The Motherwear Breastfeeding Blog

Breastmilk donations for Haiti not being used.

Reflecting the chaotic environment for aid in earthquake devastated Haiti, the urgent call for breastmilk donations issued by a number of organizations last week appears to no longer be valid. 

Late last week the several health agencies issued a statement calling for a halt to the breastmilk shipments being sent to Haiti, and a Navy spokesman indicated that milk sent for use aboard the USS Comfort hasn't been used.  

Time Magazine reports:

Through a complicated chain of communication involving various members of Congress, the U.S. Department of Health and Human Services and breast-feeding organizations galore, the Human Milk Banking Association of North America (HMBANA) dispatched two coolers' worth of donated breast milk to Haitian preemies being cared for on the U.S.S. Comfort, the floating hospital anchored near Port-au-Prince. "The fact that there is a doctor on board this ship who understands the importance of breast milk is just amazing," says Amanda Nickerson, executive director of the International Breast Milk Project, which arranged the shipment of 140 3-oz. bottles of milk. Quick International Courier, a New York City–based firm that specializes in out-of-the-ordinary cargo, handled as a pro bono matter the delivery, which involved dry ice and rapid-fire transfers between Southwest Airlines, a charter flight and finally a military helicopter.

The HMBANA cargo supplements what is likely the world's only nautical milk bank. When one of the pediatricians on board the Comfort, Dr. Erika Beard Irvine, realized that she had only three cases of formula upon arrival, she connected with breast-feeding Navy moms who had deployed and didn't know what to do with their breast milk. Beard Irvine is storing their pumped milk in the ship's freezers and feeding it to the babies under her care, including one preemie born on board.

...In the U.S., milk banks rigorously screen donors, then pasteurize, process and freeze their milk before distribution. When it's shipped to sick babies across the country, it's nestled in dry ice. Unrefrigerated, breast milk — like cow's milk — turns rancid.

That's why the World Health Organization, UNICEF and the United Nations World Food Programme issued a joint statement Jan. 21 that the necessary infrastructure isn't yet in place to utilize donated breast milk on the Haitian mainland.

MSNBC reports:

But the staff on the U.S. Navy ship [Comfort] said they haven't used the milk out of concerns raised by OFDA and other agencies. Mothers aboard the Comfort are urged to nurse their own babies and there’s infant formula available to children whose mothers cannot or will not breast-feed, said Lt. David Shark, a U.S. Navy spokesman.

I understand why it doesn't make sense to send donor milk to the mainland at this point, but I'm a little confused about why donations sent to the Comfort can't be used.  The babies aboard the Comfort must be at at least a high a risk of potentially fatal complications like necrotizing enterocolitis as babies in the U.S. (see this video on how breastmilk prevents it, and this post on the cost of treating a case).  Then again, maybe I shouldn't be too surprised.  There are plenty of U.S. hospitals that don't use donor milk in the NICUs, and an emergency is probably a difficult time to convince people of its safety and value.

I also hope that this doesn't put a damper on the resurgence of interest in donor milk banking.  Our milk banks have been experiencing a decline in donations due to H1N1, and they are still needed in many areas to help domestic hospitals care for their premature and critically ill patients.

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Urgent call for breastmilk donations for Haiti.

Here's a press release on breastmilk donations for Haiti, just released from numerous breastfeeding organizations:

URGENT CALL FOR HUMAN MILK DONATIONS FOR HAITI INFANTS

The Human Milk Banking Association of North America (HMBANA), United States Breastfeeding Committee (USBC), International Lactation Consultant Association/United States Lactation Consultant Association (ILCA/USLCA), and La Leche League International (LLLI) are jointly issuing an urgent call for human milk donations for premature infants in Haiti, as well as sick and premature infants in the United States.

