Archive | Milk Banking

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.

6

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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“World Day of Human Milk Donation” – An International Effort!

By Maryanne Perrin, MBA

I spoke with Dr. Danielle Aparecida da Silva of Brazil’s Oswaldo Cruz Foundation (equivalent to the Food and Drug Administration in the USA) to learn more about the upcoming “World Day of Human Milk Donation” which will be celebrated on May 19, 2013.  Aparecida da Silva is in charge of processing and quality control for the national reference center which supports milk banks throughout Iberoamerica and Africa.

A Day to Promote Milk Donations

DonateMilk(Brazil)PosterSince 2004, Brazil’s Human Milk Bank network (Bancos de Leite Humano or BLH-BR) has held an annual “National Day of Human Milk Donation” to promote the importance of giving milk.  This campaign involves selecting a “godmother of donation” who is usually an actress, singer, or other public figure (a few years ago it was volleyball players on the Olympic team) to bring awareness regarding the importance of donating milk to save the lives of thousands of premature babies. In 2010, Brazil began discussions with their partner countries in the Iberoamerican Program of Human Milk Banks (IberBLH) about hosting a “World Day of Human Milk Donation” which is celebrated on May 19 by Brazil and 23 other countries. This date was chosen because it is the date of the signing of the “First Letter of Brasilia,” a document to form international cooperation in milk banking. On May 19, the IberBLH member countries will promote the idea that when you donate milk, you donate life.  This year’s theme is “Give Milk, Life Thanks” and the campaign will use radio, television, posters, and community events to raise awareness of the import role that milk donors play.

About Brazil’s Milk Bank Network

brazil

Dr. Danielle Aparecida da Silva

In the 1980s, Brazil created breastfeeding promotion policies that focused on two objectives: providing breastfeeding support to mothers, children, and families and managing the human milk banks to ensure a quality product.  The combination of breastfeeding support and donor milk banking is based on the notion of human milk as a functional food that is important for decreasing neonatal morbidity.  In 2012 Brazil’s breastfeeding promotion center provided breastfeeding support to almost 1.6 million women, collected approximately 160,000 liters of donor milk throughout their 212 milk banks, and supported 167,000 premature infants. In 2007, Brazil was instrumental in forming the IberoAmerican Program of Human Milk Banks for the exchange of knowledge and technology related to breastfeeding and milk banking with other countries.

The Importance of Donor Milk on a Global Level

According to the World Health Organization over 1,000,000 babies die every year from complications associated with prematurity, and it is the leading cause of death for infants under 4 weeks old.  What kind of global impact could we have by making donor milk available to fragile infants worldwide who don’t have access to their mother’s milk?  The cooperation of the Iberoamerican network in creating awareness about the need for milk donors is an important first step. Imagine if 50 countries participated in the 2014 “World Day of Human Milk Donations” and 75 countries the following year? Congratulations to Brazil and their Iberoamerican partner countries for highlighting donor milk as an important piece in the overall strategy to improve global infant health!  

What efforts are going on in your country to raise awareness about donor milk banking?

MaryannePerrin3-2Maryanne Perrin loves all things related to food: growing it, cooking it, eating it, and now studying about it at the molecular and cellular level.  She has a BS in Industrial Engineering from Purdue University and an MBA from the University of North Carolina, Chapel Hill, and enjoyed a variety of career paths (information technology, management consulting, stay-at-home-mom, entrepreneur) before returning to school to obtain a PhD in Nutrition Science. She was quickly captivated by the amazing story of human milk and is focusing her research on understanding the nutritive and immunoprotective value of donor milk beyond one year postpartum.  When she’s not studying or helping ILCA with social media, she likes playing in the woods with her husband, three kids, and the family dog.  

4

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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The Power of Milk Donation at Milk Matters in Cape Town, South Africa

By Louise Goosen, RN, RM, IBCLC

Put a group of enthusiastic “Lactavists” in a room, give them a challenge and WOW, there is no holding back!

