Bottles of pumped breast milk. The milk will need to be transferred to bags and frozen for donation.Frozen bags of pumped breast milk. These are ready to be donated.
A human milk bank, breast milk bank or lactarium is a service that collects, screens, processes, pasteurizes, and dispenses by prescription human milk donated by nursing mothers who are not biologically related to the recipient infant. The optimum nutrition for newborn infants is breast milk for at least the first 6 months of life.[1] For women who are unable to breast feed or produce enough milk, pasteurized donor breast milk may be an effective approach to feeding.[2] Breast milk supplied by a woman other than the baby's mother that is not pasteurized and informal breast milk sharing is associated with a risk of transmitting bacteria and viruses from the donor mother to the baby and is not considered a safe alternative.[2][3] If pasteurized donor breast milk is not available, commercial formula is suggested as a second alternative.[2]
Human milk banks may offer a solution to the mothers that cannot supply their own breast milk to their child, for reasons such as a baby being at risk of getting diseases and infections from a mother with certain diseases,[4] or when a child is hospitalized at birth due to very low birth weight (and thus at risk for conditions such as necrotizing enterocolitis), and the mother cannot provide her own milk during the extended stay for reasons such as living far from the hospital.[5]
The demand and use of human milk banks is increasing.[6][7][8] The International Milk Banking Initiative (IMBI), was founded at the International HMBANA Congress in 2005. It lists 33 countries with milk bank programs.[9] The World Health Organization (WHO) states that the first alternative to a biological mother not being able to breast feed is the use of human milk from other sources.[10]
The primary and by far the largest group of consumers of human breast milk are premature babies. Infants with gastrointestinal disorders or metabolic disorders may also consume this form of milk as well. Human breast milk acts as a substitute, instead of formula, when a mother cannot provide her own milk. Human breast milk can also be fed to toddlers and children with medical conditions that include but are not limited to chemotherapy for cancer and growth failure while on formula.
History
Donating breast milk can be traced back to the practice of wet nursing.[11] The first record of regulations regarding the sharing of breastmilk are found in the Babylonian Code of Hammurabi (1800 BCE).[11] These regulations were motivated by the long-held belief that infants inherit the nurse's traits through their breast milk.[11] By the 11th-century European culture considered breastfeeding indecent, which led wet nursing to become common practice among royalty and aristocracy of Europe.[11] The practice of wet nursing declined by the 19th century due to concerns regarding unhealthy lifestyles among nurses.[11] Consequently, the medical community began researching the effects of alternative nutrition on neonates. Theodor Escherich of the University of Vienna conducted studies from 1902 to 1911 investigating different sources of nutrition and their effect on neonates. His studies demonstrated that breastfed neonate's intestinal bacteria was significantly different compared to neonates fed by other means.[11] In 1909, Escherich opened the first human milk bank.[12] The following year, another milk bank opened in the Boston Floating Hospital, the first milk bank in the United States.[13]
The 1960s saw a decline in milk banking because of recent advances in neonatal care and baby formula.[13] Despite these new advancements, in 1980 the World Health Organization and the United Nations Children's Fund maintained their position that donor breast milk is the best alternative to the mother's breast milk.[11] The practice of milk banking declined further with the HIV epidemic. The need for stringent screening increased the cost of operating milk banks, forcing them to close doors.[13]
Today, however, improved screening methods and standardization of procedure have made donated milk a viable alternative to mother's breast milk. The ability to pasteurize and store breast milk for up to 8 months[14] means milk banking could become a global enterprise.
