It’s In The Bank

photo credit: Mattman4698 via photopin cc

Human milk banking is a critical part of health care in Canada. Pasteurized human milk helps close the nutrition gaps for our sickest babies. Babies in the NICU or at home but living with significant health problems benefit greatly from this milk. Of course, the best milk for these babies is their own mother’s milk, but sometimes for various reasons, it is not available. A sick newborn needs calories but her mother’s milk has not yet come in in sufficient quantities . A micro preemie’s mother is undergoing a lung transplant or cancer treatment and cannot produce milk. A baby with a cardiac condition has a mother with insufficient gladular tissue and is not thriving on formula. Pumping and hand expression produce sufficient quantities of milk for most babies, but it is not the same stimulation for milk production as breastfeeding. Some NICU mothers find their supply initially meets their babies’ needs but drops after several weeks of pumping, before their baby has grown enough to learn to breastfeed. These babies: those in the NICU and those who have trouble thriving with formula in their diet, are desperately in need of banked human milk.

Most hospitals in Canada have no human milk option for its smallest and most fragile patients. But for 48 years, BC Women’s Hospital has been able to provide human milk for babies in need through their milk bank. In December, Mothers of Change interviewed Francis Jones, the director of BC Women’s Milk Bank, to learn more about the history of milk banking in Canada and the backstage workings of this valuable BC resource.

When was BC Women’s Milk Bank established?

It was established in 1974 and has operated without closing ever since.

What were the early years like?

The BC Women’s Milk Bank was started by a pediatric gastroenterologist named George Davidson. He worked with the hospital’s sickest babies and was frustrated by the inability of some of his tiny patients to thrive on even very specialized formulas. He was desperate to help these babies get the nutrition they needed, and so he started with just one child, accepting donor breastmilk from healthy women, and noticed a significant improvement in health for that baby.  Because it was so successful, he was able to expand to meet the needs of many babies at once.

Very soon after starting to receive donor milk, the hospital began pasteurizing so as to balance the nutritional qualities of the milk with safety concerns.  

Author’s note: At that time there were dozens of milk banks operating in North America; at its height, Canada had 23 milk banks. All but BC Women’s rapidly closed their doors during the 1980s after the awareness of HIV/AIDS changed our approach to bodily fluids. Not one milk bank recipient has contracted HIV in the history of milk banking, but legitimate concerns over safe pasteurization processes caused many hospitals to close their milk bank doors altogether.

Dr. Davidson operated the milk bank for twelve years, after which Aggie Ratcliff took over as director. She served as director of the BC Women’s Milk Bank for 25 years.

Vancouver and San Jose have the oldest milk banks in North America. San Jose’s is the biggest milk bank.

Please describe daily functioning for the milk bank. What is done, on a typical work day?

Our dedicated milk bank technicians do the labor intensive work of milk handling, pooling and pasteurizing, labeling, sealing, and freezing.

There is quite a lot of paperwork that goes along with operating a milk bank. Traceability is huge; HMABNA guidelines state that we must be able to trace back to the donor origins of each batch of milk as well as to all its recipients.

HMBANA is the Human Milk Banking Association of North America and is responsible for establishing standards and guidelines for human milk banking practices in North America.

Donor screening is a big part of the milk bank operations. Screening is done by the hospital’s lactation consultants. Screening starts with a phone conversation. If a prospective donor meets certain criteria, she will recieve a package of forms to fill out, including a consent form to contact her doctor. A simple form goes to her doctor to confirm her medications and overall health.

After this is finished, the prospective donor will be sent for lab tests. These are the same ones done during pregnancy, and the lab work is covered by MSP. The results of this lab work are sent to both her family doctor and to the milk bank, and the woman will be contacted by phone to let her know that this is complete.

Women can begin expressing and storing milk before this process is begun or completed, and continue to store her milk until she is approved as a donor. BC Women’s Milk Bank prefers a minimum donation of 200 ounces, except in cases of bereavement. Women whose infants have died and who would like to donate are screened as per normal but can donate any amount of milk. Many women find this a positive way to honor their baby, by helping other medically fragile infants.

Also involved in daily work for the milk bank is arranging recipients, and so on. Banked milk is considered our hospital’s “in house” formula, for when mother’s milk is not available.

How and why did the Vancouver Milk Bank stay open when all others closed in Canada?

BC Women’s Milk Bank was run by a pediatric gastroenterologist, as mentioned, and was initially a small operation, providing milk to a number of hospitals in Vancouver.  They felt comfortable carrying on, especially in light of pasteurization.  Dr Davidson was a passionate advocate of human milk banking.  
The concern about HIV and CMV that developed in the 1980s was legitimate, but the health benefits of human milk were quite evident. Because of the passion of Dr. Davidson, our milk bank stayed open.

