This week, in recognition of World Breastfeeding Week, I am attending a fundraiser in my community, Seattle, for the Northwest Mothers Milk Bank, (NWMMB) which includes a reception and screening of the documentary, Donor Milk. I am excited to support this important mission and am looking forward to viewing the film and participating in the Q&A afterwards with the filmmakers, NWMMB team members, a donor mom and a physician who routinely prescribes donor breastmilk for patients.

Science & Sensibility's Lisa Baker and Deena Blumenfeld discussed the newest American Academy of Pediatrics' statement on Breastfeeding and the Use of Human Milk, Donor Milk for Preterm Infants and the formation of a donor milk bank in Calgary, Alberta, Canada in some posts earlier this year.

I wanted to learn more about Northwest Mothers Milk Bank right in my own backyard, so I contacted Scotti Weintraub, Executive Board Member for the organization to get some of my questions answered.

Sharon Muza: Whose idea was it to start the NWMMB?

Scotti Weintraub: A group of local lactation professionals had been talking about the need for a milk bank for several years. In spring 2008, enough people were talking about it that an open meeting was held for anyone interested in starting a milk bank. From that initial meeting grew the beginnings of a board of directors and a committed group of volunteers.

Sharon Muza: Why Portland, OR and the Pacific Northwest?

Scotti Weintraub: Right now the closest nonprofit milk banks are in Denver and San Jose. Oregon and Washington have the highest breastfeeding rates in the country so it makes sense that we'd have a milk bank in the Northwest. Our volunteer effort grew in Portland and we incorporated as a nonprofit in Oregon.

Photo courtesy of NWMMB

Sharon Muza: How has the vision of a milk bank been received in your community?

Scotti Weintraub: Very positively! People involved in lactation are extremely supportive of our mission and want to see a milk bank open. When we talk to the public, we often get asked, "Shouldn't Portland already have a milk bank?" They are right - it would make sense that Portland and the Northwest would already have a milk bank.

Potential donor moms have been also very interested and supportive. We have a great deal of education and outreach work to do in the broader medical community. The research is strongly in support of the use of donor milk and it is evidence-based best-practice. But there are some who have been slow to embrace the unknown and have questions. Part of our work up to and from here is to educate medical professionals and increase the use of donor milk.

Sharon Muza: Have there been any concerns or less supportive comments or actions?

Scotti Weintraub: Overwhelmingly people have supported our efforts. When we are questioned about the safety of donor milk or why it's so important, we point to the clear research. Similarly, the AAP, WHO and the Surgeon General have all advocated donor milk as the next best food for babies if their own mom's milk isn't available.

Photo courtesy of NWMMB

Sharon Muza: Are you modeling your bank after one already in existence?

Scotti Weintraub: The Human Milk Banking Association of North America has been hugely helpful in our start-up process. Member milk banks have graciously shared their insight, time and wisdom. We are modeling as much as can on their success.

But each community is unique and each milk bank is unique in its structure, how it's funded and how it operated within its community. The Northwest Mothers Milk Bank is an independent 501c3 organization whereas many milk banks are part of a larger hospital system or hospital foundation.

Sharon Muza: How many human milk banks are there in the US right now?

Scotti Weintraub: Right now there are 11 operating milk banks in the US. There are several that are considered "Developing" like NWMMB - meaning that we have met some criteria set out by HMBANA and are in the works. A couple other milk banks are not yet considered "Developing" but are moving in that direction. Here's the list.

Sharon Muza: What is the cost to families who need milk?

Scotti Weintraub: Milk banks charge processing fees to cover the costs of screening donors, processing, pasteurizing, and culturing the milk and shipping. This fee is set by the individual milk bank based on their costs, so we don't yet know what NWMMB will charge for processing fees.

Donor milk that is dispensed while a baby is in the hospital is charged through the hospital. Some of our NW hospitals are providing donor milk to their patients and are absorbing the costs into their budgets. Some insurance companies cover donor milk. There is more work to be done encouraging insurance companies to cover the costs of donor milk.

