Banked Human Milk: Medicinal “Liquid Gold”

The following is a post by Nancy Holtzman, Vice President at Isis Parenting, leading Clinical Content. You can visit Isis Parenting on the web and in person.  Once each week, I take off my “VP” hat at Isis Parenting and become a nurse and lactation consultant once again. I live in a world of babies, moms, breasts and precious milk, measured in ounces, grams and sometimes drops. Once each week, I rotate through our various Centers and teach a class called Pump Talk, offering a group of ten new mothers two full hours of in-depth logistics for combining breastfeeding, expressing milk and the return to employment. Recently, I led a class where three of the ten women just happened to be physicians: in fact two were pediatric specialists and one was an Emergency Medicine resident.

We were discussing the logistics of freezing breastmilk including how to manage the occasional blessing and challenge when there is more frozen milk than freezer space. My three usual suggestions: Consider a chest freezer for the basement. Is a stand-alone freezer not an option? Ask friends, family or neighbors with a basement freezer to temporarily store a box of milk “off-site” for you. Or, consider donating your milk to a Human Milk Bank.

I received blank looks all around. A milk bank? All were unaware that banked donor human milk was desperately needed for hospitalized or sick babies – even the three physicians. I realized then that we need to work harder to get the word about this need. Most expecting parents plan to breastfeed, and most new mothers do, even if it’s for a relatively short amount of time. The catch phrase “breast is best” is often acknowledged but breastmilk is sometimes viewed as a “nice to have, if you can do it” sort of thing. But for the tiniest patients in the NICU, it can truly be the difference between life and death.

For these tiny fighters, premature babies born 8, 10, even 12 weeks early and weighing less than 2 lbs, breastmilk may be the single most significant factor that gets them home, safer, sooner or at all.

Human milk as the standard of care. Human milk is increasingly becoming the standard of care for very premature infants. For these vulnerable patients, it is considered medicinal as well as nutritional. Human milk contains specific immune and growth factors needed for development not found in formula. The smallest premature babies in particular have immature digestive and immune systems and are especially at risk of a potentially fatal complication called NEC - Necrotizing Enterocolitis - a devastating digestive tract infection that destroys portions of the newborn’s bowels, requiring dangerous and costly surgery and prolonged hospital stays. Many preemies stricken with NEC do not survive or have permanent damage to their intestines. Studies show that feeding premature babies exclusively with human milk reduces the chances of these and many other complications of prematurity.

Mother’s own milk and Banked Donor Human Milk Many mothers of premature or ill infants are able to begin expressing their milk using a breastpump and are able to provide all the milk their premature baby needs. But other new mothers may have medical or surgical complications or may have delivered their baby so early in pregnancy that they are unable to provide the milk that their baby requires. When a mother’s own milk is not available, the next best option is Donor Human Milk from a certified milk bank.

What is a milk bank? A donor milk bank is a not-for-profit service established for the purpose of collecting, screening, processing and distributing donated human milk primarily to premature and sick babies whose mothers do not have enough milk for their babies. All member banks operate under the guidelines of Human Milk Banking Association of North America (HMBANA).

Who can donate? Lactating women with available breastmilk in excess of their baby’s needs may consider becoming a milk donor. Mothers from the US, Canada and Mexico can donate their extra milk to help save premature and ill infants.  Even if there isn’t a non-profit bank in your state it is possible to become a donor and have your frozen milk shipped to the bank. Costs of screening and shipping are typically covered by the receiving bank.

How are donors screened? Becoming a donor is a thorough process that begins with a brief telephone screening interview, and then continues with paper work, medical clearance forms and required blood work. As with blood donation, it is essential to test donors to prevent exposure to viruses including HIV, CMV and Hepatitis and ensure safety to the recipient. Read more about milk donor screening.

What happens to the donated milk? Milk is transported to the milk bank frozen. The milk from several donors is pooled after thawing, and then heat-treated to kill any bacteria or viruses. The milk is processed and then refrozen. It is only dispensed after samples are cultured and show no bacteria growth. Milk is shipped frozen by overnight express to hospitals and to individual recipients at home. The milk is dispensed by physician prescription or by hospital purchase order only. There is a processing fee charged to support the non-profit milk bank to cover the expense of collecting, pasteurizing and dispensing the milk, just as agencies like the Red Cross charge a fee for donated blood products.

