Crying Over Spilled Milk

At no other time in your life does that cliché hold more weight to it than when you become a breastfeeding mother. Even more so if you are a pumping mom. And, dare I say, even more if you suffer low supply.

There may be no use in crying over spilled milk, but if you reach that point in motherhood, you certainly understand it. I would guess that likely every mom that has pumped has a story to tell about spilling milk and the lament that followed.

I remember one time when I was having a discussion with my sister-in-law as I sat at the table pumping away (yeah, no shame, but really, I did cover myself and block most from view). We were discussing how we both manages to have decent supplies and stating we hardly had a pump session that resulted in less than 5 oz. (times change, and fluctuate, because I can tell you, I've had many since then that were significantly less). In any case, some how, the strap that held the collection/storage bag onto my pump released and the almost full bag dropped to the floor, landed on it's side and ejected almost all of it's contents. After the cleanup and my return to pumping, I was able to squeeze out only another ounce. I was upset. A pumping session that would have resulted in 6 oz. left a meager 1 1/2 oz. At that time, I'd never had such an empty bag after a pumping session. The sad thing is, I was more bothered by my sullied reputation for not pumping a respectable amount. I know I did in fact pump a nice amount, but the loss, in my mind was more about the low total than the actual loss of the milk. Believe me, I know how bad that admission sounds. It makes me seem like a truly horrible person. Even then, I probably didn't realize the real reason I was upset, thinking it was the loss of the milk, or I was in denial about the real reason. The fact of the matter was though, that at the time, I didn't need to pump. I was pumping to create a stash that hardly got used. I was a stay at home mom with my first baby and hardly a reason to leave him. There were all of two times in his exclusive breastfeeding stage where he received bottles. At the time, not only did I not need a sizable stash, but if I lost any, I could always pump more. I had no reason to really be affected by it.

If I'm going to be completely honest I have to admit that I've always taken for granted the fact that I respond well to the pump and that I have oversupply. At least with donating, some good can come of my over-sized ego and sheer narcissism. Even better, those traits drive my competitive side so I try to pump more and donate more, so it's actually resulting in good, right? At least I can try to convince myself of that. Regardless, today, I experienced a huge change in my reaction that maybe means I'm more human than I thought.

I had just finished pumping and was moving the bag of freshly pumped milk to the refrigerator pressing the zipper on the pouch closed as I walked. My three year old appeared in my path and before I knew it, he was reaching up and squeezing the bottom of the pouch expelling milk in the process out of the small portion of the zipper yet to be sealed. Milk squirted out the top of the bag and splattered on the floor. A pain shot through my chest as I looked stunned at what had happened. Tears welled behind my eyes and I started to get choked up. I was so saddened by the situation and couldn't help but to glare at my child who smiled as if proud of what he had done. He then proceeded to lick the milk of the floor and declare, "It's mama milk!"

I certainly have come a long way. In reality, the amount that was spilled was probably less than half an ounce, but it seemed like it may as well have been my whole stash at the time. Things sure have changed over this journey from my first views of breastfeeding, to meeting more breastfeeding and struggling mamas, and now to having participated in donating milk over the past year and a half. I certainly have grown in my views and opinions. I've also learned a lot. I'm much more upset about the loss of milk because I know what some mamas go through to provide it for their little ones. I only hope that I can share that knowledge and the knowledge that even a small amount can be a big help.

Pumps, Pumps, Pumps

It seems these days that when a mom is expecting and planning on breastfeeding, a breast pump soon becomes a "must have" item. A lactation counselor I know says it's actually better to wait until after the baby is born to find a pump that will suit your needs when they arise. Part of this is because in the first couple of weeks it's important to establish breastfeeding with the baby and not worry about pumping. If needed, that can come later. Some women never have need of a pump. With new changes to healthcare requirements, pump ownership may become more popular. And of course, if you are like me, you'd encourage pump ownership simply for the sake of donating. This was the main use of my pump with my second.

I received my pump as a gift from my mother-in-law. She's an IBCLC and made sure to get me a high quality pump. I use a Medela Pump In Style Advance. It really is a wonderful work horse. It's the only pump I can comment on as far as quality and how it works since it's the only one I've used, but it's not the only pump out there. It is very popular for a reason, but there are other choices.

