Recently, a family in my clinic adopted a healthy newborn boy and asked me to help them with an unusual prescription. Rocking his new son in his baby Bjorn, dad requested: “One order for “human donor milk, from a donor milk bank.” Once again, a parent teaches a pediatrician something. Something really good.
The idea of an adoptive family breastfeeding this child hadn’t occurred to me (the biological mom being in another state, and wet nurses having gone out of vogue about 60 years ago). I’d heard of organ banks, blood- and even sperm banks. Milk banks? Did a system exist to feed breastmilk to babies whose biological moms were unavailable or unable to breastfeed them? Simply, yes.
Human donor milk banks are very much in existence across the country. Theirs is a story currently flying under the radar of many physicians’ and parents’ awareness. (Like, um, mine.) Fortunately, that may be changing, thanks to a burgeoning movement lead by breastfeeding advocates and motivated families.
North Americans often contradict themselves in their attitudes and knowledge about breastfeeding. While people still protest infants nursing in public on the one hand, more and more infants–about three quarters as of 2008– are breastfed at birth. In the last 20 years or so, the pendulum has swung back(and many would argue, long past due) with parents and medical providers rediscovering the physiologic, nutritional, immunologic, neurodevelopmental and financial benefits of feeding infants human milk. Just last month, yet another study–this of Dutch mothers– links breastfeeding exclusively in a baby’s first 6 months with lower rates of respiratory and GI infections. Whenever possible, breast milk is best milk.
For at least the four thousand years before refrigeration, humans used alternative approaches to breastfeeding their own young. Wet nurses, women brought into a family to breastfeed another family’s infants, were commonplace in Europe and the United States until the mid-twentieth century. At the start of the 20th century, the majority of infants were fed breastmilk. Artificial milk or infant formula was produced then only on a limited scale in the US and Europe. Human milk banks arose to address the needs of premature, or sick infants, or babies whose mothers had died from the many complications of childbirth.
The History.
The first milk banks were founded in Vienna (1909) and Boston (1919). Since then, efforts to bank human milk have ebbed and flowed, so to speak. With improvements in refrigeration and safety testing nearly two dozen milk banks arose by the 1980s across the US, with many more such programs globally. However, a number of these organizations were shuttered during the HIV epidemic, amid the growing concern that diseases could be transmitted from banked milk to infants.
Breastfeeding advocates and leadership rallied, and the milk banking effort emerged from that decade emphasizing safety, quality, and rigorous guidelines. The Human Milk Banking Association of North America (HMBANA) established research efforts and updated methods for the safe collection, preparation and distribution of human milk.
There are now 10 human milk banks spread across the U.S. (and one in Canada). Before we think we are so great, check this out: Brazil has over 180.
In the US, breastfeeding moms are busy, and generous. By 2008, some 2000 American woman were donating upwards of 1.4 million ounces of human milk through donor banks. The effort behind that number is difficult to measure, counting the time needed to pump, collect, and prepare the milk. And, yet, the need is vast. Estimates suggest the demand for banked human milk in the US approaches 9 million ounces a year.
The Questions.
So, who gets banked human milk, aka’liquid gold?’ How do families and pediatricians access this precious resource?
Naomi Bar-Yam, Executive Director of the Mother’s Milk Bank of New England based in Newton, Massachusetts, emphasizes human milk banks seek to support breastfeeding of infants in general. “Our goal is to have the mother nursing her own baby” she says. Ideally, donated milk provides a mom a bridge until her own supply arrives, if possible. Premature infants, the largest consumer of donated human milk– may be born before their moms can produce sufficient milk. She adds, “Donor milk is not intended to replace a mom’s milk.”
Human milk banks also allow access to breastmilk for children who might otherwise have none, including adopted babies like my patient. Other mothers may have medical conditions that render them unable to breastfeed (eg chemotherapy, breast surgery, etc).
Moving past ‘ick’: is it safe?
Safety and quality control for the human milk banks is paramount. To date, strict screening, testing and quality guidelnes for safety have been effective. “We’ve never documented infection from donated human milk,” says Ms Bar Yam proudly, ”After all, we’re feeding the most vulnerable people out there.”
Many potential human milk donors become interested by word of mouth or via articles they’ve read in the media or on the web. Once women have contacted a regional or local milk bank, potential donors undergo thorough screening based on guidelines developed by the American Blood Association. Before donors have expressed an ounce, they’ll have undergone extensive written and telephone health and lifestyle questionnaires, and blood tests.
The ideal donor enjoys good health, takes no medications, herbs or dietary supplements, and has a nursing infant under 12 months of age. Women who smoke or drink regularly, who have a history of recreational drug use, or a history of hepatitis, HIV exposure or other health problems will be unable to donate their milk. See? I told you: These people are thorough.
