.5°C (144.5°F) 72°C (161.5°F) 4°C (39°F) -15°C (5°F)
Time -Temp. is held for 30 minutes -Temp. is held for 20-30 minutes
-Milk is exposed to this heat for a few seconds
-Whole process takes ± 5 min.

Efficacy -Virtually eliminates the threat of viral and bacterial contaminants –Virtually eliminates HIV,
-Less inhibition of E. coli and S. aureus than Flash-heating
-Less effective than Flash-heating on HIV
-Other pathogens not directly addressed
-Virtually eliminates HIV, E. coli and S. aureus
-Other pathogens not directly addressed
-Milk may contain pathogens if from unscreened donor
-CMV gone in 7 days when refrigerated
-Milk may contain pathogens if from unscreened donor
-CMV virtually gone in 3 days when frozen
Results -Some decrease in bacteriostatic properties
-Lipase destroyed
-IgA reduced by 70%
-Lactoferrin is reduced by 40%
-Post heat treatment increase in thiamin, riboflavin, vitamin B6, folate, and vitamin B12, possibly due to release of vitamins from binding proteins in the milk.*
-Some decrease in bacteriostatic properties assumed
-Reduced but biological activity of lactoferrin not impaired
-Post heat treatment increase in thiamin, riboflavin, vitamin B6, folate, and vitamin B12, possibly due to release of vitamins from binding proteins in the milk.*

-Some decrease in bacteriostatic properties
-Lipase significantly reduced assumed
-IgA mostly intact
-Reduced but biological activity of lactoferrin not impaired
-Post heat treatment increase in thiamin, riboflavin, vitamin B6, folate, and vitamin B12, possibly due to release of vitamins from binding proteins in the milk.*
-No decrease in bacteriostatic activity
-Lipase activity breaks down milk fats
-Anti-infective properties intact
-Bacteriostatic properties 66% by 3 months
-Lipase activity breaks down milk fats
-Anti-infective properties intact
Spore Propagation Potentially Potentially Potentially None None

*We have not found any research to indicate that this is a positive result.

Community breast milk sharing

Safe and conscientious breast milk sharing does not stop at medical screening, proper handling and pasteurization. Donors are often invested in the milk sharing relationship on a more intimate level. Pumping or expressing milk is time consuming and donor mothers who dedicate themselves to freely give their breast milk are nothing short of miracles to their recipients. Just as recipients may want to screen donors, donor moms often want to know more about the recipient baby and family, especially when seeking a long term arrangement. The stories that have been shared with us about milk matches have been a wonderful testimony of how families have become friends, not only through sharing breast milk, but by sharing their lives.

In some religions, such as Islam, donor and recipient babies become unmarriageable kin (Mahram). The realization that someone else's baby is growing on her milk makes a donor feel empowered. Recipients, realizing that they are not limited to feeding their babies formula when using their own milk is not feasible, feel empowered as well. The vigilance that we practice when taking care of our children translates beautifully into growing communities and families that support each other in times of need.

A parent-to-parent milksharing network can also be vital for a fast mobilization of aid in emergencies. Identifying key decision makers who influence infant and young child feeding practices at household, community and local health facility levels is crucial information when determining the priorities of action and response in emergencies.

Supporting safe community breast milk sharing has far reaching benefits, and through milksharing, we can all contribute to infant, family, community and ultimately, global health.

For more detailed information please see the Eats On Feets Resource for Informed Breastmilk Sharing.

Get Involved with Eats on Feets

Important Links

Eats On Feets Home Page on Facebook
Your Local Eats on Feets Chapter Page
Volunteer Application
Press Kit
Hosting a Gathering
Letter to Professionals

The primary goal of Eats on Feets is to connect families (recipients) of babies in need of breastmilk with women (donors) who have milk to share. This is a mighty task for an entirely volunteer-run network and your support is vital to our success.

Supporting the Eats On Feets Network

  • Support the Eats On Feets network by clicking 'Like' on one or more of our Facebook pages. This is one of the simplest ways anyone can help match recipients with donors. With the click of a button you could be a vital link between a baby and nutritional sustenance.
  • 'Like' our Eats On Feets Facebook Home page.
  • 'Like' your local Eats On Feets local chapter page.
  • Take it a step further and check in occasionally to like and share the posts and status updates of these pages. Liking and sharing the posts of these pages helps donors and recipients find each other.

Furthering the Network

  • Help administrate existing Eats On Feets chapter pages on Facebook.
  • Support the creation of new chapters for communities that are not already in our network.

Both of these roles are an integral part of Eats On Feets and we are always looking for volunteers. If you are interested in helping an existing page or creating a new chapter please fill out the volunteer admin application and email it it us.