The story of Milk Matters Milk Bank in South Africa started 10 years ago at Mowbray Maternity Hospital in Cape Town where two of the  founding members were employed part time as lactation consultants. With the support of our colleagues, we collected 20 liters of milk only to discover, to our horror, that no one was interested in using our precious bootie … not surprising when the HIV rate in the country was over 25%.

Soon, our modern day hero, Dr Allan Horn, a neonatologist from Groote Schuur Hospital, heard about our precious milk. He was eager to use our pasteurised milk as he believed it could make a difference to the unacceptably high mortality and morbidity rates of the micro-premature babies in his unit. He was right and soon two other hospitals were requesting donor milk.

Those were small beginnings. We have since registered as a Public Benefit and Non Profit Organisation, improved our donor and milk screening techniques, developed posters, pamphlets and promo videos, sent regular articles to magazines and newspapers, developed a website, and established a presence on Facebook and Twitter. This has enabled us to dramatically increase the Milk Matters donor base. Subsequently, our processing rate has grown from one liter per week to almost six liters a day and it is still not enough. We supply donor milk to four large neonatal intensive care units on a daily basis and 24 other hospitals when the need arises.

Although we started “giving our milk away” at no charge, this had to change and we are now forced to charge a processing fee in an attempt to recover some of our costs. Our sustainability would not have been possible if it were not for the founder members who still offer their services voluntarily.

There is plenty still to be done. In a developing country where the exclusive breastfeeding rate at 6 months is a mere 8%, we could never rest on our laurels. The need to increase our breastfeeding rates as a nation is paramount. Donor breastmilk must never be viewed as a replacement for mother’s own milk, but it does fill the gap when ill health prevails or when mothers need the time to build up their own supply.

Encouraging all mothers to consider the impact of human milk is critical. Crippling, outdated information that “forbade” HIV+ mothers to breastfeed has changed and HIV+ mothers are now actively encouraged to breastfeed while they and their babies have access to antiretroviral (ARV) drug treatment. Twelve months ago, our National Department of Health called on each and every one of us to reinstitute breastfeeding as the norm in our communities. What’s more the Department is encouraging the establishment of donor milk banks throughout the country. Milk Matters has already helped in the setting up of 5 other milk banks and more are in the developmental stages. Our latest invite is from further afield, Malawi, a fellow African country to the north of us.

Milk Matters continues to reach out as the approximately 50 babies that we are feeding every day or 1,500 babies that we are feeding every month isn’t enough. Many more need access to their own mothers’ milk and that is where our true mission lies.

Please visit us on the web at www.milkmatters.org or on Twitter at www.twitter.com/milkmatters.

Louise Goosen’s full time career in breastfeeding started in 1986 when she also ran birth preparation classes for 7 years. She qualified as an IBCLC in 2003. She has been a member of the South African Breast Feeding Association for the last 30 years and been chairperson for over 10 years. Since its inception in 2002, she has been an active member of the South African Kangaroo Mothercare Foundation (KMC). After ten years at Mowbray Maternity Hospital as the resident IBCLC and BFHI co-coordinator, trainer and assessor, she has taken up the voluntary position as chairperson of the breastmilk bank, Milk Matters. She is also still involved with breastfeeding and KMC training for medical, physiotherapy, dietetic and nursing students.

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Bryson’s Legacy: A Story of Milk Donation and the Love of a Family

Those who attended the 2012 ILCA Conference had the wonderful privilege to view a video presented by Ryan Comfort, of Milk for Thought, which told the story of Amy and Bryan Anderson and their son, Bryson. There was an intense emotion in the room as they shared of their milk donation since his birth and death and we wanted to offer an update of their journey.


