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AUDIE CORNISH, HOST:

It's ALL THINGS CONSIDERED, from NPR News. I'm Audie Cornish.

For years, new mothers have been taught that breast milk contains the perfect blend of nutrients and antibodies for babies. And the messaging appears to be working: More mothers in the U.S. are breastfeeding, and for longer. But the message has been received with such eagerness that some moms who can't breastfeed are going to great lengths to obtain breast milk for their babies.

Carrie Feibel, of member station KUHF in Houston, has this report on the ongoing battles over the safety and supply of shared breast milk.

(SOUNDBITE OF CRYING INFANT)

CARRIE FEIBEL, BYLINE: Here in the intensive care unit at Texas Children's Hospital in Houston, breast milk is more than just food. It's life-saving medicine. Nurse manager Courtney Prewitt describes a frequently fatal disease that strikes low-birthweight babies.

COURTNEY PREWITT: These babies will sometimes have death in the intestine tract, meaning that your intestines and bowels will die.

FEIBEL: After the hospital started giving donor breast milk to these babies, rates of the disease dropped. Prewitt watched it happen.

PREWITT: It does amazing things, but it does amazing things at the right time and the right place, from the right person.

FEIBEL: Nonprofit milk banks collect extra breast milk from donor moms. They test and pasteurize it, and distribute it to the sickest babies. There's even a for-profit company that uses breast milk to create a concentrated food product for premature infants. These milk products are regulated by the Food and Drug Administration. But hospitals like Texas Children's buy up almost the whole supply as fast as it can be pasteurized.

Kim Updegrove is president of the Human Milk Banking Association of North America.

KIM UPDEGROVE: Today, breast milk that's donated to a milk bank is a scarce resource. So there is a prioritized gate-keeping that takes a look at the diagnosis and medical conditions of that infant.

FEIBEL: But that leaves parents of otherwise healthy babies with very few options. Many turn to the Internet. Online, women swap, share and even sell their breast milk to whomever they want. It's completely legal and unregulated.

Courtney Helms, of Dallas, used the Internet to find extra milk for her second son.

COURTNEY HELMS: It's funny because before I started to have kids, I never would have thought of anything like this. And maybe if I did, I would have - you know, thought it was weird or, you know, maybe even ooky. (Laughter)But, you know, being a wet nurse is not something that we have just invented recently.

FEIBEL: Helms was a committed breast feeder. But after Thomas was born, she had recurring bouts of strep throat. Her own milk supply declined, and she didn't want to use formula. So she found four local moms online, and asked if she could have their extra frozen milk.

HELMS: I wanted him to get, you know, the immunity protections that breast milk offers, the nutrients. I mean, I can't really go into the science of it. But it really was just kind of a gut feeling that that's what I wanted him to have.

FEIBEL: But stories like that make Updegrove - of the Milk Bank Association - very nervous. She says people who share untested milk don't realize it's the equivalent of sharing blood.

UPDEGROVE: Sharing a body fluid, with all of its potential bacteria and viruses, is dangerous. And it is playing Russian roulette with your child's life.

FEIBEL: Updegrove says a recent study in The Journal of Pediatrics now offers some proof of the risks. The study compared milk purchased online with milk donated to a milk bank by screened and trained donors. The Internet milk had higher bacteria levels, including contamination with more fecal bacteria and even salmonella.

Helms has heard all about the study, but says she trusted the moms she worked with and would even do it again.

HELMS: I asked them all basic questions about what their diets were, were they on any medication. You know, were they on anything specific like, you know, did they take a lot of caffeine; bacteria. I think I was reassured because they were giving the same milk to their children.

FEIBEL: Helms always picked up the milk in person. Sometimes, she thanked the moms with a gift card to a local restaurant.

This online trading has been hard on milk banks, who desperately need more donors to meet the demand from neonatal intensive care units. So far, the FDA has declined to regulate the informal sharing of milk, though it does recommend against it. Updegrove says simply outlawing the practice would help solve the safety issues, and maybe even the supply problem.

UPDEGROVE: Imagine a scenario where every healthy, lactating mother called a milk bank and was screened, and donated even a hundred ounces of milk. The milk banks then would have so much milk that it would be available to those healthy infants. It would be an entirely different situation from what we have today.

FEIBEL: There is some shared ground in this battle over breast milk. Almost everyone agrees that new mothers need good breastfeeding support so they don't give up. Employers should encourage pumping at work. And there's another option. Kristina Tucker is the manager of lactation services at Texas Children's.

KRISTINA TUCKER: Formula sometimes doesn't have to be the four-letter word. Sometimes, it's necessary. And that's OK.

FEIBEL: For NPR News, I'm Carrie Feibel in Houston.

(SOUNDBITE OF MUSIC)

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