Milk Donation Dilemma - Part II

The Availability of Donated Milk

"I didn't know donated milk was available./I didn't know that people did that./It wasn't available back when I had a baby."

I mentioned before that I recently put up a post on a mom forum inquiring about milk donation and what mamas thought about it. This is Part II of a series of discussions about responses and why we have a lot of work to do when it comes to donating milk.

One of the big problems surrounding milk donation is lack of knowledge and education about it's existence. Many mamas responded in one of the ways listed above. It appears, we aren't talking about it enough.

I'm not sure how to get the word out other than how I'm doing it. I talk about it, I blog about it, I have a Facebook page about it. I think if people who know about it talk about it, the word will spread. We have to share our experiences though. If we don't, no one will hear about it.

Milk donation has changed a lot over the years, and yes, it's been around a while. I can't say for how long, but certainly most of us have heard of wet nurses - women that nursed other women's babies for a variety of reasons. I can't say for sure how long donation of expressed milk has been happening. What I do know is that my mom donated when two of my sisters were babies. The older one is now 37 years old, so at least for that long. Probably longer. My mom said bottles were dropped at her house and she'd fill them up. Opposite of the milk man, is how she describes it. They'd pick up the full bottles and leave the empty ones.

Back then, they approached my mom about it. She hadn't heard of it before that point either. I'm not sure that nursing was any more popular in those days, but now, if you want to donate, you have to seek out the information. And to do that, you have to know about it first.

So, for all you expectant moms. Yes, donated milk is available. There are a couple different channels you can go through, but it is there. Yes, people do it. They do it out of the kindness of their own hearts. For many it's a matter of not wanting to waste or throw out a stash of milk they no longer need that is taking up freezer space. For others, it is a labor of love as they take the time to pump extra milk specifically for the purpose of donating. Finally, yes, it was available "back then." Though this time period is vague, it is likely that many mamas that have children over the age of 37 may not be as internet savvy, and perhaps don't have accounts on mom forums; but, that means that the majority of moms that responded probably had babies in a time period where I know for a fact milk donation was available.

Please spread the word. Let mamas know they have options.

See the next post in this series, Part III - Bodily Fluids

If you missed Part I of this series, it can be found here.

Milk Donation Dilemma - Part I

The Importance of Breastmilk

There exists such a thing called the "Infant Feeding Hierarchy" that lists the preferred methods of infant feeding in order based on how suitable the feeding method is to feed and nurture an infant optimally. Interestingly enough, there seem to be multiple lists available. Here are a few examples:

The one most commonly listed is cited as the World Health Organization Hierarchy of Infant Feeding and is as follows:

1. Breastfeeding directly from the mother

2. Expressed milk from the mother

3. Expressed, screened/pasteurized human donor milk from a milk bank

4. Formula

Other lists are available too. Here are a few:

1. Breastfeeding directly from the mother

2. Expressed milk from the mother

3. Wet nurse/cross-nursing

4. Expressed milk from another mother

5. Formula

1. Breastfeeding directly from the mother

2. Expressed milk from the mother

3. Expressed human donor milk from another mother

4. Formula

There are many considerations when looking at these lists that may need more attention and could be the source of varying the list depending on your angle. Given that breastmilk changes according to the baby's needs when they are feed directly at the breast, it could be argued that a wet nurse is a better choice than mama's expressed milk. Some argue that since pasteurization destroys many nutrients in milk, that raw milk is superior. Still others will tell you that screened and pasteurized donor milk is safer if the mom is unable to breastfeed because there is more assurance that the baby will not contract illnesses from another mother. In reality, the discussions can go back and forth and the exact order of the list can vary, but in the end, one fact remains the same:

Breastmilk. If not, formula.

But in seeing that, this is where we run into trouble. Most people think it looks like this:

Nurse. If not, formula.

And in that, we have an error.

The bottom line is that scientifically, breastmilk is superior to formula, no matter the source. Mothers need to know that breastmilk is the best choice. Sure, nursing is ideal, but if you can't nurse, breast milk. From you, from someone else, whatever. Breastmilk. If you feel more comfortable about screenings and pasteurization or if you feel more comfortable about fully intact nutrients (taking into account that regardless of being raw, storage - ie. refrigeration/freezing - can have an effect on nutrient content), breastmilk. Donor milk is available, no matter where your comfort level lies. We need to spread the word.

In the next few posts in my series, Milk Donation Dilemma, I will address many responses given to me when I inquired on a mom forum about knowledge, education, and thoughts on donated milk. Some answers surprised me. At times it was the percentages of moms that responded in particular manners. Either way, I feel the responses need to be addressed. So, here goes...

Continue to Part II in this series.

Getting the word out...

I recently started a Facebook page to continue to get the word out about milk donation. I'm hoping to build a community via social networking. I'm not trying to set up milk sharing, as there are several organizations for that. I want to get the word out, inform, and educate.

I recently made a post on a mom networking site that asked for peoples thoughts and opinions on milk donation and the answers were varied and very enlightening. Over several blog posts, I hope to address several of the responses I received to my inquiry.

There is still a lot of work to do to get the word out. For now, check out my Facebook page here.

