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".[1] 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).[2] 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."[3] Some of these protocols are described below.
According to a joint statement by the World Health Organization (WHO) and United Nations Children's Fund (UNICEF): "The best food for a baby who cannot be breastfed is milk expressed from the mother's breast or from another healthy mother. The best food for any baby whose own mother's milk is not available is the breastmilk of another healthy mother" (UNICEF, p.48). "Where it is not possible for the biological mother to breast feed, the first alternative, if available, should be the use of human milk from other sources. Human milk banks should be made available in appropriate situations" (Wight, 2001).
History
A 1930s breast pump in action on a hospital patient
The Canadian Nurse described in 1939 how nurses at the Royal Victoria Montreal Maternity Hospital travelled to Boston to learn from the successful programme at the Directory for Mother's Milk, Inc., set up by Dr Fritz Talbot. It was "a miniature dairy with all modern appliances". The quick freezing of fractions of an ounce of breastmilk had been perfected earlier that decade by researchers at Borden Labs. The women recruited were paid by the ounce, and visited daily by a nurse, as most would not have had refrigeration at home. The Maternity Hospital kept a stock of about 1000 frozen ounces.[4]
Screening donors
Milk donors are new mothers who are in good health, whose infants are growing, thriving, and under six months of age when they begin (Arnold, 1997). Some milk banks accept milk from mothers whose baby is up to two years old. Women who have given their baby up for adoption, acted as a surrogate, or are a bereaved mother may also donate.[5] Because there is some risk of passing infections and viruses to babies through breast milk, donors must undergo a medical screening and a blood test to rule out infectious diseases such as HIV-1 and-2, hepatitis B and C and syphilis (Arnold, 1997). After administering a verbal or written questionnaire, healthcare providers for the mother and her baby must sign statements confirming that both are in good health.
The mother must not smoke or regularly use any medications, herbs, or megavitamins. If she or her baby has a common cold, she can still donate her milk. If she consumes alcohol, she must wait out an "exclusion period" of six hours for one drink or 12 hours for two drinks before expressing milk for donation. For a premature or medically fragile recipient baby, even a tiny amount of alcohol, medications, or herbs in the milk may be problematic.
Collection
Methods of collection and types of containers used vary among milk banks. Donors are educated about hygienic milk expression and given containers in which to express their milk. Some milk banks have collection points where couriers pick up donations, some have mothers deliver the milk to the facility, and others ask women who live far away to freeze and ship their milk to the milk bank.
Screening and processing milk
In addition to careful screening of donors, each batch of milk is tested for bacterial counts before pasteurization. Some milk banks pool milk before testing it, others test each mother's milk as it comes in before it is pooled.
Milk banks require freezers and pasteurizers for processing milk. Most milk banks have two freezers, for unprocessed and processed milk. The HMBANA guidelines state that "all milk should be heat treated for 30 minutes at 62.5 °C. Heat treatment of milk occurs at 62.5°C for 30 minutes (Holder pasteurizing)" (Arnold, 1997, p.243). At the end of pasteurization, another sample of milk is tested to make sure the treatment was effective. Colony counts should be zero and no bacterial growth should be detected (Arnold, 1997). Containers for pasteurizing must be able to withstand heating and cooling without breakage or leaking. Most containers are recyclable, usually glass or plastic.
Distribution
Donor milk is dispensed by prescription from the recipient's physician. Often, it is used within the hospital Neonatal Intensive Care Unit (NICU) for premature or critically ill babies. Sometimes, however, donor milk is shipped to recipients' homes. In these cases, it is frozen, packed in special containers, and shipped over night.
Breast milk content of mothers of premature babies differs from that of mothers of full term babies (Wight, 2001). Therefore, most milk banks separate "preemie milk" – milk collected in the first 30 days after delivery of an infant less than 36 weeks gestation – from "term milk."