It doesn’t stop there. To assure quality of their product, milk bank programs train and educate their donors. After completing a course on proper milk handling and hygiene, donors express their breastmilk into special insulated containers and ship it on dry ice to a milk bank facility. Cool pics and slides can be seen here. When coupled to a call center, the internet, and an express delivery service, the ability of a human milk bank to receive distribute breastmilk over great distances becomes awesome to behold.
Almost 3/4 of human milk dispensed by milk banks goes to babies outside hospitals. When you have only 10 banks covering the entire country, you have to move this stuff quickly and reliably.
They do. Milk is collected in facilities that have met HMBNA standards, with input and oversight from federal, and state and local health authorities. Human milk banks pasteurize and treat the breastmilk, maintaining its nutritional value while rendering it free of infectious agents, including bacteria and viruses. Batches of human milk are monitored continuously for quality and fat and protein content. If samples do not meet proper metrics, they are discarded. Only good stuff goes out. Period.
Donated human milk is both safe and nearly as good for an infant as breastfeeding from their own mother. Research is limited, but it is growing. Dr Kathleen Marinelli, medical director of the Mother’s Milk Bank of New England, suggests soon-to-be released data demonstrates the benefits to premature infants. Preemies given breastmilk had lower rates of infection and GI problems. Happier, healthier preemies may gain better weight, have fewer hospital days, and lower costs.
Dr Marinelli concludes, ” These better outcomes may change the hearts and minds of some doctors, and open up the purse strings of some insurance companies.”
Larger hospitals may lead this wave of change as they utilize donated milk as a standard of care for premature and full term infants who are without. Recent healthcare reform does not appear to have locked in financial support for the collection and use of donated human milk. Hopefully, the trifecta of increased parent demand, the recognition of better outcomes for preemies fed breastmilk, and increasing awareness by health care providers will create an environment for milk banks to be financially self sustaining. It is a work in progress.
The Financials.
While all the milk is donated for a human milk bank, the final product is expensive, costing between $3-$5 per ounce. Human milk banks can offset some of their expenses by selling to human milk to hospitals or consumers at cost. Let us be clear: these are not for-profit enterprises. Many milk banks work leanly and exist on the vagaries of hospital or grant funding.
The majority of families in the community pay out of pocket for donated human milk. Some milk banks can offer discounts, or even retain funds (“milk money”, ha!)to help families afford the considerable cost. Unfortunately, limited supplies and high prices may put donated milk beyond the reach of some interested parents.
Ms Bar-Yam sums this aspect of human milk banking succinctly: “Happily, the conversation has changed. It used to be ‘ooh, yuck. Then we’ve gone more to ‘is it safe,’ which is reasonable. Now we are moving towards how are we gonna pay for it?”
How to get it or give it?
Forthwith, I am directing inquiring parents–potential donors or consumers–to the HMBANA website and/or to the donor milk bank nearest them. (cue Google here). Online resources or human beings on the phone can walk a parent–or, say, a pediatrician–through the process. BTW: when a baby is in hospital, lactation specialists, nurses, docs or other staff can help.
In the case of a family seeking milk for their child, milk bank protocols require that the mother document communication with her OB/GYN when applicable(not so much for an adoptive family, right?) and with the infant’s primary care provider. This transparency informs a family’s circle of clinicians, and makes for smarter care. From there, the primary care doc provides a prescription in the manner that I was instructed in the first paragraph. Thereafter, the machineries of the milk bank program kick in.
Through the miracle of lactating women’s generosity, legions of workers, and express delivery, a package of liquid gold goes to your door. Bon appetit!
Going forward, human milk banks and their proponents face the challenge on building their momentum of the last two decades. In addition to recruiting new donors and connecting with new babies, it behooves we parents and caregivers to raise our collective awareness. We may learn, and do something. Something really good.
Donated human milk may be a viable and even preferable option for some babies, who might otherwise have little or none. Safe. Biological. Smart. After a baby’s own mother’s milk, milk from a human milk bank really may be the next breast thing.
Photo above by Brett Lakanen; Cartoon below by me.
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Cool Links, check ‘em out.
http://www.usatoday.com/news/health/2010-04-07-breastmilk07_ST_N.htm
http://pediatrics.aappublications.org/cgi/content/full/126/1/e18
http://www.reachfoundation.net/nemb/hmbank.htm
Jack Maypole
Jack Maypole, MD has plenty of material to work from. He is director of Pediatrics at the South End Community Health Center and he is director of the Comprehensive Care Program at Boston ...
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