A matter of perspective

Not too long ago, my oldest brother and his family were over for dinner. It's no secret to most people that are close to me that I'm a milk donor and the topic came up. As we discussed it, my brother asked how much I had donated, jokingly asking if I had been able to collect a couple gallons. I let him know it was more than that and the last count to date from the milk bank was about 3800 ounces. "What's that?" He asks as he pulls out his phone with it's handy calculator. "Divide by 128," I tell him (this is the number of ounces in a gallon). As he calculates it up and sees the result, he practically chokes on his food and sheepishly puts his phone away with an approving nod. "How much is it?" his wife inquires. "About 30 gallons," he responds. Now, this sounds like a lot, and it is. Imagine thirty gallons of milk. This is not hard to do since many of us have milk in our homes and even if we don't, often we can recognize how much a gallon is. 30 of those is a lot. It is something I am proud of. When I consider this journey, I look at what I have been able to collect, and it's a good amount (and growing). I certainly do acknowledge that this is a significant amount, and not everyone will be able to contribute this. Although, from what I've been told by the milk bank, some donors have even contributed far more! Though tempting to make a competition out of this, I really can't. All I can do is keep doing what I'm doing. The final number doesn't really matter. What matters is that I'm giving. And here's some more perspective to consider. In a previous post, I described how in one week, the milk bank was short 3000 ounces. That's not the total amount requested in a week, that's just what they couldn't provide. I don't know how much they actually did provide or the total amount requested. What I do know is that the amount they were short was almost the entire amount that I had donated over 8.5 mo. Yes, my 30 gallons, used in a week's time, and then some. 8.5 mo of "work" gone, just like that. So, while it seems like a lot, it really is just a blip compared to the demand. Assuming that most donors don't offer up 30 gallons over their time donating, it makes it especially important that more donors come forth. A minimum donation for my milk bank is 100 ounces. 30 moms making this minimum donation will equal that 3000 that the milk bank was short for that week. The higher likelihood is that donor moms are able to donate more, like between 150 and 200 ounces and that means that 20 moms can fill that demand or that those same 30 could offer up 4500-6000 ounces. See how big of a difference that is? Every little bit helps.

"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."

Milk Shortages - How it All Adds Up

I recently received an e-mail update/newsletter from the milk bank i work with that described continued shortages of donor milk. The situation is so dire that they describe being short by several thousand ounces PER WEEK of the demand of the hospitals they work with. This situation is so bad, they are starting to offer incentives for referring donor moms.

To put things into perspective, let's look at how this divides up. They listed a shortage of 3000 ounces for this week. A baby weighing 6.5 lbs takes in 18 ounces per day. That amount that they are short could feed 166 babies in a day, or one baby for 166 days, or 5 babies for a month. Now take into consideration that most preemies that receive this milk are much smaller than 6.5 lbs and take in less milk. Think how far that amount goes. Or look at it and consider how desperate the need really is.

You may ask what the big deal is when formula is available. Well, the truth is, formula is inadequate. Babies in general stand the best fighting chance from receiving breastmilk to keep them healthy and protect them from pathogens. As many moms know hospitals and doctors offices can pose risks to young children with little or no immune system because that's where other children go to be treated for illnesses. Combine that with a pre-mature baby whose system isn't as developed as it should be and you aren't just dealing with a new immune system, but the whole body that is developmentally behind. Preemies are especially susceptible to necrotizing enterocolitis (NEC) which basically equates to death of their intestinal tract. The longer babies are kept in the NICU (neonatal intensive care unit) the longer they are at risk for getting NEC and the higher the mortality rate. The goal is to get babies as healthy as possible in the shortest amount of time possible so they can go home as soon as possible. The fastest way to do this is to feed breastmilk to these babies. Sadly, in many cases the early birth of the baby often doesn't allow the mother's system to catch up hormonally so she is making milk as she would with a full term baby. Also, given the need for the babies to be monitored and restricted from potentially harmful pathogens, these babies don't get the full benefits of skin to skin contact and unlimited access to the breast which also can inhibit optimum milk production for the mama. This means that donor milk is the preemies' best chance of getting to a healthy weight and developmentally mature enough to go home in the shortest amount if time (not to mention the immune components of breastmilk that help form a protective barrier from NEC).

Lives can be saved from donor milk, but if it is unavailable, in cases where the birth mom is unable to provide milk, formula must be used. This means the preemies may remain in the NICU for longer and don't have the added protection from NEC because formula cannot provide any immune components. Donors are vitally important. Spread the word to healthy nursing mamas you know that may be able to help. A little can go a long way.

Freezer Stash

My deep freeze is not typical. Most people have meat and other foods. My deep freeze? It has milk. Ok, sure, it has some of those other things too, but more space is taken up in my freezer by pumped milk than any other item. I have a collection of bagged milk for my own use. In addition, I have rows of containers for the milk bank. Granted, they are constantly rotated as I drop off donations every 3-4 weeks, but it certainly takes up space.

About 4 gallons waiting to be donated. I usually don't let
it build up this much, but my freezer is often stack two
high on this shelf. =)

If you are planning on donating, don't be daunted by the space it may take up. There are many things you can do. First, you don't need a deep freeze. A regular freezer is just fine, but you'll need to make sure that your samples are taken in more frequently. Remember, they have to be able to receive and process your milk before it expires. A deep freeze simply allows you to collect more at a time since you can hold onto it longer. The initial donation (at least for the milk bank I work with) is 100 oz. That equals out to about 20-30 storage containers depending on the size. The good thing about smaller containers is that they fit in more nooks and crannies making this a pretty easy task. After your initial donation, you don't have to worry about quantity and you can just make a donation when the milk starts taking up too much space.

After a couple months, you'll begin to start a system of how the containers all fit and where they "go" in your freezer. You'll figure out how to maximize space and how often you'll need to drop off your donations. You develop a system and the more you do it, the more routine it becomes. Happy freezing!