Photo: Andrea Morgan, executive director, Mothers' Milk Bank at Austin

On August 6, 1999, Kathryn Pharr gave birth to a daughter named Emily. Born two-and-a-half months prematurely, Emily weighed 2 pounds, 6 ounces. She was placed immediately in the neonatal intensive care unit (NICU) of Brackenridge Hospital, in Austin, Texas. While premature babies as small as Emily cannot breast-feed, they can benefit greatly from the antibodies and nutrients of breast milk, which can be administered through a feeding tube. Pharr wanted to breast-feed because she believes -- and many experts agree -- that "there is no substitute for a mother providing milk for her child." But there was a problem.

Blood pressure medication Pharr took prior to giving birth made her unable to produce enough milk for Emily. She'd recently seen a flyer for the Mothers' Milk Bank at Austin (MMBA), an organization dedicated to collecting donated mothers' milk and dispensing it to those in need. Pharr was determined to give Emily donated human milk rather than formula, but she ran into another problem. The program was new in Austin, and Brackenridge did not yet have a policy for doctors to prescribe donated milk -- the only way it can be dispensed.

Undeterred, Pharr contacted the head neonatologist at Brackenridge, Dr. James Courtney. Pharr said Dr. Courtney advocated for her, asking the hospital board if there was any reason, besides the lack of existing policy, to keep Emily from receiving donated milk. There was no rebuttal, though it was suggested that Pharr consider moving Emily to St. David's Hospital, also in Austin, because St. David's already had a policy for prescribing donated breast milk. Pharr did not want to risk moving her fragile child to another hospital, so she opted to sign paperwork relieving Brackenridge of any milk-related liability. "I was happy to do it," says Pharr. "I feel so strongly that breast milk is the way to go. I was willing to sign whatever I needed to." Not long after, a policy was established at Brackenridge.

Enlisting Antibodies

Human milk has two major benefits: healing and nourishment. While the majority of recipients of donated breast milk are critically ill newborns, sometimes older children and even adults are prescribed human milk for its nutritional value and for the healing properties of the antibodies it contains.

"There is some anecdotal history of giving a dose [of breast milk] -- four ounces twice a day -- for the antibodies, to patients who are getting immune suppression therapy after organ transplants," explains Andrea Morgan, executive director of the MMBA. "These patients need to have their own immune system suppressed so as not to reject the new organ, but that leaves them vulnerable to infection. The milk gives them antibodies. Babies with AIDS or cancer would benefit, too, for the same reasons as an adult transplant patient; their systems are immune-suppressed, either because they are ill or because they are taking drugs that cause suppression of the immune system." The primary recipients, however, are preemies, who sometimes spend months in intensive care.

Why donor milk instead of a baby's own mother's milk? "Some moms can't keep up with the pumping," says Morgan, "or they're sick, or they're feeding triplets, or it's a struggle to get to the hospital (for regular feedings)." And sometimes, as is the case with Pharr, "a mother's body just can't produce milk or can't produce enough milk," notes Morgan.

Babies like Emily, born late in the second trimester or early in the third, do not receive crucial antibodies that pass through the placenta during the third trimester of a full-term pregnancy. "You can get these antibodies from mother's milk," says Morgan, explaining possibly the most important reason why parents of preemies are urged to provide human milk rather than formula. In addition, because mother's milk is human tissue, it can be digested more easily than formula. "The disease you worry about most is necrotizing enterocolitis, which occurs when undigested food sits in the bowel and creates an opportunity for infection," says Morgan. The disease can kill a baby or necessitate removal of much of the colon, leading to a lifetime of bowel problems.

The MMBA is not the first milk bank in the United States, nor is the concept all that new. Currently, the Human Milk Banking Association of North America comprises seven milk banks -- six in the United States, one in Canada. There have also been "kitchen table milk banks," informal gatherings at which women donated surplus breast milk for babies whose mothers could not produce milk, or enough of it. These associations were popular in the 1970s but went into decline as HIV and other viruses transmitted via body fluids posed a threat. Kitchen table milk banks didn't pasteurize the breast milk, nor did they offer quality control.

A Careful Screening Process

Milk donors go through two initial screenings -- one is by phone, the other is a detailed questionnaire. Candidates can be declined for all sorts of reasons: smoking, being at risk for HIV, consuming more than 2 ounces of liquor (or two beers) per day on a regular basis, or using certain medications regularly. If a donor passes the screenings and receives the okay from her doctor and her baby's pediatrician, she then pumps, collects, and freezes 100 ounces of milk -- a process that can take up to six weeks. "It's a real commitment," emphasizes Morgan.

Donors deliver this batch to the milk bank, then are screened for viruses such as HIV, hepatitis B and C, and syphilis. If all blood tests are negative, the milk is thawed, pooled with other donated milk (to insure a homogenous fat content and a greater variety of immune factors), and pasteurized. The milk is then tested for viruses and bacteria and refrozen. If the tests come back negative, the milk can be dispensed.

Not all Austin hospitals are currently prescribing donated mother's milk. Cost is a major issue in deciding whether to use donor milk. Dr. Audelio Rivera is the medical director of the Newborn Nurseries at St. David's, where donor milk is used. "I think mother's milk is a very important part of treating pre-term babies," says Rivera, who points out that there was a dramatic decline in the use of donated breast milk in the 1980s due to the spread of infectious diseases such as AIDS. "That scared a lot of people," he says. To deal with the problem, advanced technology and screening became necessary. "You need the proper policies and procedures in place. This costs money, and insurance won't pay for it -- so the hospital has to."

The price of human milk can be prohibitive. Hospitals or outpatients are billed a $2.50 per ounce processing fee, which covers about half of the milk bank's expenses. The rest is, hopefully, covered by donations and grants. However, no baby who needs milk is denied for lack of ability to pay. While the price sounds steep, as a preventive measure, breast milk can save far greater costs down the line for surgery to repair digestive systems that might otherwise be damaged by formula use. No payment is offered to the donor mothers; however, their blood work is paid for, and storage containers are provided. One donor mother, Mary, explained her sole motivation. "Little sick babies need it, so I bring in my extra."

Pharr, who breast-fed Emily for the first time on September 18, says she cannot find the words to properly express her gratitude to the donors and to the NICU staff. "It's been a real lifesaver for us," she says.

Related resources:

Mother's Milk Bank at Austin, www.mmbaustin.org

Human Milk Banking Association of North America, www.leron-line.com/milkbank.htm

Pauline Sakamoto, Director, Mothers' Milk Bank, Valley Medical Center, P.O. Box 5730, San Jose, CA 95150. Phone: 408-998-4550. Fax: 408-297-9208.

Laraine Borman, IBCLC Coordinator, Mothers' Milk Bank, Columbia P/SL Hospital, 1719 East 19th Avenue, Denver, CO 80218. Phone: 303-869-1888. Fax: 303-869-2490.

Maggie Conant, Coordinator, Wilmington Mothers' Milk Bank, Medical Center of Delaware, P.O. Box 1665, Wilmington, DE 19579. Phone: 302-733-2340. Fax: 302-733-2602.

Darlene Breed, Coordinator, Regional Milk Bank, Memorial Health Care, 119 Belmont Street, Worcester, MA 01605. Phone: 508-793-6005.

Mary Rose Tully, MPH, IBCLC Coordinator, Triangle Lactation Center and Milk Bank, Wake Medical Center, 3000 New Bern Avenue, Raleigh, NC 27610. Phone: 919-250-8599.