The Ugly Side of Milk Donation

I wish I could say that donating milk is an entirely altruistic endeavor. Maybe it started that way, but to be honest, I've noticed some traits developing in myself that aren't desirable or respectable. It's sad, really, but it's the truth. Through this journey I have found that at times, donating milk has made me judgmental, competitive, guilt-ridden and full of self deprecation. All things I'd rather leave behind, but it's not really that simple.

I am surrounded by breastfeeding moms. I subscribe to breastfeeding blogs. I frequent breastfeeding support sites and follow breastfeeding information, support, and activism Facebook pages. Such activities mean that I have a truly enviable support network and access to awesome resources. The judgment creeps in though. It's horrible. I know moms that could be donating but aren't and it bugs me. I don't know their life, I don't know their story, but I can't help but wonder why they aren't donating. It's even worse, when I hear about moms with oversupply that don't donate. When they talk about methods to decrease supply, it really gets me. I feel anger creeping in. It's not fair to them, but there it is. Many don't have the time. Many don't know about donation. In the moment though, none of that matters. I just feel it. I have to remind myself to keep my mouth shut (aside from the occasional nudge to consider donation) and later, I can rationalize it to myself again that they aren't bad people. They have their own lives and stories and it may not work for them. And that's ok.

When I was donating to the milk bank, I had them send me the larger containers since I ran out of the small ones they originally provided me with. They informed me that some moms need the bigger containers. I was one of those moms (insert a prideful beaming me). I looked at the amounts that others were dropping off as I'd log my donation in their book when I dropped it off and I was smug about my donation being larger than most of the others. Yep, I'm a bad person. I even called the milk bank and asked them how much moms donated on average. I wanted to make sure I was a top donor. I got a round-about non-specific and non-helpful answer (in all honesty, it's hard to say since the number of one time donors is far greater than the number of repeat donors. Who knows if they actually keep track of the averages like that?). I was determined to be one of the best donors they had. More recently I came across the news report about the mom that had recently broken the record in the Guiness Book for milk donation. I was impressed. And it made me want to do more. I needed to beat that record! But I couldn't. My little one was already over a year and the milk bank doesn't take donations after the baby is a year old. For a flash, I thought I needed to have another baby so I could beat that record. How messed up is that???? Then I decided I'd just pump, pump, pump, and donate record breaking amounts to local moms, until I came across this story of a mom that had donated over 15,000 oz. via milk bank donations and milk sharing and realized that I was nowhere near close to that and needed to up my game again if I was going to be among the top donors. Now, competition in this arena isn't necessarily a bad thing. If it means that you are doing a little bit extra to donate more, it's all the better. In some cases, something's gotta give. If you spend so much time focusing on pumping and donating, your life and family may ultimately suffer. Granted, I didn't go as far as to boost up the galactologues and increase my supply dramatically, but if someone went as far as to do that just for donation, their pocket book would suffer more than it already does if the cost of pumping supplies wasn't being covered. Priorities are important. Family is important. It's not fair for your family to suffer for your pride or that competitive edge.

Seeing reports of moms donating more is double sided. On one hand, the competitive side kicks in. To balance that out, the guilt and self-deprecation seep in too. When I see that someone is able to do so much, I wonder why I am not doing that too. What's wrong with me that I haven't done more? Why did I spend that time reading or playing a game when I could have been pumping? Why did I drop pumping sessions? How selfish am I? It goes on and on. It's not a pretty side of self-reflection. I feel guilty every time I take a break for myself. I feel guilty for not pumping more. I feel guilty that I used to pump 20 oz. per day and now I'm down to about 6. It's my fault too. If I pumped more, I'd get more. I can make excuses and rationalize, and even if those reasons are valid, I still feel like they are just excuses. It's tough. I'm not expecting sympathy, but many times, I've skipped a pumping session and beat myself up about it. I'm constantly thinking I need to go back to pumping as much as I used to so I can be giving more. I feel guilty and selfish. It doesn't go away. Despite the upset I feel towards others that don't donate at all, I still feel like what I'm doing is inadequate.

The whole situation can get ugly. It's important to keep things into perspective and acknowledge limits. Maybe had I set goals and limits from the start it would be easier than this emotional roller coaster. I don't know. I'm attempting to turn my experiences into something positive. I try very hard to not be negative towards other moms that could donate but don't, I try to gently encourage moms to donate that can, I try to spread the word and not brag (too much) about what I've accomplished (there are certainly others that have and will put me to shame). It's a side of milk donation and myself that I never expected to see, but there it is. It keeps creeping back no matter how hard I try to suppress it. It's always there hanging over my shoulder. My hope is that despite my shortcomings, my efforts to encourage others and educate about milk donation do some good.

Has it really been that long?

