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Challenges with milk production
Considerations for donors
Donating milk: overview
Options for donating milk or finding donor milk
Arrangements with family or friends
Ensuring the safety of donated milk
COVID-19: Some considerations regarding donor milk
Wet-nursing, cross-nursing or cross-feeding
LLLI’s policy on milk donation
Human milk is the natural food for human babies, not only supporting optimal nutrition but also contributing to reaching their health potential. Yet for many reasons, not all parents are able to nurse their babies or produce enough milk to meet their needs.
Some mothers produce more milk than their babies need, and would like to give others the benefit of this amazing food. Families may practice cross-nursing or other arrangements where babies receive human milk from people who are not their parents or co-nursing when both parents participate, either directly from the breast or by pumping and bottle-feeding.
La Leche League International (LLLI) is not affiliated with any formal or informal milk-sharing organization or network. La Leche League (LLL) Leaders may not use their LLL role to set up any kind of milk-sharing network.
Skip to LLLI’s policy on milk donation
CHALLENGES WITH MILK PRODUCTION
If challenges with milk production have brought you to this page, we encourage you to read through our resources on building your own milk supply and talk with an LLL Leader prior to seeking milk from others. Your own milk is uniquely designed for your baby’s current stage of development and changing needs. While difficulty producing sufficient milk may be due to factors beyond your control, it is beneficial to first consider whether additional support and information about supply management may bring you closer to your feeding goals. Whenever possible, the first priority is considering whether there are additional strategies to help increase your milk supply. However, the need for donor milk may still exist and we hope you will find answers to your questions about obtaining human milk for your baby from the sources shared here.
Find information about building and maintaining a milk supply here:
- The baby who doesn’t nurse
- Is my baby getting enough milk?
- Frequency of feeding FAQs
- Feed the baby: building a milk supply
If you are considering entering a milk-sharing arrangement, as a recipient, we encourage you to seek as much information as possible in order to make a fully informed decision. In addition, we recommend that anyone interested in obtaining human milk for their baby discuss options with their baby’s healthcare professional.
CONSIDERATIONS FOR DONORS
If you are considering entering a milk-sharing arrangement as a donor, we encourage you to seek as much information as possible in order to make a fully informed decision. If you feel you have extra milk to share, considering the impact on your child and comfort are priorities. By comfort we mean the baby is comfortable with milk flow, the parent is comfortable with milk volume and commitment needed to address this, such as extra pumping.
Be careful to ensure that your child’s needs for milk are met first and that maintaining an oversupply with the intent of donating will not cause hardship for either of you.
DONATING MILK: OVERVIEW
This is a wonderful gift! The benefits of human milk can be lifesaving for medically fragile infants. While some mothers of these babies make more than enough milk and are donors themselves, others may struggle to produce enough. These babies may take only small amounts, so a single donation can go far with significant positive outcomes, both to the health of the child and the morale of the family. Please contact your local milk bank for information about needs and requirements.
Nursing parents who are bereaved may consider milk donation as well, sharing that this is a meaningful way to honor their baby’s legacy while supporting other families in need. However milk donation is a very personal decision and for some parents who have lost a child, seeking support to discontinue milk production may be their preferred path.
Find information about lactation/donation after loss here:
- When a Mother Experiences Infant Loss
- Commonly Asked Questions about Lactation after Loss
- Donating Milk: A Heartfelt Wish to Honor Juliette
- A Gift from Bianca: A Story of Grief and Love
OPTIONS FOR DONATING MILK OR FINDING DONOR MILK
Milk banks are medically supervised organizations that primarily supply milk by prescription to babies in neonatal intensive care units (NICU), but may also serve outpatients and well babies if sufficient milk is available. Potential donors participate in a screening process, including bloodwork and health verification by their medical providers, and continue to stay in close communication with the milk bank to report any changes in their medical history. Donated milk is pasteurized and screened for bacteria so the milk bank can ensure appropriate safety, allocation, and transport of the milk. Each milk bank has its own set of protocols. If you are searching for information about donating, the International Milk Bank organization, a local LLL Leader, or your healthcare provider may have information to offer.
