Milk Banks

From Milk Banks to Facebook in Search of Breast Milk

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Some new moms would like to breastfeed, but cannot. Some nursing women have more milk than they need. Learn how authorized milk banks are competing with the Internet and social media sites to match up these moms.

There is no doubt that breastfeeding is healthy for babies. In its exhaustive 2007 review, the Agency for Healthcare Research and Quality (AHRQ) reaffirmed that breastfeeding protects against illnesses such as ear infections, gastroenteritis, severe lower respiratory infections, and necrotizing enterocolitis.[1] In addition, the report concluded that breastfeeding is associated with lower rates of sudden infant death syndrome, childhood obesity, type 2 diabetes, and leukemia.[1]

It’s no wonder then that women who cannot breastfeed turn to other new mothers for support—and for milk. Across the country, lactating women who so desire can donate milk to a donor breast milk bank, which are repositories of milk from lactating mothers who have been carefully screened for health histories and communicable diseases and undergo blood testing, similarly to the way blood banks screen donors.[2]

Milk banks have been in existence for approximately 100 years, roughly in parallel with a decline in the use of wet nurses because of ongoing advances in both food safety processes and refrigeration. Milk banks gained tremendous recognition in the early 1930s when Canadian and American milk banks were able to provide the world-famous Dionne quintuplets—who had been born more than two months prematurely in northern Quebec—with more than 8,000 oz of donor milk![3] Throughout the developed world, donor milk banking grew as the fields of obstetrics and pediatrics progressed and increasing numbers of ill and premature infants survived. In some cases mothers provided donor milk by nursing the sick babies directly, but in most cases, there was no contact between donor and recipient.

From their inception in the early 1900s until 1985, there was no real regulation of milk banks. In 1985, the Human Milk Banking Association of North America (HMBANA) was established to set standards for all North American milk banks, which includes the United States and Canada. These standards were first published in 1990 and are updated annually by HMBANA.[3] The 11 milk banks affiliated with HMBANA are chartered as nonprofit organizations with the mission to accept, pasteurize, and dispense donor human milk by physician prescription, primarily to premature and ill infants. If milk is available, some milk banks will also provide milk to healthy adopted babies or to women who are unable to nurse because of a medication history, chemotherapy, or a prior mastectomy.

Before being accepted for distribution through the milk bank, donor moms undergo blood tests as well as health and behavioral screens. Blood screening includes tests for HIV 1,2, and 0; HTLV 1 and 2; hepatitis B and C; and syphilis.[4] In addition, milk bank donors must

  • Be nonsmokers
  • Not regularly consume any medications, including high doses of vitamins
  • Not consume excluded medications or alcohol within the specified exclusion period[2]

When the milk is donated, it is pasteurized and then frozen in individual milk bottles. Samples from the batch are also sent out to the lab after pasteurization to make sure that there are no pathogens present. Women whose infants need the milk must supply a physician’s note and can either pick up the milk at a local bank or make arrangements for overnight shipment through a special carrier.

Sophisticated tracking and notification procedures are also in place, allowing every bottle of milk sent to a recipient to be tracked to the original donor. The cost of banked milk averages $3 to $4.50/oz, which may or may not be covered by insurance depending on medical need. No financial incentives are offered to donors and the name of the donor is kept confidential.

Reaching Out

Without medical insurance, milk obtained from a milk bank is expensive and is a deterrent for some women. On the donor side, some women are reluctant to donate milk that other women must pay for—although no milk bank is getting rich from the fees charged, according to Naomi Bar-Yam, executive director of the Mothers’ Milk Bank of New England.[5] Other potential donors are put off by the testing requirements. Therefore, women have begun to use the Internet and social media to find volunteers through “milk sharing” groups such as Eats on Feets or MilkShare. Members of these groups (coined “lactivists” by some) can reach out to other local moms to share or receive milk at no cost or at a minimal one-time processing charge. Many women seeking milk through these groups have experienced a sudden health crisis; in other situations, they might have trouble making enough milk to feed their own babies. Recent activity on Eats on Feets include postings from a mom who lost a supply of frozen milk when the power went out during a hurricane; a mom who had an excess of 200 oz of breast milk in her freezer to share; and a woman who could no longer breastfeed because she was undergoing nuclear medicine tests. Milk sharing also fosters friendships and community among women; since the donations from milk banks are not identified, this opportunity does not exist among milk bank users.

