Archive | Donor Milk

Australian College of Midwives Releases Statement on the Use of Donor Human Milk

The Australian College of Midwives (ACM) recently released their “Position Statement on the Use of Donor Human Milk.” This statement was developed in collaboration between ACM members, experts, and the ACM Baby Friendly Health Initiative (BFHI) Advisory Committee. The ACM provides a unified voice for the midwifery profession in Australia. They set professional practice and education standards and are committed to being the leading organization shaping Australian maternity care so that all Australian women have the best possible maternity outcomes. In addition, the ACM is also the governing body for BFHI in Australia.

Eds. note: In Australia, the initiative is referred to as the Baby Friendly Health Initiative instead of the Baby Friendly Hospital Initiative due to their community health service accreditation.

You can read the entire statement HERE.

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Photo via The Milk Bank. Used with permission.

We spoke with Marjorie Atchan, one of the lead writers along with Dianne Haworth, to ask more about the development of the statement and to better understand the use of donor milk in Australia.

What led your organization to write this statement? 

The BFHI Advisory Committee, as its name implies, provides advice to the Australian College of Midwives on a range of matters pertaining to breastfeeding, infant feeding and the BFHI.

We (the committee members) have long been aware of the use of donor milk in Australia – both regulated and non-regulated. We were concerned on two levels. One concern was that midwives may be placed in a position of providing support or advice to women/other health professionals without access to current and accurate information on which to base their practice.

We were also deeply concerned that mothers may be placing their babies at risk by using milk from sources that were not properly screened and safe if they did not have access to current and accurate information. As no such resource existed in Australia and the ACM provides position statements on a number of issues, we decided to develop this and place it on the ACM website where it is accessible to midwives and consumers.

There were several rounds of consultation with community stakeholders, content experts, and midwife academics to ensure accuracy, clarity and professionalism and the finished product met the standards of a publishable position statement. The process took well over 12 months to complete.

What is the current state of milk banking in Australia?

Milk banking is not currently regulated at a national level in Australia. Each state/territory has local jurisdiction and may have a slightly different interpretation to the issue of whether human milk is a bodily fluid or a food.

Consequently, there are few “official” milk banks. The World Health Organization is quite clear about the viability of donor  breastmilk as the first option if a mother is unable to fully meet her infant’s nutritional needs. Amongst many women, especially those with sick or premature infants, there is increasing acceptance of and demand for donor milk. Neonatologists have also long encouraged the use of breastmilk for the improved health outcomes. Facilities where neonatal nurseries occur are also aware of the cost savings attached to the decrease in morbidity and mortality.

In three states, hospitals have been able to successfully open milk banks that primarily service their own neonatal nurseries: King Edward Memorial Hospital in Perth Western Australia; the Mercy Hospital in Melbourne, Victoria and the The Royal Brisbane and Women’s Hospital, in Brisbane, Queensland. Some large tertiary hospitals in other states have “in house” milk banks using known donor milk attached to their neonatal nurseries.

All hospitals with operating milk banks follow very strict protocols and quality assurance standards. There is also one community milk bank based in northern NSW, the Mothers Milk Bank that ships milk out across the country. This milk bank follows the protocols of the King Edward Memorial Hospital’s milk bank.

Are families in Australia participating in peer-to-peer milksharing?

As many families do not have access to the services of our milk banks, other services are often utilized. This is where the potential for risk increases. Other pathways include known websites such as Humanmilk4Humanbabies and informal sharing amongst family and friends.

In some cultures, it is acceptable and expected that milk sharing will occur. Some research has been published such as those pieces from Virginia Thorley and Karleen Gribble. There is unfortunately also a culture of scaremongering that is media driven and only serves to fuel ignorance and bigotry. Headlines scream out the fear of mothers that their baby might have contracted HIV/AIDs after having been accidentally given another mother’s breastmilk (usually by human error in a hospital setting) – despite the risks of this being almost negligible as the mother would have been screened thoroughly during her pregnancy. One might speculate at the underlying  reason for such a reaction: to garner media attention for the tabloid/station and vicariously support the use of commercially produced baby milks.

To find out more about the Australian College of Midwives, visit their website at www.midwives.org.au.

*Disclaimer: Milk sharing is a complicated issue. Readers should adhere to the standards in effect in their own regions.

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Freya’s Gold: Milk Donation After Loss

#ds37 - Mom and BabyIn today’s Lactation Matters, we’ll hear from Monique, who opted to donate milk after the loss of her daughter, Freya. Monique shared her story in honor of both daughters (Aviana and Freya) who passed away. For her, it is comforting to have their names out there and for their lives to be recognized in some way.

