Archive | HMBANA

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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Why is Donor Milk So Expensive?

What is the value of having access to safe donor milk? For families with a preterm infant in the NICU, it can be priceless, yet to many, the cost of pasteurized donor milk (at $3 to $5 per ounce) may seem excessively high.  We reached out to Mothers’ Milk Bank Northeast to learn more about their cost structure. Keep in mind that other non-profit milk banks may have different costs to process milk, and that pharmaceutical companies like Prolacta and Neolac (doing business at Medolac) include a profit margin in pricing their products.

By Naomi Bar-Yam Ph.D., Executive Director, Mothers’ Milk Bank Northeast

We often hear this question from milk donors, who wonder why the milk they donate for free costs recipients anywhere from $3.00 – $5.00 per ounce, depending on the milk bank. Families who need milk for their babies, of course, ask this question as well.

HMBANA milk banks are all non-profit organizations. We do not charge for the milk itself, since we do not pay our very generous donors. However, HMBANA milk banks take many steps to assure that the milk our recipient hospitals and families receive is safe, and we charge to help cover these costly steps.

Direct Milk Processing Costs

logging milkDonor Screening:  Each donor is screened carefully to assure that her milk is safe and that she and her baby are healthy enough to make this donation. This involves:

  1. A telephone screen conducted by a trained staff member.
  2. Paper (or electronic) health forms and consents sent to the donor and reviewed by our donor intake team.
  3. A blood test to assure that the donor is not carrying diseases such as HIV, HTLV, Hepatitis  B and C and syphilis known to transmit though human milk (even though these diseases would be killed in our pasteurization process, we do not want to take chances.) costing between $100 and $125 per test, depending on which lab the milk bank uses.
  4. Once the donor has completed all of these steps, two members of our intake team review her chart to assure that we do not miss any potential problems.

The range for these steps in the process is approximately $100 – $125 for labs + 1.5 to 2 hours of staff time.

Active Donors: Once a donor is screened and approved for donation, we must receive her milk. This involves:

  1. When the donor is ready to ship the milk to us, the milk bank pays for all boxes and shipping costs (Fed Ex Express, so that the milk arrives frozen).
  2. Our donor intake team is available to answer questions about breastfeeding in general and specific milk donation questions throughout the time a donor is active.

The range for these steps in the process is approximately $50 – $75 for shipping one cooler of milk + staff time (approximately 30 minutes to ship or receive a cooler).

pouring milkMilk Processing: Once the milk is received, it must be processed. This involves:

  1. A staff member first logs the milk into our freezer and computer system and a sample of the milk is sometimes sent out for culture.
  2. Each day, our milk pasteurizing techs carefully mix, pour, pasteurize, cool down and refreeze milk. One sample bottle from each basket of milk (anywhere from 39-58 bottles, depending on the size of the bottle) is sent out for culture. Milk banks process 6-10 baskets per day. These cultures of raw and pasteurized milk cost about $11 each. These steps are necessary to assure that we do not dispense milk with bacteria or other pathogens to the fragile premature and sick babies we serve. The small bottles that store the finished product cost $0.90 each.

The range for these steps in the process is approximately $35 – $81 for culture and bottles to process approximately 100-200 ounces + labor (Mothers’ Milk Bank Northeast has 2 full-time staff dedicated to pasteurizing milk from our donors). 

Indirect Milk Processing Costs

Research: Milk banks are also involved in research to add to our knowledge of human milk, pasteurization processing and other related areas. Costs of some research are paid for by researchers’ budgets. Individual milk banks frequently cover the costs of research directly related to donor milk screening, pasteurization and safety measures. These costs often involve staff time and milk testing.

Overhead: In addition to direct costs of mail, blood tests, milk cultures, and shipping, milk banks must cover basic office expenses of rent, utilities, office supplies, staff salaries as well as equipment such as freezers, refrigerators, pasteurizers, and lab supplies such as masks, gloves, cleaning supplies.

Milk Money Fund: Milk banks are committed to making milk available to babies in need regardless of their parents’ financial situations. They provide milk on a sliding scale and sometimes at no cost when needed. These costs are included in our yearly budgets.

We are grateful to our many dedicated donors and office volunteers without whom we would not be able to operate. They also reduce our operating costs, allowing us to make donor milk available to a growing number of babies and families in need.

NaomiNaomi Bar-Yam, Ph.D. has training in social work and social policy. She has been working in maternal and child health for over 25 years, teaching, writing and researching. Naomi is the founding director of Mothers’ Milk Bank Northeast.