Local Community Outreach

Inform your community about Eats On Feets and community based breastmilk sharing. This is a powerful way to advocate for babies and their right to accessible and commerce-free breastmilk!

We have several ways for you to support Eats On Feets. Please email us if you are interested in any of the following.

  • Downloading and printing fliers, posters and cards. Feel free to use and distribute our downloads and if you would like customization for your specific community let us know.
  • Host a Powerpoint presentation tailored to your specific group, organization or community (coming soon!).
  • Host an Eats On Feets gathering to share, support and celebrate the donors, recipients and milk-sharing supporters in your community.
  • Share our press kit with your local media.

For the Press

Eats On Feets welcomes media enquiries! We suggest that you first contact your local Eats On Feets Chapter Page on Facebook. Please email us if you need further support for your project. Please download our Press Kit for further information.

Web Outreach

  • Consider blogging about Eats On Feets. One entry alone can help normalize community based breastmilk sharing.
  • Share the link to our website.
  • Share the link to the Eats On Feets "4 Pillars of Safe Breastmilk Sharing."
  • Share any of the information found on our website and in our Resource.

Education and Research

Eats On Feets is dedicated to preserving and presenting the latest research with regards to donor breastmilk and the safety of community based breastmilk sharing. Please email us if you have a submission for our database, or if you would like to cite any of our material.

Share Your Success Stories and Pictures

If you are a donor or a recipient of community based milk sharing, we would love to hear your success story! Sharing your story provides inspiration and hope, normalizes milk sharing and facilitates the path of future babies to have access to commerce-free breastmilk. Please email us your stories and pictures, and we will be happy to share them.

Feedback and Other Offers of Support

We are always looking for ways to improve and increase the success of our network. Please email us if:

  • You want to help in a way that is not covered here
  • Have suggestions, ideas stories and/or pictures that you would like to share. (Please remember to include a short note giving us permission to share)

Donating or Requesting Breastmilk

We do not screen donors or recipients! Please see "The Four Pillars of Safe Milk Sharing" and the "Resource Guide for Informed Milk Sharing" for further information about breastmilk sharing on the Eats On Feets facebook network.

Currently, Eats on Feets is only active on Facebook, with a local page for many areas, helping match local families. If you do not have Facebook access, email us, and we will be able to help over email. We recommend getting a Facebook account if you have an ongoing need or donation, as it is faster and more effective. If there is not a local Eats On Feets Chapter in your area, contact the Eats On Feets Facebook Home Page and the ladies there will be able to assist you.

Posting Requests & Donations on the Network (basics)

  • Please read our FAQ and the Eats On Feets Resource for Informed Breastmilk Sharing for detailed information.
  • Go to your Local Eats On Feets Facebook Chapter Page and click on the "Like" button for that page.
  • Check the page for current requests or donations. If you find one that is suitable to you, respond to the post or send the poster a message.
  • If you do not find a current post that is suitable to you, post your request or offering on the wall of your Local Eats On Feets Facebook Chapter Page. Include some background information regarding your location, whether this is an ongoing or temporary request/donation, the age of your child, any special diet considerations, the best way to contact you, etc.
  • Regularly check for comments to your post.
  • It is up to the donors and recipients to connect with each other, check in on their post and to follow up with potential leads.
  • If you have not received a response to your post, please post on your area's neighboring pages as well as the Eats On Feets Facebook Home Page.
  • Please send a message to your Local Eats On Feets Facebook Chapter Page if you need further assistance.

Resource Guide

The Eats On Feets Resource Guide is a comprehensive source of information for safe breastmilk sharing. It answers common questions, gives screening suggestions, examines child feeding options and uses up to date medical research.

The Resource Guide has a search function that allows parents and professionals to perform a quick search by entering a keyword. The Resource Guide can also be set to be read in different languages. All the information in the Resource Guide is referenced with relevant research, available for the furtherance of personal research into milk sharing issues at hand.

Click this button to view it.