This week the first shipment of human milk from mothers in the United States will be shipped to the U.S. Navy Ship “Comfort” stationed outside Haiti. “Comfort” is currently set up with a neonatal intensive care unit and medical personnel to provide urgent care to victims of the earthquake. An International Board Certified Lactation Consultant stationed at the U.S. Navy base in Bethesda, MD is assisting with providing breast pump equipment and supplies to the “Comfort.” Dr. Erika Beard-Irvine, pediatric neonatologist, is on board the “Comfort” to coordinate distribution of the milk to infants in need. HMBANA, USBC, ILCA/USLCA, and LLL are responding to requests to provide milk for both premature infants and at-risk mothers who have recently delivered babies on board the U.S.N.S. Comfort, but an urgent need exists for additional donations.

At the current time, the infrastructure to deliver human milk on land to Haiti infants has not yet been established. As soon as that infrastructure is in place, additional donations will be provided to older infants.

Mothers who are willing to donate human milk should contact their regional Mothers’ Milk Bank of HMBANA. A list of regional milk banks is available at the HMBANA website at www.hmbana.org.

Currently milk banks are already low on donor milk. New milk donations will be used for both Haiti victims as well as to replenish donor supplies to continue to serve sick and premature infants in the U.S. Donor milk provides unique protection for fragile preterm infants. Financial donations are also strongly encouraged to allow HMBANA, a nonprofit organization, to continue serving infants in need.

UNICEF, the World Health Organization, the Emergency Nutrition Network, and medical professionals all recommend that breastfeeding and human milk be used for infants in disasters or emergencies. Human milk is life-saving due to its disease prevention properties. It is safe, clean, and does not depend on water which is often unavailable or contaminated in an emergency. Relief workers, health care providers, and other volunteers are urged to provide support for breastfeeding mothers to enable them to continue breastfeeding, and to assist pregnant and postpartum women in initiating and sustaining breastfeeding.

For more information, contact HMBANA at 408-998-4550 or www.hmbana.org . Additional information can be provided from the United States Breastfeeding Committee at 202-367-1132 (www.usbreastfeeding.org), ILCA/USLCA at 1-800-452-2478 (www.ilca.org  or www.uslca.org ), or La Leche League at 847-519-7730 (www.llli.org).

Three new films related to breastfeeding.

Several films on breastfeeding topics are, or will soon, be out:

One, called Formula Fed America, is directed by Leslie Ott, a mother who struggled with breastfeeding and wanted to explore our culture's attitudes toward breast and formula feeding.  You can see a trailer on the film website.

Another, called Mother's Milk, is an 11 minute film about a mother who loses a baby and discovers breastmilk donation.  You can read more about it here.

The third, already out, is an award-winning Peruvian film called The Milk of Sorrow.  It's described as a film about "a legacy of violence and oppression passed down through breastmilk."  Please be warned that the story concerns violence against women in Peru's recent past.  

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Formula maker to sell human milk product.

So, this is getting really complicated.

Let's start with the product.  Preterm babies who are in the NICU often need "human milk fortifier" in addition to breastmilk, to increase the intake of certain nutrients.  You might think that something called "human milk fortifier" is made of human milk, but it's actually made from cow's milk.  You English teachers can tell me if this is a case of a misplaced modifier.  These fortifiers are currently sold by formula makers, such as Mead Johnson, and Abbot. 

Recently a company called Prolacta Bioscience began making a fortifier that is actually made from human milk.  Prolacta processes donated milk to create a fortifier to use with NICU babies in addition to their own mothers' milk.  Prolacta's website points to a recent study (pdf) showing improved outcomes for babies who receive the human milk fortifier, compared to those who received the non-human milk fortifier.  

Prolacta is a for-profit company.  Women who donate milk processed by Prolacta, or to any milk bank for that matter, are not paid for their milk.  Some donors are recruited through the International Breastmilk Project (IBMP), a non-profit which is best known for sending breastmilk to AIDS orphans in South Africa.  According to the IBMP, 25% of milk they receive is sent abroad, and 75% of the milk remains in the U.S. to be made into Prolacta's human milk fortifier.  Prolacta makes a donation to the IBMP for every ounce donated, and processes and sells the fortifier.  According to the IBMP website, donor mothers are "required to check a box saying that they understood that 75% of donated milk would remain with Prolacta for critically-ill infants in the U.S."  I don't know if they are informed that the fortifier is made by a for-profit company.  More questions and answers about this partnership are on the IBMP website.

