A guide for donating breast milk

When I first had my daughter, even after I made it through the normal stage of engorgement, I was left with a ridiculous supply of breast milk that was way too much for my daughter to handle. Having an oversupply of milk might sound great but it is definitely not fun.

I would wake up soaked in milk after leaking through two breast pads, a sleeping bra, a t-shirt, and my sheets. I used to shoot milk across the room when my baby would de-latch herself from my overpowering letdown.

In the first few weeks, I pumped a few times for just a few minutes for comfort. I knew not to pump or empty too much because I would only make MORE milk. (Remember: the more you empty the more you make.) I ended up staying home with my girl and never giving her a bottle, leaving me with a small amount from those beginning weeks stashed in my freezer.

I went online and did a bit of research. Through mama to mama donation on Human Milk for Human Babies, I was able to give my milk to a mama in need. She so desperately wanted to give her daughter only breastmilk for her first six months of life and due to a breast reduction, she made very little milk. Even though I only gave her a small amount, it felt amazing to know my milk would be nourishing another little babe. This mom was so grateful and her baby was so sweet!

The practice of milk donation is very controversial, especially when it’s not done through a milk bank and it’s just mommy to mommy.

In the 1800’s, poorer women nursed other wealthy women’s babies for a living, straight from the breast, because it was seen as unfashionable to nurse your own. Then with the industrial revolution and more women working, lower income families used the rural poor peasants as wet nurses. “Wet nurses” as the norm stopped by the 1900’s because of the invention of formula and bottles. Formula feeding became the norm with the help of marketing and formula companies teaming up with physicians.

Today, with the rise in breastfeeding rates, more and more families are donating breast milk or getting donations of other women’s breast milk. Milk Banks and informal milk donation is the modern day wet nursing, and a way to create sisterhood across the world.

Have you ever thought of donating breast milk or felt curious what it’s all about? Are you a mama in need of breast milk for your baby? Here is some information to help guide and inform you:

1. The World Health Organization, the American Academy of Pediatrics, and the Canadian Pediatric Society all mention donor milk as the alternative and next best thing to a newborn having his own mother’s breast milk. “Mother’s own milk is always preferred, in part because some of breastmilk’s beneficial biological components may be reduced after pasteurization. But donor human milk can be an effective alternative when maternal milk isn’t available or falls short of the infant’s needs, according to the AAP.”

2. There are two ways to receive or give breast milk donations:

• Through a milk bank (either at a hospital or directly from the bank) with a prescription
• From another mama directly (most often through social media) in Private Arrangement Milk Sharing (PAMS), also called casual sharing.

3. There are many reasons a parent may decide to receive donor breast milk:

• slow weight gain, weight loss, or failure to thrive
• breast surgery or mastectomy
• medical reason that does not allow a mother to make breastmilk or a sufficient amount of breastmilk
• adopted child
• premature baby
• baby does not tolerate formula
• breastmilk can not be given temporarily (possibly because of a procedure or because of a medication the mama is on)
• baby needs post-op nutrition
• immunological deficiencies
• allergies
• congenital abnormalities such as cleft lip/palate
• maternal death

Seen through research and clinical practice, preterm infants fed human milk (including banked donor milk), have better outcomes than when fed formula alone, related to nutritional qualities, digestibility and immunological components of breastmilk. There is a reduction of length of hospital stay, Necrotizing Enterocolitis (NEC), and sepsis in premies. More and more hospitals worldwide are using donor breastmilk for their sickest and teeniest babes.

Donor milk is often not meant to replace the baby’s own mother’s milk but to complement the mother’s efforts, especially when there is a medical need.

4. Why might a parent choose to donate/receive informally online with a fellow mama? Some moms donate and receive this way because it’s faster. There is no formal interview process or wait time and you can get your milk out or receive it as soon as the recipient or donor mama can come grab it (or you drop it off to her).

Donating or receiving this way will not cost you money. You may even create a life-long bond with the family you are sharing milk with which can be incredibly rewarding and special. And lastly, there will be no risk of losing any of the amazing milk properties in the freezing and pasteurization process done in a bank.

5. Why might a parent choose to donate or receive through Milk Banking?: The Core Curriculum for Lactation Consultant Practice states that, “Donor human milk banking is the process of providing human milk to a recipient other than the donor’s own child. It involves recruiting and screening donors, storing, treating, and screening donated milk, and distributing the milk on physician order.” Going through a milk bank will ensure safety.