Amy shared with us the following: 

Bryson’s legacy begins eleven years after I fell in love with my high school sweetheart. We had been married for five years and were already the proud parents of two precious children. Our firstborn, Brody, was a passionate 3½ year old boy. And our Joey Skylor was born into heaven in December 2009 for unknown reasons early in the second trimester. Our family felt prepared for the additional joys and love that a new baby would bring, so we were all overjoyed with anticipation to find out we were expecting a baby boy due to arrive March 28th, 2011. However, the Lord had special plans for our precious baby Bryson.

After a month of constant medical interventions to save our son from the complications of a rare condition called LUTO (Lower Urinary Tract Obstruction), Bryson went home to join Joey on heaven’s playground.  It was a beautiful, sunny and windy day on that October 30th, 2010 at 1:04pm when I finally stopped trying to hold onto my baby boy as his body was torn from mine.  It was the hardest thing I have ever had to do, relax and let go of my precious baby, whom I had been incessantly praying for and loving for what seemed like an eternity…  I remember as soon as I felt him leaving I bawled and tearfully called out.  I was hopeless and helpless.  My whole body shuttered with the reality of what was happening.  I just wanted him back, I already missed him so badly.

My husband and I were beyond ourselves, completely lost in our grief and despair and yet so proud of our son’s journey/life.  Daddy noticed how he already resembled his big brother especially in the brow… that warmed our hearts.  What a beautiful and fragile baby he was… I can only imagine how gorgeous he is in heaven, no longer weakened by his delicate body.  Bryson’s body was 13oz and 10in of perfection, with 10 tiny fingers and toes with nails already formed on them.  I fondly remember watching him on the dozens of ultrasounds we had… he certainly was a fighter and a persistent little one, much like his mommy.  His personality was very strong and he had every intention of being a significant part of our family and our hearts… in that respect his life was a complete success!  He has made a huge impact in the lives of many.

As we heard at the conference, Amy began pumping and donating her pre-term milk. Their “Donation Through Grief” has totaled 3,239 ounces of milk to Mother’s Milk Bank of New England and 8,523 ounces to Mother’s Milk Bank of Ohiothat’s nearly 92 gallons of breast milk! Bryson’s milk was literally sent all around the country and even around the world.

Amy and Bryan are currently involved in advocating for bereaved parents by educating medical professionals and the community at large in how to care for those who have lost infants, especially in terms of lactation options after a stillbirth or earlier loss.  Amy says,

I’m persistently advocating to amend the US federal law “Break Time for Nursing Mothers” under the Fair Labor Standards Act.  The law is intended to support appropriate break time for expression as needed at work for “nursing mothers”.  However, this verbiage has made it possible for my place of employment to say that the law doesn’t apply in my situation because I don’t have a nursing baby, therefore am not considered a “nursing mother”.  Regardless of the fact that my body was lactating uncontrollably even though my baby was not at home to latch on.  My goal is for the law to pertain to any “lactating women”, so employers cannot use the law to discriminate against a bereaved mother whose already experiencing unfathomable grief.

So far I’ve been completely unsuccessful with getting the attention of any of my state representatives, the Department of Labor has directed me to my local La Leche League, and the White House has also yet to reply to my e-mails (lol, yup, I even reached out to the president/first lady).  My best bet so far is to get as many people as possible to hear my Bryson’s legacy.  People need to know lactation can happen even after only 20 weeks gestation (and even earlier), and that donating their baby’s breastmilk is a precious, much appreciated gift that gives meaning their baby’s short life and helps with the grief process.  I’ve already recieved a few responses that our story inspired a couple other moms to “Donate Through Grief” which is huge to me (though I understand it’s a very personal choice, the option needs to be available to the mom).  

At Lactation Matters, we are proud to share Bryson’s story and know that there are many in our community who would have unique insight for the advocacy that the Andersons are pursuing.  Please contact Amy at aranderson33@gmail.com if you’d like to help take up the cause.

Have you worked with bereaved mothers to donate milk? How has this practice positively impacted them?

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