So, the recent news is that Abbot Nutrition, a formula company, will be adding the Prolacta fortifier (made with human milk) to their line of products, and will be selling it to NICUs across the country.  The Prolacta website states that this will make their human milk fortifier more available to hospitals and their patients.  It's fair to assume that Abbot will also profit by having this product in their line.  As far as I know, this is the first time a formula company has sold a human milk product.

So, aside from a comment about grammar, I've tried very had to stick to the facts here.  Now you tell me what you think of all this.

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Breastmilk donations for Haiti, and a shortage of donor milk in the U.S.

Many of you are interested in the question of whether or not donor breastmilk can be sent to Haiti.  Here's an update from over the weekend on this question.

The International Breastmilk Project, which ships donor milk to South Africa and other countries, posted this notice on their website: 

We have received an enormous amount of calls from mothers who want to donate their milk to Haiti. Due to the perishable nature of frozen breast milk, we must wait until the infrastructure is in the place to handle a donation.

When will you be donating breast milk to Haiti?
Currently the conditions in Haiti are not such that a donations would be possible, but things are changing each day. Once the infrastructure is in place and and we have a partner there who can distribute the breast milk, then we will do everything possible to arrange a donation.

What can I do to help?
You can donate your breast milk through the Human Milk Bank Association of North America by calling 1-866-998-4550. If we are able to make a donation to Haiti, we want to make sure that the milk supply is available, and currently supply in the US is low. If a donation to Haiti is not possible, then the milk will be used in the United States for babies in the NICU and cases where it is medically necessary.

A Salem, Oregon newspaper reports that a drive is being conducted for breastmilk donations for Haiti through the Adventist Medical Center's donor milk depot.  Prospective donors are being asked to call the Human Milk Banking Association of North America for screening.

Meanwhile, a Denver newspaper reported that the Mother's Milk Bank of Denver has a severe shortage of donor milk, due in part to the H1N1 virus.  I wasn't aware of this, but they report that mothers who have either had or have been vaccinated for H1N1 have to wait for a period of time before they can donate.  This has caused the donor pool to dwindle in recent months, and now their stocks of donor milk are running very low.

Bettina at Best for Babes spoke with Pauline Sakamoto, president of the Human Milk Banking Association of North America, who has been in touch with people running orphanages.  She told Bettina that “people from the orphanage are walking through the rubble and literally picking up orphaned babies off the street.”  Bettina writes that Pauline is "urging relief organizations to especially focus on finding any surviving breastfeeding mothers, and to make them a priority for receiving food, water, and shelter so that they can begin tandem nursing orphaned babies."  Read Bettina's excellent post here.

I don't want to rain on the parade here, but the more I think about sending breastmilk to Haiti the more I think it would have to be planned very, very carefully.  Certainly, for babies who are orphaned and for whom a wet nurse can't be found, donor milk would be lifesaving and should be a top priority.  But here are a few considerations:  First, as the International Breastmilk Project points out, it doesn't make sense to send milk when there is no or unreliable power to keep it refrigerated.  Second, any substitute for a mother's own milk can undermine her milk supply, leaving her less able to feed her own baby when the substitute is gone, so special care would have to be taken to protect mothers' milk supplies.  That's why the saying "feed the mother, support her breastfeeding" is key here.  Fortunately for Haitian babies and mothers, particularly in this emergency, Haiti has a strong breastfeeding culture, and the introduction of bottles and any substitutes for mothers' own milk has to be done in ways that don't undermine that tradition and infant health.

* Photo courtesy of the Human Milk Banking Association of North America.  Want to get email updates from the Motherwear Breastfeeding Blog?  Subscribe here.  Want an RSS feed? Subscribe here.  Want to subscribe to our breastfeeding podcasts on iTunes?  Click here.

Want to help in the fight against breast cancer? Post a flyer.

I've mentioned before that I help out with recruitment for a breast cancer study which uses breastmilk to identify molecular biomarkers for the development of cancer.

To participate, a mother has to be nursing, and have either had, or be expecting to have, a breast biopsy.  Mothers are sent a box to overnight mail their milk to the lab (at the study's expense) and receive $25 in thanks.  We've been helped a lot by the Avon Army of Women, but need to continue spreading the word.  If you think you may qualify, you can email Dr. Sarah Lenington.