Donor requirement
A donor must:
Be healthy
Be in the process of lactation
Undertake a chest x-ray or tine test
Have a negative VDRL
Have no evidence of hepatitis
Be HIV negative
More requirements may apply. For example, the requirements in Australia can be found at: http://jhl.sagepub.com/content/2/1/20.full.pdf. The Australian Red Cross Lifeblood offers a self-diagnostic quiz where donors can check if they are eligible to donate before they register.[15]
Concerns
Some concerns that surround human milk bank include:
Cost
Availability
Lack of health care provider interest
Concern about the type of women who might donate[16]
After the milk has been donated the primary consumer of the milk are premature babies; other consumers include adults with medical complications or conditions. The main reason why premature babies consume donor milk is that the mother cannot provide milk for the baby. The donor milk therefore acts as a substitute.[18]
Health benefits of human milk banks
Human milk banks offer families a chance to provide their child with reliable and healthy milk from other mothers. Human milk banks are needed as they offer milk which mostly is consumed by children whose mothers are not able to provide them with reliable milk.[19]
Human milk banks around the world
Africa
In 2022, lactation consultant and medical doctor Chinny Obinwanne launched Milk Bank Nigeria.[20][21]
Brazil and Latin America
Brazil has an extensive network of 217 milk banks, and is considered to have the most cost efficient system of milk banking in the world.[22] Since the inception of the first milk bank in 1985, the infant mortality rate in Brazil has dropped 73% due, in part, to the popularization of milk banks. In 2011, 165,000 liters (5,580,000 fl oz) of breast milk were donated by some 166,000 mothers, and provided to nearly 170,000 babies. The Brazilian and Ibero-American Network of Human Milk Banks coordinates these efforts. All donors are screened: in general, they must be healthy and not be taking any medication. The Brazilian system is defined by its inexpensive pasteurization of milk and has spread to other countries such as Spain, Portugal, the Cape Verde Islands, and portions of the rest of Latin America.
Europe
There are 223 active human milk banks in 28 countries within Europe, with 14 more planned as of November 2018. Currently, Italy has the most milk banks, at 39, while Georgia, Slovenia, and Turkey have the least, having no milk banks.[23]
The Human Milk Banking Association of North America (HMBANA) has a "Guidelines for the Establishment and Operation of a Donor Human Milk Bank"[24] that establishes exhaustive guidelines for safe milk collection and usage in North America. There are 16 milk banks in North America as of 2014. They collect about 3,000,000 oz per year as of 2013.
South Africa
South Africa has a breast milk collection and distribution program, Milk Matters, based in Cape Town.[25]
Singapore
Singapore launched a three-year pilot donor breast milk bank on Thursday 17 August 2017. It is a collaboration between KK Women's and Children's Hospital (KKH) and Temasek Foundation Cares. The foundation has set aside S$1.37 million (US$1 million) for the milk bank, which will collect, screen, process and store breast milk from donor mothers.[26]
Australia
As of 2020 Australia had at least six human milk banks in operation:
PREM bank (based at King Edward Memorial Hospital, WA and also supplying Princess Margaret Hospital)
Royal Prince Alfred (RPA) Hospital neonatal intensive care unit (NSW)
Mothers Milk Bank Pty Ltd (a private charity, previously located on the Gold Coast, now at Tweed Heads NSW and supplying the Brisbane Mater Children's Hospital as well as some babies in the community)[8]
Mercy Health Breastmilk Bank (commenced 2011 at Mercy Hospital for Women, Heidelberg VIC)
Royal Brisbane and Women's Hospital (RBWH) Milk bank (commenced November 2012 at the RBWH Grantley Stable Neonatal Unit)[28]
India
Asia's first milk bank was established in 1989 at Sion Hospital, Mumbai, India under the leadership of Armida Fernandez, and is presently run by Jayashree Mondkar, a neo-natologist.[29]
In September 2013, "Yashoda" Human Milk Bank was established in D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune in Maharashtra. Established with the partnership of Rotary Club of Nariman Point, Mumbai, it is the first human milk bank established in a private medical college in India. An advanced human milk bank and Comprehensive Lactation Management, Training and Research Centre (CLMTRC) were established on 31 January 2019.[citation needed]
Central India's first human milk bank was started in 2016 at Dr. Panjabrao Deshmukh Medical College, Amravati by Rotary Club Of Amravati Midtown.
In Tamil Nadu, seven human milk banks were launched in government hospitals in 2016, by the then chief minister Jayalalitha.[31] This scheme has expanded to cover all medical college hospitals and several government and private hospitals across the state.[32]
Kara W. Swanson, Banking on the Body: The Market in Blood, Milk, and Sperm in Modern America. Cambridge, MA: Harvard University Press, 2014.