A few days ago, my youngest turned 20 mo. I can't believe he's so close to turning two! In my mind, I'm still in baby phase. Not infant phase, but he's still my baby.

With a 20 mo. old, that also means I've been donating for over a year and a half! That's truly exciting on it's own! I first donated to a local mom while I waited for paperwork to go through with the milk bank. Then, it was 10 mo. with the milk bank starting from when my youngest was 2 mo. old. I continued to donate to the local mama as long as she needed it. When my baby was a year old, I stopped donating to the milk bank (since they give to premature babies and those in the NICU, they don't use mature milk) and began seeking out other local moms that were in need of milk. Through various channels, I found several and have continued my milk donation journey.

To date, I have donated over 4700 oz. to the milk bank and over 2200 oz. to local mamas. Granted, that's no Guinness Record, but I'm sure the recipient babies don't mind. As a result of donation, I've gained 5 "milk children"  from local donations and countless anonymous ones via the Milk Bank.

I love being able to help babies in need when I've been blessed with a good supply. I'll keep on going as long as I can. I have no idea when the journey will end and when my little one will wean, but the day will come. It certainly is sad, but I hope through all of this, I've been able to inspire others to donate or at least spread the word about donation so more babies can benefit.

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.

Milk Donation Dilemma - Part V

The Cost of Donor Human Milk

In previous posts in this series, we've discussed some of the many impressions people have about donor human milk. Now, we'll visit another major concern about milk and if this concern is truly something to worry about - the cost of donor human milk.

Many mamas would love to give their baby human milk rather than supplement or entirely feed formula due to a number of reasons. Perhaps the baby has difficulty digesting the formula, maybe the mom prefers to feed breastmilk because it's safer for babies and allows them to grow to their full potential. Whatever the reason, a major drawback that moms mention is that milk obtained from a milk bank is very expensive. Depending on the source of the milk, this is a valid concern.

Human milk obtained from a milk bank can run around $4 per oz. That means that a baby that takes in 18 oz per day (the amount taken in by a 6.5 lb preemie as reported by Mothers' Milk Bank of Austin) will cost his or her parents over $2000 per month. That's not really pocket change. The cost of the milk in many cases isn't even a matter of wanting to gouge parents for all they are worth. Many milk banks like Mothers' Milk Bank are non-profit. The cost of milk covers the processing, donor support, staff, and bills. They don't make a profit so the price is set to cover costs, not make money. This can be incredibly burdensome for some parents as feeding 24-36 oz (the amount a bottle fed full term baby eats in about a day) could run a whopping $17,000-$25,000+ to exclusively feed their baby breastmilk for the first 6 months of life if obtained from a milk bank. And that's if they don't inadvertently overfeed their baby which is a serious risk for bottle fed babies. Granted, when they start introducing solids, the total intake of milk may decrease, therefore saving the parents money for the rest of the child's first year or as long as they choose to continue feeding breastmilk thereafter.

So, what's a parent to do if they can't provide all the breastmilk their baby requires, but still want to feed breastmilk? Well, certainly, if they can afford the cost, they may be able to obtain a prescription for the milk and pay for it themselves. Alternately, some insurance companies may help cover the costs, but this is much more likely in situations where the baby is in the NICU at which point, insurance companies may cut funding after the baby is sent home. However, there are babies that require a prescription because they can't handle formula for a medical reason and therefore insurance may still be an option. I'd assume these situations are few and far between, though I don't have the statistics on it to offer accurate numbers and factoids.

When milk obtained through a milk bank proves to be too expensive, moms have the option to obtain milk from mom-to-mom donations, or milk-sharing, the "black market" of breastmilk, if you will. Milk-sharing, is made possible through groups like Human Milk 4 Human Babies, Eats on Feets, and MilkShare which are organizations that help connect donor and recipient families and education people on "informal milk-sharing." Moms that are connected to donors through this avenue are not typically required to pay for the milk they receive, although, there are some that choose to charge moms for their time invested in pumping extra milk. Often recipient moms will offer to cover costs of supplies like pump part and attachment cleaning supplies and collection bags to help defray the costs that the donor must put forth in order to donate milk. Typically, these arrangements are agreed upon by the individuals involved, but usually, there is no requirement for payment. In the cases where the recipient pays or helps cover pumping costs, the amount is significantly less than a mom would pay for milk from a milk bank.

There is another option depending on your situation and where the milk is obtained. Some milk banks, like Mothers' Milk Bank of Austin, have programs for those in need. These programs help provide human milk to babies in the NICU regardless of a parents ability to pay if insurance doesn't cover it. Unfortunately, for this option, there has to be a need for the milk. Qualifying for the program may be limited as well.