Costs
The HMBANA Guidelines stipulate that donors not be paid for their milk. However, hospitals and recipients are required to cover some of the cost for collection, processing and distribution of milk which may be from $3.00 to $5.00 an ounce. This remains a much lower cost than pasteurized milk can be obtained otherwise. Community fundraising and grants also help milk banks meet expenses. The guidelines ensure that no one is denied donor milk for lack of ability to pay. For non-hospitalized recipients, the milk bank will often work with the family to obtain coverage for processing fees (Arnold, 1997). However, insurance companies rarely cover donor milk, except under unusual circumstances (Griffith, 2002). In some states, and under some circumstances, Medicaid and WIC will cover the costs of using banked milk (Arnold, 1999, Wight, 2001).
When hospitals order banked milk for their NICUs it is often brought into the pharmacy and billed through the hospital. In these cases, insurance companies are much more likely to cover the processing fees than for outpatients (Arnold, 1997).
Donors
Communities with milk banks use different methods to educate and solicit donors including brochures in doctors' offices and hospital information packets. Referrals also come from childbirth educators, nursing mothers groups, and La Leche League. Like blood banks, milk banks sometimes use newspaper, television and radio ads to solicit donors, especially when supplies are low (Arnold, 1997). NICUs with successful breastfeeding promotion and support often have mothers with excess milk, and they are frequently given information about how to donate their milk. In addition, mothers of infants who die sometimes choose to donate their milk.
Currently, many of the milk banks will receive milk from donors in states throughout the United States depending on their supply. Donors should always contact the closest milk bank first.
Recipients
Premature infants are the most frequent recipients of donor breast milk. Full term babies with gastrointestinal (GI) disorders also sometimes receive banked milk. Occasionally, adopted babies and mothers who cannot nurse their healthy babies use banked milk as well, often at their own expense.
When there is milk available some milk banks will distribute it to adults who are immuno-compromised. Preliminary research indicates that breast milk can have nutritive, immunologic and palliative effects for cancer patients (Radetsky, 1999). Adults with GI disorders and organ donation recipients can also benefit from the immunologic powers of breast milk. More research is needed in these areas.
Risks and mitigation
Two concerns are often raised by potential donor milk recipients and health care providers regarding potential risks of using banked human milk:
Viruses, including HIV, have been shown to transmit through breast milk. However, as mentioned above, breast milk donors are screened very carefully. In addition, each batch of milk is screened and pasteurized and retested for the presence of bacteria. "There have been no documented cases of disease transmission from donor milk provided by a milk bank operating under standard practice." (Arnold, 1999, p.3) All of the milk banks listed below abide by the Guidelines of HMBANA. Potential donors are excluded from donating under the following circumstances:
A history of hepatitis, systemic disorders of any kind or chronic infections (e.g. HIV, HTLV, TB) (Arnold, 1999)
Some of the worthwhile components of breast milk are compromised in the pasteurization process. However, many are not. "Donor milk retains its bioactivity despite partial or complete loss of some components" (Arnold, 1999, p.3). The enzymes in breast milk (e.g. lipase) appear to be most affected by the heat. However, immune factors are less sensitive to heat and growth factors and fatty acids are stable at pasteurization temperatures. The lower the temperature at which safe processing can take place the better (Arnold, 1999). HMBANA Guidelines reflect careful research in this area.
Besides the individual milk banks in the above states/provinces, HMBANA has sent donor milk to hospitals in 39 states and 3 provinces.[7]
Milk banking alternatives
Private milk donation is an alternative arrangement to milk donation through the Human Milk Banking Association of North America. Private donation is a less formal method of donation that involves direct connection between mothers donating milk and the families receiving donations. Many families engaging in private milk donation, include blood testing and complete donor screening while involving a supportive care provider. This is a modern continuation of the ancient concept of the wet nurse.
Arnold LDW, "Cost savings through the use of donor milk: Case histories," Journal of Human Lactation, 1998, 14(3) pp.255–258.
Arnold LDW, "How North American donor milk banks operate: results of a survey, Part 1," Journal of Human Lactation, 1997,13(2) pp.159–162.
Arnold LDW, "How North American donor milk banks operate: results of a survey, Part 2," Journal of Human Lactation, 1997,13(3) pp.243–246.
Arnold LDW, "How to order banked donor milk in the United States: What the health care provider needs to know," Journal of Human Lactation, 1998, 14(1) pp.65–67.
Arnold LDW, "Use of Banked Donor Milk in the United States," Building Block for Life, Pediatric Nutrition Practice Group, Volume 23 No. 1 Winter 1999.