Newman, Susan; Nahman, Michal (2021). "Nurture commodified? An investigation into commercial human milk supply chains". Review of International Political Economy.
Thornton, Sarah. Tits up: What Sex Workers, Milk Bankers, Plastic Surgeons, Bra Designers, and Witches Tell Us about Breasts. W. W. Norton & Company, 2024.
Reference List
Italian Association of Donor Human Milk Banks (2015) Survey of Italian Human Milk Banks. Retrieved from http://jhl.sagepub.com
Bertino E., Giuliani F., Occhi L., Coscia A., Tonetto P., Marchino F., Fabris C. (2009). "Benefits of Donor Human Milk for Preterm Infants: Current Evidence". Early Human Development. 85 (10): 9–10. doi:10.1016/j.earlhumdev.2009.08.010. PMID19800748.{{cite journal}}: CS1 maint: multiple names: authors list (link)
Infant formula, also called baby formula, simply formula, baby milk or infant milk, is designed and marketed for feeding to babies and infants under 12 months of age, usually prepared for bottle-feeding or cup-feeding from powder or liquid. The U.S. Federal Food, Drug, and Cosmetic Act (FFDCA) defines infant formula as "a food which purports to be or is represented for special dietary use solely as a food for infants by reason of its simulation of human milk or its suitability as a complete or partial substitute for human milk".
A breast pump is a mechanical device that lactating women use to extract milk from their breasts. They may be manual devices powered by hand or foot movements or automatic devices powered by electricity.
Breast milk or mother's milk is milk produced by the mammary glands in the breast of human females. Breast milk is the primary source of nutrition for newborn infants, comprising fats, proteins, carbohydrates, and a varying composition of minerals and vitamins. Breast milk also contains substances that help protect an infant against infection and inflammation, such as symbiotic bacteria and other microorganisms and immunoglobulin A, whilst also contributing to the healthy development of the infant's immune system and gut microbiome.
A galactagogue, or galactogogue, also known as a lactation inducer or milk booster, is a substance that promotes lactation in humans and other animals. It may be synthetic, plant-derived, or endogenous. They may be used to induce lactation and to treat low milk supply.
Lactational amenorrhea, also called postpartum infertility, is the temporary postnatal infertility that occurs when a woman is amenorrheic and fully breastfeeding.
A human milk bank is "a service which collects, screens, processes, and dispenses by prescription human milk donated by nursing mothers who are not biologically related to the recipient infant". As of November 2019, there are 28 milk banks in North America that are members of the Human Milk Banking Association of North America (HMBANA). They are usually housed in hospitals, although some are free standing. Members of HMBANA follow the annually revised "Guidelines for the Establishment and Operation of a Donor Human Milk Bank" which include protocols for soliciting donors and collecting, processing, and distributing the milk. In addition, some states have required standards for donor human milk banks. However, the Food and Drug Administration (FDA), states that "the FDA has not been involved in establishing these voluntary guidelines or state standards." Some of these protocols are described below.
Breastfeeding difficulties refers to problems that arise from breastfeeding, the feeding of an infant or young child with milk from a woman's breasts. Although babies have a sucking reflex that enables them to suck and swallow milk, and human breast milk is usually the best source of nourishment for human infants, there are circumstances under which breastfeeding can be problematic, or even in rare instances, contraindicated.
Breastfeeding, variously known as chestfeeding or nursing, is the process where breast milk is fed to a child. Breast milk may be from the breast, or may be pumped and fed to the infant. The World Health Organization (WHO) recommend that breastfeeding begin within the first hour of a baby's birth and continue as the baby wants. Health organizations, including the WHO, recommend breastfeeding exclusively for six months. This means that no other foods or drinks, other than vitamin D, are typically given. The WHO recommends exclusive breastfeeding for the first 6 months of life, followed by continued breastfeeding with appropriate complementary foods for up to 2 years and beyond. Of the 135 million babies born every year, only 42% are breastfed within the first hour of life, only 38% of mothers practice exclusive breastfeeding during the first six months, and 58% of mothers continue breastfeeding up to the age of two years and beyond.
