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Photos and text by Steve LaBadessa
When Brionna was born 13 weeks early, she weighed less than 2 pounds. Joshua weighed only 2 1/2 pounds when he was born 12 weeks early. Twin infants Rett and Charlotte arrived 10 weeks early. The "medicine" prescribed for these babies is among the most proven remedies: breast milk. But giving birth prematurely often means trouble making the breast milk your baby so direly needs. The moms of Brionna, Joshua, Charlotte, and Rett all rely on donated breast milk to feed and fortify their babies.
Getting donated milk from a safe source is essential, as much milk sold or offered in the "casual" market is be tainted by bacteria and viruses. But there is another way. our site followed one batch of milk donated by Monica, a mother of two, to a milk bank and then to its final destination: the tiny bellies of Brionna, Joshua, Charlotte, and Rett.
October 6, 4:14 p.m.: Monica Lutgendorf of Tacoma, Washington, uses a double pump to express milk while watching over her two sons, Matthew, 3½, and Andrew, 1½.
A year and a half ago, Monica started pumping and freezing milk for her son Matthew to drink while she was working. Over time, she built up an extra supply she knew Matthew would never use. "The freezer was getting pretty full. My husband said we need more space for food," she says. "Friends suggested I contact a milk bank." She's been donating milk for more than a year and has shipped hundreds of ounces of milk to the Mothers' Milk Bank in San Jose, California.
"Pumping does take dedication," she says, but as an ob-gyn herself, she knows the babies who receive her milk are in serious need. "I'm going to continue pumping for another six to 12 months. It's a gift to the babies my milk helps. But it's also a gift to me," says Monica.
October 6, 4:31 p.m.: Monica pours 6 ounces of milk into a donation bag sent to her by the Mothers' Milk Bank.
To help new donors establish a clean environment for pumping and storage, the milk bank sends an information sheet on how to safely handle the milk. If frozen shortly after pumping, the milk lasts a year. Given the demand, though, most hospitals will use the milk within a week or two.
October 7, 8:46 a.m.: Monica prepares to ship her frozen milk overnight from a dedicated freezer in her garage to the milk bank.
"I don't need any extra ice because the cooler will be filled entirely with frozen milk. It keeps itself frozen," Monica explains.
The bank has about 100 donor moms who give milk regularly. The bank will also take milk from moms who want to give occasionally, as long as they pass the screening process.
October 7, 10:57 a.m.: Monica greets Dave from FedEx, who is used to picking up her Mothers' Milk cooler.
Monica has colleagues at work who also pump and donate their milk. "Our donors are absolute saints. They do this out of the goodness of their hearts," says Pauline Sakamoto, executive director of the Mothers' Milk Bank. "They don't get paid for the time and effort that it took them to pump."
October 8, 9:16 a.m.: Eight coolers filled with frozen milk arrive at the Mothers' Milk Bank in San Jose, California. Jill Ng unpacks them, then she'll call each donating mom to thank her.
The Mothers' Milk Bank is the oldest milk bank in the United States. "The bank started 40 years ago when a local physician needed breast milk for one child who was failing to thrive," says Pauline Sakamoto, executive director of the Mothers' Milk Bank.
Now there are 16 milk banks in North America that are certified by the Human Milk Bank Associa-tion of North America (HMBANA), with two more in development.
The process of establishing a HMBANA-accredited milk bank is painstaking. Developing banks must remain under mentorship for up to two years before operating independently.
October 8, 9:53 a.m.: Kim Jordan, milk bank operations manager, organizes the milk, including Monica's donation, for thawing. For now, she keeps the milk from each donating mom separate.
The Mothers' Milk Bank screens milk donations in the same way as blood donations. Sakamoto explains the process: "First, a nurse interviews a potential donor about her medical history and medical behavior. The donor fills out an eight-page questionnaire and gets blood tests, then we contact her doctors. Also, each shipment of her milk is tested for bacteria levels. Then we pasteurize it. Then we test it again for bacteria after processing."
The screening, testing, pasteurizing, and freezing are all necessary to ensure the safety of the final product.
October 9, 9:31 a.m.: To make hospital-grade breast milk, technician Gerald Astrero adds preterm milk to Monica's 6 ounces.
Preterm milk is breast milk from a mother who gave birth to a baby prior to 36 weeks of pregnancy. This milk is higher in protein and has more antibodies in it.
The Mothers' Milk Bank supplies milk to 90 hospitals, most of them on the West Coast. A typical batch of milk shipped to a hospital contains 200 ounces of milk blended from three different donors.
October 9, 9:34 a.m.: The blended milk is poured into six 4-ounce bottles and is ready to be pasteurized.
Mothers' Milk Bank now has about 100 moms donating regularly. In addition to the hospitals, the bank supplies 160 families with babies at home. For hospitalized babies, the hospital orders the milk directly. For babies at home, a doctor's prescription is needed to get it. Either way, donated milk costs roughly $3.50 per ounce. Pricier by far than formula, but Sakamoto points out, "For a lifetime of benefit, it's very cheap."
While a baby is in the hospital, donor milk is covered by insurance, but when these babies go home, most insurance companies won't cover it. "They consider it food, not medicine," says Sakamoto. "Casual sharing could be stopped dead in its tracks if insurance companies would consider donor milk a medical necessity – and if you saw the babies, you'd know it is, no question about it."
October 9, 10:01 a.m.: Aaron Mehmi pasteurizes the milk, heating it enough to kill any harmful bacteria but not enough to destroy the helpful antibodies and proteins.
