|In the spirit of informed choice, Eats On Feets expects full disclosure from every person who participates in sharing breastmilk.|
Recipients generally expect donors to make safe and healthy lifestyle choices, and to lovingly share their healthy breastmilk, breastmilk that, in most cases, would otherwise be given to their own children. The amount of milk a donor can supply will vary depending on the demands of their own child(ren) and with menstruation, changes in eating and drinking patterns, stress, etcetera. Donors should not be pressured by recipients nor put pressure on themselves to produce a certain amount of milk. While good eating and drinking habits are important, following a specific regimen to raise milk supply in order to donate is not suggested. Milk sharing is based on sharing the extra milk that may exist, not on ‘farming’ our breastmilk.
Some recipient families may have a questionnaire and/or request blood work. It is important to be open and honest with each other. The details of milk sharing arrangements will differ from family to family and may be facilitated with the aid of a written agreement between the two parties. Eats On Feets does not provide forms for contracts, nor does Eats On Feets provide official questionnaires.1 It is between donor and recipient to arrange for this.
For full informed choice process, our network requires that offers and requests are made by individuals who are the legally or clinically responsible party.2 Siblings, children, grandparents, friends, doulas, breastfeeding counselors, nurses etc. are not legally nor clinically responsible. Legal guardians, donors, recipients, midwives, doctors, etc. are. The exception to this rule is when the third party adds direct contact information in their post in the form of a phone number, email address, FB profile or FB tag for the donor/recipient. This still allows for full informed choice process.
In this section:
1. Possible reasons for not donating breastmilk.
2. Questions typically asked of donors.
3. Suggested blood tests for donors.
4. Finding a recipient.
5. After finding a recipient.
6. Questions typically asked of recipients.
7. Handling breastmilk (for donors).
Further information can be found in ‘Additional Information’
1. Is there any reason why someone should not donate breastmilk?
|The list below is only meant to be used as a guideline. There may be other reasons why someone should not donate their milk. Recipients, donors or others may have lesser or greater restrictions than those listed here.|
- If they do not want to or if they are feeling coerced,
- If they are at risk of punishment due to religious or social conventions,
- If they are having difficulty meeting the needs of their own baby,
- If doing so would place undue stress on themselves or their family,
- If they do not meet a recipients criteria/requests,
- If they suffer severe psychiatric disorder(s),
- If they are in poor general health,
- If they are confirmed positive for HIV I, HIV II, HTLV I or HTLV II,3
- If they or their sexual partner are at risk for HIV,
- If they have an outbreak of herpes or syphilis lesions,
- If they have open sores, blisters, and/or bleeding cracks on the skin,
- If they are undergoing chemotherapy or radiation treatment,
- If they are receiving radiation treatment or thyroid scan with radioactive iodine,
- If they are taking medication that is contraindicated while breastfeeding,
- If they are currently abusing drugs or alcohol,
- If they are in the fever stage of chicken pox or shingles.
In addition to the above,
- If they drink, smoke, use certain herbal supplements or take megavitamins and there is a chance that their milk may be fed to a premature or critically ill baby.
Please see ‘Health Considerations’ for an alphabetical list of breastmilk topics.
2. What questions are typically asked of donors?
|Please consult with a qualified health care provider if you have any questions about the medical conditions listed below and donating milk.|
Questions typically asked of donors:4
- Is there anything that would prevent you from donating safe and healthy breastmilk?
- Have you read the Resource for Informed Milk Sharing?
- Do you have any concerns about sharing your milk that you want to talk about?
- Have you ever tested positive for: TB, HTLV I or II, HIV I or II, Herpes Simplex, Hepatitis B or C, or Syphilis?
- Have you had close or intimate contact with anyone infected with any of the above?
- Are you or your sexual partner(s) at risk for HIV?
- Were you born in or have you ever visited any of the following countries: Cameroon, Central African Republic, Chad, Congo, Equatorial Guinea, Gabon, Niger or Nigeria?
- Has a blood relative been diagnosed with Creutzfeldt-Jakob Disease (CJD)?