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New JHL Paper Calls for Standardization of Data on Human Milk Banking

By Monica Buchanan, Media and Public Relations Manager, Connecticut Children’s Medical Center

Photo by Mistel de Varona

Photo by Mistel de Varona

Most healthcare professionals know the health benefits of human milk for infants admitted to the NICU are well documented.  Human milk not only provides essential nutrients, but also helps build immunities in this fragile population.

Unfortunately, most mothers of NICU babies may be unable to provide some or all of the milk their infant needs.  However, the use of donor human milk (DHM) in the NICU setting provides an opportunity for very low birth weight infants (<1500 grams) to receive the valuable benefits of human milk.

While donor human milk undergoes extensive screening and testing to ensure its safety, a first-of-its-kind study by the Connecticut Human Milk Research Center at Connecticut Children’s Medical Center, published in the Journal of Human Lactation (JHL), has found a serious lack of standardized data among donor milk banks across North America.  Human Milk Banking Association of North America-affiliated milk banks do not collect consistent data regarding milk donors and milk bank operations.  The authors of the study conclude that “this lack of standardization and transparency may deter implementation of donor milk programs in the neonatal intensive care unit setting and hinder benchmarking, research and quality improvement initiatives.”

Dr. Elizabeth Brownell, Director of the Connecticut Human Milk Research Center, and her colleagues also found a consistent lack of data available to hospitals who offer a donor milk program.  There is no consistent definition, collection, or management of data among milk banks and a clear lack of transparency.  Again, this is not an issue of the milk’s safety, but rather one of failing to obtain critical information about how milk is categorized and distributed across the United States.

This becomes problematic when you consider that many hospitals offering a donor milk program don’t buy milk from the same milk bank, which could mean milk from Bank A may not be defined in the same way as milk from Bank B.  Of note, the study finds the definition of preterm milk varied between milk banks.

In 2010, the Food and Drug Administration recognized the need to develop a centralized registry to collect and disseminate standardized data.  This registry still does not exist.  Dr. Brownell suggests HMBANA- affiliate milk banks work with leadership and/or academic researchers to develop this registry as soon as possible.  Accountability by the FDA could help expedite this process.

Because donor milk use in NICU’s across the country is expanding rapidly, this study highlights the increasing importance of monitoring its infrastructure and reporting outcomes.  It also suggests standardizing data collection among all milk banks, storing it in a central repository, and distributing that information to stakeholders and hospitals.

The full article may be accessed by JHL subscribers HERE.

Buchanan, Monica (1)Monica Buchanan is the Media and Public Relations manager at Connecticut Children’s Medical Center. She joined the corporate communication department in August 2013. Monica transitioned into the PR world after spending nearly 10 years in local news. She was most recently an investigative reporter with WVIT- NBC CT in West Hartford, CT. There she covered major political stories involving corruption at Hartford city hall, covered Superstorm Sandy and the October snowstorm that devastated the Northeast. Monica began her news career as a general assignment reporter for WCTV in Tallahassee, FL in 2004 and has lived in Valdosta, GA and Sarasota, FL as well. She graduated summa cum laude from the University of Florida with a degree in broadcast journalism and is a wife and mom to son Brandon.

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How to Become a Human Milk Donor

By Carissa Hawkins, Communication Coordinator, Indiana Mothers’ Milk Bank

The information provided below is a general overview of how to become a donor for a Human Milk Banking Association of North America Milk Bank. While we’ve tried to be as accurate as possible, some HMBANA banks might have slightly different requirements. Please contact your closest HMBANA Milk Bank directly

IMG_0527

Carissa with her OWN milk donation!

Becoming a human milk donor is an incredibly valued and important role. Currently, there are 13 HMBANA milk banks serving all of North America and many of them have experienced donor shortages over the last few years as demand for donor milk has grown.  HMBANA banks provide pasteurized milk via physician prescription to some of the most vulnerable infants, where access to donor milk can sometimes literally be life-saving. HMBANA estimates they need 9 million ounces of donated breast milk to fill the needs of NICU babies in the US alone. For many women, the path to donating may seem intimidating but, in reality, by following a few simple steps, we can get you on your way quickly!

Step #1: Contact your closest HMBANA Milk Bank for pre-screening.