Infant formula, baby formula, or simply formula ; or baby milk or infant milk, is a manufactured food 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 baby bottle, nursing bottle, or feeding bottle is a bottle with a teat attached to it, which creates the ability to drink via suckling. It is typically used by infants and young children, or if someone cannot drink from a cup, for feeding oneself or being fed. It can also be used to feed non-human mammals.
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.
A wet nurse is a woman who breastfeeds and cares for another's child. Wet nurses are employed if the mother dies, or if she is unable or chooses not to nurse the child herself. Wet-nursed children may be known as "milk-siblings", and in some cultures, the families are linked by a special relationship of milk kinship. Wet-nursing existed in cultures around the world until the invention of reliable formula milk in the 20th century. The practice has made a small comeback in the 21st century.
Breast milk or mother's milk is milk produced by mammary glands located in the breast of a human female. Breast milk is the primary source of nutrition for newborns, containing fat, protein, carbohydrates and variable minerals and vitamins. Breast milk also contains substances that help protect an infant against infection and inflammation, whilst also contributing to healthy development of the immune system and gut microbiome.
A boycott was launched in the United States on July 4, 1977, against the Swiss-based multinational food and drink processing corporation Nestlé. The boycott expanded into Europe in the early 1980s and was prompted by concerns about Nestlé's "aggressive marketing" of infant formulas, particularly in underdeveloped countries. The boycott has been cancelled and renewed because of the business practices of Nestlé and other substitute manufacturers monitored by the International Baby Food Action Network (IBFAN). Organizers of the boycott as well as public health researchers and experts consider breast milk to be the best nutrition source for infants. The World Health Organization (WHO) recommends infants to be exclusively breastfed for the first six months of their lives, nevertheless, sometimes nutritional gaps need to be filled if breastfeeding is unsuitable, not possible, or inadequate.
A supplemental nursing system (SNS), also known as a lactation aid, is a device that consists of a container and a capillary tube. It is used to provide additional nutrients to a baby whose mother has low milk supply. During breastfeeding, the end of the tube is placed alongside the mother's nipple so that both the tube and the breast are in the infant's mouth.
The World Alliance for Breastfeeding Action (WABA) is a network of people working on a global scale to eliminate obstacles to breastfeeding and to act on the Innocenti Declaration. The groups within this alliance tackle the problems from a variety of perspectives or point of views, such as consumer advocates, mothers, and lactation consultants.
Erotic lactation is sexual arousal by breastfeeding on a woman's breast. Depending on the context, the practice can also be referred to as adult suckling, adult nursing, and adult breastfeeding. Practitioners sometimes refer to themselves as being in an adult nursing relationship (ANR). Two persons in an exclusive relationship can be called a nursing couple.
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, or nursing, is the process by which human breast milk is fed to a child. Breast milk may be from the breast, or may be expressed by hand or pumped and fed to the infant. The World Health Organization (WHO) recommends that breastfeeding begin within the first hour of a baby's life and continue as often and as much 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. 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 animals 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.
The International Breast Milk Project is a non-profit organization that solicits donations of human milk and provides the milk to needy infants.
A human milk bank, breast milk bank or lactarium is a service that collects, screens, processes, 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 breastfeeding, if possible, for the first year. Human milk banks 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, or when a child is hospitalized at birth due to very low birth weight, and the mother cannot provide her own milk during the extended stay for reasons such as living far from the hospital.
Breastfeeding promotion refers to coordinated activities and policies to promote health among women, newborns and infants through breastfeeding.
Mary Rose Tully MPH IBCLC was an American lactation consultant, director of the Department of Lactation Services at the University of North Carolina's Women's Hospital, and an adjunct clinical instructor of pediatrics at the University of North Carolina's School of Medicine. She researched and helped to expand knowledge of human breast milk. In the mid-1970s, she helped establish the non-profit Piedmont Milk Bank, now known as the WakeMed Mothers' Milk Bank and Lactation Center located in Raleigh, North Carolina. She was a founding member of the Human Milk Banking Association of North America in 1985 and received a lifetime achievement award from the organization in 2007.
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.
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.
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.
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