When her daughter was born about a month ago, Amy Vincze wanted to breast-feed her. The first-time Oakland mother knew about all the benefits - how the milk would give little Skye immune protection, energy and nutrients.

But Vincze's right breast had been removed after a diagnosis for breast cancer, and her other breast had undergone reconstructive surgery. She couldn't pump out more than a tablespoon of milk.

No matter. If Vincze couldn't use her own milk, she'd use someone else's.

Like a growing number of mothers unable to produce any or enough breast milk for their child, she turned to the Internet. In September, she sent out a plea to the Bay Area Breastmilk Cooperative, a Facebook group and website where local mothers arrange to give away milk to those who want it.

Going online is easier, many say, than going to sanctioned breast milk banks, where the milk they store and sell tends to be in short supply. And, said Vincze, 43, a marketing director for an environmental consulting firm, "I think it's so much better than formula. I just wanted to be able to give her what I couldn't do naturally."

Potential risks

But, according to a study published last week in the journal Pediatrics, these unregulated marketplaces may come with health risks. What's more, some experts worry that pediatricians' long-running emphasis on breast milk has perhaps backfired and led mothers to reject formula for a bottle of milk that may not be any safer.

"It's a gamble," said Sarah Keim, a researcher at Nationwide Children's Hospital in Columbus, Ohio, and the study's lead author.

It's easy to see why so many mothers want breast milk for their infants. Breast-feeding a baby exclusively in the first six months of life - a course recommended by the World Health Organization, the American Congress of Obstetricians and Gynecologists, and the American Academy of Pediatrics - yields many benefits. It reduces infections and newborn mortality, and provides most of the energy and nutrients in a child's first year of life.

At the same time, not breast-feeding a newborn - in other words, using formula - elevates the risks of infectious diseases, childhood obesity, diabetes, leukemia and sudden infant death syndrome.

Public health providers have encouraged mothers to breast-feed for decades. As a result, 77 percent of U.S. infants now breast-feed at some point, according to the Centers for Disease Control and Prevention.

Breast milk coop

But for various reasons, it is not an option for everyone. Three years ago, two East Bay moms, Ajira Darch and Beth Waters Rago, noticed that requests to give or acquire breast milk were popping up on the parenting e-mail lists they subscribed to.

They decided to start the Bay Area Breastmilk Cooperative. To date, Darch estimates that 300 to 500 donors and recipients have found each other through the site. A typical post reads: "Looking for milk anywhere in the SF Bay Area for 7 month old twins as I'm down to producing 8oz per day to split between them."

Darch, 33, a San Pablo mother, said the idea is a 21st century twist on an old-fashioned idea. Her mother, she recalled, breast-fed her cousins because her aunt didn't produce enough milk.

"I've grown up thinking that it was perfectly normal to give breast milk to a baby who needs it," Darch said. "It's kind of outrageous we've become so afraid of so many different things that we're unwilling to use a resource that's just there. A lot of moms are like, 'I'm just glad this precious milk I spent so much time pumping isn't going to wind up just going to the drain.' "

One of them is Tammy Agustin, 32, of Concord, who gave away a whopping 600 ounces to two women this summer. "There had to be a reason why I was given so much milk," she said with a laugh.

But the exchange of breast milk comes with potential problems, warns the Ohio researchers. The team logged onto a popular milk-sharing site - they didn't disclose which - and bought 101 samples of breast milk. They analyzed the bacterial content and compared it to 20 unpasteurized samples of milk donated to a breast milk bank, which collects, screens, processes and distributes donated human milk. The 14 in North America are required to meet standards laid out by the Human Milk Banking Association of North America.

No such standards are set for milk-sharing sites. Nearly three-fourths of the milk bought online contained what's known as Gram-negative bacteria, a group that includes the species E. coli and salmonella, the researchers found. Even at modest levels, this kind of bacteria is known to cause many types of infections, from minor gastrointestinal illnesses like diarrhea to life-threatening conditions like meningitis.

Bacteria found

In addition, the study found, 44 percent of the samples had coliform bacteria, which are an indicator of whether other infection-causing bacteria are present. One-third of the samples had a type of bacteria known as Streptococcus, which is common skin bacteria that's generally harmless at normal levels. But in some samples, this bacteria was found in unexpectedly high levels.

The high rate of contamination and bacterial growth was probably because the milk was poorly collected, stored or shipped, the researchers said. This milk could be hazardous to any infant, but particularly to those who are premature or unhealthy. In contrast, all the milk bank samples contained relatively lower concentrations of all the bacteria researchers looked for.

"There's not much information at your disposal to know whether the milk you receive (through milk sharing) is truly safe," said Keim, the lead author.

But Darch said the Bay Area Breastmilk Cooperative links users to safety information, such as methods to pasteurize milk at home and blood tests for donors to screen for illnesses. She also said the all-local community enforces a sense of trust.

"If I'm getting breast milk from a mom who lives in my own community, the likelihood is we've been exposed to same bacteria and viruses and all the rest of it," she said. "It's a little different than if you're buying breast milk from somebody completely anonymous over the Internet."

Kincze, the Oakland mother, ended up driving to San Francisco to pick up 200 ounces from a woman she'd never met, free of charge. She said she was comfortable taking milk from her donor, who told her that she eats only organic food and that her own daughter hadn't reacted badly to the milk. From now on, though, Kincze said she is more inclined to get it from friends, whose medical history she knows.

Kincze has considered turning to a milk bank, but figured that supplies would be low and she should "leave the milk for moms who really, really needed it."

At the Mothers' Milk Bank in San Jose, Executive Director Pauline Sakamoto gets far more requests than she can fulfill. Milk here comes with peace of mind: Donors are screened, and milk is tested, pasteurized and tested again. But at $3.75 an ounce, it adds up.

Three-fourths of the milk supply goes to hospitals, and individual customers - there were 250 of them last fiscal year - divide the rest.

"We need to bump that number way up, and we can't do that unless we get donors to donate," Sakamoto said.

Pressure on mothers

It's little wonder that milk-trading websites have emerged, considering how much pressure mothers feel to be perfect parents, said Dr. Valerie Flaherman, an attending physician at the newborn nursery at UCSF Benioff Children's Hospital. That culture is especially prevalent in California, where breast-feeding rates are among the highest in the nation, and in the Bay Area, where rates are some of the highest in the state.

"Sometimes now women are embarrassed to bottle-feed in public because there's so much pressure," she said. "People have to make feeding choices that are in the interest of themselves and their baby.

"For the vast majority, it's probably going to be breast-feeding, and sometimes it isn't. We need to support those people and not make them feel guilty, whatever that choice is."

Learn more

Mothers' Milk Bank (San Jose): www.sanjosemilkbank.com/

Bay Area Breastmilk Cooperative: www.bayareabreastmilk.wordpress.com/