- Do you have any open sores, blisters, and/or cracks on the skin?
- Would you agree to have your blood screened if requested?
- Would you agree to be tested for TB if requested?
- Have you required hospitalization or blood transfusion the last 12 months?
- Have you ever received an organ transplant?
- Have you received any vaccinations in the last 12 months?
- Do you have a history of cancer?
- Do you take any prescription medications on a regular basis, including hormone replacement?
- Do you take excessive amounts of prescription drugs?
- Do you have any general health concerns?
- Does your baby have any general health or weight gain concerns?
- Do you smoke?
- Do you consume more than 3 caffeinated beverages per day?
- Do you drink alcohol? How much and how often?
- Do you use recreational drugs? Which ones and how often?
- Do you use over-the-counter (OTC) medication? Which ones and how often?
- Do you use herbal supplements? Which ones and how often?
- Do you have silicone breast implants?
- Have you had body piercings, tattoos, accidental needle stick injuries, acupuncture, electrolysis or wear permanent make up?
- Do you take megavitamins?
- Do you know how to clean milk collection items?
- Do you know how to safely store milk?
Please read the section ‘Health Considerations’ if you have questions about any of the above.
3. What are the suggested blood tests for milk donors?
Please follow the guidelines for your country/region. Donors may be asked to have lab-work repeated every 3-6 months.
Suggested blood tests:5
- HIV I and II
- HBV (Hepatitis B Antigen & Antibodies –if vaccinated, provide record)
- HCV (Hepatitis C)
- HTLV I and II
Additional screenings to consider:
- TB (Tuberculosis –once, unless exposed, or symptomatic)
- CMV (Cytomegalovirus –IgG and IgM)
- WNV (West Nile Virus –IgA and IgM)
For blood screening, please visit your health care provider, or you may be able to order “breastmilk donor panels” online.
Please read the section ‘Health Considerations’ if you have questions about any of the above.
4. I would like to donate milk. How do I find a recipient?
|Offers of donor milk must be posted by the person who produced the milk.|
- Find a local chapter page and click on the ‘Like’ button at the top right of the page;
- Check for current needs on the page;
- Post an offer on the Wall with some background information regarding location, whether this is an ongoing or a one time offer, the age of the child, the best way to be contacted, etc.;
- Check for comments on the offer regularly.
- Connect with potential recipients via private messages.
For any assistance with posting, please contact the admin of the page via the ‘Message’ button at the top right of the page.
Because Facebook is a public forum, some people prefer to offer breastmilk without revealing their identity. Please contact the admin of the page via the ‘Message’ button with the donation and background information. The admin will then post the donation on the Wall. It, however, remains the responsibility of the donor to check on the post and follow up on requests.
If there are no needs at the time of posting, breastmilk can stored for future needs.
It is up to donor and recipient to connect with each other, to check in on posts and to follow up with a request.
Not on Facebook:
- Please email us with the donation and appropriate background information, including a contact to share. The donation will be posted on the relevant Facebook page(s) and recipients will make private contact.
If donations are offered on a more regular basis, a Facebook account is suggested as it allows for a more effective connection with recipients.
5. I have found a recipient. How do I proceed?
Discuss with each other how you would like to proceed. Do you want to e-mail a list of questions or ask questions over the phone? Are you a good fit for each other? Do you want to meet in person first? What questions would you like to ask each other? Can you drive to each other? Does the milk need to be shipped? Etcetera.
Remember to practice safe social networking.
6. Do you have suggestions for addressing recipients?
|This list is only a guide and does not imply that all of these questions will apply to you or that you should feel restricted from asking other questions.|
- How will my milk be used?
- Are you or your baby being treated for any disease, infection or disorder?
- Are you or your baby taking medication?
- Have you and your baby had recent blood work done?
- Would you be willing to have blood work and/or a health screening done?6
- Have you spoken with a health care specialists about your breastfeeding issues?
- Would you like referrals to local resources for breastfeeding support?
- If the donor needs, are you willing to supply breast pump and supplies?
- Who will own the supplies and how should the purchase be handled?
