Tuesday, June 28, 2011

Reply turned post: Milk bank or mother-to-mother - what's the "best" way to donate milk?

Several commenters on my last post about where your milk donations are really going said they liked mom-to-mom milk donation in part because they know exactly where their milk is going. That got me thinking about mom-to-mom vs. milk bank, and before I knew it I had a reply-turned-post. As usual, revised and expanded below:

I think it's wonderful that you donate locally/mom-to-mom but let's remember that milk banking, done honestly and correctly, reaches babies that mom-to-mom donation cannot reach and who need human milk the most - the very sick and premature babies. Especially since Eats on Feets came on the scene, I feel like there has been a privileging of mom-to-mom over milk bank donation in some communities. Yes, it is usually much more fulfilling to meet a mother and baby and know your milk will be going directly to them. It is wonderful to give that mother milk for free or for a much lower cost than the milk banks, knowing she wouldn't be able to afford it otherwise. Done correctly and safely, I think mom-to-mom donation is great.

But (non-profit) milk banks are struggling for donations and there is absolutely value in what they do. I see milk banks sometimes getting slammed by the mom-to-mom donation community because of the price they have to charge for their milk. For people who think this way, please keep in mind that these banks are non-profit (unlike Prolacta!) They charge only what they have to in order to collect, process, store, and ship the milk. And they serve babies who would NOT receive milk through mom-to-mom donation. A 26-week premature infant in the NICU whose mother has a drug dependency, and cannot or will not provide her milk for her baby still needs human milk...he will not get it from mom-to-mom donation. A two-day-old late preterm infant who is jaundiced, not feeding effectively and needs a boost until her mom's milk comes in should still be able to receive human milk...but she won't get it from mom-to-mom donation.

I am perhaps biased because I work in a hospital where we have donor milk available and I see how important it is to the babies and to the parents. I am so grateful to the moms who donate to milk banks. That's why I think if you are able to donate to a milk bank - and I know not everyone can, because of the restrictions they have to place on their donors - you should try to do so. The mothers who are restricted from donating to banks for reasons that are still acceptable to recipients in their community (for example they are taking fenugreek, or don't meet the minimum donation amount for the milk bank) should absolutely pursue mother-to-mother donation. But let's remember that milk banks play a very important role for babies; just because a donor cannot meet or talk to the recipients, or because milk banks need to charge for their milk, does not mean milk bank donation is second-best.


Mama Z said...

I'm not hugely familiar with milk banking, so I'm curious - is it generally the individual (mom) who acquires donor milk, or would it be the hospital? I'm just thinking, if Mom would be the responsible party for obtaining breast milk for her baby, then I don't see it helping out the 26-weeker in the NICU whose mom is drug dependent - I would think that she probably either wouldn't have the money, wouldn't care about having breast milk over formula, or both. But if the hospital incurs the cost of getting donor milk for their NICU babies, then I could definitely see how it works out. For the average Josephine, though - moms who have healthy full-term babies but for whatever reason can't breastfeed and would still like their babies to get breast milk - would it still make more sense to pay money for donor milk versus seeking out a local mom willing to provide extra milk? Just curious.

Rebecca said...

Hi Susan,

That is the key - the 26-weeker would get milk through the hospital, and the hospital and/or insurance would pay for the donor milk, being knowledgeable about the importance of donor milk and recognizing that it is worth spending money on to prevent significant and expensive complications for the infant. (Also, I would not necessarily say that the drug-dependent mother does not care - she might want her baby to get breast milk, but be addicted to street drugs that make her inappropriate to be the donor. Even if she is ready and willing to enter treatment, her baby needs milk now.)

For the average Josephine, the question of donor milk vs. direct donor is a subject of a lot of debate. The FDA and other authorities are discouraging direct mom-to-mom sharing. But for many mothers, it is direct sharing or formula. Their insurance will not pay for banked donor milk without a compelling documented medical need, and paying out of pocket is prohibitive. (I posted a link a while pack to Neil Patrick Harris talking about his daughter receiving donor milk for formula intolerance. I don't know l whether the baby had a severe enough formula intolerance that insurance might have covered it, but the fact that he's a TV star makes that a moot point - he can afford to pay for a steady diet of donor milk, most parents cannot, and getting insurance to pay can be very tricky.) The average Josephine mothers need to honestly weigh the risks of direct mother-to-mother donation vs. the cost of donor milk vs. the risks of formula and decide what they are comfortable with. It's a crappy situation we're putting mothers in, but that's the way it stands.

Unknown said...

I agree with you, that moms should first try and donate to HMBANA. If for whatever reason you are denied as a donor, then go ahead and offer your milk up locally or on Facebook. I truly believe every baby deserves breastmilk but it's the tiny, sick babies in the NICU who need it the most. What makes it tricky for me is the moms who could express milk in the hospital but choose not to. Should they get donor milk for their babies when there is such a limited supply?

Rebecca said...

@Elita: I started a little series on that exact question many moons ago and still have the next post in draft form...thanks for reminding me to get back to it!

