to wonder why my breast milk is good enough for my baby but not for anyone else's?

[entropygirl]

I wanted to donate breast milk but found out I would be disqualified due to having a blood transfusion after labour. Noone ever suggested to me that I should not breast feed because of the transfusion, so it seems my milk is safe for my baby but not safe for anyone else's baby. This seems outrageous to me! If breast milk is such an asset, particularly for prem babies, then why disqualify people based on the stupidly tiny chance of blood transfusion generated vCJD when there is not even any evidence the disease can be transmitted through milk?

"Yes I would pick formula over milk that had an unknown risk of vCJD (or hepatitis, etc.) "

But maybe women who have had blood transfusions would choose formula over that risk too?

This is really annoying me as it doesn't seem to make any sense

I am trying to remember whether they asked me if I had ever had a blood transfusion when I had my booking visits...

Sardine if my recollection serves me correctly (and it is entirely possible that it does not ) I am pretty sure the q of whether you have had a transfusion is standard on the 12 wk booking in form.

Even at 12 weeks I can recall being asked how I would feed the baby but no one has ever suggested there might be a risk.

It is illogical

I think it may well be if you had contracted vCJD from your blood transfusion you would only be able to pass it on to your children (if indeed you did contract it, and then it was possible to pass it on).

However, if you donated bm you might donate 120ml a day for 4m (just for instance) which would be 13,440ml. A 2lb prem baby might take ~240mls a day. Can you see how many babies could be affected by the milk donated? Especially if you donated milk to a milk bank that mixes the milk to average out the calorie content then you could (if you had contracted vCJD from the blood donation) infect a whole lot more than that.

The thing is though, you may develop vCJD yourself independent of any transfusion, or you might develop it from a blood transfusion so you have an extra chance of developing it therefore the risk is higher for you. Obviously this risk is minuscule in the first place but milk banks don't want to take an extra risk with vulnerable babies.

I phoned the milk bank to ask about donating milk but was told that as I had had the anti d injections, because of being rhesus negative, they couldn't accept my milk as Anti d is a blood product. It was never suggested that there was a risk to my own babies from breastfeeding.

I had anti-D too halycon. Also no suggestion there might be a risk to my babies.

The plot thickens

Now I know it is a very small risk, but still, if it's enough for them to decline the milk, it's enough to give the mother the info, surely

QoD yes it is illogical. I hate illogical.

Before people get too panicky, I think it is worthwhile pointing out that worldwide, milk banks use the same screening criteria as blood banks. In other words breast milk is treated as a blood product even though it is clearly not blood nor is it administered parenterally. So even though there is NO evidence that vCJD can be transmitted through breast milk, you still cannot donate breast milk post transfusion because it is on the screening check list for blood donation.

There is debate wether the same criteria should be used, but as the blood donation and screening criteria is the most stringent it has obviously been adopted as the gold standard for now.

That's a really helpful post rumnoraisins.

I still think that they should say something to women who have had transfusions, as if they feed their babies and then get knocked back for donating milk due to "risk" - as per the OP - then there is a lot of room for unnecessary worry there.

A 2lb prem baby might take ~240mls a day.

Not likely if donated bm, I already said this (impatiently taps foot ). I think your avg. 1kg premie on donated bm has a max of 50ml/day (source1, source2). The premie gets formula or IV nutrition, otherwise, until they are up to about 5lbs and then they get formula plus (if lucky) up to 50ml real breastmilk/day. That's what I understood from my tour at the Rosie, anyway. But because the milk is parcelled out in amounts of just 5-15ml a time, that 120ml could in theory be given to 29 different babies each time. So the risk is spread quite widely, unlike when you have your own DC (who could be exposed in utero, anyway, some evidence that prions & other nasties may cross the placenta).

My guess is that the real risks of these nasties being transmitted via breastfeeding are still MUCH lower than the extra risks incurred by formula feeding (all other factors being constant). So a campaign to highlight the potential risks of breastfeeding following blood transfusion/antiD jab would only have the net effect of undermining the image of breastfeeding in the minds of the larger populace, not reducing the real risks to anybody.

I understand the frustration of OP, but there are other ways to "donate": your time, your energy, your support. Would be good if better science was done to determine the real risks of the nasties getting into breastmilk, that would be a good outcome for those upset by the risks discussed in this thread.

"So a campaign to highlight the potential risks of breastfeeding following blood transfusion/antiD jab would only have the net effect of undermining the image of breastfeeding in the minds of the larger populace, not reducing the real risks to anybody."

