When Healthy Children faculty Laurie Tollens, RN, CLC, ANLC, IBCLC traveled overseas a few weeks ago to present donor milk research at a conference in England, she never expected to end up doing lactation consults on livestock. That’s right when Laurie hopped over to Scotland to visit old friends, they requested she examine a calf’s mucosal cleft and assist an ewe with mastitis.
“The hardest part was separating him from his mother and then catching him to have a look,” Laurie says of the calf. “It must have been quite a sight, me straddling a calf and getting him to open his mouth enough for me to check it out.”
Laurie also had the opportunity to feed Ewe Milk Replacer to orphaned lambs, which comes in giant, 25-pound bags.
“Even mixes in cold water,” the bag reads.
Lambs feed from plastic water bottles with funny, red teats, Laurie explains.
“They eat furiously and are so friendly once you’ve spent time with them,” she says.
Although there is no equivalent to species specific milk, there are certainly medical indications for the use of formula for both lambs and humans.
However, Laurie tells me about an interesting method farmers use for orphaned sheep: One lamb is orphaned by a mother who dies during childbirth. Another ewe survives, but her lamb does not. Farmers skin the deceased lamb, place it over the lamb who survived and present the “costumed’ lamb to the surviving ewe as an adoption method that will allow for a nursing relationship.
This practice so clearly doesn’t translate for human use, but we have another option when biological breastmilk isn’t available: donor human milk (DHM). Women’s breastmilk is a miracle commodity that saves lives every day. Unfortunately, it remains underappreciated and invisible.
Laurie recently completed research about the use of DHM in full term babies at Wake Med Raleigh Campus where she practices as a lactation professional.
Her work and research shed light on the realities of supplying human milk for all babies.
The importance of breastmilk for very low birth weight babies is well documented, but Laurie’s research serves to answer questions like:
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“What is the experience of mothers of term babies who had been supplemented with banked donor milk for medical reasons during the hospital stay immediately after birth?
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Are they more likely to exclusively breastfeed for six months or longer?
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Are they more likely to donate their milk to a milk bank so other families can benefit the way they did?
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Did they feel using banked milk shortened the hospital stay?”
Because of a shortage of banked DHM, the American Academy of Pediatrics created a hierarchy for donor milk recipients with the highest need being for infants in Level III nurseries. The Human Milk Banking Association of North America (HMBANA) estimates processing about two million ounces of human donor milk last year, but needed close to four million ounces. Still, Wake Med has access to small amounts of donor milk for term infants.
Wake Med’s milk bank is located directly below the mother-baby floor.
“We have access to milk right here and right now,” Laurie says.
Unfortunately, her research shows that this resource is virtually invisible to families and health workers alike perpetuating the idea that sharing banked donor milk is a taboo practice.
In fact, Laurie tells me that many partners demand a tour of the bank before allowing the use of donor milk for their infants because they simply can’t imagine that something like this exists.
It’s like they think there is a room full of women hooked up to breast pumps sitting in rocking chairs, Laurie laughs.
Interestingly, preliminary findings from Laurie’s research show that all mothers who received DHM for their term babies thought of the milk as a lifeline and deemed it valuable.
However, “the milk bank is under-appreciated by the administration,” Laurie says. “Someone needed to do something to show that this is around.” (Wake Med’s milk bank has been up and running for close to 25 years.)
Laurie shares an exchange she had with a Wake Med administrator:
“I want to know about the milk bank,” Laurie requested during a meeting with hospital administrators and staff members.
The hospital’s vice president cringed.
“Well apparently it’s a problem for you,” she replied.
“It just has such a stigma,” he said in defense.
Laurie suggested a billboard marketing the facility’s milk bank. Something along the lines of “Got milk?” or “We need milk” or “Donors needed.” She offers a simple design.
“Donor milk sounds like roadkill,” she adds. “We need another name.”
Solicitation of milk banks will help to change perceptions about DHM and make breastmilk visible.
After all, we openly accept sperm, eggs, blood and plasma donations, but the miracle of human milk has somehow become tainted.
Laurie remembers seeing an advertisement in London decorated with the photo of a beautiful baby. “Need sperm?” it reads, promoting an infertility clinic.
Breastfeeding advocates have been successful in teaching the public the importance of breastmilk; as a society we are very slowly accepting breastfeeding as the normal infant feeding method. But the idea of milk sharing is something to work on.
“With this study, I got some really funny remarks from women,” Laurie says about the almost disgusted way mothers responded to the option of donor milk versus artificial baby milk when supplementation was indicated.
Still, Laurie finds that making such a significant decision about infant feeding, sometimes so unexpectedly, promotes special bonding between couples.
“Where I get my giggles is watching couples become families,” she says.