For many milk banks, there was fear of the increased liability of using human milk, and at the same time an increase in development and marketing of preemie formulas. So although human milk pasteurization was becoming standardized and researched, increased liability involved in using human tissue caused a great number of milk banks to close. In the United States, the number of milk banks dwindled to five in the year 2000, and Canada had just one.

Since then, there has been an explosion in the number of milk banks. The early 21st century saw an acknowledgment by the medical establishment that breastmilk cannot be replicated. Its value has increased in our culture, and as a result, we have seen an explosion in our milk bank population.

How many employees work at the milk bank?  

We have two milk bank techs, each of whom work part time, and five lactation consultants who cover both BC Women’s/Children’s hospitals, and the milk bank.

What type of education or background do they have?

Our technicians are nutrition and dietetics specialists. They don’t have a single specific training or background, but we look for someone who has extensive experience and training with sanitation and food preparation. Someone who is a food supervisor, works with kitchens, formula prep, menus, sanitation, etc.  They need to be meticulous in the handling of food.

Our Lactation Consultants are nurses who have specialized training in lactation. They are board certified IBCLCs with extensive lactation knowledge, training, and experience.

IBCLC is the certification International Board Certified Lactation Consultant.

How did you develop an interest in human milk banking?

I started with breastfeeding. I breastfed my own children, who were born in the 70s and 80s.  It was definitely common then to feel odd for breastfeeding because it was not the cultural norm.  I breastfed one of my children when they were critically ill in the NICU, and was insulted by a nurse. That lit a fire that never went out. I became very interested in public health and maternal health.

Twelve years ago BC Women’s Hospital was looking at whether to keep the milk bank open or to close our doors. In all of 1999 there were only 33 recipients from our milk bank, and no other milk bank was operating in Canada. The hospital administrator asked me, “Do you think we are behind the curve, or ahead of the curve, by remaining open?” Of course I said emphatically, “Ahead of the curve.” I was correct. In 2011, we provided banked milk for more than 2500 babies.

Do you have a volunteer program?

No. BC is very unionized and so we are not able to use volunteers in our milk bank when a paid staff member could be utilized.

Who are your donors?

Healthy women who have given birth in the previous 12 months, who have undergone screening. We are always looking for more donors to help us meet the ever increasing need for banked human milk.

Who are your recipients?

The majority of our recipients are NICU babies. A small number of babies we provide milk for are in BC Children’s hospital with a kidney problem or cardiac problem that makes them medically fragile, if there is a gap in their mother’s supply. BC Women’s Milk Bank donor milk is our “in house” formula and is used in some cases of hypoglycemic babies, or on the postpartum ward.

Our outpatients who receive donor milk tend to be graduates of the NICU. They have a feeding intolerance, formula intolerance, severe allergies, or kidney or cardiac problems. These are sick babies who really need human milk.

Finally, if a mother cannot breastfeed because she is receiving chemotherapy or radiation, and her baby is healthy, we try to provide at least a few bottles of milk for their babies, but we are running low CONSTANTLY. We wish we could provide milk for so many more, but we have to triage our milk to the sickest babies first.

How do recipients get donor milk? Who initiates this process; the parents or the care providers?

It depends on the situation. In the NICU often parents are overwhelmed, and because in our hospital we use human milk so often, it is common that the health care provider suggests using donor milk.

Do you ever have an excess?

Yes, we used to go through swings of highs and lows; but since late spring it has been down.  Every week we are having to say no and triage the milk to only the sickest of babies. We are currently experiencing a critically low shortage of donor milk.

Do you have external funding?

We receive hospital funding. In approximately 2003 we started charging a partial recovery processing fee of $5 for 4 oz of milk to community recipients.  If a baby is in the NICU or at BC Women’s or Children’s Hospitals, the family is not charged. The Hospital Foundation currently has a project to raise funds for milk bank to help us expand. Our plan is to expand and become a Provincial bank within 5 years. This means we would expand across the province and be a centralized processing site with collection depots and recipients all over the province. This would help us meet the needs of so many more patients.

What would you love to see happen for your milk bank, as a vision for the future?

I would love to see a vision for the children of BC rather than for the milk bank specifically: I would love to see wonderful breastfeeding support throughout the entire province. And I would love to see donor milk be available to ALL families.

Our deep thanks to Francis Jones and all the dedicated staff of BC Women’s Milk Bank for the important work you do. Mothers of Change has a vision to see wonderful breastfeeding support throughout Canada, and to have donor milk available to all families, too! Thank you for this interview and for the countless hours you dedicate to the milk bank.

For more information on the BC Women’s Milk Bank, visit their website. For more information on becoming a donor please visit their Donating Milk page. For information on becoming a recipient, visit their Recieving Milk page and talk to your care provider.

Don’t have milk to donate? Consider a financial donation to BC Women’s Milk Bank.

Finally, for a peek into what it is like for the parents whose babies receive this most precious donation, read the story of little Matthew.

~Melissa V