For most HMBANA Milk Banks, calling them by phone is the fastest way to start the pre-screening that is required for donors. We pre-screen potential donors to make sure that the donor human milk we provide is free of substances that could compromise the health of the critical babies we serve and assists us in processing milk in the most efficient manner possible. You will connect with the Donor Mother Coordinator who will ask you a number of questions such as:

  • How old is your baby?
  • Was he or she born before 36 weeks gestation?
  • Are you donating milk collected prior to contacting the milk bank?
  • Since you started storing your milk, have you taken or are you currently taking any prescribed or over-the-counter medications (used regularly or occasionally) including birth control, allergy medications, or alternative treatments?
  • Are you willing to have a simple blood test, at the milk bank’s expense?
  • Do you use nicotine products?
  • Do you use illegal drugs?
  • Can you donate at least 100 ounces or more? (Volume requirements vary by Milk Bank.)

A number of Milk Banks also have pre-screening on their website. You can fill out the questionnaire online at your convenience.

Step #2: Fill Out Appropriate Paperwork

Your conversation with the Donor Mother Coordinator helps us to determine if you meet the Donor Selection Criteria. We want to make sure that both you and your baby are healthy enough to take on the task of donation. This paperwork needs to be filled out and returned to the Milk Bank. Some banks also have the option of filling out these forms online. Included in your packet will be:

  • A consent form for you to sign and return to the milk bank.
  • A Donor Interview and Lifestyle Questionnaire to fill out and return.
  • A Healthcare Provider Release for you to forward to your OB/GYN.
  • A Healthcare Provider Release for you to forward to your Pediatrician
  • Blood Testing Information
  • Collecting and Storage Guidelines
  • Medication and Lifestyle Guidelines

Step #3: Have a Simple Blood Test

The milk bank will provide you with the information necessary to have your blood drawn. You will receive a form to take to your local lab or a kit that can be shipped to have your blood drawn by your health care provider. All HMBANA Milk Banks will cover the cost of this blood draw and it is a similar experience as to what you had while pregnant. The results of your blood testing will be forwarded directly to the Milk Bank. HMBANA Milk Banks test for the following:

  • HIV 1, 2 & O
  • Hepatitis B & C
  • HTLV I & II (Human T-lymphotropic virus)
  • Syphillis

Step #4: Review and Approval

After all of your paperwork and blood testing results are returned to the Milk Bank, your file will be submitted to the Clinical Coordinator for review and approval. You will then be contacted by the Donor Mother Coordinator, who will give you a donor number and provide you with options for transporting your milk to the Milk Bank.

Step #5: Send Us Your Milk!

There are a number ways that donors get their milk to us. Here are some of our options. Ask at your local Milk Bank for specific methods that they use:

  • Milk Pick Up – If you are local to the Milk Bank, staff are occasionally available to come to your home to pick up your milk.
  • Milk Drop Off – If you are within driving distance of a HMBANA Milk Bank, you can come by our office during our business hours and deliver your milk to us yourself!
  • Milk Depot – Many Milk Banks have convenient drop off locations. These locations are operated by volunteer staff who will take care of the packing and shipping of your milk to the Milk Bank.
  • Shipping – If none of the other options are available to you, the Milk Bank will ship you a cooler for you to fill with your milk and 5 lbs of dry ice. It will also include an overnight return label and instructions on how to pack the box so that your milk arrives safe and sound. Dry ice can be purchased at some grocery stores or your local Praxair or Home City Ice location. Some ice cream shops and hospital laboratories sell dry ice as well. Make sure you forward your dry ice receipt to the Milk Bank for reimbursement.
Carissa with her OWN milk donation!

Carissa with her OWN milk donation!

Step #6: Feel Fantastic About What You’ve Done!

Your hard work pumping is paying off in the lives of babies you will probably never meet. You can take pride in your donation and your commitment to health babies and their families. 

Step #7: Share Your Story!

We’d love to connect with you by Facebook and hear about your HMBANA donation experience. And, we’re suckers for cute donor baby photos, too!

Carissa Hawkins Headshot- USEAbout Carissa Hawkins, Communications Coordinator:  Everyone said Motherhood would change me. I knew they were right, I just didn’t anticipate a career change in addition to all the other capacities I have gained after having my first child. I chose to breastfeed and quickly found that I was making more milk then my babe would use, so I donated. My role at Indiana Mother’s Milk Bank is all things marketing and communications. I have a Bachelors Degree in Communication Studies and have worked in care coordinator since graduating. I am so thankful to be using my skills for such a worthy population. Aside from spending time with my baby girl and biking, I volunteer with the Junior League of Indianapolis. Feel free to contact me: chawkins@immb.org.

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