When Ariyah Georges was born 15 weeks early, she weighed only one pound, 12 ounces. Her mother, Jovan, knew how important breastfeeding was, especially for micro-preemies like Ariyah, so she began pumping milk to feed her through a tube. But two days later, Jovan felt dizzy and feverish—104 degrees, in fact. She had a blood infection and was close to full septic shock.
“I almost croaked,” Jovan says. She entered quarantine for nearly two weeks at the regional Northern Virginia hospital where she’d delivered. During that time, she could still pump breast milk, but Ariyah couldn’t consume it because of the risk of developing sepsis herself. Without it, the newborn was particularly vulnerable to a disease called necrotizing enterocolitis, the number-one cause of death among premature infants in the United States.
Enter donor milk—breast milk purchased by hospitals for mothers who aren’t able to produce enough milk on their own, due to health complications, stress, or other factors. The milk comes from milk banks, organizations that collect, screen, and pasteurize breast milk from lactating women willing to donate. Usually dispensed in neonatal intensive-care units, the milk is only available by prescription. And it hasn’t just been found to improve infants’ health outcomes; it can lower hospital costs by reducing the number of surgeries and interventions to correct life-threatening conditions.
In recent years, both milk banks and the use of donated human milk have risen swiftly in the United States. In 2011, 22 percent of NICUs used donor breast milk; four years later, that number doubled to nearly 40 percent, and went even higher for the most intensive NICUs—as much as 75 percent. There are 23 milk banks in the United States accredited by the Human Milk Banking Association of North America, or HMBANA, double the number that existed five years ago.
But as demand for donor milk rises, banks must find more charitable donors—a task made more complicated by informal, unregulated networks of milk sharing that happens online. And many of the most vulnerable infants are still not being reached.
* * *
I became acquainted with the world of human-milk donation quickly and unexpectedly last April, when my own son was born 10 weeks early. I blamed myself for his premature arrival, even though there was nothing more I could have done to prevent it. When it came to breastfeeding, my body seemed determined to redeem itself. I was lucky to have an immediate and bountiful supply—so bountiful, in fact, that I quickly stocked two freezers full of extra milk. I was producing double what my son needed, and quickly running out of room.
I began donating to the Mothers’ Milk Bank at Austin, which served the hospital where my son stayed. The Texas-based organization caters to hospitals in 22 states with milk from about 1,200 donors around the country. They’re on track to dispense a total of 5 million ounces by the end of this year.
The screening process to become a donor is extensive. Before I began trundling a cooler packed with vials of frozen breast milk through downtown Washington, D.C., I completed several phone interviews with the bank, submitted recommendations from my doctor and my baby’s doctors, took a blood test, and filled out a detailed questionnaire to screen for medical history, drug and alcohol use, diet choices, and so forth. Once the bank received my donated milk from the drop-off center in the city, they screened it for bacteria, pooled it with other donated milk, pasteurized it, and shipped it back out to hospitals.
To cover these costs, the bank charges each hospital a “processing fee”—usually $4 to $5 per ounce. The donors themselves don’t receive any of this money. Even as I pumped away, I began to wonder about the industry built upon donations from women like me. Were donors ever reimbursed for our efforts or expenses?
“We don’t pay donors,” says Kim Updegrove, the executive director of the Mothers’ Milk Bank at Austin. Doing so, she explains, might encourage pay-to-pump situations where mothers are cashing in on their “liquid gold,” as breast milk is often called. What if a mother begins neglecting her own child’s nutrition in pursuit of money? In addition, one study found that breast milk available for purchase is often tainted with cow’s milk; and milk sourced via the internet may contain higher traces of bacterial contamination.
Still, a company called Prolacta Bioscience, which produces a human-milk fortifier used to supplement both formula and breast milk for extremely premature babies, pays $1 an ounce to approved donors. Some moms also sell their milk outright—either to a co-op like Mother’s Milk Cooperative in Oregon or through the website Only the Breast, kind of a Craigslist for breast milk.