6. Screening a donor for a milk bank

When a parent decides to use a milk bank, they will start with a conversation about requirements, type of screening and storage requirements. Next is a screening questionnaire, more detailed set of forms asking about health and lifestyle and consent to contact the mamas and baby’s physicians.

The infant’s doctor is contacted to make sure the donation will not have an adverse effect on the mom’s own child. The donor’s blood is tested for HIV, human T-lymphoma virus (HTLV), hepatitis B, Hepatitis C and syphilis. HMBANA (Human Milk Banking Association of North America) requires additional serological screening for cytomegalovirus and tuberculosis.

7. Processing and storage of milk at a milk bank

It is extremely important that the milk given out from a bank is treated/pasteurized because most of the milk goes directly to the most fragile of babies who are immunocompromised and whose lives may be dependent on it.

Banks collect, process, screen, store and distribute the milk to individuals who have been prescribed by a licensed practitioner. All donor milk is screened for bacteria and it is refrigerated or frozen until it is dispensed. Freezing, although it preserves most the unique milk properties, does not destroy many of the pathogens. Careful heat treatment is done with Holder Pasteurization preserving as many as the properties as possible

A note on pasteurization: It is a myth that all the best nutrients and “good stuff” is destroyed in this process. Kelly Mom writes, “Pasteurization is a very gentle, controlled heating process using special equipment that kills viruses and bacteria while still maintaining 95% of everything that was originally in the milk.”

8. Safety

Donor milk banks worldwide have shown an incredible safety record and there has never been a recorded case of becoming seriously ill from donor milk received from a recognized bank. However, it is very important to know how a mother is screened and how her breast milk is tested and processed whether you get the milk directly from the mama or if you receive it through a bank.

With informal sharing of milk, straight from another mother, there is no way of being 100% positive you are receiving safe milk—unless you pasteurize the milk yourself, it is not being done. There are possible risks associated with informal sharing such as diluted milk, contamination with pathogens or chemicals (medications), or environmental contaminants. There is the low risk (but risk nonetheless) of disease transfer. And the risk of poor hygiene and improper storage of the milk before it gets to you.

What questions can I ask a mother I am going to receive milk directly from?

Ask for her medical records, if she is on any medications, if she smokes, how she stores and handles her breastmilk and pump equipment, and her alcohol/drug use. You can even go onto the HMBANA (Human Milk Banking Association of North America) website and use their screening criteria to make sure you ask all the right questions.

Eats on Feets, the first established milk sharing organization, has created four pillars for safety that you should follow:

1. Informed choice
2. Donor screening
3. Safe handling
4. Home pasteurization.

9. Some women, after the loss of a pregnancy, decide they want to donate their breast milk.

Breast milk will ‘come in’ after the placenta comes out regardless of your baby passing away which is absolutely heartbreaking. Some of these women find comfort to know their milk is nourishing another newborn in need or may feel like it’s their own baby’s gift to another.

10. Breast milk is expensive from a milk bank

Because of the expense of screening donors, processing, dispensing and record keeping, milk banks must charge for their services. Depending on the country you are in and the service setting, the price will vary. In 2013, the price was $5-$6 an ounce, plus the expense of overnight shipping. The donor of the milk to a milk bank does not pay any money. If your baby does not have a medical need, health insurance will not cover the cost of breast milk.

If you receive breast milk privately from a fellow mama, it will depend on the mom whether she wants to ask for compensation or not (hopefully not and if so, you may want to find someone else!) HOWEVER, if you go through the milk sharing established organizations online they are not-for-profit.

A really important part of donation/receiving of breastmilk is that you as the mama make your own informed choice. This topic brings about a lot of ethical questions and concerns. You need to make sure you never feel pressured to donate your milk. Do not let the “yuk-factor” in our society push you away from gaining more knowledge.

Donated breast milk can be lifesaving for sick or premature infants. Stay open-minded and do your research on ALL feeding options and their risks and benefits. If you decide to become a donor, remind yourself that it is something only a mama can do and that you may create a life-long connection with another mama and babe. And that can feel pretty great.

Resources:

• If you’re interested in donating your milk to a milk bank or receiving breast milk from the bank, you can find locations here: https://www.hmbana.org/locations, mothersmilkbanking.com, and https://europeanmilkbanking.com/
• If you are interested in sharing your milk or receiving informally on the internet: Milk Share, Eats on Feets, Human Milk 4 Human Babies, Only the Breast, Mothers Milk Coop.