But is it OK for the authorities to decide not to tell mothers about the risk, while simultaneously saying through their stance on donated milk that it is not a risk worth taking?

I think that if there is a risk then women need to be told about it. Nothing else makes any sense. The suggestion that authorities should with-hold this information as "they know best" it terribly paternalistic. And there is an enormous potential for worry when women go to donate and are turned away on the basis their milk may be contaminated.

I have had many doses of Anti-D over the last 19 years and was a milk donor after my last pregnancy- ie wasn't turned down because of it at my trust. The plot thickens indeed...

ime the guidelines on whom milk banks accept and for how long are very hazy and it seems to be left up to the individual coordinator.

It is the same principle wrt blood donation - you might be perfectly fine, no problem with your blood for you, but there is a risk which is not quantifiable to others which disqualifies you.

FWIW, there is no risk to your own baby as you shared a body for 9/12 and any potential transmission is quite likely to have happened.

It is never nice to be 'rejected', but I would really stop taking it personal, OP.

And yes, the issue with nvCJD is prions, not antibodies (which are a Good Thing) or antigenes (which as a rule, are a Bad Thing).

Ragged - sorry for the mistake in amount. I tried to find a reputable source for how much milk a prem baby takes and could only an actual amount on babycentre Obviously completely incorrect then.

There is no way on earth I'd feed my baby bm from somebody that had had a blood transfusion.CJD kills end of,there is no cure.

I turned down a blood transfusion for this very reason and sorry if it aint good enough for me it aint good enough for my baby.If I ever found out that my baby had been fed b/m from somebody who had had a transfusion I'd sue big time. Scientific research changes all the time and I prefer to go on the side of caution re my dc. No way would I want to live years of uncertainty.It's my choice to make and nobody else's.

Also I wonder if the op read her consent form in detail.I read mine and it was massively comprehensive,I wonder if it was mentioned in the small print somewhere there.Consent forms generally list absolutely everything under the sun.Clearly if it isn't mentioned it should be.

isn't this about Hep transmission?

See it from somebody else's point of view? You are using donated breastmilk for a prem baby - by definition, more susceptible to infections etc - and find out there is a stupidly small chance of something being passed on to your child?

Nuff said. If them's the rules, YABU. I wouldn't go near it were I in teh above position, no offence, but I wouldn't take the risk.

More interested in the science behind it, personally.

It is less about a quantifiable health risk than legal risk.
I was going to post this before Mila's post btw .

But how can you quantify the risk of vCJD transmission in breastmilk when there has never been any cases known? Low birth weight infants fed exclusively formula milk are six times more likely to develop necrotising enterocolitis compared to purely human milk fed babies.

NEC also kills and it is a known significant risk as opposed to vCJD transmission via breastmilk which is an unknown theoretical risk. Feeding preterm infants human milk is not done out of desire to promote the breastfeeding (it would be a very very costly way of doing it!). It is done because there is proven benefit in giving human milk.

Hey, you are preaching to the converted, here - 'tis nonsense IMO.

I am sure there are health care legal eagles out there who are quantifying the risk of their trust being sued though

Sorry PacificDogwood, my last post wasn't aimed at you. Cross posted. It was in response to all the calls for being informed about the risk of vCJD transmission via breastmilk post transfusion (phew what a mouthful).

"FWIW, there is no risk to your own baby as you shared a body for 9/12 and any potential transmission is quite likely to have happened."

But with eg HIV I thought that not all babies had HIV and there was a risk of transmission after birth via the breastmilk? I don't think the idea that the baby will have been exposed to everything in your system is quite right?

You are right in your assumption regarding HIV SardineQueen but it's different rules for different organism. Although strictly speaking I am not sure we can call a prion an organism.

Aaaaaargh, I just typed a huge, long, considered post re BFing and HIV twice and the interweb swallowed it - TWICE!

In summary: HIV+ woman with access to good medical care - don't BF
HIV+ woman without access to good medical care - BF.

I am happy to elaborate should you wish, but cannot face typing it all again just now.

Oh, and sorry, Rum, I should stop assuming people always mean me [narc]

rumnoraisins so does that mean that if a person has been exposed to vCJD then so will their baby through pregnancy and birth, in all cases?

If so then the approach would start to make a little sense

It's not like a virus though is it - or is it?

How does the exposure work - is it once exposed you have been exposed and can develop it at any time? Or is each exposure a discrete event and you either get it or not from that event?