- Are you willing to cover the cost, if any, of donor blood screening?
- Are you willing to reimburse or provide bottles or bags for milk collection and storage?
- Will the donation relationship be ongoing or one-time only?
- How much milk are you expecting/hoping for?
- Will you be supplementing with breastmilk substitutes or from another donor if needed?
- How often and when will you be coming to pick up the milk?
- Do you want all of the milk to be frozen? Would you want fresh, unfrozen milk?
- Would you like your baby nursed by your donor when possible?
- Are you familiar with safe handling techniques for breastmilk?
- Are you educated in at-home heat-treating of breastmilk?
- Do you have any concerns that need to be addressed or researched further?
7. How do I handle breastmilk for donors?
|Always make sure that supplies are clean and wash your hands before handling breastmilk.|
Following are suggested steps for safely expressing and storing breastmilk:
- Before beginning, make sure that your supplies are clean and dry.
- Vigorously wash hands, fingers, forearms and under nails with soap and warm water for 20 seconds, dry hands with paper towel and then use paper towel to turn off faucet. Read these instructions for more information on proper hand washing techniques.
- Inspect your breasts and make sure that the nipples are not cracked and bleeding and that there are no open sores, lesions or blisters on your breast. If so, do not donate at this time. Please read this section for more information on open sores, blisters, and/or bleeding cracks on the skin.
- Follow the instruction manual for your pump or consider expressing by hand. Please read this link for expressing tips and pumping information. This video is a good tutorial on how to express breastmilk by hand.
- Properly label the storage container and place in the freezer or refrigerator.
- After pumping and storing, wash and properly store your supplies.
Further information can be found in ‘Handling of breastmilk’.
II. Additional Information
1. Can I donate milk that was donated to me?
There are a few situations where it can happen that the donated breastmilk cannot or will not be used.
Expressed breastmilk, especially milk that has been frozen, can develop a taste or smell that some babies do not like. Some of this can be caused by excess lipase but there are other reasons for this to occur. Please read more about breastmilk developing a strange taste and/or smell here.7
It also happens that recipients end up with too much donated milk, or with enough to share with another parent in need.
If the donated milk will not be used, or if a recipient has more than is needed, the breastmilk can be returned to the original donor or donated to someone else. When donating to someone else, it is important that the original donor is asked for permission, and that the contact information of the original donor is added to the page post so that the new recipient is able to have direct contact for full informed choice process.
In order to return bags of milk to donors, or to pass milk on to another recipient, it is important that bags be labeled properly.
Please see Handling Milk for proper handling information.
2. How do donors know that the person requesting milk really needs it?
All babies, including young children up to 2 years and beyond, benefit from breastmilk.8
If a recipient seems to be in need of breastfeeding support, please see ‘My recipient may benefit from extra breastfeeding support. What can I do?’ for more information.
It is suggested that donors get to know the recipients and inquire about how their breastmilk will be used. Some adults might request milk for non-medical reasons. Please see this site for more information. Eats On Feets encourages families to practice safe social networking.9
3. My recipient may benefit from extra breastfeeding support. What can I do?
Simply providing breastmilk to a recipient in need is a wonderful way of supporting the breastfeeding relationship.
While donors may possibly have more experience and education in breastfeeding than anyone else in the recipient’s life, it is a personal decision whether broaching the subject of breastfeeding issues would be appropriate or not. Please keep in mind that the recipient may be in an emotionally delicate place.
This article can be referred to for suggestions of possible issues.
Please see local resources for possible suggestions for referrals.
4. Can I donate when I am taking medication?
Though few medications are contraindicated for breastfeeding, all medications and vaccinations should be disclosed to recipients. Please consult a health care provider about any effects that prescription or over-the-counter medications may have on breastmilk.
Please see this section for information on medication and breastmilk.
Please see this section for information on pumping and discarding post consumption of potentially harmful substances.
5. I want to donate but my milk develops a noticeable smell. What can I do? Can I donate?
Changes in the taste and smell of breastmilk can be attributed to: Lipase, oxidation, diet and/or water and cleaning supplies.