Lactation describes the secretion of milk from the mammary glands and the period of time that a mother lactates to feed her young. The process naturally occurs with all sexually mature female mammals, although it may predate mammals. The process of feeding milk in all female creatures is called nursing, and in humans it is also called breastfeeding. Newborn infants often produce some milk from their own breast tissue, known colloquially as witch's milk.
Breastfeeding promotion refers to coordinated activities and policies to promote health among women, newborns and infants through breastfeeding.
The Baby Friendly Hospital Initiative (BFHI), also known as Baby Friendly Initiative (BFI), is a worldwide programme of the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF), launched in 1992 in India following the adoption of the Innocenti Declaration on breastfeeding promotion in 1990. The initiative is a global effort for improving the role of maternity services to enable mothers to breastfeed babies for the best start in life. It aims at improving the care of pregnant women, mothers and newborns at health facilities that provide maternity services for protecting, promoting and supporting breastfeeding, in accordance with the International Code of Marketing of Breast-milk Substitutes.
In Western countries extended breastfeeding usually means breastfeeding after the age of 12 to 24 months, depending on the culture.
Infant feeding is the practice of feeding infants. Breast milk provides the best nutrition when compared to infant formula. Infants are usually introduced to solid foods at around four to six months of age.
Late preterm infants are infants born at a gestational age between 34+0⁄7 weeks and 36+6⁄7 weeks. They have higher morbidity and mortality rates than term infants due to their relative physiologic and metabolic immaturity, even though they are often the size and weight of some term infants. "Late preterm" has replaced "near term" to describe this group of infants, since near term incorrectly implies that these infants are "almost term" and only require routine neonatal care.
The Human Milk Banking Association of North America (HMBANA) is a not-for-profit organization that accredits nonprofit milk banks in the United States and Canada, produces the standards and guidelines for donated breast milk in North America, and promotes lactation and breast feeding. The organization was founded in 1985. As of 2022, it has thirty-one member milk banks, including twenty-eight in the US and three in Canada. HMBANA is accredited by the US FDA, and is funded by membership dues and donations.
In breastfeeding women, low milk supply, also known as lactation insufficiency, insufficient milk syndrome, agalactia, agalactorrhea, hypogalactia or hypogalactorrhea, is the production of breast milk in daily volumes that do not fully meet the nutritional needs of her infant.
The human milk microbiota, also known as human milk probiotics (HMP), encompasses the microbiota–the community of microorganisms–present within the human mammary glands and breast milk. Contrary to the traditional belief that human breast milk is sterile, advancements in both microbial culture and culture-independent methods have confirmed that human milk harbors diverse communities of bacteria. These communities are distinct in composition from other microbial populations found within the human body which constitute the human microbiome.
Human milk immunity is the protection provided to the immune system of an infant via the biologically active components in human milk. Human milk was previously thought to only provide passive immunity primarily through Secretory IgA, but advances in technology have led to the identification of various immune-modulating components. Human milk constituents provide nutrition and protect the immunologically naive infant as well as regulate the infant's own immune development and growth.
Delayed onset of lactation (DOL) describes the absence of copious milk secretion (onset of lactation) within the first 72 hours following childbirth. It affects around 20–40% of lactating women, the prevalence differs among distinct populations.
Establishment of breastfeeding refers to the initiation of providing breast milk of mother to baby. According to the World Health Organization(WHO), breastfeeding is the best way to provide nourishment, including essential nutrients, energy and antibodies, to infants and toddlers. The start of breastfeeding is supported by the milk production which depends on the development of internal and external breast structure and hormonal control on milk secretion. Besides milk supply, adopting the correct approach of breastfeeding helps build up the maternal bond, which in turn promotes breastfeeding. Not only does nursing strengthen the mother-child relationship, but it also improves the intelligence and immunity of breastfed children and diminishes breastfeeding mothers' risks to have ovarian and breast cancer.
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