Breastmilk Sharing Resource Guide

Customizable Resources

Eats On Feets Tear Tab Flyer
Four Pillars Postcards
Community Breastmilk Sharing Postcards
Storage Guidelines Postcards
Business Cards
World Health Organization Strategy

Tuesday, September 23rd 2014

Protecting PAMS Participants’ Privacy – Group Asks Participants to Share Private Information

Angie B. Bond MS, PhD student Arizona State University College of Nursing and Health Innovation

Foundation of Privacy Rights

The establishment of protections for personally identifiable information security in healthcare and human subjects research through the Health Insurance Portability and Accountability Act (HIPAA) establishes rights of control, disclosure, and informed consent for the collection and use of said information for the person the information pertains to (United States Department of Health and Human Services [HHS], 2013). Protection of this information becomes increasingly more complicated when electronic records are involved, transmission or sharing of protected information occurs, or when the use of information is for purposes secondary to the collecting practitioner use in treatment (Schweitzer, 2011). Difficulty or complexity in maintaining the integrity of personally identifiable information is accepted as a challenge, however, sanctions against violation of rights concerning health and personal information exist and are a significant financial and criminal liability with additional liabilities potentially levied on a state by state basis (Schweitzer, 2011; Pritts, 2007). In order to ensure that every effort is made to protect both the subject of the information and the organization or researcher collecting the information for use in research or providing care, Institutional Review Boards Human Subjects Committees (IRBs) and specific requirements for Risk Analysis and Management within all health organizations, programs, and clinics (Nass et al., 2009).

How is PAMS affected?

Private Arrangement Milk Sharing (PAMS) is a complex practice. Part of that complexity arises from the frequent nature of the agreements being “Contract Implied in Fact” arrangements involving individually identifiable information and/or the exchange of health information. A Contract Implied in Fact “Consists of obligations arising from a mutual agreement and intent to promise where the agreement and promise have not been expressed in words. Such contracts are implied from facts and circumstances showing a mutual intent to contract, and may arise by the conduct of the parties. A contract implied in fact is a true contract” and is entered into upon exchange of milk in a PAMS relationship. The exchange of milk in PAMS fulfills requirements of conduct illustrating “an unambiguous offer, unambiguous acceptance, mutual intent to be bound, and consideration.” A critical part of this contract obligation is the use of the donated milk and information regarding health and lifestyle of the donor obtained during screening be used for the purpose of providing for the recipient infant/family and that infant/family alone, and this is supported by the claims of each of the major PAMS networks.

All of the major milksharing networks make clear their stance to be uninvolved in the specific between party agreements involved in PAMS including questionnaires and screening tools (Eats On Feets), asserting that all individuals take complete responsibility for outcomes of milksharing as individuals (Human Milk 4 Human Babies). This explicit maintenance of non-participation ensures that as networks, they are not included in provisions requiring adherence to HIPAA. These organizations provide description of their belief that information collected for research or analysis should not be undertaken by the networks, presumably for both philosophical and practical conflict of interest reasons. Encouragement to violate this foundation of expectation by soliciting third party information is counter productive to the specified intent and spirit of milk sharing as a private arrangement strictly between the donor and recipient, and undermines the security in providing information confidentially. So who is intentionally asking that this expectation and potentially contractual obligation to honor privacy in the PAMS agreement be violated?


The Milksharing Incident Database and Survey (MIDAS) is described on their website as “…a grassroots public health program created by World Milksharing Week.”* Neither the survey nor the incident reporting options provides an informed consent document, indication of data security, intended use, authority to collect such data, de-identification procedures, or information regarding data security and storage. There is no IRB approval for any of the actions undertaken by this organization. In the frequently asked questions tab of the website, it is stated that there is absolutely no follow up on any information provided, and that all information is provided anonymously. On the same page, follow up is discussed as occurring in “severe and very severe” instances, with a medical professional that MIDAS chooses. No information is provided regarding vetting of medical professionals, authority for them to contact respondents, and certainly not to contact individuals who’s personal information was obtained through a third party without consent. So, if the reporting is anonymous, how does the follow up occur? The answer is likely that this website is an integrated WordPress account, as it is hosted by Bluehost, and WordPress has the capability of tracking the IP addresses of users who interact with websites. Not particularly anonymous, or secure.


No evidence or foundation based on the current level of knowledge concerning PAMS is provided by the creators of MIDAS. The efforts are redundant, as my own research and that of several other teams operating in the US and Canada are collecting practice information and participant beliefs. These research endeavors are being conducted under approved IRB circumstances, and with full disclosure to all participants. Considering this information is being collected in such a way that it cannot be used for legitimate research, it is likely that such a site poses more harmful potential than benefit for any efforts to generate policy and evidence regarding PAMS.

Closing Thoughts

The PAMS community and participants are operating under very biased and intensive scrutiny from existing health authorities. Concerns about the cavalier attitude of those participating and the presumed ignorance of those involved is frequently discussed. A site clearly not manned by an experienced researcher or data manager, seeking information from third parties without any right to do so and potentially in violation of individual state and federal regulations regarding protected information and contract law, and without recourse for those who may be seriously wronged in this process certainly does not refute these views of PAMS. It is deeply disturbing to me, personally, to see otherwise well respected researchers who would certainly be expected to understand their inability to be associated with such an undertaking per their involvement with research institutions already are being named as partners in this endeavor through World Milksharing Week.