Here are links to find milk banks around the world:
- International: http://www.internationalmilkbanking.org/index/worldbanks/
- Europe: https://europeanmilkbanking.com/
- North America: https://www.hmbana.org/locations
- France: https://association-des-lactariums-de-france.fr/
- Hungary: https://www.mellettedahelyem.hu/pici-ellatas/anyatejgyujto-allomasok
- Italy: aiblud.com
- Ireland: https://westerntrust.hscni.net/service/human-milk-bank/
- New Zealand: https://www.cdhb.health.nz/health-services/human-milkbank/
- Spain. https://www.aeblh.org
- UK: http://www.ukamb.org/
There are several well-known milk-sharing networks on the internet that have established protocols to help potential donors connect with those who are in need of milk. For example Eats On Feets, Human Milk 4 Human Babies (HM4HB), and MilkShare. Your country or local community may have additional programs for informal milk-sharing. Most of the organizations engaged in facilitating milk-sharing encourage donors and recipients to sign an agreement to protect both parties. If you are considering informal milk-sharing through a network such as these, we encourage you to read the information offered carefully and check your local regulations to ensure that you provide milk safely, feel comfortable with all aspects of the process and protect yourself from any liability. If you choose to donate through an informal milk-sharing network, you will have more say in which families receive your donation and you may be able to choose to build an ongoing relationship with them. These programs serve all families in need of donor milk and do not focus on milk for ill or fragile babies. Donations often support healthy babies of varying ages whose families are unable to produce enough milk for their children. Donors may find it rewarding to know who the recipient of their milk will be.
Some questions for recipients to ask potential donors:
- Is the milk donor willing to share health or lifestyle information that could possibly impact the safety of their milk?
- Does the donor use any substances (tobacco, alcohol, drugs, medications, supplements) that could be present in the milk?
- Is there a cost to buy or ship the milk?
- What protocols are used to collect, store, and transport the milk safely?
ARRANGEMENTS WITH FAMILY OR FRIENDS
You may also choose to share your milk with a family member or friend in need, making your own arrangements. Some people nurse the baby directly, others will share expressed milk. Many of the considerations will be the same as for an informal milk-sharing network (described above).
Some people choose to sell their milk. This can be done either through certain for-profit milk banks, or through other, less formal groups. Some women also receive pay for wet-nursing another person’s baby. We encourage anyone who may be considering this practice to research information thoroughly in order to protect themselves and their own baby as well as other babies and parents. Not all businesses may have the best interests of families in mind, and concerns have been raised that some companies offering money for human milk have deliberately targeted low-income families to the detriment of their own babies. Pumping output can vary from day to day, contributing to household stress if certain donation quotas are required. No matter how you choose to share your milk, please do ensure that you meet your own baby’s needs first.
ENSURING THE SAFETY OF DONATED MILK
The act of expressing or pumping milk and transferring it into storage containers always entails a risk of contamination. The most important steps a donor can take are to practice hygienic collection (washing hands and pumping equipment), use appropriate short- and long-term storage measures, and use safe transportation procedures. Milk banks will provide guidance to donors. Informal milk-sharing groups often offer practical guidance on collection, storage, and transportation as well. An additional resource is the milk storage protocol published by the Academy of Breastfeeding Medicine (ABM) which is updated every five years or earlier if significant new information comes out, so is a good source of the most current, evidence-based information to assure that you are protecting your milk and the recipient infant to the fullest extent possible. You can read their protocol about human milk storage here.
In general, while human milk contains antibacterial properties that help prevent bacterial colonization after pumping even when left at room temperature for a few hours, it is known that the cleanliness of the milk expression technique affects the safe time period. Hence, milk should be refrigerated as quickly as possible after pumping, then frozen within 24-48 hours at or below -20° C (-4° F) in appropriate containers if the recipient will not receive it within a few hours.
Milk banks use Holder pasteurization to eliminate or deactivate unwanted or dangerous (pathogenic) bacteria and viruses that may be present in donor milk. After pasteurization, milk banks screen all batches before distribution and will discard milk still containing bacteria. Any method of reducing contamination will impact the quality of the donated milk to some degree. Overall, the Holder pasteurization method is considered to be “extremely effective” in eliminating dangerous pathogens while impacting quality as little as possible.
If you are a recipient of raw human milk (i.e., it has never been heat-treated), you could use a flash heating method or home pasteurization techniques to reduce bacterial and viral contamination. While flash heating will cause less damage to nutrient components, it also does not do as complete a job as the Holder method on eliminating bacterial and viral contamination. Freezing human milk at -20° C (-4° F) for 20 days has been shown to reduce the viral load for cytomegalovirus (CMV) to undetectable levels. It is important to use the milk in less than three months, though, as the nutritional and immunologic properties degrade over time in the freezer.