If you don't qualify for the study, but would like to help out, please consider posting a flyer in your pediatrician's office, you OB or midwife's office, at your La Leche League meeting, or anywhere else you think nursing moms might see it.  You can download the flyer here, or you can email a request for hard copies from Dr. Sarah Lenington. 

More information about the study is at the study website.  Thanks for your help!

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Mothers' Milk Bank at Austin celebrates ten years

I thought that this news piece celebrating the ten year anniversary of the Mothers' Milk Bank at Austin was a nice tribute to donor milk banking.

And I love that the mother of babies who received donor milk is now the director of the milk bank!

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Our breastfeeding coalition in the news.

Our breastfeeding coalition, which meets at Motherwear, has been making the local news a lot recently.  Here are some articles that showcase things we're doing:

Going Baby Friendly, Valley Advocate

A Victory for Nursing Moms and Babies, Valley Advocate

Breastfeeding Welcome, Pioneer Valley Parent

Milk Bank supplies 'the perfect food:' Breastfeeding task force brings critical resource to Pioneer Vallley, Valley Kids

There was also a great news segment about the breast cancer research project I'm working on.

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What I learned at the milk banking conference.

A few weeks ago I spent the day at the Mothers' Milk Bank of New England's first annual conference.  It was a great event, with people from all over New England and many good presentations on the use of donor milk.

The sponsoring milk bank (you may remember from a flurry of posts I wrote about the Ideablob contest last year) is currently dispensing milk from the Mothers' Milk Bank of Ohio, and expects to be processing milk later this year for NICUs all over our region.  Currently, the nearest milk banks to our area are in Ohio or North Carolina. 

The night before the conference some of us gathered to learn more about how to open a donor breastmilk "depot," where approved donors can drop off their milk to be stored until it's shipped to the milk bank.  Our local breastfeeding coalition has been working to open a depot at a pediatric practice where I work.

The most striking things to me about the presentations at the conference were: 1) how incredibly powerful donor milk can be in preventing serious, life-threatening conditions like necrotilizing enterocolitis (NEC) and late onset sepsis, and 2) how astonishing it is that insurance companies often don't pay for it.  One neonatologist talked about the hours she spends faxing studies to insurance companies and arguing over the phone to try to get donor milk covered for her patients.  

You may have heard that pasteurized donor milk can cost $3.00 to $4.50 an ounce.  That might sound like a lot.  But consider that a tiny preemie who is primarily receiving her mother's own milk may need a supplement of only a few ounces a day.  Then compare that to the estimated $350,000 cost of surgically treating NEC.  That number doesn't even start to take into account the lifelong medical costs from that episode of NEC.  

I'm not going to pretend to understand how insurance companies look at something like this, but doesn't it seem worth it to pay for donor milk?

The most inspiring thing about the conference was the number of people - neonatologists in particular - who are dedicated to making donor milk part of the standard of care for tiny preterm babies.  People have been at this for a long time, but I still felt like I was at the birth of something big - a moment to look back on when donor milk is as accepted as any other therapy for vulnerable babies.  

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A "Call to Action on Breastfeeding"

The US Department of Health and Human Services, Office on Women’s Health wants to know what you think DHHS should do in the next decade to promote and support breastfeeding in the United States.

The Office of Women’s Health is looking for comments in the following twelve areas:

1. Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care
2. Access to Lactation Care and Support
3. Health Professional Education, Publications, and Conferences
4. Use of Banked Human Milk
5. Worksite Lactation Support, Onsite Child Care, and Milk Expression
6. Paid Maternity Leave
7. Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media
8. Support for Breastfeeding in Public Settings
9. Peer Support and Education of Family Members and Friends
10. Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training)
11. Research and Surveillance
12. Other Areas

Comments are requested until 31 May 2009.  Here's the link where you can make your voice heard! You can read the comments left so far.

This is your opportunity to help influence and shape the decisions that may affect breastfeeding promotion and support in the United States for the foreseeable future.

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