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An Alternative to Mother’s Own Milk: Maternal Awareness of Donor Human Milk and Milk Banks
Abstract
Background
The use of donor human milk is rising. Maternal awareness of donor human milk use, milk donation, and milk banks has not been well described in the United States.
Research Aims
To explore maternal experience, knowledge, and attitudes regarding donor human milk use and milk donation. We also assessed counseling by medical providers about donor human milk use and donation.
Methods
A cross-sectional prospective survey design was used in this study. We anonymously surveyed mothers ( N = 73) attending the 1 to 2-week well newborn appointment. Analyses were completed using one-way ANOVA and logistic regression.
Results
Participants’ infants primarily received their own mother’s milk (87%, n = 61). No infants received donor human milk, but 4% ( n = 3) of participants donated milk. The majority of participants had positive responses to attitudinal statements about donor milk. When presented with a hypothetical scenario, participants chose formula (89%, n = 59) over donor human milk (11%, n = 7) for their infant. Moreover, if donor human milk was the only option available, they chose donor human milk from a relative or friend (60%, n = 40) over a milk bank (40%, n = 26). Medical providers had discussed donor human milk use or donation with 4% ( n = 3) of participants.
Conclusions
The majority of participants previously had minimal experience using donor human milk and limited knowledge regarding donor human milk and milk banks. According to participants, medical providers did not routinely discuss milk donation and the role of donor human milk with families.
... These findings are in concordance with a similar study conducted in USA among 73 postnatal mothers, where 73% of mothers said that donated human milk is a primary source of nutrition for all infants and helps in a new born's growth and development. 8 However, another study conducted in Hyderabad, India, is in contrast to our findings where 57.3% mothers said that donor breast milk provides certain immunity, while 46% said that donor milk had higher nutritional contents compared to formula feed. 9 In the present study, 38.8% antenatal mothers had adequate awareness, 43.6% had average level of awareness and, 17.6% had inadequate awareness regarding human milk donation and milk banking. ...
... This finding is consistent with findings from a study conducted in the USA. 8 Similarly, almost all antenatal mothers from the current study agreed that they would donate their breast milk only to the newborns of their relatives and friends, which is comparable to the study findings from Turkey where 90.7% of mothers disagreed on giving their breast milk to the strangers. 12 In the current study, 64.2% of antenatal mothers were willing to donate their excess breast milk to the human milk bank, and 68.5% agreed that they would reach out to the milk bank if they did not have enough breast milk after delivery. ...
Awareness and Perception Regarding Human Milk Donation and Milk Banking among Antenatal Mothers in a Tertiary Hospital of Kathmandu – A Cross - sectional Study
Abstract
Introduction: Breast milk is universally recognized as the most beneficial source of nutrition for all newborns. World Health Organization (WHO) recommends the use of donor human milk to sick and normal newborns if mother’s milk is unavailable to them. The objective of this study was to assess the awareness and perception regarding human milk donation and human milk banking among antenatal mothers.
Methods: A descriptive cross-sectional study was carried out among 165 antenatal mothers. Data were collected via face-to-face interviews after obtaining informed written consent. Descriptive and inferential statistics were used to analyze the findings.
Results: From the study findings, 43.6% antenatal mothers had average awareness level whereas 38.8% had adequate, and 17.6% had an inadequate awareness level. Similarly, 66.7% antenatal mothers had positive perception and 33.3% had negative perception regarding this. The level of awareness and perception was significantly associated with age (P = 0.001), educational status (P = 0.002), residence (P = 0.013) and religion (P = 0.004).
Conclusions: Antenatal mothers tend to have average awareness and positive perception regarding human milk donation and milk banking. As there is positive perceptions of human milk donation and milk banking among them, this practice should be promoted to improve the nutritional benefit for infant and non-nutritional benefit for mother.
... In human milk banks, it is crucial to identify both the donor and the recipient when transferring donations. 22,23 When a mother has no other option but to obtain donor breast milk, she often prefers to receive it from a relative or friend due to religious concerns. 21 However, human milk banks are generally accepted when the baby's gender is known, the number of recipients is limited, and the identities of the donor and recipient are disclosed. ...
... Obtaining breast milk from a breast milk donor or a milk bank is the last method they choose. 22 However, donor human milk has been shown to offer several advantages over formula feeds, including lower rates of infection and feeding intolerance. 27 The mothers' religious concerns, their anxiety regarding hygiene and their scant knowledge of human milk banks are striking. ...
Objective: This study aimed to review the opinions of mothers with children of ages 0-2 about human milk banks. Method: The study was of phenomenological design. The purposive sampling method of criteria sampling was used. Seventeen mothers of children aged 0-2 who were hospitalized in the pediatrics department of a state hospital and who consented to participate were recruited into the study. The data gathered from the discussions were grouped under themes in Colaizzi's phenomenological content analysis. Results: The mothers pointed out that they did not look positively on human milk banks because of religious concerns. The mothers stated that they would share their human milk if they knew the child and parents who gets donor human milk. Conclusion: As in organ and blood donation systems, human milk banks can be implemented under the support of the Ministry of Health, which will be instrumental in developing human milk donation protocols and registration systems. This will increase the numbers of babies benefiting from breast milk, thus extending the duration of the breastfeeding period. This in turn will result in the growth and development of healthier generations.
... In this study, the majority of the women had heard about wet nursing and reported that they would be willing to be wet nurses; only one in eight, however, had experienced this. Although the use of wet nurses has decreased significantly today [7], mothers' willingness to be wet nurses is also supported by the literature [19,21]. ...
... More than two-thirds of the women included in this study reported that they had never heard of HMB before. Similar studies report that women have higher awareness in countries where HMBs are used [21][22][23] and levels of awareness about HMB are low in other countries [24][25][26]. Although the respondents' awareness level of HMB was low, at the end of the study, more than half of the respondents supported the founding of an HMB in Turkey. ...
Background
Human milk banks (HMB) play an essential role by providing human milk to infants who would otherwise not be able to receive mother’s milk. There is currently no donor milk bank in Turkey. For any new health intervention to be successful, determining its acceptability is a vital first step. This study intends to determine the opinions, knowledge, and attitudes of native Turkish and refugee women living in Çeştepe, Aydın, a rural area in Turkey, about HMB.
Methods
A population-based cross-sectional, mixed-methods study was conducted. Qualitative study data were collected through in-depth interviews with 33 women, and quantitative study data were collected using a questionnaire. A total of 271 women in the region were included in the study. Qualitative data were thematically analyzed and then a conceptual framework was created. Logistic regression was performed for quantitative data.
Results
Fifty-seven point nine per cent of the women were willing to donate breast milk, whereas only 27.7% were willing to use donor milk for their babies. Religious concerns, fear of infectious diseases, and distrust in people they did not know were among the reasons for the negative attitudes of the women. Fear of infectious diseases was mentioned specifically by native Turkish women, and religious concerns were reported both by native Turkish and refugee women. The importance of breast milk and religion were among the reasons for positive attitudes. Additionally, odds of having a positive attitude were 4.19 times higher in homemaker women (95% CI 2.0, 8.76); 4.77 times higher in women with three or more children (95% CI 1.25, 8.15); 6.12 times higher in women who had a positive attitude towards wet nursing (95% CI 3.14, 9.63); and 2.68 times higher in those who had previously heard about human milk banking (95% CI 1.24, 5.79).