Clinical Lactation, the journal of the United States Lactation Consultant Association, has published an article entitled Lactation After Loss that you may find useful as you support bereaved families.

You may also find previous articles on how to become a milk donor and debunking common milk banking myths helpful as you educate others about milk donation options.

Monique’s story:

When I found out that I was pregnant in 2011, my husband, Justin, and I were both excited and scared because we had already been through a first trimester miscarriage and a loss at 23 weeks gestation when my cervix dilated and I went into early labor (Aviana only lived an hour and a half). Due to previous complications during pregnancy, we decided to work with a high-risk specialist to prevent preterm contractions and cervical dilation. During my pregnancy, I was on bed rest for over three months and was monitored very closely. In preparing for the possibility of preterm labor, I was working with a lactation specialist to learn how to pump milk for a preterm baby. At 33 weeks gestation, there was a cord accident and our second daughter Freya died in-utero. I never had the opportunity to breastfeed or pump milk for Freya.

Even though I had no baby to feed, I produced milk and decided that I wanted to pump. The lactation specialist that I worked with during my pregnancy was bewildered that I wanted to keep pumping my milk after Freya died. She seemed confused as to why a bereaved mother would want to keep pumping her milk . . .

My main support to keep pumping came from my husband and a dear friend, who is a naturopath and a midwife. Both of them encouraged me to pump my milk as long as I wanted to.

The pain of losing a baby is indescribable and for me, pumping milk helped create a structure for the days after my loss that were filled with grief. I pumped my milk multiple times a day for six weeks. I stored every drop of milk that I pumped in a freezer. I couldn’t imagine throwing away “Freya’s Gold” because there was so much love in that milk.

In my experience, there is a general discomfort with grief and loss in our culture. There is pressure to close the loop on suffering which is not realistic for bereaved mothers. Pumping milk is one way that bereaved mothers can manage the intense and ongoing grief of losing a baby.

I have always felt very lucky in love (I love you Justin), and even in the darkest days of my grief, I could feel this light and this love from Freya. I knew I wanted to do something meaningful in memory of our daughter. So I called the Mothers’ Milk Bank about donating my milk. For me, donating milk was a way to help other babies benefit from our daughter’s milk and it was a way to honor my body and my experience.

When I lost Aviana at 23 weeks, I suppressed lactation and never pumped my milk. When Freya died, I chose to continue expressing my milk and then donated it to the milk bank. I made these decisions based on what was best for me at the time. I feel strongly that it is important for lactation consultants to address lactation with bereaved mothers and give them the option to pump their milk so they can make an informed decision.

Special thanks to the Mother’s Milk Bank (a San Jose, California based non-profit milk bank serving 13 states in the U.S.) for working with Monique and sharing her story with Lactation Matters. To stay in touch with the Mother’s Milk Bank, please click here.

Photo credit: Indiana Mothers’ Milk Bank

What strategies and tools have you used when talking with bereaved mothers?

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Myth Busting the Milk Banks: The Top Four Misunderstandings about Milk Banks

Recently we started a conversation within the IBCLC community about milk banking.  This post is dedicated to clearing up some common milk banking misunderstandings. IBCLCs and others who support breastfeeding families can be important advocates and the issues surrounding milk banks are very relevant to your practice. A study in Brazil showed that the top reason mothers donated milk was that it was recommended by a health care professional so this is certainly an area where IBCLCs can have an impact regarding improving access to the gold standard of infant nutrition – human milk.

By Frances Jones, RN, MSN, IBCLC 

Does milk keep its healthful properties when pasteurized?

pumped milkThere has been quite a bit of discussion about the impact of pasteurization on human milk’s “miracle” properties. Milk banks provide milk to the most fragile infants and cannot risk even the every-day types of viruses that mom’s own baby could tolerate. The Holder Pasteurization method, used by HMBANA milk banks, impacts some of the biological activity of the milk, but many of the compounds unique to human milk are retained either completely or partially.  Studies show that Human Milk Oligosaccharides (HMOs) that contribute to gut development and pathogen binding are retained, and partial amounts of antibodies and antimicrobial proteins also remain.  Researchers are studying other pasteurization techniques, such as ultrasonication, high-temperature short-time, and microwaving, that would allow even more of the beneficial elements to be preserved while continuing to ensure the product is free of pathogens.

Related to this issue, we are often asked about whether or not “raw” milk is better for babies. Yes –milk directly from the breast of the baby’s own mother is absolutely the best choice! Policies and practices in the United States and beyond must continue to focus on supporting and protecting women to breastfeed their own children. Every HMBANA bank supports breastfeeding as a central operating principle. Pasteurized donor human milk is the alternative after mother’s own milk.