For instructions on how to carry out flash heating and pasteurization at home, these resources may help:
Eats on Feets’ Resource for Informed Breastmilk Sharing.
ABM’s Position Statement on Informal Breast Milk Sharing for the Term Healthy Infant.
Current LLLI information on collecting and storing human milk can be found in our Pumping and Milk Storage articles.
COVID-19: SOME CONSIDERATIONS REGARDING DONOR MILK
There is a growing body of research showing there are COVID-19 antibodies in human milk, we have listed several studies here.
Note: sars-cov-2 is the virus that causes the disease COVID-19.
The immunological components in human milk provide some measure of protection for infants. Often, babies who are being fed human milk remain healthy even when their parents or other family members fall ill with an infectious illness. There is much research showing babies benefit from multiple and diverse immunologic proteins, including antibodies, provided in human milk.
The World Health Organization (WHO) stress those with COVID-19 can breastfeed. Their video explains how to observe careful respiratory hygiene, the main points are summarised as:
- Wash hands with soap and water or use alcohol-based hand rub frequently
- Wear a medical mask during any contact with the baby
- Sneeze or cough into a tissue
- Routinely clean and disinfect surfaces touched
We recognize that milk sharing by whatever method involves human contact:
- It is essential to follow careful respiratory hygiene, described above, in compliance with local public health guidelines; especially when there has been a possible or known exposure to Covid-19, or anyone has symptoms while in contact with:
- your own baby
- any other person, as well as their baby and other family members
- while directly breastfeeding or chestfeeding another person’s baby
- Plan a method of contactless delivery to deliver milk
You may find these resources useful:
- Human Milk Banking Association of North America Why Donor Human Milk is an Essential Need During COVID-19
- Hearts Milk Bank, UK I’m donating my milk – what do I need to know about COVID-19?
- World Health Organization Breastfeeding and COVID-19
- World Health Organization Q&A: Pregnancy, childbirth and COVID-19
LLLI multi-language resources Breastfeeding and Coronavirus
When two or more mothers or parents choose to share the responsibility of nursing their baby together, this may be known as co-nursing. Co-nursing parents have the opportunity to share in the experience of lactation which can bring them all closer to their baby. Alloparental nursing can additionally include grandparents and aunties, as will be described in the next section.
A gestational parent, for their own reasons, may or may not choose to lactate for their baby. However, their partners and chosen family can induce lactation or use an at-breast/at-chest supplementer with donor milk or formula to provide that skin-to-skin nursing experience and relationship to the baby. Even in a situation where no one parent has a full supply for the baby, through collaboration there may be enough milk.
Find more information about co-nursing here.
A non-gestational parent may need to induce lactation through such methods as the Newman-Goldfarb protocol; a number of different protocols are described here.
Read more about induced lactation here.
You may also find useful information on breastfeeding without giving birth here.
Even when parents wish to share lactation with their partner, they may experience complicated feelings about this experience. Cuddling the baby skin-to-skin soon after birth is a special opportunity for the gestational and non-gestational parent; if co-nursing baby may be encouraged to begin establishing a nursing relationship with both. Each nursing parent will need support and may need to balance their milk production against the feeding pattern of the other parent. A missed feed can lead to a reduction in milk supply, and expressing can be used to make up the difference. Feeding the expressed milk skin-to-skin using an at-breast/at-chest supplementer helps to support continued milk production.
Information about using an at-breast supplementer can be found here.
WET-NURSING, CROSS-NURSING, OR CROSS-FEEDING
These terms are often used interchangeably to describe feeding a baby who you are not parenting. For example, the World Health Organization (WHO) recommends wet-nursing by a healthy wet-nurse in cases where a baby cannot receive its own mother’s milk, whether directly from the breast or expressed. In this case, “wet-nursing” refers to any arrangement where the baby is being nursed by someone who is not its parent. As with all milk-sharing arrangements, priority should be given to maintaining a milk supply that will meet the needs of the wet-nurse’s baby, with milk being shared only when there is a surplus.