Conclusion
Attitudes towards HMB are affected by religion, cultural beliefs, and concerns about the safety of breast milk in HMBs. Refugees and native Turkish women are found to have similar religious concerns. These findings should be taken into consideration in human milk banking initiatives and in activities to increase acceptance by the public.
... Por otro lado, todos los trabajos sin excepción detectan y defienden cómo son cruciales, en el proceso (la motivación para ello y el mantenimiento de la práctica) de donar, la información previa, significativa y adaptada, así como el apoyo multifactorial efectivo a madres, familias y entornos. De hecho, la importancia de los bancos de leche contemporáneos se vincula con la necesidad de recogida de los excedentes de leche humana como servicio social(24,25); así, y en tanto que los bancos evidentemente dependen de las donaciones voluntarias de madres, es clave comprender qué las motiva a esta donación (aspectos intersubjetivos que interfieren) y qué puede hacer la sociedad para contribuir a ello(25). Se ha probado como elemental el contacto previo con el banco, así como el apoyo, la ayuda, la información y el tratar de incrementar la comodidad para la donante, a través, por ejemplo, del mantenimiento de un sistema de recaudos para evitar molestias y viajes frecuentes a los bancos de las madres que quieren donar su leche(23).En casos de países con comunidades musulmanas, destaca el abordaje de las dificultades específicas ligadas a pautas culturales. ...
... Por otro lado, todos los trabajos sin excepción detectan y defienden cómo son cruciales, en el proceso (la motivación para ello y el mantenimiento de la práctica) de donar, la información previa, significativa y adaptada, así como el apoyo multifactorial efectivo a madres, familias y entornos. De hecho, la importancia de los bancos de leche contemporáneos se vincula con la necesidad de recogida de los excedentes de leche humana como servicio social(24,25); así, y en tanto que los bancos evidentemente dependen de las donaciones voluntarias de madres, es clave comprender qué las motiva a esta donación (aspectos intersubjetivos que interfieren) y qué puede hacer la sociedad para contribuir a ello(25). Se ha probado como elemental el contacto previo con el banco, así como el apoyo, la ayuda, la información y el tratar de incrementar la comodidad para la donante, a través, por ejemplo, del mantenimiento de un sistema de recaudos para evitar molestias y viajes frecuentes a los bancos de las madres que quieren donar su leche(23).En casos de países con comunidades musulmanas, destaca el abordaje de las dificultades específicas ligadas a pautas culturales. ...
The human milk donation has been an undervalued and very biasedly examined subject until relatively recently, in comparison with other types of human donation (organs, tissues, fluids), not being recognized its dimension of bodily altruistic and philanthropic act in the same way as other (mildly) analogous realities, as well as in its approach from the perspective of feminist and gender studies. On the other hand, although the COVID-19 pandemic and the various lockdown processes have had an onerous impact on human breastfeeding in general, we find data on the global increase in breastfeeding donation as a specific altruistic gesture during the pandemic in Spain and, even, on the decisions in the most complicated moments of the state of alarm about donating one's own milk in the tragedy of perinatal death. These altruistic donations contribute to carrying out the fulfillment of what has already been declared a human right and one of the social investments with the most advantageous cost-benefit index. The recognized, intensified and amplified need for milk banks in a pandemic brings to the fore in a specific way the condition of human milk as capital physiological resource, and, ultimately, as a global good. This article is dedicated to delving into a critical hermeneutics of milk donation in light of the pandemic and as an opportunity to rethink the studies of recent decades in this regard.
... This finding also suggests that healthcare workers might lack knowledge of human milk sharing safety and resources and HMB usage, which needs to be rectified first. In countries where HMBs have been well established, a lack of discussion with families about milk donation and the function of donor human milk contributed to the limited knowledge and usage of human milk banks in the community [52]. Additionally, many international organisations like the American Academy of Paediatrics (APA) and HMBANA do not encourage milk sharing outside a certified human milk bank [53,54], which may contribute to the reluctance of HCWs to discuss milk sharing with parents. ...
The World Health Organisation (WHO) recommends that all babies be exclusively breastfed, stating that donor milk is the next best alternative in the absence of the mother’s own milk. Milk sharing takes many forms, namely wet nursing, co-feeding, cross-feeding, and a human milk bank (HMB). However, the establishment of a human milk bank is still not widely accepted and is a debatable topic because of religious concerns in Malaysia. The aim of this study is to determine the facilitators and barriers among Malaysians towards the acceptance of an HMB. A cross-sectional study with 367 participants was conducted; the participants answered an online-validated, self-administered questionnaire. Data on sociodemographic, knowledge on breastfeeding benefits, knowledge and attitude on HMB-specific issues were analysed in terms of frequency before proceeded with multiple logistic regression. The majority of the respondents were Muslim (73.3%), had completed their tertiary education (82.8%), and were employed (70.8%). Only 55.9% of respondents had heard of HMB, stating the internet as their main source of information, but many respondents were agreeable to its establishment (67.8%). Most respondents had a good score on knowledge of breastfeeding benefits and on HMB-specific issues (70% and 54.2%, respectively), while 63.8% had a positive attitude towards HMB. In the multivariate analysis, mothers with a good score on general knowledge of breastfeeding (AOR: 1.715; 95% CI 1.047–2.808) were more likely to accept the establishment of HMB, while being a Muslim was negatively associated with its establishment (AOR = 0.113, 95% CI 0.050–0.253). The study found a high prevalence of mothers who were willing to accept the establishment of HMB. By educating mothers on the benefits of breastfeeding, as well as addressing their religious concerns, the establishment of a religiously abiding HMB in Malaysia may be accepted without compromising their beliefs or the health benefit of donor milk.
... Despite such an important function, breast milk banking is a practice that has become widespread all over the world but is little known. Among the reasons for little knowledge, breast milk donation and its application through the concept of banking are influenced by social, cultural, and religious aspects (Ellsworth et al., 2021). In the literature, it has been seen that concepts such as milk kinship and milk siblingship, especially in terms of religion, lead individuals to have a prejudice against this practice (Bhoola & Biggs, 2021;Jahan et al., 2022;Kimani-Murage et al., 2019;Onat & Karakoç, 2019). ...