What does it cost to process human milk and how is this cost passed on to the consumer?

Some donors confuse the milk processing charges of non-profit HMBANA milk banks with the profit-motive of for-profit pharmaceutical companies. HMBANA banks operate on very tight budgets, relying on grants and charitable donations to provide their service to families whose infants’ lives may depend on the milk. The milk processing fee charged to the family (and, in some cases, covered by their medical insurance) only partially covers a milk bank’s operating costs.  Clearly, the fee for pasteurized donor milk in North America is a barrier to access for some and HMBANA leaders are working behind the scenes to shape health reform laws so all insurance companies cover this medical expense.  In Brazil, where the milk banks are part of the government health services, pasteurized donor milk is dispensed via prescription at no charge to the recipient. Access to human milk is an important public health initiative and future policies and programs should reflect this.

Can families who don’t have babies in the NICU access milk from HMBANA milk banks?

Photo by bgreenlee via Flickr Creative Commons

Photo by bgreenlee via Flickr Creative Commons

While critically ill infants are the first priority for milk banks, when adequate donations are available, HMBANA banks provide for infants whose mothers are ill or deceased, toddlers with medical conditions, and even adults.  Donor milk is dispensed via physician’s prescription.  Last year, demand shot past supply, and as word continues to spread about the benefits of donor milk, HMBANA banks routinely experience low or empty freezers.  The more regular donors HMBANA has, the better equipped they will be to meet the needs of all who could benefit from donor milk.

How can IBCLCs support families in donating to HMBANA milk banks?

Currently, there are 13 HMBANA milk banks serving all of North America and more are opening each year. The first thing you can do as someone who supports breastfeeding families is to identify which HMBANA milk bank serves your community. If you need help, please don’t hesitate to contact HMBANA directly. If you are fortunate enough to have a bank close to you, please direct families to contact them for information about donating. For out of town donors, nearly all HMBANA banks will provide coolers and pay the shipping costs to have milk sent overnight to the bank for processing. In an upcoming blog post, we’ll discuss the requirements for donation and interview a current donor to a HMBANA milk bank about her experience. 

IMG_3767Frances Jones is the Coordinator of the Lactation Services and Milk Bank at British Columbia Women’s Hospital in Vancouver, British Columbia, Canada. Frances has worked with breastfeeding families for over thirty years and has been running the milk bank since 2000. She is the author of the HMBANA’s Best Practice for Expressing Storing and Handling Human Milk in Hospitals Homes and Child Care Settings and has spoken at many conferences on breastfeeding and milk banking topics. Most importantly, she is the mother of five sons and grandmother of one granddaughter – all breastfed. 

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Getting Human Milk to Human Babies: The Role that HMBANA Milk Banks Play

One of the wonderful things about the internet is having access to so much information. Need a recipe, driving instructions, or a referral for an electrician? It’s a click or two away.  The downside is that information isn’t always complete or accurate, and misinformation can spread.  The amount of media attention on the sharing of human milk has exploded in recent years leading to a certain amount of confusion.  We caught up with Frances Jones, Executive Director of BC Women’s Mothers’ Milk Bank in Vancouver, Canada and president-elect of the Human Milk Banking Association of North America (HMBANA) and have developed this “Milk Banking 101” blog in order to clear up some confusion about non-profit milk banks and open a conversation within the IBCLC community so that IBCLCs are positioned to support the choice that best meets the needs of breastfeeding families and their babies. We hope you’ll join in this conversation!

By Frances Jones RN, MSN, IBCLC

Photo used with permission from Indiana Mothers' Milk Bank

Photo used with permission from Indiana Mothers’ Milk Bank

Background on Milk Banking

The first milk banks came into existence in the early 20th century as food technology evolved allowing for successful storage of human milk. Even in those early banks, donors and their milk were carefully screened. Fast forward to the 80’s and a post-AIDS era of caution. Those of us who believe in the power of human milk formed the Human Milk Banking Association of North America (HMBANA) to ensure safe standards for all donor milk banks in North America. The HMBANA guidelines, developed with the assistance of the Food and Drug Administration (FDA), the Center for Disease Control (CDC) and the American Academy of Pediatrics (AAP), have been used globally in the development of nearly all milk banking standards and are reviewed annually to ensure safety.

