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

Milk Donation Dilemma - Part III

Bodily Fluids

This is part III in my discussion of problems faced by the milk donation community in response to the replies I received when posing a question about moms' opinions of the use of donated human milk. In this portion, I will discuss the repeated concern expressed (no pun intended, or maybe it was) regarding milk as a bodily fluid.

Many mamas on the mom networking site where I posed my inquiry that did not nurse their child(ren), responded that they were not interested in donated milk because they didn't want to be handling someone else's bodily fluid. In today's society, there is a concern about diseases passing via bodily fluids such as urine and blood. To a lesser extent, there seems to be a mild concern with saliva as well. And feces certainly can be a source of disease and contamination, though not typically a fluid. I apologize if this is taking a rather unsavory turn. In any case, it stands to reason that along with other body fluids that are known or suspected to be of concern, breastmilk would fall into that same category causing concern for many moms.

Here's the thing though. Breastmilk is not considered a bodily fluid. This may come as a surprise to many, but it's true. Here is a response taken from the CDC (Center for Disease Control and Prevention) website's Frequently Asked Questions regarding the handling of breastmilk:

Are special precautions needed for handling breast milk?

CDC does not list human breast milk as a body fluid for which most healthcare personnel should use special handling precautions. Occupational exposure to human breast milk has not been shown to lead to transmission of HIV or HBV infection. However, because human breast milk has been implicated in transmitting HIV from mother to infant, gloves may be worn as a precaution by health care workers who are frequently exposed to breast milk (e.g., persons working in human milk banks).

For additional information regarding Universal Precautions as they apply to breast milk in the transmission of HIV and Hepatitis B infections, visit the following resources:

• Perspectives in Disease Prevention and Health Promotion Update: Universal Precautions for Prevention of Transmission of Human Immunodeficiency Virus, Hepatitis B Virus, and Other Bloodborne Pathogens in Health-Care Settings. MMWR June 24, 1988, 37(24):377–388.
• CDC. Recommendations for prevention of HIV transmission in health-care settings. MMWR1987, 36 (supplement no. 2S):1–18S.

The full list of FAQs can be found here (though they are not all concerning the handling of breastmilk).

So, what does this tell us? Well, healthcare and daycare workers don't need to worry about special handling of breastmilk. Gloves can be worn, but it is not necessary in most cases, when preparing and feeding breastmilk. The bottom line is that breastmilk does not fall into the same category as other bodily fluids as many may believe.

Despite the status of not being a bodily fluid, there still is the possibility of transmitting disease as discussed by the CDC's website. Because of this, many health professionals would recommend that if you do use donated human milk, it is best to obtain that milk via a milk bank where the donors are screened for transmissible diseases and the milk has been pasteurized. This is one way to ensure that disease is not passed along to a young infant. Many moms do take comfort, however, in using milk donated privately if they know the donor personally. In such cases, they are likely aware of any health concerns there may be in regards to the donor and their decision to use the milk. While it does pose risks not seen when milk is obtained via a milk bank, there is less uncertainty in regards to knowing exactly from whom the milk is coming. Either way, the milk certainly is not a bodily fluid.

Continue on to the next part of the Milk Donation Dilemma Series:
Part IV - Safety and Nutrient Content of Donated Milk

If you missed previous entries, they can be found here: 

Part I - The Importance of Breastmilk     

Part II - The Availability of Donated Milk

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.