Breast milk is considered the best source of nutrition for infants. The establishment of breast milk banks for infants who cannot consume breast milk has always been a subject of debate from the past to the present. Religious orientations and cultures have shaped positive or negative attitudes towards these debates. This study aimed to determine and compare the attitudes towards breast milk banks in different religions. In this cross-sectional study, data were collected from people living in Turkey, Nigeria, Pakistan, India, Nepal, Madagascar, the Turkish Republic of Northern Cyprus, Azerbaijan, Iran, Mexico, Japan, England, Malaysia, Albania, Libya, Bangladesh, and Indonesia between May 2022 and April 2023. The study was conducted with individuals from Islam, Christianity, Hinduism, Buddhism, atheism, and other religions. The sample was determined using snowball sampling and the research was carried out with 2714 individuals from different religions who agreed to participate in the study. Data were collected using an Introductory Information Form and a “Questionnaire for Attitudes Towards Breast Milk Bank”. R programming language 4.1.3 was used for regression analysis with machine learning approach and artificial neural networks, and SPSS-25 was used for other statistical analyses. There was a significant difference between the individuals' mean total score on the Questionnaire for Attitudes towards Breast Milk Bank and their religious beliefs (p < 0.05). According to the results of the regression model, which was established to reveal the effect of religious belief on the attitude towards breast milk banks, statistical estimates of the regression model showed that the model was meaningful and applicable (F(5,2708) = 14.749, p = 0.001). Religious belief explained 2.7 % of the total variance in the level of attitudes towards breast milk banks. According to the results of the t-test regarding the significance of the regression coefficient in the regression model, the mean scores regarding the attitude towards breast milk banks were higher among participants from Hinduism (t = 6.971, p < 0.001), Christianity (t = 4.690, p < 0.001), Buddhism (t = 3.442, p < 0.001), and atheism (t = 4.424, p < 0.001) compared to those from Islam (constant). Individuals' attitudes towards breast milk banks differ according to their religions. The most important model in prediction with data mining was K nearest neighbour regression. It was determined that the attitudes of individuals from Islam were more negative than that of individuals from other religions. It is recommended that longitudinal studies be carried out on attitudes towards breast milk banks.
... In these cases, the human milk bank (HMB) is the main alternative for promoting breastfeeding and performing HM collection, processing, and quality control activities. The administration of this diet is commonly done with the aid of an infusion pump (which keeps the diet flow controlled) or by gavage (which allows flow according to the force of gravity; Ellsworth et al., 2020). ...
Background
The retention of human milk nutrients in gastric tubes used to feed premature infants is a challenge to be overcome.
Research Aims
To evaluate (1) the performance of six homogenizers (mixing processor, piston valve, ultrasonic bath, ultraturrax, stirring mixer, and ultrasound probe) for the fat retention reduction in gastric tubes; (2) the influence of the best homogenization conditions on the fatty acid and protein profiles of human milk; and (3) the cost/benefit ratio for the inclusion of homogenization as a new step in human milk processing.
Methods
The influence of different levels and times of homogenization on reducing fat retention of human milk in probes was evaluated in this comparative prospective cross-sectional study. After homogenization, human milk flowed through a gavage and infusion pump apparatus used for feeding. Fat content was quantified before and after feeding. The techniques that reduced fat globule sizes and/or promoted a lower percentage of fat holding were evaluated for efficiency, variations in the fatty acid and protein profiles, and energy density and operating costs.
Results
Homogenization led to a reduction in fat retention in feeding probes. The mixer processor and the ultrasound probe reduced fat retention by 99.23% (SD = 0.07) and 99.95% (SD = 0.02), respectively, and did not negatively influence fatty acid and protein profiles. The mixer processor demonstrated low energy density and low cost for human milk processing.
Conclusion
Homogenization promoted reduced fat retention in the feed probe and could help maintain fat nutrients of human milk during enteral feeding.
Background
When premature infants cannot receive their own mother's milk, donor human milk (DHM) is the first‐line recommended option, with growing demand for DHM use outside of neonatal units. To meet the potential need, we need to consider whether DHM supply can increase. This study aimed to explore the reasons that prevent women who wish to donate their milk in the United Kingdom from doing so to understand which barriers may be modifiable.
Methods
Women who wanted to donate their milk but did not do so completed an online survey. Open and closed questions examined the response they received, their reasons for not donating and what they did with any milk that they had already stored.
Results
Out of 732 mothers, 391 (53.4%) did not enquire as they did not think it was possible for them, 218 (29.8%) enquired but were told that they could not donate, 59 (8.1%) enquired but decided not to proceed and 64 (8.7%) received no response. Reasons for being told they could not donate included the use of certain medications, infant age, inadequate staffing, geographic barriers and incorrect storage. Process aspects (e.g., blood tests, practicalities) and lifestyle limitations led mothers to decide not to donate.
Conclusions
Although some women will be prevented from donating due to medication or health issues, investment in milk banking staffing and infrastructure and awareness campaigns could increase DHM supply, enabling guidelines to extend eligibility criteria for receiving DHM such as for late preterm infants, gestational diabetes or to support low maternal milk supply.
The objective of this study was to collect information through a questionnaire with pregnant women about the level of knowledge and intention to donate surplus breast milk to the Human Milk Bank (HMB) or to a nearby Collection Point. The sample consisted of 60 pregnant women, with an average age of 25 to 30 years, and most of them had elementary and secondary education, were brown and primiparous. About 95% of these pregnant women intended to breastfeed their offspring, often being "when to cry" and, in their majority (80%), choosing not to give any complement to breastfeeding. When asked about information about the HMB, 51 pregnant women were already aware of the presence of the institution, most of whom had a level of knowledge considered average. The main source of information spread about HMB was the Family Health Unit/Hospital itself, and this information was classified as "very important" by the majority of participants (43%). About 73% of the pregnant women wanted to donate breast milk, 85% would use HMB milk and 83% thought the HMB's work was reliable. Of the total number of pregnant women, only 2 (3%) reported that they had already donated breast milk, and their experiences were classified as "very good" or "good", but only 50% of them would donate again. It is imminent that these results will be analyzed by health managers so that they can develop strategies to increase both information and the intention to donate surplus breast milk among pregnant and future breastfeeding women.
Background
Pasteurized donor human milk provides a safe and desirable alternative when a parent’s own milk is insufficient or unavailable. Currently, the demand for donor human milk exceeds the available supply. Little is known about the beliefs breastfeeding individuals have about milk bank donation.
Research Aims
The aims of this exploratory study were to (a) provide a preliminary estimate of how well intention can be predicted, and to suggest which of the global constructs of the Reasoned Action Approach has the most influence on intention; and (b) identify the salient, top-of-the-mind beliefs underlying the intention to donate some of the milk an individual is currently producing to a milk bank.
Methods
An exploratory, cross-sectional study design, based on the Reasoned Action Approach, was used to measure the theory’s global constructs and elicit beliefs underlying the intention to donate milk of lactating individuals ( N = 118) living in Indiana, Illinois, Missouri, and Kentucky. Thematic and frequency analyses and multiple regression were performed.
Results
Quantitative analyses found that injunctive norm and the autonomy component of perceived behavioral control were independently associated with intention. Qualitative analyses identified the advantages (e.g., help and save babies, won’t waste milk), referents who support (e.g., husband, family), and facilitators (e.g., having a convenient, close location, having more knowledge and information) of donating milk.
Conclusions
This research provides insight into how milk banks might recruit and retain donors. Additional quantitative research with a larger sample is necessary to confirm the preliminary findings of this study.