Why is there such a shortage of human milk? Lack of awareness of need and a very small pool of potential donors are the primary reasons.

Demands for banked human milk continue to increase each year as NICUs shift to the evidence-based practice of using only human milk for their tiniest, sickest population. The 12 non-profit Human Milk Bank Association of North America (HMBANA) milk banks that serve the US and Canada are experiencing critical shortages of banked, screened human donor milk for premature or ill babies, in relation to this increased demand. Just as hospitals require a constant and reliable supply of carefully screened and safely obtained blood products, there is also a need for carefully screened and safely obtained banked human milk to use when a mother’s own milk is not available. Most people know about the need for blood donation, but few are aware of the need for human milk donation.

Another major issue is that the potential pool of donors is quite limited – lactating women who pass the medical clearance and also have additional milk they are able and willing to express, store and transfer to their milk bank regularly. Being a human milk donor takes time, effort and a great deal of dedication, all on a volunteer basis.

What about informal “Milk Sharing”? With the popularity of various “milk share” organizations (informal donation arrangements done on the internet), some altruistic nursing mothers decide to go that route because it’s a quicker and easier way to donate their milk and “do good”, and there may be a personal connection that goes along with it – the ability to see or meet the family or recipient baby. However, there is no safety assurance in those types of informal arrangements (much like accepting a blood donation directly from a helpful, well-meaning stranger). Taking the extra steps to become accepted into a non-profit milk banks that adhere to the Human Milk Banking Association of North America (HMBANA) guidelines lets you know that your milk is being dispensed to fragile and sick infants who need it most, improving their potential to survive and thrive. 

How can you help? At Isis Parenting in Massachusetts, we’re helping by launching the first and only Human Milk Depot in New England, in partnership with Mothers’ Milk Bank of New England. By offering this service, more potential donors will become aware of the need for donation, and with the convenience of an official donor milk drop-off site, hopefully more nursing mothers will choose to participate in the donation program.

Even if you can’t donate milk, there are many other ways to help. Find your nearest HMBANA milk bank location – there are only 12 in all of North America, so it may not be nearby, but that’s okay. These banks are non-profit and rely on active volunteers for many support roles – perhaps you’re able to help with awareness campaigns, program promotion, fundraising, website skills or other opportunities.

I’m always glad to have the chance to share information about the need for human milk donors in classes, in conversations and by using social media. Earlier this week, I received this email from one of the class participants:

“After you told us about the need for banked breastmilk in your Pump Talk class, I investigated the Mothers Milk Bank New England website and I was able to register as a donor. I’m proud to say that my approval and clearance to be a donor came through today and I wanted to let you know. Thank you so much for the info – I would never have known. When I told my mother about this, I learned that my grandmother used to donate her milk for preemies back before any of it was regulated. So great to be able to help those little ones!”

I couldn’t agree more! Let’s help raise awareness of the need and importance of having enough human milk donors. Not every nursing mother is in the situation to be able to donate surplus breastmilk to a human milk bank, but to those who are able, the benefits to both the donor and the recipient and family are immeasurable. Happy World Breastfeeding Week!

Nancy Holtzman RN BSN IBCLC CPN

VP Clinical Content and Learning Isis Parenting, Inc

@nancyholtzman

Nancy is a Vice President at Isis Parenting and leads Clinical Content. As one of the original co-founders, she was instrumental in the creation of many prenatal and new parent programs at Isis Parenting, helping to develop the Isis vision in its earliest stages. Nancy has over 25 years of clinical nursing experience including ten years at Boston's Beth Israel Hospital,  and is a mother/baby nurse educator, a board certified lactation consultant and board certified pediatric nurse. She is the founder of the Great Beginnings New Mothers Group series which has now reached over 10,000 Boston-area mothers. She speaks and writes for a national audience about breastfeeding and infant development, and has served on the board of MLCA, the Massachusetts Lactation Consultants Association. She received a BS from Northeastern University College of Nursing, and a Certificate in Advanced Pediatric Assessment from Boston College. Nancy lives in Boston with her husband, two teens and a rescued Bichon. Find her tweeting about all about babies at @nancyholtzman