* The milksharing network Human Milk 4 Human Babies and Modern Milksharing are included in the committee responsible for the creation of MIDAS. This involvement and endorsement is in direct opposition to stated intentions to stay removed from involvement and to support individual accountability of participants on their networks and sites.


Nass, S. J., Levit, L. A., Gostin, L. O. (2009). Beyond the HIPAA privacy rule: Enhancing privacy, improving health through research. Washington, D.C: National Academies Press.

Pritts, J.L. (2007) Federal efforts to impose uniformity on state healthcare laws. Health Law and Policy. Vol. 20 (2). Pp 20-23.

Schweitzer, E. J. (2012). Reconciliation of the cloud computing model with US federal electronic health record regulations. Journal of the American Medical Informatics Association : JAMIA, 19(2), 161-165. doi:10.1136/amiajnl-2011-000162

Thursday, November 28th 2013

Goodbye to longtime New Zealand admin Zoe Reid

Eats on Feets would like to thank former long time New Zealand administrator Zoe Reid for all of her hard work and dedication to the network. Zoe and her co-admins have chosen to take the former EOF New Zealand chapter and direct it towards a non Eats On Feets project. We wish them the best in their new endeavor.

Eats on Feets remains dedicated to staying 100% volunteer, commerce free, and free from accepting any payment, donations, or funding of any kind. This has been a core tenant of our philosophy since our inception.

If you are committed to EOF's philosophy and goals and are interested in holding a space for others to request and receive human milk, please contact us at

Monday, October 21st 2013

American Academy of Pediatrics Study Unwittingly Validates “Four Pillars of Safe Breastmilk Sharing”

Maria Armstrong and Shell Walker Luttrell

***Eats on Feets is referenced this week in a study published by the American Academy of Pediatrics (AAP) entitled “Microbial Contamination of Human Milk Purchased Via the Internet”. The authors purchased milk from two websites which sell breastmilk to explore the potential for contamination. Results showed of the 101 purchased samples from the internet and shipped in various ways and distances, compared to 20 rejected milk bank samples, two classes of bacteria had statistically higher growth. The viral content was not significant. The following is an elaboration on the response requested by media outlets.***

Eats On Feets is uniquely dedicated to safe, ethical, and informed breastmilk sharing between families. Eats On Feets also fervently opposes the selling of breastmilk. It is our firm belief that the selling and buying of breastmilk carries undue medical and ethical risks.

In order to provide the breastmilk sharing community with current research and information, Eats On Feets created and maintains the "Resource for Informed Breastmilk Sharing" and "The Four Pillars of Safe Breast Milk Sharing." We consider the latter to be fundamental for all individuals and entities involved in the safe use of donor milk. These resources are under regular scrutiny from members of the medical and research community, and concerns are immediately addressed (and welcomed!) to ensure the accuracy of this resource. The AAP’s publication validated the Resource and Four Pillars, while providing opportunity to clarify the third pillar, “Safe Handling,” to more precisely impart the need for the cleaning of equipment and the use of impeccable shipping methods.

Three important notes should be made about this study: 1) The authors specifically excluded potential donors attempting to engage in informed practices, such as “Know Thy Source”, to avoid seeking approval of their study by an ethics committee. 2) The authors themselves state that the presence of bacteria is not predictive of infant health risk. Only two of the four screened microbial groups were statistically significantly higher than samples obtained from a milk bank (because their pre-screened donors had failed their own quality measures). Specific pathogenic species were not isolated, making the results rather ambiguous. 3) When necessary, proper home pasteurization is, contrary to the authors’ assertions, possible in most homes in the United States by Holder method on stove-top or by single bottle pasteurizer.

The methodology, analysis, context, and ethics of this study are questionable. The study attempts to implicate all non-milk bank use of donor milk. In fact, it only addresses the use of donor milk obtained in a deceitful and unethical manner on behalf of the recipient (the researchers), and shoddy methods(the donors). These practices do not apply to the breastmilk sharing community.

Eats On Feets remains committed to the altruistic sharing of breastmilk between families, and asserts that it can be done safely and ethically. Until the Human Milk Banking Association of North America, the AAP, and social policy makers are willing to commit to practical and feasible means of meeting the needs of their communities, there will remain a need for community based milk sharing. Eats On Feets will continue to do its part in contributing to safety through reasoned and ethical research, distribution of educational materials, and advocacy.

The AAP Article detailing the study can be found here: Microbial Contamination of Human Milk Purchased Via the Internet

Q: Are you worried about safety?