Background: Prematurely born, low birth weight, or sick infants are vulnerable and often do not receive enough breast milk from their mothers. In such cases, donated breast milk from other mothers can be safely stored in a milk bank. However, some Muslim countries have been hesitant to establish milk banks due to religious and ethical concerns. Despite this, a few Muslim nations have established Muslim-friendly milk banks to meet the increasing demand for donated breast milk. Nonetheless, it is unclear whether the Muslim community will fully embrace these efforts. This systematic review aims to gather and appraise evidence on Muslim knowledge, perceptions, and views towards breast milk donation and establishing Muslim-friendly milk banks. Methods: A systematic search was conducted in Wiley Online Library, Scopus, Science Direct, ProQuest, and EBSCOhost databases using specific search terms and keywords. The search aimed to identify articles published between 2016 and November 2023 that discuss Muslim knowledge, perceptions, and views regarding breastmilk donation, as well as the establishment of Muslim-friendly milk banks. The identified articles were then screened and retrieved. Results: A total of 2498 articles were initially retrieved out of which only twelve studies met the inclusion criteria and were finally considered for analysis. All the studies were conducted in Middle East countries among Muslim women. The analysis revealed that the majority of Muslim women were not aware of the availability of Muslim-friendly milk banks. They showed reluctance in donating their breast milk due to religious concerns. Moreover, a significant proportion of women expressed their doubts about the endorsement of milk banking due to religious beliefs and concerns regarding the potential transmission of diseases. Conclusion: Recent studies have shown that there is a lack of awareness regarding Muslim-friendly milk banks, and there are also negative perceptions and views about donating breast milk and setting up milk banks. It is important to provide information that can increase women’s confidence and encourage them to participate in breast milk donation and milk bank utilisation.
Breast milk is very important and is the best nutritional supplement for newborn. The milk boosts the baby's immune system to protect the newborn from diseases like NEC etc. Due to some problems, some mothers are unable to give milk to their babies. In many countries around the world, human milk banks are widely used as milk suppliers to save premature babies. In line with the Sustainable Development Goals (SDG) 3, which prioritize health and well-being, Human Milk Banks (HMB) are massively supporting SDG 3.4 to reduce premature mortality by 2030. However, there are many obstacles for Muslim parents to get breast milk for their babies. This paper reviews the challenges among Muslim parent to get human milk for their babies. This study conducted a review of existing literature on human milk banking implementation and challenges in selected countries from Mendeley and Scopus databases, as well as World Health Organization (WHO) and United Nations (UN) websites. Atlas.ti is used identify the related terms and themes. As a result, a list of challenges was identified regarding the difficulties Muslim parents face in obtaining breast milk for their babies. Most parents worry about the kinship problem that would arise if their babies consumed milk from other mothers. The identified challenges validated parents' perspectives on using milk donations for their babies. To successfully implement a human milk bank, these challenges must be properly addressed. Massive work should be done for future work, campaigning and raising awareness of the importance of human milk to human babies and disclosing human milk banks that adhere to Sharia observance.
Donor human milk (DHM) though primarily administered in the NICU setting is increasingly being offered in well baby nurseries to promote exclusive breastfeeding. Despite the evidence supporting the use of DHM as a preferred supplement when mother’s own milk (MOM) is unavailable or insufficient, foreign-born non-Hispanic black women are less likely to use DHM. Recognizing the cultural diversity and uniqueness among foreign-born non-Hispanic black communities in the USA, this exploratory study sought to understand perceptions of DHM and human milk banking (HMB) as well as factors influencing decision-making toward DHM among Ghanaian immigrant women living in the USA.
Semi-structured interviews were conducted with 16 Ghanaian women living in the USA. Using a narrative thematic approach, interview transcripts were coded, analyzed, and organized into categories and themes.
Findings indicate mixed sentiments toward DHM/HMB among Ghanaian immigrant women. Regarding decision-making toward DHM utilization and donation, four themes were identified: (1) women’s decision-making which is informed by external influences, (2) health provider’s role in promoting human milk utilization, (3) the importance of addressing barriers to human milk utilization and donation, and (4) superstition and spirituality.
Maternal perceptions of DHM/HMB are influenced by individual-, interpersonal-, and community-level factors. It is imperative that health promotion efforts adopt multi-level approaches to addressing the disparities in DHM access and utilization as well as factors that impact milk donation in order to ensure optimum health outcomes for neonates of foreign-born non-Hispanic black populations.
Background
Wet nursing and human milk banks are vital sources of human milk for infants unable to breastfeed.
Research Aim
This study aims to determine the knowledge and opinions of neonatal intensive care unit nurses regarding wet-nursing and human milk banks in Türkiye.
Methods
This descriptive cross-sectional study was conducted with 219 neonatal intensive care unit nurses using an online survey comprising 20 questions. The data were collected between August and September 2021.
Results
Among the participants, 64.4% ( n = 141) expressed that they would be a wet-nurse and 59.8% ( n = 131) would search for a wet-nurse if necessary. Some, 47.0% ( n = 103) of participants did not know if there were any human milk banks in Türkiye, 53.9% ( n = 118) would like to be a donor if human milk banks were established, and 71.7% ( n = 157) stated that the establishment of human milk banks should be supported. Religious concerns were the basis for reluctance to donate milk to human milk banks for 60% ( n = 51) of the participants. Knowledge was greater and opinions about wet-nursing and human milk banks were more positive for participants with higher education, more time in the neonatal intensive care unit, or work at a tertiary care center.
Conclusion
The approaches of neonatal intensive care unit nurses towards personally being wet-nurses and milk sharing were generally positive, although more information about human milk banks is needed. Religious beliefs are an important consideration when providing information about milk sharing.