The first thing to think about when you are considering a pump is that some moms don't respond to the pump well or at all. That's ok. Our bodies are made to respond to a suckling baby, not plastic cones mimicking the movement. Unfortunately, many women don't realize this and think that if they only pump a small amount that they are having supply issues. Pumping small amounts is never an indication of supply problems. The normal amount women pump is 1/2 - 2 oz. for both breasts combined per session that lasts 20-30 minutes. Many women find that as time goes on, they respond better and better to the pump (usually after multiple daily pumping sessions), but not all women find this to be true. It's important not to be discouraged. If you need to pump and provide expressed milk for your baby, consider increasing the number of pumping sessions. If you are simply building a stash or pumping to donate, just go with whatever works into your schedule. Any little bit helps. No matter your pumping situation, if you encounter problems, low yield, pain while pumping, etc., always seek the help of a lactation consultant. They are trained to not only help with breastfeeding, but also pumping and may be able to help you with positioning, making sure parts are sized correctly for you, etc.

So, when comparing pumps, here are a couple of things to consider. Think about what you want and what will work best for you.

Type of Pump
There are two basic types of pumps hospital grade and personal. Hospital grade pumps are typically the most powerful pumps available. They are owned by hospitals and other pump locations/nursing centers and typically rented out. Most moms don't use these for an extended period of time - usually only if providing for a baby that must remain in the NICU. If a pump is needed for extended use, like for moms that go back to work or those donating, a personal pump is usually preferred. These are a bit less powerful and vary based on manufacturer, but they are smaller and more convenient to carry around.

Pumping Mechanism
There are three different types of "pumping mechanisms" as I'll call them for pumps. Pumps come in manual, single electric, or double electric. A manual pump is just that. It is a pumping mechanism with a "trigger" like you find on spray bottles. The top attaches to a bottle or other collections container. As you pull on the trigger, milk will be drawn out and collected in the container. Manual pumps are great for their compact size and affordability  Many moms will get one of these as their starter pumps or if they are only going to be pumping a limited amount. Single electric pumps are electric pumps that will pump one breast at a time. They are electrically run so they are more powerful than a manual pump. Pumping may take more time since only one breast can be pumped at a time, but the cost savings can be a bonus. Double electric pumps allow for pumping both breasts simultaneously. These pumps are the most popular for working moms and other moms that pump multiple times a day because of the time savings. Some offer the ability to pump only one or both breasts at a time which is a nice feature.

Pumping System
Electric pumps come in one of two types of systems. This is a very important aspect to examine when choosing a pump and is often the most overlooked. Pump systems are either open systems or closed systems. While the style of system may or may not affect the efficiency/efficacy of pumping, it makes a difference to many moms who may be looking for a deal on pumps. An open system pump is a single user pump. It should always be purchased brand new and never sold or donated. With proper use, no milk should ever get into the electronics, but it is built without a mechanism to block any contamination of the parts so it they are never to be given to another user for hygienic purposes. Many "experiments" have been done where pumps of this style have been opened up and growths found which can not be cleaned out. It sounds gross, but since the pumped milk never comes in contact, it doesn't affect the milk, but it can pose health risks if shared by another mom. Similar to toothbrushes - you can reuse yours over and over, but you wouldn't want to use someone else's. These pumps may be more affordable or effective depending on the manufacturer and since some moms plan to use pumps for multiple children (and often run it down anyway after multiple kids), the single user requirement is a non-issue. Closed system pumps have a sort of cut-off that prevents anything from entering the electronics chamber in the unlikely event that milk or other contaminants go beyond the pump attachments. This is the system used for hospital pumps which is what allows them to be rented and used by multiple moms. Each mom simply purchases a new attachment kit. In the case of closed system personal pumps, these pumps can be used by multiple moms, purchased used, sold or donated after use. In most cases, these pumps are safe to use as long as the new user purchases their own pump attachments. Users may find that these pumps are more expensive than others depending on the manufacturer.

In addition to what I mentioned above, different pumps will have additional features or traits that make them more able to tailor to your needs. Some of these features may include a battery pack, car hook-up, and hands-free features. Some pumps come with parts and additional "goodies" that should factor into cost such as storage bottles, bottle cooler, and pump attachments.

In many cases, moms find that you pay for what you get. As a general rule, more expensive pumps are often more efficient and easier to use, but that doesn't mean there aren't other good quality pumps at lower prices. It's a good idea to talk to pumping moms that will have the same type of pumping requirements or habits to see what they use and which ones they like. Another option is to consult a lactation consultant as they will be able to help you choose a pump that suits your needs as well. Happy pumping! And remember, if you have extra stash or can donate some extra pumping time, NICU babies and other babies that are unable to get milk from their own mom will greatly appreciate your efforts and donations.

Let's look at some numbers for 2012...