Photo courtesy of NWMMB

Since we are not yet open, I will share the policy from Mothers' Milk Bank Austin, TX

"When your baby is hospitalized, the milk processing fee and shipping are billed to the hospital, and subsequently your insurance company. If a baby is not hospitalized, the fee will be billed to you. Texas Medicaid currently covers the cost for donor milk for a limited period of time, when medically necessary. If your family has private insurance, we encourage you to file a claim. We are happy to work with the family, the baby's healthcare provider and insurance company to obtain coverage. If necessary, we can establish a payment plan. All babies with a medical need for milk, whose moms cannot provide milk, are eligible to receive it for at least a limited time, regardless of ability to pay."

Sharon Muza: What is the cost to collect, test, process and distribute milk?

Scotti Weintraub: Nonprofit milk banks do not recoup their processing costs with the processing fees they charge and must raise additional funds. Costs vary a bit depending on volume, equipment, etc.

Sharon Muza: Who will the milk be available to? How will priority be determined?

Scotti Weintraub: Donor milk is available by prescription only. Priority is given to the sickest and most vulnerable infants depending upon availability. So there is a triage system for dispensing milk, especially during times of low supply.

Sharon Muza: Under what circumstances are babies most likely to need donor milk?

Scotti Weintraub:

• preterm birth
• failure to thrive
• malabsorption syndromes
• allergies
• feeding/formula intolerance
• immunologic deficiencies
• pre- or post-operative nutrition
• infectious diseases

Sharon Muza: What if a family cannot afford the milk?

Scotti Weintraub: Families are not turned away due to inability to pay.

Sharon Muza: How is the donor milk tested and treated to insure its safety?

Scotti Weintraub: Here's how the milk is processed. The milk is pasteurized and then cultured to ensure the absence of bacteria. Frozen donor milk is thawed, nutritionally analyzed, cultured, pooled and poured into bottles, then pasteurized at 62.5 C in a shaking water bath or automatic pasteurizer. Pasteurized milk is quick-cooled, then frozen at -20'C. Microbiological cultures are obtained by an independent laboratory from individual donors' deposits prior to pasteurization and pooling, and from each batch of milk after pasteurization. This is done to verify that no heat-resistant pathogens are present before pasteurization, and that there is zero growth of bacteria after the heating process.

Sharon Muza: What are the obstacles to establishing the Northwest Mothers Milk Bank?

Scotti Weintraub: Fundraising! If someone gave us a check for $150,000 tomorrow we could be open in a matter of months. We have raised over $300,000 but must raise the remaining $150,000 before we can open. As soon as we have secured the necessary funds, we will work quickly to open.

Photo courtesy of NWMMB

Sharon Muza: How much milk do you anticipate moving through your milk bank yearly?

Scotti Weintraub: We anticipate processing at least 40,000 ounces (more than 312 gallons) a year. We also know that we are shipping a large volume of milk out of the region right now. For instance, in June we shipped over 5,700 ounces of donated milk from four of our Donor Drop Off Sites to other milk banks. And that's only the milk from less than half of our current drop-off sites (the others haven't yet reported their volume). We anticipate growing the number of drop-off sites and donors once we open. So we expect to have a large volume right away.

Sharon Muza: How can childbirth educators help spread the word about donor milk in their classes, both for potential donors and those in need?

Scotti Weintraub: Everyone who works with pregnant and new parents can play a role in spreading the word. Childbirth educators can tell expectant families about the availability of donor milk should they need it (most have no idea what donor milk is or that they could access it) and let them know that donation is also possible, if they have an abundance.

You can also encourage medical facilities and providers to utilize donor milk for their patients. Find out if donor milk is available in your area NICUs and family birth units. Share information about research and best practices to encourage the use of donor milk.

Sharon Muza: Can nursing mothers with babies of any age donate milk? Do you try and match new mothers' milk with new babies?