Pada September 2021, Pertubuhan Pendidikan, Sains dan Kebudayaan Pertubuhan Bangsa-Bangsa Bersatu (UNESCO) telah melancarkan Sidang Kemuncak Pendidikan Transformasi (Transforming Education Summit) sebagai tindak balas kepada krisis global dalam pendidikan. Pelancaran ini merupakan inisiatif UNESCO menggembleng usaha pemulihan COVID-19 dan pemerkasaan Matlamat 4 Pendidikan Berkualiti, Matlamat Pembangunan Mampan (SDG) 2030. Hal ini kerana Pertubuhan Bangsa-Bangsa Bersatu (UN) mendedahkan bahawa COVID-19 telah memburukkan lagi krisis pembelajaran di dunia, 147 juta kanak-kanak tercicir lebih separuh daripada pengajaran dalam kelas sejak tahun 2020. Impak pandemik ini turut mengancam kemenjadian pelajar pelbagai peringkat pendidikan. Selaras dengan misi SDG, Kerajaan Negeri Kelantan komited dalam membangunkan rakyat menjadi insan mulia melalui pendidikan berdasarkan prinsip ketiga dalam Dasar Pendidikan Rabbani Kelantan (DPRK) iaitu Kemenjadian Insan Mulia. Prinsip ini menekankan generasi rabbani memiliki kecintaan ilmu pengetahuan dalam jiwa pelajar. Merujuk perspektif Islam, perbuatan menimba ilmu pengetahuan bermula dari peringkat rendah hingga ke peringkat tinggi perlu ditekankan dalam pembinaan insan mulia. Justeru, inisiatif pembangunan dan pemerkasaan pendidikan serta pemulihan krisis pendidikan merupakan kewajipan setiap individu. Jika kewajipan menimba ilmu hingga ke peringkat tinggi dipandang enteng maka kecintaan ilmu pengetahuan menjadi pudar malah menjejaskan kesejahteraan negara dan ummah. Sehubungan itu, kajian ini dikemukakan bagi membincangkan kelebihan pembangunan pelajar sekolah Yayasan Islam Kelantan (YIK) hasil pelaksanaan prinsip Kemenjadian Insan Mulia berdasarkan dalil al-Quran kecintaan ilmu pengetahuan dalam DPRK. Berasaskan metode analisis tekstual secara tematik, kajian kualitatif ini mendapati pelaksanaan prinsip Kemenjadian Insan Mulia berpotensi membangunkan kecintaan terhadap ilmu pengetahuan dan membantu mengurangkan krisis pendidikan global. Kajian ini turut positif prinsip Kemenjadian Insan Mulia berupaya menambah kualiti pendidikan negara dan mampu melahirkan generasi rabbani. Kesimpulannya, pelaksanaan prinsip DPRK dilihat berkemampuan menyumbang kepada usaha pembangunan pelajar secara holistik sebagai insan mulia yang diperlukan oleh masyarakat dan negara. Kata kunci: Pembangunan, Kemenjadian, Insan Mulia, Pendidikan, DPRK
Objective
To explore the effect of donor human milk usage on the emotional experience of mothers with premature infants in a multiracial Asian population.
Design
A qualitative descriptive study. Semistructured individual interviews were audio-recorded, transcribed and analysed using Braun and Clarke’s process of thematic analysis.
Setting and patients
Seventeen mothers whose premature infants received donor human milk in a level III neonatal intensive care unit.
Main outcome measures
Perceptions of mothers whose premature infants received donor human milk.
Results
Mothers described their experience as a journey of acceptance with three sequential themes. ‘Resistance to receiving somebody else’s milk’ was a process of overcoming initial hesitation and concerns. ‘Recognising maternal limitations and baby’s needs’ depicted the mothers’ struggles in reconciling their infant’s milk demand and their low milk supply. ‘Embracing benefits of donor human milk and acceptance with gratitude’ illustrated the mothers’ joy and gratitude to milk donors as they embraced benefits of donor human milk usage. Although participants had agreed to use of donor human milk after counselling, many still struggled with negative emotions of anxiety and guilt. Mothers of Muslim faith had additional concerns about milk kinship and religious permissibility of donor human milk.
Conclusion
Mothers undergo a spectrum of complex emotions from initial hesitation to acceptance with gratitude, when their premature infants receive donor human milk. Some continue to struggle with negative emotions and require more support. By recognising their emotional responses, healthcare providers can support mothers in their breastfeeding journey with targeted counselling.
Human donor milk from established milk banks is the safest alternative to mother’s own milk. The current study examined US mothers’ perceptions of human milk banks as a response to the ongoing infant formula shortage in the United States. A cross-sectional study with closed and open-ended items was administered through nine Facebook groups, and a final sample of 863 responses was retained in the study. We used descriptive and inferential statistics for statistical analysis, and content and thematic analyses were conducted on open-ended responses. In our sample, 77.4% of respondents perceived human milk banking as a feasible response to the formula shortage crisis. Marital status, education, religion, and willingness to donate milk were associated with respondent perceptions of milk banking as a response to the formula shortage. US mothers’ concerns around the accessibility of milk banks and the cost of human milk were the primary reasons accounting for the hesitancy toward milk banking as a response to the infant formula shortage crisis. The study findings indicate support for milk banking as a potential ‘temporary’ solution to the formula shortage and reveal that milk banking is a tool that is currently being underutilized. It is imperative that stakeholders address the challenges identified by the current study to improve infant feeding and health.
Resumen Fundamentos: Colombia mantiene una reducida práctica de lactancia materna, lo que demuestra la necesidad de fortalecer estrategias como la de los Bancos de Leche Humana (BLH). Esta investigación propuso como objetivo identificar las representaciones sociales (RS) sobre donación de leche humana de madres lactantes residentes en cinco ciudades de Colombia donde funcionan BLH. Métodos: El estudio se abordó desde la teoría de las RS, se utilizaron métodos mixtos y diversas técnicas, como: la evocación jerarquizada, encuesta, entrevista semiestructurada y diario de campo. Resultados: se presentan los resultados de las 83 entrevistas realizadas a madres lactantes, clasificadas en cuatro grupos según su experiencia y conocimiento del proceso de donación de leche humana. Conclusiones: la principal motivación para donar es la empatía y el deseo de ayudar a otros bebés, el principal factor favorecedor tiene relación con la gestión de los BLH, y la principal barrera para dejar de donar fue la falta de tiempo de las madres.
Background: Human breast milk is the most healthful form of milk for human babies. Every infant deserves the best possible start in life in terms of nutrition by breastfeeding or receiving donated human milk. Breast milk is very important for the infant’s growth and well-being that the non-availability of the mother should not deprive the infant from its benefits. To enhance the availability and use of human breast milk for hospitalized babies whose mothers may not have enough milk, there is the need to embark on human milk banking.Objective: To determine the perception of mothers towards breast milk banking in Benin City, Nigeria.Subjects and Methods: The study subjects included 198 mothers who brought their babies to Well Baby/Immunization Clinic of the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria. A structured researcheradministered questionnaire was used to assess their biodata, awareness and perception of breast milk banking.Results: The mean age of the mothers was 29.8 ± 5.5 years with 46.5% having some form of tertiary education and 48.5% having secondary education. Only 51 (25.8%) of them had heard of breast milk banking; source of information being mainly from health workers (43.1%) and from friends (27.5%). Majority 168 (84.8%) of the mothers would not give their babies human milk donated by another nursing mother mainly because of fear of transmission of infections/diseases. Most 105 (53.0%) were also unwilling to donate breast milk to be used for other babies due to the fact that they disliked the idea (51.4%) and because of fear of not having enough for their own babies (16.1%). However, most (59.1%) strongly agreed that human milk banking would help assist mothers in need, orphans and abandoned babies.Conclusion/Recommendation: The awareness of human milk banking and its acceptance among mothers in Benin City is poor. The current findings strongly justify the need for public enlightenment on human milk banking and its benefits.Key words: Breast milk banking, mothers, Perception
Introduction:
Mother's own milk has long been accepted as the best source of nutrition for the newborn. In those cases where mother's milk is not available, the best choice is the human milk provided by selected donors. Human milk banks are the most institutionalized method of milk sharing and play a vital role for neonates that cannot be breastfed. This study aims at systematically reviewing factors influencing donation to human milk banks.
Materials and Methods:
A systematic review of the literature was performed on authentic electronic resources, including PubMed, Scopus, Embase, ScienceDirect, and Web of Science with no time limitation. To increase the sensitivity and to find additional studies for systematic review, the reference list of the published studies was examined as well. Data extraction and quality appraisal were carried out by two independent reviewers. The study was qualitatively summarized to generate descriptive and explanatory themes that emerged from the literature.