Breastmilk is naturally meant to be consumed within the closed bio-system of parent-child. Exposing breastmilk to the different elements outside of this closed bio-system (temperature, air) by expressing and storing the milk affects the activity of lipase, an enzyme that aids in the digestion of fats. “Lipase activity is stable at a pH level of 3.5 at 37°C for one hour, which is just long enough for effective fat digestion at the level of the infant’s small intestine.”10 Exposure can also cause chemical oxidation of the milk.
Some parents find that their breastmilk develops a soapy smell and a metallic taste after it has been frozen and thawed. “This change in smell has been attributed to changes in the milk fats related to storage in self-defrosting refrigerators-freezers; it has not been found to be harmful to the baby.”11 This suggests that the freeze-thaw cycles of such freezers may change the fat structure of the breastmilk.
How long it takes for lipase to alter the smell and taste of breastmilk depends on the lipase level and varies from person to person: “Depending upon the level of lipase, some mothers notice this rancid smell after milk has cooled in the fridge; others notice it only after the milk has been frozen for awhile.”1213 Some parents may therefore be able to keep their milk refrigerated or frozen for a short time before the soapy taste and metallic smell develop. Others find that their milk begins to smell soapy soon after it has been expressed. Most babies will drink this milk without a problem and the milk is generally considered safe to consume.14
Another reason for this change in taste to occur is possibly related to diet and/or metal ions in the water used to clean the supplies. In ‘Breastfeeding Answers Made Simple: A Guide for Helping Mothers,’15 Nancy Morhbacher writes: “Sour or rancid-smelling milk is probably unrelated to milk lipase levels. According to some milk storage experts, the most likely cause is chemical oxidation, rather than lipase-caused digestion of milk fat or bacterial contamination.”
“Possible contributing factors are the mother’s intake of polyunsaturated fats or free copper or iron ions in her water. In this case, heating the milk can actually speed oxidation, making the problem worse. While she is storing milk for her baby, suggest any mother whose expressed milk smells rancid or sour temporarily avoid her usual drinking water and any fish-oil or flaxseed supplements, as well as any foods like anchovies that contain rancid fats. While handling her milk, suggest she also avoid exposing it to her local water. It may also help to increase her antioxidant intake by taking beta carotene and vitamin E.”
Some parents have indeed found that using distilled water (and phosphate-free soap) to clean supplies addressed this issue and that the expressed milk could be cold stored or frozen without problems. However, others found that they were only able to store their milk for a longer period of time than before until changes in taste or smell occurred.
Still other parents found no change when altering their diet and/or water exposure. If in doubt whether milk is high in lipase or not, make sure that distilled water and phosphate free soap are used to clean supplies, and taste the breastmilk several hours after expressing it to see if the milk has acquired this off-smell and -taste.
When a baby does not like the taste of expressed breastmilk, and cleaning methods and/or diet have been ruled out as the potential cause of the change in smell and taste, lipase can be deactivated by heat-treating the milk.
Heat-treating milk that is high in lipase is done as soon as possible after expressing the milk, or before the milk changes in taste and/or smell. As mentioned above, depending on lipase levels, some parents can keep the milk in the refrigerator for a period of time before heat-treating, sometimes over 24 hours. In most cases, the donor16) would however be responsible for heat-treating their milk prior to freezing and/or donating. “Once the milk has acquired the rancid smell, […], treating the milk will not help.”17
Most references refer to ‘scalding’ as the method used to deactivate lipase. Scalding milk means to bring the milk up to the boiling point, which is 82°C/180°F and then immediately removing from heat source. The high heat of this process combined with the direct heat source potentially damages important components of breastmilk, like lactoferrin and immunoglobulin. Online references say however that this is not likely to be an issue unless all of the milk that a baby is receiving has been heat-treated.
Heat is known to deactivate lipase in breastmilk and thus flash-heating18 is another method that can be used. Per La Trobe Table # 7, flash pasteurizing milk at 72°C/161.5°F for 15 seconds deactivates the lipase by 97% (which is presumably enough to stop the activity of the lipase). The lower temperature used with these methods, as well as the indirect heat source, does not harm the milk as much as scalding does.