After pasteurization, all the milk is frozen again. Then one bottle is sent to the Santa Clara Public Health Department for a second test for bacteria. Once it passes, Monica's frozen milk will go to the University of San Francisco Benioff Children's Hospital in San Francisco and the Alta Bates Summit Medical Center in Berkeley, California, to be fed to premature ba-bies.
October 21, 12:30 p.m.: A cooler of frozen breast milk arrives at University of San Francisco Benioff Children's Hospital. Fritzi Drosten, lactation consultant for the NICU, inspects the delivery, which includes Monica Lutgendorf's milk donation.
"We order 40 to 80 bottles of milk every two to three weeks," says Drosten. Because of a shortage of safe breast milk, she adds, "we have run out and had to use formula – but it was for less than a day."
Of the 850 NICUs in the United States, 30 percent use donated breast milk.
October 21, 2:28 p.m.: Regina Pate thaws the milk in its bottle then puts some in a needle-less syringe and warms the syringe to body temperature in water.
October 21, 2:08 p.m.: Joshua Riley Overman lies in his isolette waiting for Monica's milk.
Joshua was born 12 weeks early and weighed only 2 1/2 pounds. After six weeks of receiving donated breast milk, his weight is climbing: He now weighs 3 pounds, 15 ounces.
Joshua's twin brother, Lawrence, died of necrotizing enterocolitis shortly after birth. "Necrotizing enterocolitis, a disease that attacks the bowels, is the leading cause of death for premature infants," says Valerie Flaherman, a pediatrician at Benioff Children's Hospital. "Breast milk helps prevent the disease and makes a huge difference in the survival rates in infants under 28 weeks."
"Breast milk is rich in prebiotics, a type of sugar that promotes growth in preemies," she explains. "It also contains healthy bacteria, which crowd out the bad bacteria."
October 21, 2:38 p.m.: Joshua is prepared for a feeding. His nurse, Regina Pate, checks his temperature and changes his diaper.
Joshua is fed every three hours, around the clock.
October 21, 2:47 p.m.: Joshua's mom, Kim, watches as he is fed 1 ounce of Monica's milk from the syringe through a small tube powered by gravity.
The orange and white feeding tube leads directly to Joshua's stomach through his mouth. Preemies are often fed this way initially because they haven't yet developed the sucking reflex.
Kim is also pumping breast milk for Joshua, but using donor milk has reduced the stress on her to produce enough milk for him.
October 21, 1:53 p.m.: Down the hall from Kim and Joshua, Crystal, of San Francisco, sits between her twins in the NICU.
The twins, Rett and Charlotte, were born 10 weeks early. Crystal isn't sure why she can't produce enough of her own milk to feed them, but she says, "Donor milk lets me know I'm doing the best for them in their vulnerable state." Today, her children are being fed Monica's milk.
October 21, 1:34 p.m.: Crystal's baby Charlotte sleeps in an isolette. The orange and white feeding tube going into her mouth is taped to her chin to keep it securely in place.
"The donor milk allows my babies to have lifesaving nutrients that only a mother can provide. Formula just doesn't have the same components," says Crystal. "I was nervous about using donor milk till I found out it was prescreened and pasteurized and safe for my children. I'm hypersensitive about that."
October 22, 12:29 p.m.: At the Alta Bates Summit Medical Center in Berkeley, California, nurse Nieves Feied pours a protein additive into Monica's thawed milk.
One 4-ounce bottle of Monica's milk could provide anywhere from four to 12 feedings.
October 22, 10:58 a.m.: Donna Hurth, of Berkeley, holds her baby, Brionna, amid the wires of a ventilator and heart monitor in the Alta Bates NICU. Brionna is also attached to a pump for her feeding tube.
Brionna still spends most of her time inside the isolette.
October 22, 1:06 p.m.: A nurse attaches two ends of the feeding tube, as Monica's milk is fed to Brionna. On this day, Brionna's family and doctors are concerned because she has lost weight.
Brionna was born 13 weeks early, weighing just 1 pound, 12 ounces. After five weeks on a breast milk diet in the NICU, she now weighs 2 pounds, 1 ounce. Doctors expect she'll be in the hospital another seven weeks.
At first, Donna was worried about using donated milk. "I was leery. I had a visual of someone else feeding my daughter. My doctor reassured me that's not how it works, and that it's safe. Now, I would love to tell the mom who donated the milk thank you. It's helping her grow," says Donna.
Debra Busta Moore, a lactation consultant at Alta Bates Summit Medical Center says, "Brionna has been growing and progressing, just as we'd hoped. She hasn't had any serious infection – one of the primary reasons to use donated breast milk is that it helps avoid life-threatening infections."
October 22, 1:14 p.m.: Flashing lights and buzzing alarms are constantly going off in the NICU, alerting nurses to any change in the babies. The pump in the center pushes 1 ounce of Monica's milk through a feeding tube to Brionna.
"Pumps and gravity-fed tube systems are used to feed preemies for a variety of reasons. Maybe the baby is being intubated, or unable to suck vigorously, or unable to protect their airway when swallowing," explains Valerie Flaherman of UCSF.
Babies who've relied solely on donated breast milk are generally weaned from donor milk to formula before they leave the NICU.
October 22, 10:54 a.m.: "I was hoping that breastfeeding would help me establish a bond with my daughter," says Donna. Now she hopes that holding her daughter skin to skin, kangaroo style, will work just as well.
With so many premature infants and so few accredited milk banks to serve them, access to safe donated breast milk is an ongoing challenge. Milk banks believe every infant who needs breast milk has a right to it. It's hard to argue with that.
Interested in donating milk?Find out how.
Dana Dubinsky is a health and science editor.
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