Scotti Weintraub: Each milk bank sets their own donor requirements based on the HMBANA guidelines. Generally milk is accepted from babies less than one year old. All milk donations are pooled - meaning that the milk from 3-5 donors is mixed together within one batch. This ensures even distribution of the milk components. Occasionally, specialized milk is available - for instance preterm milk or dairy-free milk.

NWMMB Education Vid from Bob Eggleston on Vimeo.

Sharon Muza: What are some of the benefits of donor milk for babies?

Scotti Weintraub: According to the AAP, these are the benefits:

• lower rates of necrotizing enterocolitis (NEC) and sepsis
• fewer readmissions to hospital
• higher intelligence testing scores and higher total brain volume
• lower rates of retinopathy of prematurity
• lower blood pressure and low-density lipoprotein concentrations
• improved leptin and insulin metabolism

Sharon Muza: Can older children with severe allergies have access to the milk?

Scotti Weintraub: Milk is sometimes available to older children or adults for a variety of conditions depending on availability.

Sharon Muza: Any final comments to share with our educators and other birth professionals and readers?

Scotti Weintraub: Donor milk is lifesaving for our most vulnerable babies and it's very cost effective. Just for NEC,

"Research shows that necrotizing enterocolitis (NEC), which donor human milk can help prevent, will increase a baby's length of hospital stay by two weeks at an additional cost of $128,000 to $238,000. In addition, reductions in other complications such as sepsis through the use of donor human milk instead of formula means that the baby goes home sooner with fewer medical issues - and stays healthier."

The remaining investment needed to open the NWMMB is less than the cost of ONE case of NEC!

Childbirth Educators, do you talk about donor milk and milk banks in your childbirth and breastfeeding classes? How would you bring up this subject? Do you think it is important to talk about with expectant and new parents?

Do any of our readers work in a facility that has human milk available for the tiniest patients in the hospital?

Have any of our readers chosen to donate breastmilk or been on the receiving end with their child? I would love to hear your experiences. - SM

References

American Academy of Pediatrics. Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics 2012; 129: e827-e841.

Arnold LDW. The cost-effectiveness of using banked donor milk in the neonatal intensive care unit: prevention of necrotizing enterocolitis. J Hum Lact May;18, 2002, (2):172-7

Boyd, CA, Quigley MA, Brocklehurst P. Donor breast milk versus infant formula for preterm infants: systematic review and meta-analysis. Archives of Disease in Childhood - Fetal and Neonatal Edition 2007;92:F169-F175

Kuschel CA, Harding JE. Multicomponent fortified human milk for promoting growth in preterm infants. Cochrane Database of Systematic Reviews 2004, Issue 1.

McGuire, W, Anthony MY. Donor human milk versus formula for preventing necrotising enterocolitis in preterm infants: systematic review Arch Dis Child Fetal Neonatl Ed. 2003 8 F11-F14.

Quigley MA, Henderson G, Anthony MY, McGuire W. Formula milk versus donor breast milk for feeding preterm or low birth weight infants (review). Cochrane Database of Systematic Reviews 2007; 1-41.

Silvestre D, Ruiz P, Martinez-Costa C, Plaza A, Lopez MC. Effect of pasteurization on the bactericidal capacity of human milk. J Hum Lact. 2008 Nov;24(4):371-6. Epub 2008 Sep 10.

Sisk PM, Lovelady CA, Dillard RG, Gruber KJ, O'Shea TM. Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants. 2007. J Perinatol Jul;27(7):428-33

Sullivan S et al. An Exclusively Human Milk-Based Diet Is Associated with a Lower Rate of Necrotizing Enterocolitis than a Diet of Human Milk and Bovine Milk-Based Products The Journal of Pediatrics 2010; 156:562-7.

Tully DB, et al. Donor milk: what's in it and what's not. J Hum Lact. 2001. 17: 152-155.

United States Breastfeeding Committee. Statement on the Safe Use of Donor Human Milk. Washington, DC: United States Breastfeeding Committee. 2008.

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