Some parents have used bottle warmers and a kitchen thermometer to heat-treat the milk in order to deactivate the lipase. Per Lawrence & Lawrence, “bile salt-stimulated lipase can also be destroyed by heating the milk at 144.5 F (62.5 C) for one minute, or at 163 F (72 C) for up to 15 seconds”.19
Recipients should be informed that the milk was heat-treated for deactivation of lipase. In circumstances where a long term milk sharing arrangement needs to be made, finding a donor who is willing to wet-nurse or whose milk does not require heat-treatment is preferable.20 Please see ‘How can breastmilk be pasteurized at home?’ for more information on heat-treating.
The above information assumes that the baby who will receive the breastmilk is healthy and full-term, and that, considering the anti-infective qualities and superior nutrition of raw milk, heat-treated milk is not the sole source of nutrients for the baby. Please see ‘What about premature babies?’ for more information on heat-treating and the effect of it on some important anti-infective properties of breastmilk.
Please consult with a lactation specialist with further questions.
6. Will I be able to meet the babies who receive my milk?
Meeting the baby that is receiving donated breastmilk or not is a decision that is based on the mutual agreement between donor and recipient. This can vary per arrangement.
7. My baby passed away. Can I donate my milk?
We are very sorry for your loss. Many parents find great solace in donating their milk to another baby after their own baby has passed away. It can be a very important part of healing for families while they grieve the loss of an infant.
If your loss was a result of prematurity, please see ‘What about premature babies?’ for more information on donating breastmilk.
The information on ‘Baby Loss Comfort’ may also be helpful to you.
8. What about milk banks?
Eats On Feets respects the lactating person’s right to determine the most appropriate use for their breastmilk. We also honor every baby’s right to human milk.21
The benefit of using donor milk from milk banks, when and if it can be obtained, is that the milk has been stringently screened for bacteria and infectious disease, pre- and post-pasteurization.
There are, however, always risks associated with feeding a baby anything other than his/her own parent’s healthy breastmilk via direct nursing, especially to those in the hospital. When considering donor milk, parents are balancing the benefits of superior nutrition and immunity against the risk of disease transmission. Even after donor milk is screened, some argue that pathogens can still remain22 in the milk, and after donor milk has been pasteurized, pathogens can (re-)contaminate milk. Please see ‘Are there risks to using donor milk?’ for more information.
A possible risk of milk from milk banks is that there is no control of exposure to non-infectious contaminants. Milk banks rely on self-exclusion of donors to keep milk free of tobacco, alcohol, medications, etc. There is no donor/recipient relationship when pursuing milk from milk banks. Getting to know a donor personally is an important aspect of informed milk sharing.
Raw versus pasteurized milk
Most milk from milk banks is given to hospitals for premature and sick babies.23 Sick and premature babies are at risk for neonatal hospital acquired infections. The lack of anti-effective properties in pasteurized milk can put a baby at risk, especially when a baby is sick or premature. Please see the section ‘What about premature babies?’ for more information.
In this previous but valuable study on the effect of routine screening of raw human milk and donor milk for premature babies, the authors discuss that while the data clearly document that premature infants fed raw expressed human milk are frequently exposed to large numbers of bacteria, no adverse events directly related to consuming this milk were documented.
Please see ‘Why breastmilk?’ for more information on the benefits of (raw) breastmilk for all babies.
Risk from handling
Some of the risks of donor milk are associated with the methods that are used when feeding the expressed breastmilk to a baby.24 There have been documented cases in hospitals where newborns developed bacterial infections after receiving milk obtained from milk banks and delivered via feeding tubes or artificial nipples. For instance, “one outbreak of F. meningosepticum was not from milk, but was located on milk bottle stoppers and ‘cleaned’ teats, as well as the ward environment.” La Trobe Table #5 identifies four related deaths as a result of contaminated breastmilk in hospitals. Some of these infections appear to have been associated with a single donor, which indicates that there was some cross contamination that occurred with that particular batch of donor milk. The infections linked to contaminated breastmilk were generally caused by normal bacteria that live on human skin and are by definition not isolated to babies in hospitals. Sick and premature infants are more at risk for these infections. Please see ‘Handling of breastmilk’ for more information on proper handling techniques.
