A Snapshot of Milk Banking in Other Countries
From: LEAVEN, Vol. 36 No. 2, April-May 2000, pp. 22-23
We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time
Milk banking has generally been discontinued throughout southern Africa due to the fear of HIV infection.
The milk bank in the San Jose Municipal Hospital opened in October 1994 and serves the city and surrounding area. It has contributed to a fall in infant mortality. About 40 mothers donate milk in any month. This is collected from their homes once a week. The milk is pasteurised (at 62.5 degrees Celsius for 30 minutes) and a culture is left for 48 hours before the milk is used; many of the immunoglobulins in the breast milk remain and provide protection against infection. About 800 liters are processed a year, enough for all premature infants to be cup-fed. When there is enough milk, the infants of mothers infected with HIV receive donated milk instead of infant formula. Donors in the Sao Paulo region are tested for HIV even though pasteurisation is sufficient to kill the HIV virus. There are 94 milk banks in the Brazilian Banco de Leite Nacional Associacion. One bank in each region has the role of training staff in new banks as these are introduced.
Reprinted with permission from Baby Milk Action Update 24, February 1999. Baby Milk Action is the British IBFAN group. (Baby Milk Action, 23 St Andrews Street, Cambridge CB2 3AX, UK)
Around thirteen years ago, human milk banking was in decline in Britain because of the fear of HIV transmission through breast milk and also because of funding cuts. Several events revived interest in milk banking. In 1987, Dr. Sue Balmer organised a conference on the future of human milk banking and in 1990 Professor Alan Lucas published a study on the beneficial effects of donor breast milk on reducing the incidence of Necrotising Enterocolitis. At a successful milk banking conference in London in 1997, the second such conference, delegates approved the formation of a new Organisation: The United Kingdom Association for Milk Banking (UKAMB).
"Every Drop Counts" appears on the logo of the UKAMB, with a drip symbol. According to Milk Banking News and Views, the Association's newsletter:
"The UKAMB has been established to:
- provide a forum for the exchange of information about milk banking,
- set standards for the practice of milk banking,
- regularly review guidelines for milk banking,
- encourage research into milk banking practices,
- promote milk banking so that more milk donors come forward.
"The UKAMB welcomes membership from interested institutions such as neonatal units and associations with a concern about breastfeeding; individual professionals working in the field of breastfeeding; nonprofessional individuals who have an interest in milk banking; and companies who do not violate the WHO Code of Marketing of Breast Milk Substitutes. International memberships can be accepted."
The launch of the new association secured so much media coverage that "the phone never stopped ringing" for days. Hundreds of the calls were from women wanting to donate milk. Sadly, many had to be told that their nearest milk bank was too far away as most of the 13 human milk banks in the United Kingdom are based in neonatal units and serve only that particular unit. Seven of the banks are in London and the southeast part of England, but plans are being made to open milk banks in some other areas of the UK.
Much of the work of collection is done by volunteers, so donors have to be within reasonable traveling distance of the bank. The UKAMB has developed guidelines for donors, who are always volunteers, and has set up a working party including donors to develop a leaflet to recruit additional donors.
Hospitals rarely have "extra" milk to make available to other units, but occasionally some may be spared for a sick baby in another unit. One Mothers' Milk Bank in Birmingham has milk available for sale.
The use of banked human milk in United Kingdom hospitals gives a strong message about the value of human milk and breastfeeding to every mother and member of staff in the hospital. Every drop counts!
More information and membership details are available from Gillian Weaver, Milk Bank Coordinator, Queen Charlotte's and Chelsea Hospital, Goldhawk Road, London W6 OXG, UK. The UKAMB website is at http://www.ukamb.org/ and email at ukamb at sciencenetwork.com
Adapted from United Kingdom Association for Milk Banking (UKAMB) "Milk Banking News and Views" Special thanks to Gillian Weaver, BSc Hons Nutrition, Dip. Dietetic.
Tragically, the only milk bank in Canada is slated to be closed by the hospital where it is located.
[Editorial note: On September 23, 2002, we received this information from C&W Lactation Services: "The news of our death was premature. We were threatened by closure in April 2000 but have managed to hang on and persevere." The milk bank is in Vancouver, BC.]
Some hospitals in China have human milk banks which use milk donated by newly delivered mothers who have too much milk. The milk is usually hand-expressed into cups, then pasteurised at 62 degrees C for 30 minutes and frozen. It is used for premature babies and those whose mothers are severely sick after birth.
Information excerpted from "Milk Banking News and Views" September 1996
Japan does not have any official national bank programs. However, individual hospitals with neonatal intensive care units (NICU) may have their own milk bank. One such hospital is the National Okayama Hospital, which holds the distinction of being accredited in 1991 as the first Baby Friendly Hospital in developed countries. It was there that Dr. Itsuro Yamanouchi, a noted friend of LLLI as a member of Health Advisory Board and supporter of breastfeeding, worked until he passed away. In the National Okayama Hospital all healthy full-term infants are totally breastfed and the rate of breast feeding is almost 100 percent during the mothers' week long stay at the hospital. The milk bank belongs to the NICU and the mothers of babies in NICU store their milk in a big freezer, which they call "milk bank." However, they sometimes use donor milk for very low weight babies and severely infected babies when these babies need more than their mothers produce, after the written agreement for donor milk usage is obtained. They screen all banked milk for the following: HBV (Hepatitis B), HCV (Hepatitis C), HIV, HTLV-1 (Human T-cell Leukemia virus type 1), and Syphilis. If mothers do not want to be screened, their milk is assumed to be positive and would not be used for donor milk.
The first French milk bank, called a "lactarium," was established in Paris in 1947. Before 1947, wet nurses were housed, sometimes with their children, in hospitals.