The point then is this. Yes, donor human milk can be expensive if it is obtained from a milk bank. Fortunately, that's not the only option for moms hoping to supplement with or entirely feed donated human milk. Regardless of where the milk comes from, moms need to be aware of their options so they can research them and make the best decision for their family.

For more posts in this series visit:
Part I - The Importance of Breastmilk
Part II - The Availability of Donated Milk
Part III - Bodily Fluids
Part IV - Safety and Nutrient Content of Donated Milk

Milk Donation Dilemma - Part IV

Safety and Nutrient Content of Donated Milk

Continuing on with my forum post inquiring about whether or not non-nursing mamas considered or used donated milk, I saw this concern come up among one of the top concerns posed by moms. Many moms responded that they knew about milk donation but said they wouldn't take breastmilk from someone when they didn't know what that person's diet or medication habits were or what their disease status was. These all sound like very reasonable concerns, but let me try to calm some fears with rational thinking.

Breastfeeding is a conscious decision in most cases. A mom that breastfeeds their child is concerned about the well-being of the baby. It is unlikely that a mom who breastfeeds (or any mom for that matter) would want to do harm to her own child. Her breastmilk that is fed to her own baby is affected by her life decisions and disease status. The chances of her taking in something that could cause harm to her own child or nursing with a potentially harmful disease that could pass to her child are low.

But what about diet? Should a mom be concerned about the overall nutrient value of the milk she feeds her baby? Despite the low probability of a mom taking on medications that could harm the baby, diet is quite another thing. Not all moms eat well, even well meaning moms. Most of us fall into the habit of eating fast food once or more per week. Should this be a concern? It sounds logical, but surprisingly, the answer is, "No." The body has an amazing way of making sure that breastmilk has the appropriate amount of nutrients to grow a baby regardless of the diet of the mom. According to KellyMom, among other sources, the mother's own system is more likely to take a hit from nutritional deficiencies than her milk. Just like in pregnancy, the mother's body does all it can to provide for the baby, even if that means taking from the mom's own stores. Prenatal vitamins are for the health of the mom, not the growth of the baby. The same goes for breastfeeding. Eating well and ensuring proper nutrient intake while nursing helps the mom to stay healthy and put back into her body what is taken in the production of milk. This is one of the many reasons that in the third world it is not uncommon for young children to continue to nurse far beyond infancy because breastmilk is far more nutritious than the limited amount of food they may have access to. Regardless of the diet taken in by the mom, you can rest assured that the milk she donates is nutritious.

To add more fuel to the fire, despite the small possibility that a mom may take a medication that is not recommended during breastfeeding, it is important to think about the caliber of woman that pumps milk. A mom that pumps milk is so concerned about her own baby's health that she is wanting to provide her milk for her baby even when she is away. Either that or she's pumping to help her supply to be able to provide more of her own milk than supplement. Regardless of the main reason, a mom that pumps is doing so to ensure a successful breastfeeding relationship with her baby. That's how important it is to her. She is conscientious enough to pump and that concern is likely to affect other areas of her life in the decisions she makes about diet (even though it may not directly affect her milk) and the medications she takes. Pumping takes time and effort. No mom that pumps takes the activity lightly. This care and concern is passed along when a mom chooses to donate. Additionally, there are two types of donors - those that donate extra milk they can no longer use and those that pump extra for donation purposes. A mom that donates extra milk she has stored intended that milk for her own child but in finding she is unable to use it sees such a high value to that milk, that she won't just throw it away - that is how precious it is. A mom that pumps extra for donation is taking extra time out of her day that she may not otherwise take to pump for another person - someone who cares that much for another mom is only thinking of helping and supporting other moms and she will ensure the milk she donates is just as safe and healthful as the milk for her own child since her own child is nursing as well.

While illnesses and disease status may be of concern with donated milk, there are a few ways to address this possibility. An open an honest dialogue with a potential donor may present a situation that a recipient mom is not comfortable with;  however, as long a good communication is maintained, these concerns may be addressed and likely, through the donation process the moms will become friends and trust will be built. Another option is receiving milk from a milk bank where the milk has been screened and pasteurized. While some feel the pasteurization decreases nutrient content, the nutrient alteration is negligible and a recipient mom can rest assured that the milk is free from harmful bacteria (although, at the same time, it's free from beneficial bacteria as well, so that is something the mom needs to be aware of).

The bottom line, is that a mom that donates is likely a person of high standards of care for he own child and a very caring individual. She cares enough to nurse her own child and on top of that, pumps to either nurture her own child or help someone in need. Pumping and donating is not malicious or negligent. It is a true gift from a caring individual who values the gift as much as the mom who receives it.

For the next part in the series, click here: Part V - The Cost of Donor Human Milk

Please see other entries into this series Milk Donation Dilemma:
Part I - The Importance of Breastmilk
Part II - The Availability of Donated Milk
Part III - Bodily Fluids