Another potential risk of milk from milk banks is that there is no control of exposure to non-infectious contaminants. Milk banks rely on self-exclusion of donors to keep milk free of tobacco, alcohol, medications, etc.
Please also know that in the US per HMBANA guidelines, donors must be “willing to donate at least 100 ounces of milk; some banks have a higher minimum.” Other countries may have different requirements.
For the purpose of making informed choices, we encourage donors (as well as recipients) to research their options, to investigate milk bank procedures regarding heat-treatment,25 storage,26 distribution27 and usage,28 and to weigh the pros and cons of donating milk to a milk bank or to an individual.
- The suggested questions we offer are typically asked of donors by milk banks. The are not meant to be used as an official Eats On Feets questionnaire. [↩]
- Someone licensed to provide independent health care [↩]
- The Human Milk Banking Association of North America (HMBANA) excludes donors who have had a positive blood test result for HIV, HTLV, Hepatitis B or C, or Syphilis, whose sexual partner is at risk for HIV, who use illegal drugs, who smoke or uses tobacco products, who have received an organ or tissue transplant or a blood transfusion in the last 12 month, who regularly have more than two ounces or more of alcohol per day, who have been in the United Kingdom for more than 3 months or in Europe for more than 5 years since 1980 and who were born in or has traveled to Cameroon, Central Africa Republic, Chad, Congo, Equatorial Guinea, Gabon, Niger, or Nigeria.The US milk bank guidelines are followed fairly closely by other countries. [↩]
- Some of these questions are typically asked of donors by milk banks. Milk banks offer a big percentage of their milk to premature and sick infants. Some milk banks may also ask for clearance by a health care provider to donate milk, and for completing a form with current health information to include with shipping or delivery of milk. Donors and recipients of informed milk sharing may have different expectations than those presented here. [↩]
- The Human Milk Banking Association of North America (HMBANA) excludes donors who have had a positive blood test result for HIV, HTLV, Hepatitis B or C, or Syphilis, whose sexual partner is at risk for HIV, who use illegal drugs, who smoke or uses tobacco products, who have received an organ or tissue transplant or a blood transfusion in the last 12 month, who regularly have more than two ounces or more of alcohol per day, who have been in the United Kingdom for more than 3 months or in Europe for more than 5 years since 1980 and who were born in or has traveled to Cameroon, Central Africa Republic, Chad, Congo, Equatorial Guinea, Gabon, Niger, or Nigeria. The US milk bank guidelines are followed fairly closely by other countries. [↩]
- Establishes baseline of health for caregivers and donor, should baby ever become sick. Fair trade of personal information. [↩]
- This information can also be shared with donors in order to possibly avoid this issue in the future. [↩]
- In ‘Global Strategy for Infant and Young Child Feeding’, bullet 10, p. 14, the WHO states: “Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health.Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond.” Please also see Who needs donated breastmilk?’ [↩]
- A strong case can be made for the medical use of breastmilk by adults. Though our focus is babies and children, Eats On Feets supports informed choice and a woman’s right to share her breastmilk with whomever she chooses. [↩]
- Garza C, Schanler RJ, Butte NF, Motil KJ. Special properties of human milk. Clin Perinatol. 1987;14(1):11-32.3. [↩]
- Lawrence R. A., and Lawrence R. Breastfeeding: A Guide for the Medical Profession, 6th ed. Philadelphia, Pennsylvania: Mosby, 2005: p.696. Print. [↩]
- The terms soapy smell and metallic taste on one side, and rancid or sour smell on the other, seem to be used interchangeably when reading about the experiences of parents as well as the recommendations of the experts. [↩]
- Nancy Mohrbacher, IBCLC, and Julie Stock, BA, IBCLC. La Leche League’s The Breastfeeding Answer Book, 3rd edition (1997): p 229. Print. [↩]
- Per Gaskin, Ina May. “Soapy-, Metallic- or Rancid-tasting Milk that You Have Thawed.” Ina May’s Guide to Breastfeeding. New York: Bantam, 2009. p.165. Print. [↩]