A: Of course we are concerned about safety! Which is exactly why we created the Four Pillars of Safe Breast Milk Sharing. And, if like was practiced in this study, we would also be concerned if babies were being fed cow’s milk that was shipped across the country, in unstable conditions, and left sitting thawed in a P.O box.

Q: But how do you know that families are doing this safely?

A: Doing what safely? Sharing breast milk? Humans have been sharing breast milk since the beginning of time. This study does not address milk sharing, it addresses milk selling. Milk selling increases the risks of using donor milk. If someone is attempting to make money by selling breast milk, how do we even know that what they are selling is actually 100% breast milk? How do the researchers of this study even know if what they bought was 100% breast milk? It certainly wouldn’t be the first time that someone tried to increase profits by diluting their product. And if the milk was diluted with something else, like cows milk or formula, how would that skew the findings?

We frequently poll the users of our network, we constantly provide them with updated guidelines and information. The consistent feedback and analysis of the polls is that breast milk sharing is happening safely. We cannot say the same for breast milk selling and purchasing, which is why we do not allow the selling of breast milk through our network.

Q: What do you think about this study?

A: We have a lot of thoughts about this study. We are wondering if anybody has looked into where the money for this study came from and if the funder collaborated with Grant Medical Center to initiate the use of donor milk and the formation of the Mother’s Milk Bank of Ohio. If the answer is “yes” we wonder if there should be some red flags raised. We are also wondering if any of the researchers who designed this study are also associated with the milk banks.

Q: What are your concerns about this study?

A: We are concerned that the research seems to have been funded by one of the founders of the Ohio Milk Bank and that the methods of the study are questionable and that the actual conclusion of the study does not match the sensational title of the article. We are concerned that this study is purposefully intended to attack safe community based breast milk sharing.

Q: Who regulates breast milk sharing?

A: Since breast milk is considered to be essentially safe, neither milk banks nor individuals are regulated by the government.

Q: What about sick babies? Are you concerned that some of this milk will go to them?

A: Sick babies really need access to free breast milk! We encourage all users of donor milk to follow the Four Pillars of Safe Breast Milk Sharing. This may be why there have been zero reports of negative outcomes from milk shared on our network.

Q: What do you think about this report?

A: Though it is clear that the report does not apply to normal community based milk sharing we think that it proves the importance of our Four Pillars of Safe Breast Milk Sharing.

Q: How do you think this will impact milk sharing?

A: Except for the fact that we will even more emphatically caution against the selling of breast milk and continue to endorse the Four Pillars of Safe Breastmilk Sharing, it will be milk matching as usual.

Q: Are you worried that they found bacteria in the breast milk?

A: It is normal and even beneficial for bacteria to be in breast milk. By following the Four Pillars of Safe Breast Milk Sharing, parents can ensure that it stays at acceptable levels.

Saturday, May 25th 2013

What do CMAJ, Midwifery Today, Pubmed and CAPPA have to do with Eats On Feets?
By Maria Armstrong

Eats On Feets... First, why do I choose to volunteer at Eats On Feets? I am not a milksharing mother; I don't plan on being a milksharing mother in the future. I am all done with babies… of my own that is. My breastfeeding days are over and are a fond memory of a growingly distant past. I nursed my babies well past the AAP's minimum recommendation of breastfeeding for at least one year. I never even had any problems.

No, my interest in milksharing, and in Eats On Feets specifically, comes from my work and passion: being a birth doula. Unfortunately, I have had clients who had supply issues for various reasons, and it was a frustrating experience to see them having formula as their only recourse, whether short term as the issues were being resolved, or long term in case of unresolvable issues. Formula simply is not as health giving as breastmilk is. It did not occur to me however that mothers would want milk from another mother except via milk banks and thus for medically indicated reasons, nor did I know the birth community well enough to realize that some midwives may have known lactating mothers who had milk to share.

After one such experience yet again, I ran into Shell Walker (now Shell Luttrell), a midwife in Phoenix, AZ. I "met" her on, yes, Facebook, this awesome social networking medium. Shell had an active and local milksharing community going on called Eats On Feets, and the idea of having more communities like that all over the world inspired many of us. It seems to me now that all it took was one evening of brainstorming with a few people and Eats On Feets, the grassroots milksharing network, was born. I set up the Oregon chapter that same night, and it quickly took off, growing to 100 likers in a couple of days.

With the unexpected rapid growth of this network however, and the eagerness with which mothers were jumping on milksharing, also came the question about safety. How safe was it, really, when the milksharing happened outside of your own [Shell's] direct midwifery community? Mothers were asking questions about expressing, storing, shipping, feeding options, bacteria, screening, blood tests, mitigating diseases with pasteurization, and much more. We needed answers; parents needed answers.