Since donating to the Mother's Milk Bank at Austin (MMBA), I've been receiving their newsletter that they send out periodically. One of the great things about the newsletter is that they often include status reports of moms they've helped, donors they've approved, etc. It's nice to look at milk donation on this level and see what's going on. It's one of the few ways we can. Since milk-sharing is not regulated or controlled, there is virtually no way to count it and keep stats. This is good and bad. It means we don't know how many moms are in need, how many of those moms are getting help, how many moms there are out there helping, etc.

So, let's take a look at some of the numbers we can look at from one of the 13 HMBANA (Human Milk Banking Association of North America) milk banks.

21 - the number of states where MMBA ships milk
90 - the number of hospitals that MMBA serves
20 - the percent of milk donated to MMBA from the Houston area
20 - the percent of milk processed at MMBA that returns to serve Houston area hospitals
484 - the number of donors approved in 2012 (as of the date of publication)

In addition to those numbers, there is one more

5 - the number of HMBANA milk banks in development

While these numbers are wonderful, I can't help but be slightly saddened. In my mind, it's still not even remotely close to being enough. According to the CDC, about 1 in 8 babies is born premature. While not all babies will need donor milk, a lot do. Often, more than one donor is needed to feed a single baby, and considering that many babies continue to need donor milk after they leave the hospital to their first year after birth or longer, and the number of term babies that need donor milk, it starts to get really daunting. MMBA has even recently sent out a notice on their Facebook page describing how their freezers were empty. With no milk, they can't help babies in need. These babies will either have to receive milk from other milk banks, if it's available, or try to make it off of formula.

With hard work, more exposure to milk banking, recruiting more donors, and educating moms on breastfeeding, the demand can be lessened. One day, we may be to a point where the needs are all met, but for now, we just must spread the word and do what we can to facilitate moms and babies in need.

Down the Drain...

The other day, I did something truly depressing. I dumped milk down the drain.

To many people, this isn't a big deal at all, but breastfeeding moms, and especially those feeding donated milk, feel a twinge of pain in the gut when they hear this. It's sad. Terribly sad. That milk could have fed some super cute and needy babies.

Oh, how very depressing...

In my case, that milk was part of a small stash I saved for my little one just in case we needed it when he was young. It was hanging out in my freezer for over a year. In a regular freezer, which this was, milk is good up to 3-4 months. Likely closer to 4 in mine since we keep it so cold, but regardless, 12 mo. is a far cry from four, so it was time for it to go. It's just that as a breastfeeding mom, it's hard to toss, even when it's been long expired.

Here's the kicker though, as a milk donor, this makes me feel a bit irresponsible. I really could have planned better, and had I had some forethought, I likely never would have been wasted. What I should have done, and what I'd suggest to any mom that pumps, for whatever reason, is to manage your stash and rotate stock. It'll avoid waste and hopefully help someone in the process.

If your stash is looking too big, or you have some milk that you may not be using in the next couple of months or so, see if there is a way to donate it. Pump some off to replenish your personal stash and donate the earlier milk to somewhere or someone where there is a higher likelihood of it being used. It's completely understandable to have milk as back-up. I'd recommend it to most breastfeeding moms because I'm just the type to want to plan for everything (though my execution is often lacking). By rotating your stock, you are sure to stretch the usefulness of your personal stash and you can help others. If your stash is larger and you get up to 100 oz., you can donate to a milk bank (more or less depending on their guidelines). The bank I donated to took 100 oz. as a minimum for only your first donation and after that you could bring as much or as little as you had. Every little bit counts, so if you brought in that first 100, then maintained a freezer stash of 20-25 oz., you could rotate every so often so you have the freshest supply and donate the milk that is still within date, but then it can go someplace where it will get used before it goes bad. If you find a local mom that can use it, they typically don't have minimums and will take any amount you have to give, so that's a great option to consider.

The aftermath

Now, a plan like this doesn't always work out, for example, I have some milk I pumped when I got sick a few times. That milk I saved for myself and wouldn't give to anyone but my own kid who was already exposed to the illness and antibodies through nursing during the illness. Certainly, that milk will stay in my stash until it expires. In most cases though, rotating your stash is a great option and doesn't take a huge commitment in many cases. Every little bit helps. You can be sure those babies appreciate it.

Obtaining Liquid Gold

Among mamas that find it extremely important to feed breastmilk to their baby but have difficulty nursing themselves, there is a big problem: Access.

Sad to say, many moms do not have access to donated milk, or they don't know how to gain that access.