Milk that is subject to storage and transportation is not the same product as milk that is consumed straight from a mother’s breast (which is why Louis Pasteur is considered a founder of disease-prevention-science for figuring out how to reduce the pathogens in milk and wine through a technique that still carries his name today). HMBANA’s safety steps include screening donors through interviews and blood tests (for HIV, HTLV, syphilis, hepatitis B and C), pasteurizing the milk, testing for pathogen growth, tracking milk and implementing mock recalls.  Milk banks put huge effort into ensuring donor human milk is safe for the most vulnerable of infants.

Photo used with permission from Indiana Mothers' Milk Bank

Photo used with permission from Indiana Mothers’ Milk Bank

What is the Difference Between “Milk Banking” and “Milk Sharing”?

Milk banking involves donating human milk to an intermediary (similar to a blood bank) who ensures the safety of the product and distributes it to those in greatest need.  Milk sharing involves sharing human milk with sisters, neighbors, and friends, and is a practice that has been going on for centuries as mothers have helped each other.  Today, the Internet has changed the way we communicate, enabling a rise in milk sharing outside of our closest circles. This capacity for expanded milk sharing may increase the risk associated with the transmission of disease and contaminants (e.g. drugs and alcohol). Several health authorities including the FDA, AAP, Health Canada as well as the French government have expressed concern over Internet milk sharing.

When supply is scarce, as it has been in recent years with a growing demand for donor milk,  HMBANA banks are limited to serving the most vulnerable and critical babies in our communities. In 2010, the CDC reported over 325,000 low-birth weight (LBW) births in the United States, of which over 55,000 were very low birth weight (VLBW) babies, weighing less than 1.5kg.  In 2011, HMBANA banks collected a little over 2 million ounces of donor milk, which averages only 7 ounces per LBW/VLBW baby. We simply need more milk to be able to meet the needs of these vulnerable infants. We recognize that many non-NICU infants (and even some adults!) would benefit from donor milk and that the cost of pasteurized donor milk in North America is a barrier to access for some (which is one of the factors contributing to the rise in milk sharing). This is why HMBANA supports many families through charity care and our leaders are working behind the scenes to try to shape laws so donor milk is covered by more insurance companies.  In Brazil, where the milk banks are part of the government health services (in contrast to the practices in North America), pasteurized donor milk is dispensed via prescription at no charge to the recipient. Access to human milk is an important public health initiative and future policies and programs should reflect this.  In the meantime, the more milk that HMBANA banks collect, the more families can be served.

What is the Difference Between Non-Profit Milk Banks and For-Profit Pharmaceutical Companies?

HMBANA defines a milk bank as  ”a service established for the purpose of recruiting and collecting milk from donors, and processing, screening, storing, and distributing donated milk to meet the specific needs of individuals for whom human milk is prescribed by health care providers who are licensed to prescribe.” There are also “milk depots” which are locations that collect and store milk and then transport it to a “milk bank” for processing and distribution.  These terms are used loosely and some sites that are actually depots label themselves as milk banks.

Increasingly, our non-profit milk banks have faced competition for donors from for-profit pharmaceutical companies that solicit donor milk and turn it into high-end products.  HMBANA milk banks are non-profit and keep processing costs associated with safety protocols as low as possible.  For-profit companies sell their products at a profit while relying on donor mothers to provide the raw human milk for processing. HMBANA banks count on additional funds through grants and in-kind donation to continue operating. Private companies must achieve profit from their products to satisfy investors.  Many IBCLCs and others who support breastfeeding mothers are confused because some of the for-profit collection sites have names that seem to indicate that they are association with non-profit banks (e.g. Milk for Wishes Milk Bank, Helping Hands Milk Bank). Ambiguity can sometimes mislead and confuse donors. Every donor should understand who is receiving their milk and what will be done with it (read this great blog post by a mom who felt misled regarding the generous donation of her milk).

IMG_3767Frances Jones is the Coordinator of the Lactation Services and Milk Bank at British Columbia Women’s Hospital in Vancouver, British Columbia, Canada. Frances has worked with breastfeeding families for over thirty years and has been running the milk bank since 2000. She is the author of the HMBANA’s Best Practice for Expressing Storing and Handling Human Milk in Hospitals Homes and Child Care Settings and has spoken at many conferences on breastfeeding and milk banking topics. Most importantly, she is the mother of five sons and grandmother of one granddaughter – all breastfed. 

In our next blog we’ll tackle some misunderstandings about milk-banking.  If you have questions you’d like answered, please leave a comment and we’ll do our best to find answers.  We’d love to hear about the resources you feel would help you to provide mothers with good information regarding their options when they have extra milk or are seeking milk for their infants. We look forward to continuing this conversation.

* A special THANK YOU to Indiana Mothers’ Milk Bank for permission to use their photos. For more of their photos, check out their Instagram profile.

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