Offering a living substance to nourish infants brings a sense of life and loving into hospital-care, something Laurie says we have been missing.
“Babies have become the football in the room,” she says of the treatment of babies like objects. “It makes it easy for moms not to feel connected.”
DHM offers a unique way for care providers to make connections with families and offer babies nourishment in an almost ceremonious fashion when biological breastfeeding isn’t an option.
And because DHM offers a healthy alternative to biological mother’s breastmilk, hospital stays are generally shortened. That means higher turnover rates for hospitals and generation of revenue.
Further, The Joint Commission and Maternity Practices in Infant Nutrition and Care Survey (mPINC) track the success of exclusive breastmilk feeding rates.
When mothers’ desire to breastfeed is close to 100 percent but only about half of moms leave hospitals breastfeeding, that generally sends the message that providers are failing at breastfeeding support. DHM can serve as a bridge for both mothers and health care providers.
Evaluating birth practices can decrease a hospital’s risk of perpetuating the need for supplementation.
For instance, medically unnecessary, scheduled c-sections may pose difficulties to breastfeeding.
Laurie also reminds us to question what’s going on during labor. What kind of practices affect a mother’s milk from coming in on time? Which practices cause exaggerated weight loss in baby?
One culprit is the widespread use of pitocin. The drug’s risks are documented.
One of the side effects includes excess artificial oxytocin in mother’s body that suppresses the production of her own oxytocin. Her body may be producing milk, but the hormone to release it is stifled.
Further, severe water retention as a result of excess fluids from epidurals may cause a mother’s breasts to become so firm that her baby has difficulty latching on.
While the direct effects of common hospital practices on breastfeeding are evident, it’s important to remember that the practices affect the stores of rationed DHM.
Fortunately, Laurie’s research shows that women who have received DHM for their babies, report that they would donate their own milk if they had enough.
Promoting HMBANA milk banks has the potential to decrease informal milk sharing, a potentially risky practice.
In some instances, hospital staff encounter informal milk sharing.
This practice is a hot topic. Some trust the unscreened milk from another woman over artificial milk from a formula factory.
Authors of Milk sharing and formula feeding: Infant feeding risks in comparative perspective? suggest that “instead of proscribing peer-to-peer milk sharing, health authorities should provide parents with guidance on how to manage and minimize the risks of sharing human milk.”
While the risks of formula feeding are well documented, families should also be aware of the dangers informal milk sharing.
The Missouri WIC Association shares a slideshow describing the risks including infection and medication risks and motivational concerns.
Hospitals should consider adopting health policies for dealing with informal milk sharing. Laurie says Wake Med has yet to do so.
Laurie comments on the dangers of informal milk sharing as she remembers an article about two pediatricians who put an ad out for human breast milk donations for their baby. They tested the milk received and some of it was contaminated with hepatitis and HIV, she recalls.
“It was available, but unusable,” Laurie says.
So how do we turn usable milk into available milk?
“I wish everybody would be educated so that if they have extra milk, they would know that there are babies out there who need it,” Laurie says.
She explains that right around Thanksgiving and the winter holidays, mothers who don’t have room for food in their freezers because of excess frozen milk, look for a place to donate.
Perhaps this could turn into a clever marketing campaign for milk banks?
Laurie’s hopes for the future of milk banks don’t end here. She says many hispanic mothers aren’t able to communicate with milk screening staff. If there were a more inclusive process, perhaps we could reach a larger population of mothers with milk to donate.
If receiving DHM from a facility with an established milk bank is difficult, imagine the issues families face once they are discharged.
“Once I left the hospital, trying to get donor milk was like searching for reindeer milk,” Laurie quotes one of the mother’s responses from her research.
Cost can be one concern for families. While donor milk cost is generally consumed by the hospital (Laurie explains that food is included in the hospital stay; you don’t pay for formula), once a family leaves, the cost of milk usually falls on the individual.
According to this Massachusetts Breastfeeding Coalition article, HMBANA milk banks charge a processing fee to help defray some of the costs of donor screening and milk processing. Currently, fees average $3.50 to $4 per ounce. Shipping may or may not be included in this fee, depending on the milk bank.
And depending on the circumstance, insurance plans may or may not cover the expenses.
In Nikki Lee’s, RN, MSN, IBCLC, ANLC, CIMI, CCE, CKC article The dollar value of human milk., she describes the bizarre paradigm of the value of human milk.
“…Human milk is priceless, one meaning of which is without economic value,” she writes.
At the same time, scarcity generates economic value.
Human milk matters. It’s time to celebrate the value of the banks that collect, screen, process and distribute it so that more families can benefit from this remarkable, invisible commodity right under our noses.