Is Milk Sharing a Safe Practice?

While human milk banks take steps to screen donors and safety collect and store milk, there are no such precautions taken when women share their milk amongst themselves. While common sense might suggest that a woman successfully nursing her own infant would have a safe milk supply, that doesn’t hold true in all cases. “If a woman has active hepatitis B virus in her blood, her infant is treated in the hospital with immunizations against hepatitis B and can safely breastfeed. However, that milk is likely to be harmful to other (untreated) babies,” notes Dr. Kathleen Marinelli, medical director for the Mothers’ Milk Bank of New England.[5]

The U.S. Food and Drug Administration (FDA) concurs. According to a November 2010 FDA Science and Research Paper: “If you are considering feeding a baby with human milk from a source other than the baby’s mother, you should know that there are possible health and safety risks for the baby. Risks for the baby include exposure to infectious diseases, including HIV, to chemical contaminants, such as some illegal drugs, and to a limited number of prescription drugs that might be in the human milk, if the donor has not been adequately screened. In addition, if human milk is not handled and stored properly, it could, like any type of milk, become contaminated and unsafe to drink.”[6] The American Academy of Family Physicians,[7] the American Academy of Pediatrics,[8] and the La Leche League[9] echo these recommendations and do not recognize milk sharing as a viable substitution for a mother’s own milk.

Aside from the safety issues, there are also practical issues related to milk sharing of which women should be aware. Physicians, midwives, and lactation experts recommend that women should not pay for milk shares because some donors dilute their milk to increase their profits. They should screen their donors as best they can and match donor milk to baby’s age, as breast milk is age-specific and changes as the baby gets older. And they should never obtain milk online without having had the opportunity to speak with and screen the donor.

Recognizing that the bank-versus-sharing issue is not going away, the FDA has posted the following guidelines for moms about milk sharing[6]:

  • Talk with a pediatrician. All babies’ nutritional needs are different and you should discuss your baby’s particular situation with your doctor.
  • Consider safety risks, including exposure to infectious diseases such as HIV, chemical contaminants, or prescription drugs, as well as proper storage and handling of the milk.
  • Avoid using milk acquired through the Internet. Donor milk acquired through the Internet is unlikely to have been adequately screened for infectious disease or contamination risk. Also, you can’t be certain that the milk was stored correctly.
  • Only use screened milk. Obtain human milk through banks that take voluntary steps to screen milk donors, and safely collect, process, handle, test, and store the milk.

 

Jill Shuman, MS, ELS
Published September 20, 2011

 

References

  1. Ip S, Chung M, Raman G, et al. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. AHRQ Publication No. 07-E007. Rockville, MD: Agency for Healthcare Research and Quality; 2007.
  2. Frequently asked questions. Human Milk Banking Association of North America Website. http://www.hmbana.org/faq. Accessed September 15, 2011.
  3. Jones F. History of North American donor milk banking: one hundred years of progress. J Hum Lact. 2003;19(3):313-318
  4. FDA Presentation: Human Milk Banking Association of North America. http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/PediatricAdvisory Committee/UCM235648.pdf. Accessed September 15, 2011.
  5. Alpert J. Moms who can’t breast feed face challenges. WBUR Website. http://radioboston.wbur.org/2011/01/25/breast-feeding. Published January 25, 2011. Accessed September 15, 2011.
  6. Use of donor human milk. U.S. Food and Drug Administration Website. http://www.fda.gov/ScienceResearch/SpecialTopics/PediatricTherapeuticsResearch/ucm235203.htm. Updated November 30, 2010. Accessed September 15, 2011.
  7. American Academy of Family Physicians. Breastfeeding, Family Physicians Supporting (Position Paper). AAFP Website. http://www.aafp.org/online/en/home/policy/policies/b/breastfeedingpositionpaper.html. Accessed September 7, 2011.
  8. American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics. 2005:115(2):496-506.
  9. Arnold LDW. Becoming a donor to a human milk bank. La Leche League Website. http://www.llli.org/llleaderweb/lv/lvaprmay00p19.html. Updated October 14, 2007 Accessed September 9, 2011.