Among many health professionals, the only substitute for mamas own milk is milk from a milk bank. The reason for this is because milk obtained from a milk bank is screened and pasteurized for safety. Breastmilk is considered to be "living" because it has many live components like antibodies and beneficial bacteria. As a result, it is highly susceptible to spoilage and is a wonderful site for more "bad" bacteria to grow and thrive. Because this is obviously dangerous to a young baby, pasteurization is used to decrease the risk of pathogens that could cause illness in a baby. While the elevated temperatures required to pasteurize the milk may destroy some nutritious components, it's not enough to make it non-nutritious and still contains many more nutritive and health promoting factors that make it far superior to any formula.

The issue with obtaining milk from a milk bank is two-fold: limited supply and cost. The sickest, tiniest babies and those with the greatest need for it are given preference for receipt of the donated milk. This is certainly as it should be. A full term baby is much more likely to grow and do decently well on formula, whereas preemies in the NICU (neonatal intensive care unit) are at a much larger risk of diseases, especially necrotizing enterocolitis, which literally will kill off the lining of the digestive tract which then can lead to death. In many cases, obtaining a prescription for donated milk is reserved for those in most dire need. Given our advanced medicine today, many immature babies are able to survive when born earlier and earlier in the gestation process and therefore, the demand for human milk is growing as these babies are at the highest risk for infection. This means even less available for otherwise healthy full-term babies. Assuming a parent can obtain a prescription for milk from a milk bank, cost then becomes a limiting factor. Many insurance companies may not pay for human milk, and those that do may limit the amount they will pay for. Given that the milk can cost about $4 an ounce, parents may not be able to afford to give it to their child for any extended period of time.

There are fortunately, a few solutions to the above listed problems. First, donors, donors, donors! There almost certainly will never come a time when milk banks tell mamas they no longer need donors. More donors can certainly ease the lack of supply to support the demand for milk through milk banks. Second, moms may consider milksharing. Milksharing is obtaining donated milk directly from another mama. Certainly, there may be risks associated with feeding donated milk that has not been screened or pasteurized; however, through open communication, those risks may be minimized. There are many milksharing organizations out there that connect potential donors and recipients. Donors may either donated to a milk bank or via milksharing or both depending on their preferences and comfort level.

No matter the method, mamas can obtain this liquid gold for their babies. It's a matter of asking the right questions and knowing their options.

"Booby Traps" in the NICU and How Donor Milk Can Help

I recently read an article from a great site, Best for Babes, that discussed challenges to breastfeeding that moms encounter when their baby must spend time in the NICU. The article was one of many in a series that brings to light societal challenges to breastfeeding that almost leave breastfeeding moms defenseless and defeated. In any case, one of the NICU challenges the article discussed mentions lack of donor milk.

The lack of milk available in NICUs is multi-facited. Some hospitals don't offer donated milk at all forcing moms of fragile babies to depend on artificial feeding if she experiences difficulty or is not allowed to provide milk herself via nursing or pumping. Some hospitals offer donated milk, but it may not be a feasible option if the patient's insurance does not cover the cost (despite the fact that treating illnesses that donated milk can help fight could cost hundreds of thousands of dollars more in comparison). Only a few hospitals provide donated milk (if the mother can't/doesn't provide it) regardless of insurance (at cost to the hospital) but typically this is based on the gestational age of the preemie. Fortunately this number of hospitals is growing, but it is still very low. The cost of donated milk itself can be daunting if insurance refuses to pay for it. Donated milk can cost $3-4 per ounce. That means if parents choose donated milk regardless of the insurance company's refusal to pay, parents could spend $16-60 PER DAY their baby is in the NICU. Depending on the age and development of the baby, that could be several months worth of milk. In addition, physically having the adequate quantity needed on hand to provide to babies is necessary as well, which is a huge concern considering that over the past several weeks, the milk bank I donate to was several thousand ounces short of requested milk. They physically could not supply what was needed by the hospitals they provide milk for.

Certainly, it is up to the administrations of individual hospitals to determine if they will make donor milk available to their patients, but likely lack of supply could be a leading factor in the decision. Obviously, one of the biggest contributing factors to helping babies thrive in the NICU is encouraging and supporting the moms to breastfeed and pump for their infants. Donor milk can help fill in the gaps to protect these babies from life-threatening diseases. The more moms that are willing to become donors and the more milk that is donated will help relieve some of the stress on hospitals meaning they have more to provide to their patients. If these hospitals are able to receive adequate supplies, perhaps more hospitals could be served by milk banks, helping more babies.

It's a lot of pressure when the big picture is examined, but every ounce counts - in more ways than one, and every donor can help new moms break free from a very common "booby trap."