In 1999, there were 20 lactariums. Lactariums collect milk, transform or treat, stock and distribute mother's milk. Collection is done by "collecting ladies" who go to donor mothers' homes. In many places, a mother willing to donate must commit to a certain amount of milk. A collection is also made through the hospital system mainly through neonatalogy or maternity services.
Although all lactariums are members of the same organization, the Association des Lactariums de France, each has its specific protocols. For instance, one lactarium in the southwest of France, Marmande's lactarium, uses deep-freezing and lyophilisation of human milk while the other lactariums in France heat-treat raw or frozen milk.
After the use a few years ago of contaminated banked blood that resulted in many HIV infections, the French government instituted very strict regulations on collection and use of blood and human milk by health professionals. It is now mandatory for all donor women to be tested for HBs antigen, for antibodies for HIV 1 and 2. HCV, HTLV1, and HTLV2 testing is done only for populations considered at risk such as when a woman or her partner comes from a country identified as high risk. The milk is further tested for bacteriological content twice, before and after pasteurization. These regulations apply for an anonymous donor and also for a mother who needs to pump her milk for her own hospitalized baby. This means that a breastfed baby needing hospitalization but not well enough to feed at the breast directly may be denied his mother's milk until the tests are performed. In the meantime, he will often receive formula. After a mother has gone through the testing process, her own milk will be donated to her own baby in most lactariums. The cost to the milk banks for collecting and handling milk and for the serologic tests is about 800 to 1000 FF/liter (about 4 to 5 dollars per ounce). In France, donor mothers make a gift of their milk, and do not receive any money. Mother's milk is mostly bought by hospitals for a fixed price of about 400 FF per liter (about 2 dollars per ounce), well below the cost of processing. The French social security system pays the cost of prescribed mother's milk and families who are not insured under this system are rare. Prescription for human milk by any doctor is theoretically possible for any baby.
Because the breastfeeding
rates after the first few weeks are low - less than 10 percent at three
months - there are insufficient donors and the available milk is usually
only given to very premature babies. For information on milk banking
in France contact:
Association des Lactariums de France at Siège Social: 26, Boulevard Brune, 75014 Paris, Tél: 01.40.44.39.14.
Editor's note: This list includes countries with official, national milk banking programs, countries with non-governmental associations of milk banking, and countries where milk banking is undertaken independently by hospitals. This list is partial at best. If you have additional information about milk banking or milk banks in countries other than the USA, please email me at Carole Wrede, Managing Editor, LEAVEN 103050.3411 at compuserve.com or write to: Rte.1, box 110, Greeley NE 68842 USA
Milk Banking Worldwide
The Czech Republic
The United Kingdom
From A Former Milk
One June 4, 1998, I gave birth to a beautiful baby boy, Rainer. As soon as he was born, we knew something was wrong. Two weeks late, he was only four pounds, eight ounces, was having trouble breathing, and didn't have any suck reflex. He lived six weeks, most of the time on a respirator, and died of a rare disease called Mitochondrial Depletion Syndrome.
We didn't know the diagnosis until after he died and during most of his short life, we assumed he'd survive. I had planned on breastfeeding so I pumped my milk which was fed to him through a nasal gastrointestinal tube because he never developed the ability to suck. Being able to provide breast milk to Rainer was important to me because I felt it was the one thing I could give him that no doctor or nurse could. I couldn't stay with him 24 hours a day; I couldn't even give him my loving care as I had dreamed. But I could give him my milk. The bond we had through that, even though he never nursed, is something I still feel even after his passing.
When he died, I had a freezer full of breast milk. We learned about the Bank in Denver, Colorado through La Leche League in Madison, Wisconsin. We contacted the nurses at the Milk Bank who were easy to work with and sympathetic. In fact, we learned that a lot of the milk they receive comes from mothers whose babies have died. The Mothers' Milk Bank sent me shipping cartons for the milk and paid to have it sent back to them. Later they told me I had sent almost 700 ounces - enough to help a lot of babies. Rainer had blessed our family in so many ways and he was also able to help these other very sick babies. I am deeply grateful the Mothers' Milk Bank was there for me.
They are also there for babies whose families cannot afford the milk. The Mothers' Milk Bank never turns down a request for breast milk due to an inability to pay. If insurance or other programs do not pay, the Milk Bank assumes the cost. To help defray these costs, they have developed a cookbook called "Cookies and Milk."
As both a mother of a terminally ill child and a donor, I assure you the work they do is invaluable.
Michelle Byrne and her husband, Keith Woodruff live in Madison, Wisconsin, USA. In January 2000, they were delighted to welcome a new baby boy, Whitman Woodruff. Michelle writes, "I'm so glad you're doing an article on the milk banks. I remember the hospital where Rainer was born told us there were no such things - so, clearly the word needs to get out. It's such a huge contribution to these babies' lives, and especially for moms who have lost their babies, a profound way to honor those who have died."Thank you, Michelle.
Special thanks to the following people for making this "snapshot"possible:
Rachel O'Leary, ID Division Publications Administrator Burwell, Cambridgeshire, Great Britain
Laure Marchand Lucas, MD, IBCLC , a Leader in Paris, France and the International Division's Administrator of Professional Liaison Resources.
Gillian Weaver, BSc Hons Nutrition, Dip. Dietetic, United Kingdom Association for Milk Banking (UKAMB)
Hiroko Hongo, LLL Leader, IBCLC, Tokyo, Japan.
Marianne Brophy, LLL Leader, Vancouver, Canada
Nan Jolly, LLLI Board Of Directors, South Africa
[Addendum: as of December 2003 there are at least two milk banks in South Africa, we are told. You can learn about one of them here: http://www.ithembalethu.org.za/breastmilk.htm -- this address last updated 11/17/06 ]