Natalie Shenker, September 2020
When the Hearts Milk Bank started operating back in 2017, I used to pick up a lot of the milk from donors in the evenings and weekends. I’ll never forget one woman, Odira, who had called asking to donate a ‘large quantity’ of milk. So I turned up to her flat with two medium sized insulated boxes, climbed to the third floor, and was welcomed inside. Her freezer was almost overflowing with six shelves of milk. I gawped. Her baby was only 2 months old. I stutteringly explained that I would need to come back with more boxes. “That’s fine”, she said. “And what about the chest freezer?”
Odira had true hyperlaction. She was so engorged that she could not latch her baby, and was practically confined to her flat as she needed to pump to relieve the pressure so often. She produced over 4 litres of milk each day, and was developing joint pain and other physical discomforts.
Back in the milk bank, our IBCLC Jo Watt called her every few days. Over the next few weeks, she supported Odira to gently manage her supply down. Lots more milk was collected. Over the next 2 months she donated over 85 litres, all of which went to neonatal units across the southeast. But the happiest day for the team at Hearts was when Odira called and said she had finished donating – she just had enough for her baby now.
If maternal milk is not available, the World Health Organisation recommends that the first alternative should be pasteurised donor human milk (DHM). Human milk banks (HMBs) screen and recruit milk donors, and screened DHM principally feeds very-low-birth weight babies, reducing the risk of a range of complications. DHM availability can support maternal breastfeeding when used alongside optimal lactation support. The work of HMBs and the provision of DHM should protect, promote and support breastfeeding at all times, and it was in this ethos that the Hearts Milk Bank was established in 2017.
As well as supporting scores of hospital neonatal intensive care units with assured access to DHM 24/7, we have been supporting families in the community with lactation support. So far, we have supported over 150 families, and over 80 of these included mothers who were in the care of an IBCLC with babies who needed supplementation. The majority went on to establish a full milk supply, and five have returned months later as milk donors.
HMB has far reaching duties of care to the donors and recipients. The whole team take these very seriously. Our entire vision is to integrate lactation support deeply into the roots of a future milk bank network. Used inappropriately, donor milk could easily become another breastmilk substitute, and it is the responsibility of those who operate HMBs to ensure that DHM is never used to undermine a mother’s breastfeeding journey.
Globally, paying mothers for their milk is a thorny issue and at the Hearts Milk Bank we have looked into the pros and cons of this. We’ve thought long and hard about how we can make sure we do our best to provide the best service to donors and if we should compensate mothers for their time and their costs. Research has shown that milk donors are motivated by altruism, and the chance to support other families and mothers who might be struggling. Women do not want their milk to be wasted, and HMBs see at first hand how appreciated and often life changing it can be. Research in Pediatrics in 2015 found that 10% of human milk available for sale over the internet contained milk from other species, which for vulnerable infants could represent a serious health risk. While we truly believe to our core that donors should be celebrated and appreciated, financial inducements skew the relationship and introduce added risks through potential non disclosure of behaviours that diminish safety and quality of the milk. We only have to remember the disasters associated with payments for blood ‘donations’ in the USA that led to the infections of over 30,000 UK transfusion recipients in the 1980s and 1990s, and very many more in the USA to be cautious about adopting a similar model.
Our ethos is:
- Donors should be supported to safely provide surplus milk but in so doing it should not put the donor or her baby at risk
- There should be equitable opportunities to donate to non-profit milk banks across the whole of the UK
- Donors should not be coerced or otherwise induced to provide more milk than is safe or optimal for her or her infant. Financial inducements, in some circumstances, may introduce a level of coercion and the chance of exploitation
- Operations and advisory boards should be completely transparent
- Accurate feeding information should be provided to parents in each instance
- DHM should always be used in line with medical or expert lactation advice to ensure it does not undermine breastfeeding
- Provide suggested means of delivering supplementary feeds that do not interfere with feeds at the breast and with the effective removal of milk
- All donations of breastmilk will be valued and accounted for through our state-of-the-art track and trace system developed with Savant
- Training should be provided to hospital teams by the HMB in the safe and appropriate use of DHM. We are delighted to announce that CPD-accredited training will be available online from December through the Human Milk Foundation
The availability of DHM should never undermine efforts to support the mother to improve her lactation and/or breastfeeding. Specialist assistance from a qualified lactation consultant or breastfeeding counsellor should be available to ensure the mother is following all recommended steps to initiate, increase and maintain her milk supply and to establish full breastfeeding or breastmilk feeding where necessary.
If Odira had been paid for her milk, the subtle balance of doing what was right for her and her baby’s health and wellbeing might have been shifted. The non-profit milk banking system is effective and safe, and the model adopted by over 60 countries to ensure the most vulnerable babies are protected.
*Odira gave permission for her story to be used to help other families.