Results:
From a total of 1,157 articles, 31 met the inclusion criteria in which 64 factors are extracted. From these, 26 factors act as barriers and 38 factors act as facilitators of milk donation. Having excess milk, altruism, and helping other babies are found to be the most important facilitators of milk donation, while the most important barriers are religious and cultural concerns.
Conclusion:
Developing practical strategies to attract milk donors are crucial for successfully establishing human milk banks. These include providing reliable information regarding the milk bank goals and functions and developing breastfeeding polices with regard to differences in countries' contexts and trying to resolve any uncertainties regarding milk donation, especially those arising for religious concerns.
Background
Due to the health and economic benefits of breast milk, the World Health Organization (WHO) recommends that for infants who cannot receive breast milk from their own mothers, the next preferred option is donated breast milk. This recommendation is however rarely practiced in most developing countries where donor milk is not widely accepted.
Methods
This cross-sectional multi-center study enrolled mothers attending antenatal or pediatric clinics in six tertiary institution in south-east Nigeria using purposive and convenient sampling method. Data collection was done using pretested questionnaires. The study aimed to assess the knowledge, acceptability and willingness to donate breast milk and/or use donated breast milk for their infants It also explored factors that determine this behavior.
Results
A total of 1235 mothers participated; 39% (480/1225) have heard about the concept of donor milk, while only 10% (79/759) and 7% (81/1179), respectively, had adequate knowledge of the concept and policy on donor milk. Sixty percent indicated willingness to use donor milk or donate breast milk if need arises. Respondents with lower age (p = 0.049) and with higher occupational status (p = 0.001) were more likely to have adequate knowledge of donor breast milk, while respondents with lower educational attainment (p = 0.002) and those who are non-Christians (p = 0.004) were more likely to request financial inducement for donating their breast milk. Adequate knowledge of the concept of donor milk (p = 0.001), preference of donor milk to infant formula (p = 0.001) and requirement of financial remuneration (p = 0.001) were the only significant predictors of willingness to donate and/or receive donated breast milk.
Conclusion
The knowledge of the concept of donor breast milk and awareness of policies regulating its practice in Nigeria is low, but the prospect of its acceptability is high among mothers surveyed in south-east Nigeria. Targeted public education by relevant government agencies in collaboration with clinicians, community and religious leaders about the concept of donor breast milk to families may help increase the acceptance and practice of donating breast milk and/or use of donated breast milk among mothers in the region.
This systematic review and meta-analysis synthesised the post-1990 literature examining the effect of human milk on morbidity, specifically necrotising enterocolitis (NEC), late onset sepsis (LOS), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) and neurodevelopment in infants born ≤28 weeks’ gestation and/or publications with reported infant mean birth weight of ≤1500 g. Online databases including Medline, PubMed, CINAHL, Scopus, and the Cochrane Central Register of Controlled Trials were searched, and comparisons were grouped as follows: exclusive human milk (EHM) versus exclusive preterm formula (EPTF), any human milk (HM) versus EPTF, higher versus lower dose HM, and unpasteurised versus pasteurised HM. Experimental and observational studies were pooled separately in meta-analyses. Risk of bias was assessed for each individual study and the GRADE system used to judge the certainty of the findings. Forty-nine studies (with 56 reports) were included, of which 44 could be included in meta-analyses. HM provided a clear protective effect against NEC, with an approximate 4% reduction in incidence. HM also provided a possible reduction in LOS, severe ROP and severe NEC. Particularly for NEC, any volume of HM is better than EPTF, and the higher the dose the greater the protection. Evidence regarding pasteurisation is inconclusive, but it appears to have no effect on some outcomes. Improving the intake of mother’s own milk (MOM) and/or donor HM results in small improvements in morbidity in this population.
The provision of donor human milk can significantly reduce morbidity and mortality among vulnerable infants and is recommended by the World Health Organization as the next best option when a mother's own milk is unavailable. Regulated human milk banks can meet this need, however, scale-up has been hindered by the absence of an appropriate model for resource-limited settings and a lack of policy support for human milk banks and for the operational procedures supporting them. To reduce infant mortality, human milk banking systems need to be scaled up and integrated with other components of newborn care. This article draws on current guidelines and best practices from human milk banks to offer a compilation of universal requirements that provide a foundation for an integrated model of newborn care that is appropriate for low- and high-resource settings alike.Journal of Perinatology advance online publication, 10 November 2016; doi:10.1038/jp.2016.198.
The importance of breastfeeding in low-income and middle-income countries is well recognised, but less consensus exists about its importance in high-income countries. In low-income and middle-income countries, only 37% of children younger than 6 months of age are exclusively breastfed. With few exceptions, breastfeeding duration is shorter in high-income countries than in those that are resource-poor. Our meta-analyses indicate protection against child infections and malocclusion, increases in intelligence, and probable reductions in overweight and diabetes. We did not find associations with allergic disorders such as asthma or with blood pressure or cholesterol, and we noted an increase in tooth decay with longer periods of breastfeeding. For nursing women, breastfeeding gave protection against breast cancer and it improved birth spacing, and it might also protect against ovarian cancer and type 2 diabetes. The scaling up of breastfeeding to a near universal level could prevent 823 000 annual deaths in children younger than 5 years and 20 000 annual deaths from breast cancer. Recent epidemiological and biological findings from during the past decade expand on the known benefits of breastfeeding for women and children, whether they are rich or poor.
Background:
Feeding infants unscreened, raw human milk from a source other than the mother may pose health risks. The objectives of the Moms2Moms Study were to estimate the proportions of mothers who were aware of breastmilk sharing, considered sharing, and shared milk and to identify associated maternal and child characteristics.
Subjects and methods:
All eligible women (n=813) who delivered at The Ohio State University Wexner Medical Center (Columbus, OH) and did not indicate an intention to exclusively "bottle feed" were asked to participate in this cohort by completing a postal questionnaire at 12 months postpartum (499 [61%] responded). Women who shared milk participated in a follow-up interview.
Results:
Awareness of milk sharing was high (77%) and positively associated with socioeconomic status, age, non-Hispanic white race, having fed one's infant at the breast, and reporting no difficulty making enough milk. Twenty-five percent considered sharing. Primiparous women (odds ratio [OR]=2.12; 95% confidence interval [CI] 1.02, 4.62) and those who delivered preterm (OR=3.27; 95% CI 1.38, 7.30) were more likely to consider feeding milk from another mother. Women with public/no insurance (OR=0.52; 95% CI 0.27, 0.97) were less likely to consider providing milk for someone else; highly educated women were more likely (OR=1.90; 95% CI 1.12, 3.32). Almost 4% of women shared milk and did so among friends or relatives or had a preterm infant who received screened and pasteurized donor milk.
Conclusions:
Sharing milk among friends and relatives is occurring. Many women are aware of milk sharing and have considered it.