Shell and I, as well as a handful of dedicated volunteers, poured ourselves over the information available to us and we quickly realized that we needed to make all this information more accessible, to both parents and professionals. There was so much to read, analyze, research and gather that we felt this was an impossible task for any, often sleep deprived, new parent to do, especially in acute need situations. We also wanted to make the information more easily available to medical, birth and lactational professionals, so that they could support community based breastmilk sharing and their clients or patients.

In the end, it took countless hours, a couple of all-nighters, days of missed work from daytime jobs, and several months to get our heads around all the information. We also talked to scientists, doctors (one of them using donor breastmilk for his grandchild from within his community), researchers, the very people involved with the studies we were reading about, always checking and double checking that we had it right. At times, steam came off of the Google document where we collaborated; some virtual doors were slammed. It was hard, hard work and crazy times.

Not only that, but as we researched, we discovered that some of our long held opinions and assumptions about certain issues like screening and pasteurization were inaccurate. Yikes! There was no way to go back and correct ourselves everywhere we had gone on record with some of these inaccuracies. However, the Canadian Medical Association Journal had published a news article earlier that year (Milk Sharing: Boon or Biohazard. 2011) for which Eats On Feets was interviewed, and considering the scope of the journal, we decided that it was important to send them a correction. Thankfully, it was published as a response to the article.

Finally, finally, out of the extensive research that we did, "The Resource for Informed Breastmilk Sharing" was created. This resource is truly unique in its kind. It is a searchable database, containing all the current information and research on breastmilk sharing, its safety concerns and informed choice process. It is complete with references, links, and official recommendations. This resource is continuously scrutinized and updated by volunteers in the medical, lactating and research community.

Out of our research, and the writing of our resource, came Shell's easy to understand and implement concept of the 4 pillars of safe breastmilk sharing: Informed choice, donor screening, safe handling and, if needed, pasteurization. These four pillars were elaborated on in our article "The Four Pillars of Safe Breastmilk Sharing," which was written for and published in the spring 2012 edition of Midwifery Today Magazine. This article is now also cited in PubMed!

But it doesn’t stop there: "The Four Pillars of Breastmilk Sharing," as well as an excerpt from the article, are also being used and cited in CAPPA's recently released document for perinatal professionals, called "Milk Sharing and Perinatal Professionals" by Laurel Wilson, IBCLC, CLE, CCCE, CLD, CAPPA Executive Director of Lactation. In it, Laurel Wilson writes that "parents considering peer-to-peer milk sharing should follow the '4 Pillars of Safe Breastmilk Sharing.'" [emphasis added]

Now, this is really why I am with Eats On Feets specifically, and what excites me the most personally, aside from babies getting breastmilk: Not only has Eats On Feets become a leading resource in providing safety information and setting a standard for community based breastmilk sharing, Eats On Feets is also influencing and supporting changes in breastmilk sharing policy. From a correction to the CMAJ to Midwifery Today, Pubmed and CAPPA, we have made a long and fruitful journey. We have become a reference on other people's documents and guidelines!

And we are not done! There is so much to do still; there are so many plans, ideas and hopes. As we grow, we are attracting people in the research field who want to research methodologies for safe milk sharing. We want to look into education opportunities and collaborate with health professionals who have a direct impact on the most vulnerable members of our society so as to normalize community breastmilk sharing. I cannot wait to see what the future brings!

I absolutely love being part of such a wonderful grassroots movement as Eats On Feets! I am so grateful for everything that I have learned these past few years, and for the deep relationships made. But most of all, I thank everyone who is involved in making breastmilk normal for every baby! Nowadays, when I have a client who has supply issues, I can offer an alternative to formula: I can offer to find someone who can safely provide her baby with species appropriate nutrition. And that is HUGE.

Maria Armstrong, is a doula, childbirth educator and community breastmilk sharing consultant who practices in Portland, OR.

Wednesday, June 20th 2012

Midwifery Today Article

Shell Walker Luttrell and Maria Armstrong contributed a major article to the 2012 Spring edition of Midwifery Today reflecting their research into the safe handling and sharing of breastmilk.
Click here to view it.

Sunday, November 13th 2011

Profiting off of Breastmilk

In response to the many stories about how unsafe 'informal' breastmilk sharing is and how people should use 'formal' milk banks.

Community based milk sharing is an affordable, viable and important option that should be protected and furthered, not stymied.