- Mohrbacher, Nancy, IBCLC. Breastfeeding Answers Made Simple: A Guide for Helping Mothers. 2010. pg. 461. [↩]
- Please know that elevated lipase blood levels can be an indicator of an inflammation of the gall bladder or pancreas, high amounts of triglycerides, and other health problems. Elevated lipase levels can be asymptomatic for some time before health problems are obvious. Please consult a health care provider if you think there may be a medical reason for excess lipase in your milk. (Free Medical Dictionary [↩]
- Nancy Mohrbacher, IBCLC, and Julie Stock, BA, IBCLC. La Leche League’s The Breastfeeding Answer Book, 3rd edition (1997): p 229. Print. [↩]
- See ‘How can breastmilk be pasteurized at home?’ for more information. [↩]
- Lawrence R. A., and Lawrence R. Breastfeeding: A Guide for the Medical Profession. 6th ed. Philadelphia, Pennsylvania: Mosby, 2005: p. 205, 771. [↩]
- Eats On Feets believes that raw and fresh (not frozen) milk is better than heat-treated milk when possible. [↩]
- In ‘Global Strategy for Infant and Young Child Feeding’, bullet 10, p. 14, the WHO states: “Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond.” [↩]
- Screening tests are designed to have a relatively high incidence of false positives in order to prevent any false negatives. While false positives happen to many people, they tend to be higher in those who are pregnant or were recently pregnant. From the perspective of a milk bank which will be testing the donors on a regular basis, it makes sense to exclude anyone with a history of false positives since the cost of pursuing confirmations at every testing opportunity is not only prohibitive for a non-profit org, it also can lead to logistical issues with the milk received from the donor. This study does not follow up on the actual serological status of those screened but, even per the most optimistic values, it is quite likely that many did not in fact have any current infections. [↩]
- HMBANA states: “In the US if a [milk] bank has difficulty meeting the demands of one of their client hospitals they are able to refer them to another non-profit milk bank, but this does not happen very often. The [milk] banks also serve many infants in the home who need milk because of medical conditions such as intolerance to breastmilk substitutes or feeding issues related to prematurity (see HMBANA FAQ: Why use donor milk?). When possible the [milk] banks serve healthy babies who have been adopted or are not able to get their own mother’s milk.” [↩]
- The same potential infections can occur when breastmilk substitutes are used in the same setting. [↩]
- Milk banks most commonly use the Holder Method as heat-treatment. See this La Trobe table for the effects of the various heat treatment and storage techniques on breastmilk. [↩]
- BPNI writes: “The American milk bank guidelines give clear recommendations regarding these practical issues. Fresh-raw milk must be stored continually at 4 degrees Celsius for no longer that 72 hours following expression, whereas fresh-frozen milk can be held at 20 degrees Celsius for 12 months. Pasteurized milk may be stored under the same conditions as fresh milk.
The method of transportation varies from shipping milk in commercial airlines that donate their cargo space, to refrigerated vans (as for blood products) or local volunteers driving their own vehicles.
In France, however, one center freeze-dries the milk (a previously frozen liquid is dried under vacuum) increasing its storage duration at room temperature to eighteen months. This technique is not used in other counties for a number of reasons: loss of calcium and phosphorous, cost and possibly inaccurate reconstitution methods.” and “Unless the milk being stored is for a mother’s own infant, banked milk is then pooled. […] It is thought to be beneficial because it averages out the immunological and nutrient content of the milk. The numbers are kept low so that any contamination can theoretically be traced back to its source. In Germany, however, pooling is not used because of the concern regarding contamination.” [↩]
- Not everyone who needs breastmilk will necessarily be able to obtain breastmilk from a milk bank. Please see this information from the FDA and this information from the Utah Breastfeeding Coalition about the priorities of milk banks in the US. [↩]
- Donors should know that some milk banks serve for-profit companies. [↩]