For me, coordinating milk drop-off in the city was enough of a hassle and expense that I soon tried a different route: I found a local mother of a NICU baby to donate to on my own. I met the NICU mom online, through a Facebook group set up to facilitate informal sharing. Every few weeks, she drove to my house and picked up dozens of bags of frozen milk, which helped ease my workload as a donor. (I later learned that milk-bank volunteers may help overtaxed moms like me with milk drop-offs.)
I certainly wasn’t the first person to try this approach. Social media is a major factor deterring potential donors from formal milk banks. It’s often simpler, logistically, to get milk to a local parent in need than to ship it across the country. And there’s no complicated paperwork. There are, of course, no regulations at all.
For Updegrove, informal sharing of this nature is a question of ethics: “how we decide to use the limited resource for the most vulnerable.” She argues that extremely premature and ill babies need donor milk more than healthy, full-term infants. Babies fed breast milk are less vulnerable to illnesses such as diarrhea, ear infections, and pneumonia, and they are less likely to develop asthma or become obese later in life. But among premature babies, the effects can be even more profound; in addition to helping prevent NEC, breast milk can help stave off sepsis and promote long-term development. For these reasons, the American Academy of Pediatrics recommends feeding preemies donor breast milk over formula when mothers’ milk is not available.
The very lack of regulations in informal sharing, though, means that breast milk is often not given to the babies who need it most. “We’ve got babies who would die otherwise if they don’t get human milk,” Updegrove says. Her reasons were convincing enough for me to resume formal donations once my son’s needs eased.
* * *
Although milk banking has sharply increased in the past few years, there are still many hospitals where donor milk isn’t an option—and they tend to care for the most vulnerable babies at the highest risk of developing complications.
“I know this will sound backward to you,” Updegrove says, “but we are working hard to increase the demand.” She is confident that donations will continue to go up as demand increases, because more mothers will learn about the option to donate from hospitals using donor milk.
Expanding the supply of donor milk is about reaching out to women who aren’t yet aware that milk banks exist, says Naomi Bar-Yam, the executive director of Mothers’ Milk Bank Northeast and the current president of HMBANA. “There are a lot of moms who still don’t know about this possibility. So we work hard to educate them,” she says. Beyond recruiting more donors in the short term, banks also focus on strengthening breastfeeding in general—which has ripple effects for donation. Promoting a culture of breastfeeding, Bar-Yam argues, will result in more breast milk out in the world.
In fact, she highlights a counterintuitive trend: “As hospitals use donor milk in the NICUs, over time they need less donor milk.” This has to do with those hospitals’ newfound veneration of the bodily fluid, Bar-Yam explains. Both the staff and the parents learn the value of breast milk, and they work harder to support successful lactation with new parents—thus decreasing the amount of donor milk they need. “Just the very fact of having the milk there,” she says, “is a very important message.”
In Northern Virginia, the hospital staff encouraged Jovan to continue pumping as she recovered from her blood infection, even though she had to discard the milk during her illness. Although she was frustrated to “pump and dump,” Jovan was encouraged by the thought that her daughter would seamlessly transition from donor breast milk to her own—without ever relying on formula. In the 1990s, Jovan’s two older children had also been born prematurely, and donor milk was not an option at that hospital. “A lot of kids got sick because they had to give [them] formula,” she says.
For Jovan, the message was now loud and clear: Donor milk had helped her baby, and it was time to pay it forward. When Ariyah left the NICU after 105 days, Jovan donated all the extra milk she’d saved up for her daughter at the hospital—about 350 ounces. She continues to pump about 100 ounces a month for donation to the milk bank, The King’s Daughters, that served her daughter’s hospital.
“If someone else didn’t donate, it wouldn’t have been available for my daughter,” she says. “I want to help someone else’s baby the way that they helped my baby.”