Eats On Feets facilitates a world-wide network of parents and professionals who have made the informed choice to share or support the sharing of breastmilk. Eats On Feets was the first network on Facebook to do so and has a history of rigorous dedication to the furthering of milk sharing information.

Scare tactics and shocking stories of milk-selling and milk-sharing are frequently used to dissuade the public from participating in milk-sharing activities outside of the milk-banking system. But these tales do not tell the whole story.

Milk banks are called BANKS for more than one reason. Milk selling is a money making business whether on the streets, in the labs or in the milk bank office. It is more than curious that the very institutions who warn against the informal selling of breast milk and/or the free sharing of it, are the very ones who sell the most of it.

Eats On Feets does not allow the selling of breastmilk on its pages. It does support a safe, free and truly altruistic form of milk sharing that can be as safe as the milk bank process, and has an even greater amount of regulation possible in order to meet the specific needs of individual donors and recipients.

This can be accomplished by following The 4 Pillars of Safe Breastmilk Sharing and by referring to the Eats On Feets Resource Guide. Our document has been reviewed by three former milk bank employees, two physicians and countless IBLC Lactation Consultants and is cited as a sound resource for milk sharing by many. Were any deficiencies to be noted, we would take them seriously and update as/if needed.

While community based milk sharing is misleadingly accused of lacking any safety nets what-so-ever, there are also considerations regarding (U.S) milk banks that have not been addressed:

  • The use of outdated pasteurization techniques that denature the milk and may put preemies at greater risk and is less than optimal for other babies,
  • The use of milk that has not been tested for non-pathogenic contaminates such as alcohol and tobacco but instead rely on a questionnaire,
  • The use of an unfair distribution model,
  • The use of a model that is insensitive, and therefore unusable, to families of specific religious and cultural groups,
  • The use of less than transparent and less than truthful informed consent documents,
  • The use of misleading tactics to solicit donations,
  • The lack of a public document for emergency distribution or community organization,
  • and finally,

  • The processing of a product that is freely given to them which is then marketed and cost prohibitive to all but the very wealthy or insured.

Yet somehow milk banks are regarded as the supreme keepers of knowledge regarding milk sharing and the feeding of babies. If they know something about milk sharing that would contribute to its safety for babies, if they have information that the milk sharing public does not already know or does not have access to through organizations such as Eats On Feets, then we insist that they are morally obligated to share that information. If not with us, then with the World Health Organization. Immediately!

Until the (U.S) Milk Bank Associations step up and truly show an interest in meeting the needs of their communities, there will remain a need for community based milk sharing and Eats On Feets will continue to do her part to contribute to its safety through research, educational materials and advocacy. I am thankful that milk banks have helped so many babies but there is still much work to do.


Shell Walker Luttrell

The 4 pillars to support the safe sharing of breastmilk

Informed Choice - Mothers are responsible for understanding the options, including the risks and benefits, of all infant and child feeding methods.

Donor Screening - Mothers can communicate with donors by asking questions about their health and lifestyle, and by requesting blood screening test results.

Safe Handling - Mothers and donors should handle milk with clean hands and equipment and use proper storage methods.

Home pasteurization - If in doubt, mothers can pasteurize milk at home; on the stovetop in order to inactivate HIV or using a single bottle pasteurizer that performs the Holder method of pasteurization

Friday, April 12th 2011

How to run an Eats On Feets chapter page

Running an Eats On Feets chapter page is rewarding and a wonderful way to get to know other moms and their babies, as well as midwives, doulas, lactation consultants and other professionals in your area.

The basic two things needed in order to run an Eats On Feets page are reposting offers and requests as admin so that all 'likers' of the page see them in their News Feed, and keeping the Wall clean of spam, ads and anything else not related to Eats On Feets and milk sharing.

A helpful aspect of an Eats On Feets admin is being in the position of networking with local moms and/or birth professionals, that is, being tied into your community, able to make real life connections. Eats On Feets operates locally, and chapters are run with local admins. Knowing or getting to know likeminded people will allow for the network to grow and flourish.

Something to remember is to let the moms (and dads) work things out. The page belongs to them. You may never know who is getting whose milk. Don't feel the need to keep lists or try to organize things. Less is more. Let the moms be responsible to match themselves up.

When questions about milk sharing arise, we have a Resource which contains much of the information available in order for parents to make informed choices about milk sharing. It can be linked to when needed on the pages. Other moms on the page are often also a wealth of information because of their experience. It is a wonderful thing to be able to involve them so that everyone can help each other!

For more information on what Eats On Feets does and does not do, please read our FAQ

If you are wanting to run a EOF page, please contact us at:

Thank you for your interest!

