Tag Archives | NICU

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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ILCA Launches New NEO-BFHI Webpage

ILCAThe ILCA website now hosts a special webpage to disseminate information about the expansion of the Baby-Friendly Hospital Initiative to neonatal care, or Neo-BFHI. The Neo-BFHI program was developed by a Nordic and Quebec working group consisting of health professionals from Sweden, Norway, Denmark, Finland and Quebec, Canada.

The working group developed a unified expansion of the BFHI to neonatal wards, based on review of the evidence, expert opinion, and experiences in the Nordic countries and other countries around the world. To remain consistent with the WHO/UNICEF Global Criteria, the expansion closely follows the revised Ten Steps to Successful Breastfeeding. The preparation of this adapted version of the BFHI is being done in consultation with representatives of the WHO and UNICEF. The UNICEF has agreed to disseminate the program assessment materials in the same way as for the original BFHI assessment.

Please visit the Neo-BFHI webpage to learn more about the piloting phase of the program. Also on the page is information about an international conference planned to launch the program in late 2014, with invited experts who will complete the program’s documents and form an international steering committee. The core document will be posted soon. Watch the webpage for that and for further updates as planning continues!

For more information about the program, contact Kerstin Hedberg Nyqvist at kerstin.hedberg_nyqvist@kbh.uu.se.

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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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