Unknown said...

Can't wait to hear your thoughts! At the end of the day, it's all about the baby but I know I'd rather my own milk donation go to a mom who could not breastfeed rather than one who simply chose not to.

JoyFilled said...

Since I guess this is pretty much directed at me, considering there was only one other comment, I guess I'll respond. First off, I'm a mother of three OTHER nurslings on top of my donations...so with 3 kids nursing and a "fourth" via the pump, if I have someone locally who can "meet me halfway" in the process, you bet that'll be my priority. (FWIW, I don't go through EOF, I just keep my milk until I hear of someone- or a mom contacts me directly- who needs it). I completely understand (and agree with) your reasons, but donating locally is certainly not half as good as a bank or anything. Second, I'm not really a fan of pasteurizing breast milk. To me, even the best of that defeats part of the purpose of the benefits of breast milk. I am not a fan of the FDA as it is, so what they discourage doesn't hold much weight with me. (I mean, for goodness sake, look at what the ENcourage! LOL)

When we traveled halfway across the country to visit family I brought a huge cooler of frozen milk for a young mother with an 8-month old in the Children's hospital. (she was not able to breastfeed due to a medically necessary breast reduction a few years back and had no mammary glands) She wasn't able to afford bank donations but wanted her baby on exclusive breastmilk (since obviously, especially in an immunocompromised baby, it's by far the best choice!). I'm glad to have helped where clearly a bank didn't.

I don't mean to sound defensive, as I do understand your reasons. I just want to stand up for the women who do donate locally, because we do work just as hard and help just as much as those who donate to banks. :)

I do appreciate these posts though! I am always glad to see milk donation talked about, because it seems to be one of those "taboo" subjects that people just try to avoid. It's so important that we address it though, for the babies that NEED the milk, and for the mommies that desperately want to provide it for them! :)

I also completely agree with the other comment about who is getting the milk...are they getting it because they CAN'T breastfeed, or because they WON'T? That is one advantage to knowing who I am donating too...not that I'd deny anyone milk, and it's probably shallow of me to even admit that it makes a difference, but I would prefer the mother who CAN'T breastfeed to get the majority of the milk, since the other mom at least had the opportunity, ya know?

Rebecca said...

@Joy: The comment was partly in response to you & the other commenter, but also thoughts that I'd been having reading various blogs/FB comments/etc over the past few months. I appreciate your response!

I am surprised and disappointed that the mom you donated to couldn't get her hospital to order and pay for donor milk. I know if the hospital had ordered it, the bank would have gladly dispensed the milk - all they require is a physician's prescription. I think it's wonderful that you stepped in, and I'm sure it meant the world to the mother and to her baby, but I think it's important to note that it sounds like it was her hospital - not the bank - unwilling to help. (BTW where did she tell the hospital the milk was coming from? Were they OK with donor milk or did she not tell them about it?)

I don't mean to imply that either mom-to-mom or milk bank donation is "second best" and I hope you don't feel attacked as a mom-to-mom donor - they each have their own roles right now the way our milk donor system is set up. And all donor moms deserve praise! But I would be sorry to see milk banks, and the babies who receive their milk, suffer for the perception that mom-to-mom is somehow morally superior. I think we have to remember what the alternative is when milk bank supplies run low. Fresh milk is of course better than pasteurized milk, but milk bank donor milk has to be pasteurized for a variety of reasons, and it is still so much better for infants than formula.

You're right that more people need to talk about milk donation. When I used to teach breastfeeding classes I would hand out milk bank brochures and encourage people to donate if they were able. In the end this is a debate because donor milk seems like such a finite and precious supply, when we might be able to get a lot more milk if more mothers were aware of milk donation.

JoyFilled said...

I am not sure if the hospital would have ordered it or not but I am sure they offered, as the problem was that she couldn't afford the milk (whether she had insurance or not, I do not know), which is a common problem it seems. Regardless, she wan't able to get milk from the bank, which is my point. I beleive she was able to take her baby home from treatments a couple of days a week and gave it to him at home, primarily, but I cannot say for certain.

I would/have never claimed that local donation is superior (in fact even prior to this post I've always felt that it seems to be the other way around- in my experience mom-to-mom donation is certainly frowned upon), because I think it's all very important in the big picture. I absolutely think every baby deserves breastmilk and would like to see everything possible be dobe to ensure that!

I also donated a few hundred ounces to a local mom adopting two babies from Africa who was having trouble qualifying for the milk in the first place (because the babies were older) and to top it off her insurance didn't cover bank milk and it was outrageously expensive (I've since gotten to know her better).  Again, very happy to help her where she had no other options.

It's stuff like that where I believe the playing grounds are level. Both types of donation are extremely valuable in their OWN ways.:). I absolutely believe in milk bank donation (as I've said, I understand and agree with you) but my whole point is that I think it's important that we don't discourage mom's from donating locally as well (if they can) because it, too, is an important factor in milk sharing. :)