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When the Quest for Best Puts Patients at
Published Thursday, May 13​, 2021 by Regina Hoffman, MBA, RN​



Consider this: You arrive at a hospital in need of a blood transfusion. The nurse informs you they are no longer screening blood for HIV or other bloodborne pathogens. Instead, they’ve arranged a meeting for you with the donor. If you’re comfortable, they’ll proceed with the transfusion.

Sounds absurd right? What if that practice applied to other bodily fluids like breast milk, which could also transmit some pretty scary diseases?

I pondered this question after reading a post on our local “mommy exchange” Facebook page. A “mommy exchange” is a forum to buy and sell gently used clothing and other household items. You can also search “hard-to-get” items—including breast milk.

Seeking breast milk online is common and is strongly supported by moms who have been told time and again, “Breast is best.” It didn’t take long for the person seeking the milk to find it: The second commenter asked how much she needed.

I was stunned. Not being one to sit quietly on the sidelines, I raised the risks involved with this practice, the most significant of which include exposing your baby to an infectious disease like HIV, hepatitis, or cytomegalovirus; contamination from unsafe pumping and storage; and potential contact with illegal drugs, prescription medications, environmental contaminants, and alcohol.

People should make the decisions they believe are best for them—
if they are informed decisions.

After posting my comment, I was bombarded with well-intended but misinformed beliefs, and some not so well-intended people who told me to mind my own damned business—which is not uncommon when expressing an unpopular opinion on social media.

A common theme surfaced: Most moms met with the donor before using her breast milk to “be sure they were comfortable with her.” Or that all women are screened for sexually transmitted diseases during pregnancy, so that shouldn’t be a concern. One mom wasn’t worried about the breast milk because “if the milk was good enough for the donor’s baby then it’s good enough for mine.”

It’s easy to understand why this might be the case, but you can’t tell how safe a stranger’s breast milk is just by meeting with them. Even if a person is being honest, they may not know they have an infectious disease, and not all women get adequate prenatal care or consent to testing for sexually transmitted diseases. Even those who acknowledged these concerns felt the benefits of receiving human milk outweighed the risks.

I’m a mother of four children, and I had four different experiences when it came to breastfeeding. However, one thing was consistent: The pressure to breastfeed each child was tremendous. Though breastfeeding is a best practice, the guilt placed upon me for choosing not to breastfeed my first child and being unable to breastfeed my last was almost unbearable.

You feel like you’re a failure if you can’t give your baby the “best.”

And while “breast may be best” in an ideal situation, it is not the best decision in every situation. The American Academy of Pediatrics advises against informal milk sharing.1 New moms should talk to their pediatricians about what might be best for their baby in their specific situation and what they can do to reduce the risk should they decide to use another woman’s breast milk.

That’s not the only new baby guidance worth examining.

“Rooming in,” or having the baby stay in the mother’s room most of the time instead of the nursery, has been accepted as a best practice for quite some time. New parents can bond with and learn to care for their newborn.

It sounds great, and is most of the time, but new parents, especially moms, may be really exhausted after giving birth. Some moms may be taking pain medication after having a cesarean section, making them more tired.

Exhaustion while caring for a newborn may seem like a normal part of life, but this situation could place babies at risk. Infants are at higher risk for falling or suffocating when a parent falls asleep while holding them—some babies have died.

Be sensitive to the mother’s feelings. Listen to her if she says she is too tired to care for her baby and watch for signs of fatigue. Reserve judgment—new moms are not superhuman.

Educate parents and other visitors on the risk factors for newborn injury, like fatigue, cesarean section, and pain medications. Discuss risk reduction strategies, like not holding the baby when tired; tell mom it’s OK for her baby to go to the nursery if she needs to rest. Saying the words aloud may make her feel more comfortable making this request. Rooming in may be a best practice but it’s not always best for everyone.

Sometimes we need look beyond the accepted “best practice,” and provide the best care instead.                    
About this blog

Regina Hoffman serves as the  executive director of Pennsylvania’s Patient Safety Authority and editor-in-chief of Patient Safety, its award-winning journal.  Ms. Hoffman was recognized by Becker’s Hospital Review as one of the top 50 experts leading patient safety in both 2018 and 2020. This blog serves as a source for her to share her insights in patient safety and leadership with Pennsylvania’s healthcare leaders.




1. AAP Committee on Nutrition, AAP Section on Breastfeeding, AAP Committee on Fetus and Newborn. Donor Human Milk for the High-Risk Infant: Preparation, Safety, and Usage Options in the United States. Pediatrics. 2017;139(1):e20163440. DOI: 10.1542/peds.2016-3440.


***​ The views and opinions expressed at or through this blog are the opinions of the author alone and may not reflect the opinions or positions of the Patient Safety Authority or the Commonwealth of Pennsylvania, nor do these views represent in any way medical or legal advice. ​ 

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