Thursday, March 31st 2011

Dear Eats On Feets Friends and Family,

As you may be aware, a network called HM4HB (Human Milk 4 Human Babies) has publicly claimed that the Eats On Feets network has changed its name to HM4HB. This assertion is simply not true. Eats On Feets never changed its name and remains the same entity it has always been, doing what we have always done - supporting breastmilk sharing on a community level. HM4HB is a separate entity. EOF and I have no connection with HM4HB and HM4HB has no connection with EOF.

What precipitated the departure from EOF of those who are now operating as HM4HB was a fundamental disagreement over safety and informed choice issues. After Maria Armstrong and I began research into safe options for breastmilk sharing, it became clear to us that prenatal blood testing is insufficient as a tool for proper donor screening. We learned from the published research that for EOF to claim that stove-top flash heating inactivates viruses would be a misrepresentation of what flash heating can or cannot accomplish. The scientific research does not support claims that flash heating kills any viral pathogen other than HIV. We also learned from this research that any pasteurization of breastmilk carries certain risks, especially for premature or sick babies.

In order to provide families with useful resources for their own investigations, we changed our website to include this evidence-based research about proper blood screening, pasteurization, and the use of raw milk.

Trademarking the Eats On Feets name was necessary in order to protect use of the name in connection with all that it stands for -- that is, specifically, providing evidence-based information and research to the families that Eats On Feets serves, and providing a venue for commerce-free milk sharing on a local community level without centralized control. Having a trademark (actually, a "service mark," since what EOF does is a service, not a product) protects the name Eats On Feets from being used outside of these parameters, and assures that those who want to maintain Eats On Feets pages as administrators can retain their autonomy to run their respective pages as they see fit, within these parameters, without having to be "approved" by some central authority.

A group of former Eats On Feets page administrators did not agree with our research and the trademarking, and founded HM4HB. In and of itself, there is nothing wrong with starting a new breastmilk sharing network. However, the page admins who left EOF publicly and falsely claimed that the Eats On Feets network had been renamed HM4HB, and they then proceeded to rename Eats On Feets pages or used the Eats On Feets pages to funnel EOF content to their new HM4HB pages, while locking the EOF pages for further posting -- all based upon a false assertion that the network had changed its name. When we realized what was happening, we believed there was no choice but to report the participating pages to Facebook because the name Eats On Feets was being misused and Eats On Feets content was being misappropriated and used by HM4HB, content which they had not created. Our chief concern, however, has been and continues to be that the name Eats On Feets not be associated with any network that does not provide the evidence-based researched information that we consider essential for true informed choice on the part of families who participate in breastmilk sharing. We do not want the name Eats On Feets associated with any safety claims that are not supported by evidence-based research.

Please accept our apologies for any confusion this may have caused and for our not having communicated with you sooner to explain what was happening. We are pleased that today, after this trying time, our website now contains evidence-based information for milk sharing. We encourage you to visit that site, as well as the new Eats On Feets Facebook page at where we facilitate the sharing of breastmilk and direct families to their local Eats On Feets page and/or to our new forum.

Shell Walker Luttrell,
Eats On Feets Founder & Licensed Midwife


Tuesday, March 15th 2011

This is a response to the original article published in the Canadian Medical Association Journal
Milk sharing: boon or biohazard?

Dear Lauren,

Please allow me to post some corrections.

Routine prenatal testing is inconclusive when it comes to safe milk sharing. It does not address every disease milk is typically screened for, and testing is primarily done at the beginning of pregnancy. Many opt out of HIV screening. Both HMBANA and UKAMB recommend testing every 3-6 months for HIV, HTLV, HBV, HCV, Syphilis and Rubella. These guidelines are followed by most milk banks.

The only country I know of that relies on donor screening alone is Norway. Milk banks generally also use the Holder method of pasteurization for safety.

Regarding pasteurizing breastmilk, flash-pasteurizing is a commercial method that requires special equipment and cannot be duplicated in a home setting. What can be done at home is called "flash-heating." The only virus that this method has demonstrated to inactivate is HIV. While flash-pasteurizing has shown to inactivate HIV, HTLV, HBV and HCV, and CMV as well as markers for many other viruses, the effectiveness of flash-heating on viruses other than HIV is theoretical.

It is important to note is that any pasteurizing of breastmilk raises the risk of spore release from spore-forming bacteria.

When mothers look for information for safe breastmilk sharing, it is important that all available information is presented. Deviation from standard is and should be a personal choice and not the only information given.

Currently, Eats on Feets is in the process of restructuring. Emma Kwasnica is no longer affiliated with Eats on Feets. We will soon present a press release.

Maria Armstrong
EOF Admin

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