Accessibility to alternative infant feeding options is extremely important for all parents, especially those who cannot or choose not to breastfeed. This importance only increases when a baby has special nutritional needs or has been admitted to the hospital. With one of BIOMILQ’s core goals being empowering parents through choice, we recognize that it is just as important to have those choices as it is to make sure those choices are discussed and known about.
Donor milk is a widely used infant feeding option, whether it is through a milk bank or informal sharing, getting those who want or need human breast milk is an important process. We have recently interviewed the former Milk Bank Manager at WakeMed Mother’s Milk Bank, now a BIOMILQ teammate, Montana Wagner-Gillespie (MS, IBCLC) to help answer some of the most commonly asked questions about human milk banking. With eight years of milk bank management experience under her belt, she knows the ins-and-outs of how milk banks help NICU babies and babies with special feeding needs get all the nutrients they need.
Montana Wagner-Gillespie, MS, IBCLC
Q: What is HMBANA?
A: HMBANA stands for the Human Milk Banking Association of North America, they’re the accrediting body for all non profit milk banks in the US and Canada. They provide evidence based guidelines for all milk bank operations, that means everything from donor screening to milk processing and distribution. Ultimately these guideline are designed for safe and effective operations of milk banks, and they are all published on the HMBANA website.
There are also for-profit milk banks (not a part of HMBANA) that pay donors for their milk and typically charge a higher processing fee for the milk to hospitals and families.
Q: Why are human milk banks important?
A: Milk banks primarily provide milk to families staying in the NICU that don’t have access to any or enough maternal milk. For most babies, breast milk is the ideal source of nutrition, but for NICU babies, breast milk serves as medicine. Using donor milk can shorten the length of hospital stay, decreases feeding intolerances and incidence and severity of infections that premature babies might experience in the NICU. Human milk banks provide a vital medical resource for NICU babies and babies with nutritional needs all across the US and Canada.
Q: What was the typical demand for donor milk like in the Wake Med area?
A: There are several NICUs in the Triangle with very high acuity, meaning they treat critically ill babies. There was a high demand for donor milk in this area and beyond. When I worked in the milk bank, we dispensed donor milk to 44 NICUs in 8 different states. We served North Carolina and states all along the east coast.
Who receives HMBANA donor milk?
A: The vast majority HMBANA donor milk goes to NICUs all over the US and Canada. There are other instances where folks are eligible to receive donor milk. A baby that goes home from the NICU may still need donor milk, or there are families that need to supplement and want to use donor milk instead of formula. Donor milk could be an option in those circumstances, but a prescription is required for obtaining [HMBANA] donor milk outside of hospital settings. Outpatients, meaning those not admitted to a NICU, can get donor milk depending on where they live and whether or not their milk bank has ample supply to serve them.
Q: What does the screening process for donors look like?
A: People who want to donate to a HMBANA milk bank have to go through a triple screening process starting with an initial screening, typically over the phone. They’re asked general health history questions about the lactating parent and baby, then if they pass that initial questionnaire, they complete a more in-depth written questionnaire inclusive of sign-off from their obstetrician or midwife and their baby’s pediatrician if the baby is still in their care. Finally, in order to donate to a HMBANA milk bank, donors must have their blood tested for Hepatitis B and C, HIV, HTLV, and syphilis.
Q: Can you walk us through the process of receiving the donor milk to distributing it?
A: Once a donor is approved, they can ship or drop off their milk at the milk bank directly or at a community donation site known as a “depot site”. Once received, the donation is then logged, sorted, and inspected prior to storage at the milk bank. Donations are grouped together into what is referred to as a milk “pool” containing many donors’ milk. Multiple donors are used because milk composition varies from donor to donor and including many donors creates a nutritionally consistent product. The pool of milk is then thawed, processed into bottles, pasteurized in batches, and sent for microbiological testing. Once the test results are received and the milk batch is approved it can be shipped to hospitals and families.
Q: What is pasteurized donor human milk?
A: Pasteurized donor human milk is going to have the same macronutrient profile as human milk (proteins, lipids, carbohydrates) and it is going to have a lot of the bioactive components still available for the baby in relatively high concentrations, which support infant immune and gut health. Donor milk is never going to be the same as mom’s own milk because it isn’t age and environmentally matched to the baby receiving it and it must be heat treated for safety, but it is really thought to be the next best option when maternal milk isn’t available.
Q: How does donor milk benefit babies?
A: The greatest body of evidence for donor milk use is in babies that are delivered preterm or very low birth weight. Donor milk helps to decrease morbidity, feeding intolerances, and incidence of NEC (necrotizing enterocolitis), an intestinal disease that can be fatal to premature babies. Donor milk has similar protective immune benefits to maternal milk and is easier for babies to digest than formula.
Q: How can I receive milk?
A: The best thing to do is reach out to your local milk bank and see if they provide donor milk to outpatients. If you are staying in a NICU, reach out to your baby’s healthcare provider to see if donor milk is an option. Most NICUs use donor milk in very specific populations, so some babies qualify for it and some may not depending on the hospital. Medicaid and insurance coverage varies from state to state, the overall cost can change depending on where you’re located and what the infant’s medical need is.
Q: How can I help?
A: Aside from donating milk, most non profit milk banks have robust volunteer programs. Volunteers function in many different capacities. They might help sort and receive milk donations, represent the milk bank at community events, assist with outreach and marketing, and complete general operational tasks. If you want to get involved, reach out to your nearest milk bank. Visit hmbana.org/locations to find your local milk bank.