OBJECTIVE: To describe the characteristics of donation behavior and identify reasons, beliefs and feelings relative to this practice, based on the reports of donor women. Personal and social-environmental aspects, which seem to affect donation behavior in donors and former donors, were also investigated. METHODS: An exploratory, descriptive and cross-sectional study was carried out with women donors at two breast-milk banks within the public health system of the Brazilian Federal District. Data was collected from July to September 2005. The participants were 36 women, aged 14 to 33 years (average=24.78; SD=5.22), with different levels of schooling, 58.3% of which were first-time mothers. Data gathering was based on interviews carried out during home visits. In addition to descriptive statistical analyses of quantitative data, a qualitative data categorical analysis was also performed. RESULTS: The most frequently reported reasons for donating breast milk were altruism and excess milk production. The most frequent time interval for donation was 13 days after delivery. Contact by phone with the milk bank was the most common means of communication used by the majority of participants (n=22) to obtain information that enabled the donating process. CONCLUSIONS: Psychosocial aspects identified and the experience of donors can contribute to the empowerment of the formal and informal social donation-support network, in addition to serving as a driver for the implementation of technical and policy strategies in promoting future donation practices.
Objective:
To explore the intersection of peer-to-peer milk sharing and donor milk banks.
Methods:
A descriptive survey design containing closed and open-ended questions was used to examine women's perceptions of peer-to-peer milk sharing and milk banking. Closed-ended questions were analyzed using descriptive statistics and conventional qualitative content analysis was used to analyze open-ended responses.
Setting:
Participants were recruited via the Facebook sites of two online milk-sharing networks (Human Milk 4 Human Babies and Eats on Feet).
Participants:
Ninety-eight milk donors and 41 milk recipients who had donated or received breast milk in an arrangement that was facilitated via the Internet.
Results:
One half of donor recipients could not donate to a milk bank because there were no banks local to them or they did not qualify as donors. Other respondents did not donate to a milk bank because they viewed the process as difficult, had philosophical objections to milk banking, or had a philosophical attraction to peer sharing. Most donor respondents felt it was important to know the circumstances of their milk recipients. No recipient respondents had obtained milk from a milk bank; it was recognized that they would not qualify for banked milk or that banked milk was cost prohibitive.
Conclusion:
Peer-to-peer milk donors and recipients may differ from milk bank donors and recipients in significant ways. Cooperation between milk banks and peer sharing networks could benefit both groups.
Background:
Pasteurized human donor milk (DM) is recommended by the World Health Organization and American Academy of Pediatrics for preterm infants when mother's own milk is unavailable, yet the extent and predictors of use and criteria for use in US neonatal intensive care units (NICUs) are unknown.
Objective:
This study aimed to evaluate current DM use in US level 3 NICUs and predictors and criteria of use.
Methods:
We sent mail surveys to 302 US level 3 NICU directors. We used multivariable logistic regression to analyze predictors of DM use.
Results:
Survey response rate was 60%, and 76 of 182 (42%) directors reported DM use. Among DM users, 30% have used DM < 2 years and 55% for 2 to 5 years. Among nonusers, 63% were uncertain of turnaround time when ordering DM, 36% were unclear what guidelines milk banks followed, and 31% were unsure of parent receptiveness. In multivariate analyses, > 800 annual admissions (odds ratio [OR], 4.11; 95% confidence interval [CI], 1.43-11.82; reference ≤ 400 admissions) and location in the Midwest (OR, 3.02; 95% CI, 1.17-7.76) and West (OR, 6.33; 95% CI, 2.28-15.57; reference Northeast) were positively associated with DM use; safety-net hospitals (> 75% Medicaid insurance) were negatively associated (OR, 0.35; 95% CI, 0.14-0.89).
Conclusion:
Pasteurized human donor milk use is rapidly emerging among US level 3 NICUs. Larger NICUs and those in the West and Midwest were more likely to use DM, while safety-net hospitals were less likely to use DM. Lack of knowledge by medical directors of accessibility, safety, and parental receptiveness may be barriers to DM use.
ARTICLE AT: http://jhl.sagepub.com/content/29/2/222.short
BACKGROUND: The beneficial effects of breastfeeding for mothers and babies are well recognized. When maternal breast milk is not available in sufficient quantity, donor breast milk is recommended as an alternate source of nutrition, particularly in preterm and other high-risk infants. Australia lags behind the rest of the developed world in establishing and promoting human milk banks; there is no human milk bank in South Australia and little is known concerning mothers' perceptions of using human milk banks in that state.Objective:This study explored mothers' knowledge of and attitudes toward human milk banks, to inform the development of human milk banking policies and guidelines in South Australia should a milk bank be established.
METHODS: In-depth semistructured interviews were conducted with 12 mothers who were breastfeeding and/or had preterm or sick babies. In addition, 2 focus groups were conducted-1 with breastfeeding mothers as potential donors (n = 5) and the other with mothers of preterm or high-risk infants (n = 4) - to answer questions raised by early analysis of the individual interview data.
RESULTS:Breastfeeding mothers, as potential donors, unanimously supported donating their breast milk to a human milk bank, provided it would be easy (especially if required to drop off milk) and not overly time consuming. Mothers of preterm or sick infants would use a human milk bank if they were assured the milk was safe and appropriate for their babies.
CONCLUSION:Study participants would welcome having access to a human milk bank for both donating and receiving milk in South Australia.
Objective:
To determine acceptance of donor human milk (DM) for feeding preterm infants and whether offering DM, alters mothers' milk (MM) feeding.
Study design:
Infant feeding data were collected from medical records of 650 very preterm infants enrolled between 2006-2011 in two hospital level III neonatal intensive care units (NICUs) in Cincinnati, Ohio. The study was conducted during the implementation of a program offering 14 days of DM.
Result:
From 2006-2011, any DM use increased from 8 to 77% of infants, largely replacing formula for the first 2 weeks of life; provision of MM did not change. DM was more likely to be given in the first 2 weeks of life, if infants never received MM or were >1000 g birth weight, but DM use did not differ by sociodemographic factors.
Conclusion:
Offering DM dramatically increased human milk feeding and decreased formula use, but did not alter MM feeding in hospital.
The importance of breast milk for infants' growth, development and overall health is widely recognized. In situations where women are not able to provide their infants with sufficient amounts of their own breast milk, donor breast milk is the next preferred option. Although there is considerable research on the safety and scientific aspects of donor milk, and the motivations and experiences of donors, there is limited research addressing the attitudes and experiences of the women and families whose infants receive this milk. This study therefore examined attitudes towards donated breast milk among mothers, families and healthcare providers of potential recipient infants.
The study was conducted at a public hospital and nearby clinic in Durban, South Africa. The qualitative data was derived from eight focus group discussions which included four groups with mothers; one with male partners; and one with grandmothers, investigating attitudes towards receiving donated breast milk for infants. There was also one group each with nurses and doctors about their attitudes towards donated breast milk and its use in the hospital. The focus groups were conducted in September and October 2009 and each group had between four and eleven participants, leading to a total of 48 participants.