When used specifically, the term wet-nursing refers to the complete nursing of someone else’s infant. Wet-nursing has a long and painful history in some areas of being imposed on enslaved women and under-privileged women, which has resulted in much abuse and loss of their biological children. LLL cautions those contemplating a wet-nursing arrangement to guard against any coercion towards the wet-nurse or any harm or neglect for the wet-nurse’s own children. Nevertheless, a well-considered wet-nursing arrangement offers many benefits to the baby. Some wet-nurses choose to enter an employment relationship after their own children are weaned, or to wet-nurse another child alongside their own infant. Others will offer to take on the full nursing care of a child out of love and concern. All varieties of these arrangements need similar consideration of the same issues as do the other milk-sharing arrangements discussed here.
Cross-nursing or cross-feeding usually means an arrangement when friends, sisters, grandparents and aunties in a relationship of equality share breastfeeding duties by nursing each other’s babies. This often informal activity is practiced by people in countries all over the world for a variety of reasons; for example, it may be used as a means of helping stimulate milk production, in a baby-sitting arrangement, or as an expression of friendship.
If you are considering a cross-nursing arrangement, LLL encourages you to discuss it carefully with the other participants and to look into possible concerns before making a final decision. Some things to consider are: the effect on each person’s milk supply; meeting the baby’s need for responsive nursing; and the emotional effect on the baby and the nursing parents. Some babies refuse to nurse from another person, at least initially. Nursing a baby is not just a physical act, and many people will experience intense emotions, which may be negative or positive, when nursing a baby. Being prepared for these reactions can help in working through them.
Milk-sharing is a special relationship that can require much thought and effort. The aim is to support the health of the baby, enhance the relationships between all the participants and share the love inherent in the act of breastfeeding and chestfeeding.
LLLI’S POLICY ON MILK DONATION
The first priority of LLLI is to help mothers to breastfeed their babies at the breast. A second priority is to help mothers when it is necessary for them to express and safely store and handle their own milk for their babies. When their own mother’s milk is unavailable, babies may need human milk donated by other mothers. According to the World Health Organization, donor milk is the best option following one’s own expressed milk.
It is always important for the Leader to encourage the mother to talk with her own and the baby’s health care providers about their particular situation. If the baby or mother is hospitalized and breastfeeding is not possible, the Leader would recommend that the mother dialogue with medical staff regarding possible hospital policies related to obtaining and using the mother’s own milk or donor milk.
When a mother contacts a Leader seeking to acquire donated milk or to discuss personal options, the Leader’s role is to respond with information and support, including information about the benefits and risks of such practices as induced lactation, relactation, wet-nursing, or cross-nursing. This discussion may include formal, commercial, or informal (peer-to-peer) forms of milk sharing, which are practiced in various ways around the world.
If a mother is interested in donating her milk or in receiving donated milk, the Leader should urge the mother to investigate various ways of donating and acquiring human milk. The mother should be encouraged to make an informed decision that is best for her and her baby and meets cultural expectations. A Leader may provide contact information for non-profit human milk banks, other regulated collection centers, and formal/medically supervised or informal milk-sharing networks. Protocols for the careful and safe collection and handling of human milk are the responsibility of milk banks and networks, and the Leader should encourage the mother to evaluate these protocols. It is not the responsibility of LLL Leaders or LLLI to license, recommend, or assess milk banks or networks, but to share information with mothers.
A Leader should never use her position as an LLL Leader to set up any type of milk-sharing network.
As with other breastfeeding-related topics, Leaders are expected to keep up-to-date with current best practices and information for their locations.
Find LLL support in over 80 countries here
Find LLL online LLL support resources here
- Milk sharing in the age of social media
- Breastfeeding without giving birth
- LLLI Webinar – Donor Milk Banking
- Donating Milk: A Heartfelt Wish to Honor Juliette
LLL entity resources
LLLGB Milk Sharing article
LLL Alliance – video of Mid-Atlantic Mothers’ Milk Bank, Executive Director Denise O’Connor reading childrens’ book ‘An Ounce of Sharing At The Milk Bank’
(accessed 19 September 2020)
- Barry S. Hewlett and Steve Winn, Allomaternal Nursing in Humans, Current Anthropology, April 2014, vol 55, no. 2,
(accessed 19 September 2020)
- Milk-sharing is not Wet-Nursing – a Facebook ‘live’ broadcast for Native Breastfeeding Week 2020
One series of Indigenous experiences from USA and Canada on the meaning of milksharing in various communities.
(accessed 19 September 2020)
- From LLLI’s Leader Today – Islamic and Cultural Practices in Breastfeeding, including a section on wet-nursing
Published September 2020.