Although breast milk was seen as important to child health there were concerns about undermining of breast milk because of concerns about HIV and marketing and promotion of formula milks. In addition there were concerns about the safety of donor breast milk and discomfort about using another mother's milk. Participants believed that education on the importance of breast milk and transparency on the processes involved in sourcing and preparing donor milk would improve the acceptability.
This study has shown that there are obstacles to the acceptability of donor milk, mainly stemming from lack of awareness/familiarity with the processes around donor breast milk and that these could be readily addressed through education. Even the more psychological concerns would also likely be reduced over time as these educational efforts progress. With government and health care worker endorsement and commitment, breast milk donation could have a promising role in improving child health.
To estimate the prevalence of positive serology among potential donors to a human milk bank.
Retrospective review of our experience with donor serological testing at our milk bank over a 6-year interval.
Not-for-profit, regional human milk bank.
Volunteer, unpaid potential donors of human milk.
Serological testing for syphilis, HIV, hepatitis B, hepatitis C, human T cell lymphotropic virus type 1 (HTLV-1) and human T cell lymphotropic virus type 2 (HTLV-2).
Results of serological screening tests performed on potential donors.
Of 1091 potential donors, 3.3% were positive on screening serology, including 6 syphilis, 17 hepatitis B, 3 hepatitis C, 6 HTLV and 4 HIV.
There is a significant incidence of positive serology among women interested in donating human milk. This implies that there may be significant risk associated with peer-to-peer distribution of human milk from unscreened donors.
To describe the characteristics of donation behavior and identify reasons, beliefs and feelings relative to this practice, based on the reports of donor women. Personal and social-environmental aspects, which seem to affect donation behavior in donors and former donors, were also investigated.
An exploratory, descriptive and cross-sectional study was carried out with women donors at two breast-milk banks within the public health system of the Brazilian Federal District. Data was collected from July to September 2005. The participants were 36 women, aged 14 to 33 years (average=24.78; SD=5.22), with different levels of schooling, 58.3% of which were first-time mothers. Data gathering was based on interviews carried out during home visits. In addition to descriptive statistical analyses of quantitative data, a qualitative data categorical analysis was also performed.
The most frequently reported reasons for donating breast milk were altruism and excess milk production. The most frequent time interval for donation was 13 days after delivery. Contact by phone with the milk bank was the most common means of communication used by the majority of participants (n=22) to obtain information that enabled the donating process.
Psychosocial aspects identified and the experience of donors can contribute to the empowerment of the formal and informal social donation-support network, in addition to serving as a driver for the implementation of technical and policy strategies in promoting future donation practices.
In many developing countries, the use of pooled human milk is not widely accepted. Six hundred eighty breastfeeding mothers were interviewed to ascertain their acceptance of donated breastmilk. Their attitudes toward stored breastmilk, human milk banking, and breastfeeding in the event of human immunodeficiency virus (HIV) positivity were solicited. About 71 percent would not accept donated breastmilk for their baby while the rest would consent only if the donor were a close family relative, owing to fear of transfer of diseases (28 percent), fear of transfer of genetic traits (22 percent), and religious and cultural taboos (14 percent). However, 60 percent were willing to donate breastmilk. Only 38 percent would accept milk from a breastmilk bank. None would breastfeed if she were HIV positive.
The aim of this investigation was to identify factors that influenced or motivated women (N = 737) to donate human milk to human milk banks in Alagoas, Brazil. The most common characteristics of a regular donor were having 4 to 7 pregnancies (relative risk [RR] = 1.9285; 95% confidence interval [CI] = 1.0388-3.5800) and having obtained a higher education level (RR = 2,0625; 95% CI = 1.0097-4.2130). The most commonly reported reasons for donating were "encouragement of a health professional" (61.3%), followed by "the needs of the babies the banks serve" (25.3%). Most of the donors (49.9%) were introduced during their stay in the hospital to the human milk bank to which they donated, and 25.8% chose the bank recommended by a health professional. Health professionals play an indispensable role in motivating mothers to become human milk donors.
There are limited data available about the prevalence of human milk (HM) sharing and selling in the general population. We aimed to describe attitudes toward HM selling among participants in a qualitative‐interview study and prevalence of HM sharing and selling among a national sample of U.S. mothers. Mothers (n = 41) in our qualitative‐interview study felt that sharing or donating HM was more common than selling; none had ever purchased or sold HM. Three themes related to HM selling emerged from this work: questioning the motives of those selling HM, HM selling limits access to HM to those with money, and HM selling is a legitimate way to make money. Some mothers had reservations about treating HM as a commodity and the intentions of those who profit from the sale of HM. Nearly all participants in our national survey of U.S. mothers (94%, n = 429) had heard of infants consuming another mother's HM. Approximately 12% had provided their milk to another; half provided it to someone they knew. Fewer mothers (6.8%) reported that their infant had consumed another mother's HM; most received this HM from someone they knew. A smaller proportion of respondents (1.3%) had ever purchased or sold HM. Among a national sample of U.S. mothers, purchasing and selling HM was less common than freely sharing HM. Together, these data highlight that HM sharing is not uncommon in the United States. Research is required to create guidelines for families considering HM sharing.
Background and objectives:
Pasteurized donor human milk ("donor milk") is an alternative to formula for supplementation of breastfed infants. We conducted a survey to determine (1) prevalence, trends, and hospital-level correlates of donor milk use for healthy newborns in the northeast United States and (2) clinician knowledge and opinions regarding this practice.
Methods:
We conducted parallel surveys of clinicians (88% nurse and/or lactation consultant) at (1) all birth hospitals in Massachusetts (MA) and (2) all birth hospitals served by a northeast United States milk bank. We asked about hospital use of donor milk for newborns ≥35 weeks' gestation and receiving Level I care in well nursery, hospital-related factors we hypothesized would be associated with this practice, and clinician knowledge and opinions about donor milk use.
Results:
35/46 (76%) of MA birth hospitals and 51/69 (74%) of hospitals served by the milk bank responded; 71 unique hospitals were included. Twenty-nine percent of MA birth hospitals and 43% of hospitals served by the milk bank reported using donor milk for healthy newborns. Hospitals that used donor milk for healthy newborns had higher exclusive breastfeeding at hospital discharge than hospitals that did not (77% versus 56%, p = 0.02). Eighty-three percent of respondents agreed or strongly agreed that using donor milk is an effective way to increase the hospital's exclusive breastfeeding rate.
Conclusions:
Many northeast United States birth hospitals currently use donor milk for healthy newborns. This practice is associated with higher exclusive breastfeeding at hospital discharge. Relationships with breastfeeding after discharge and related outcomes are unknown.
It is universally accepted that breast milk is the optimum exclusive source of nutrition for the first six months of life, and may remain part of the healthy infant diet for the first two years of life and beyond. Despite advances in infant formulas, human breast milk provides a bioactive matrix of benefits that cannot be replicated by any other source of nutrition. When the mother's own milk is unavailable for the sick, hospitalized newborn, pasteurized human donor breast milk should be made available as an alternative feeding choice followed by commercial formula. There is a limited supply of donor breast milk in Canada and it should be prioritized to sick, hospitalized neonates who are the most vulnerable and most likely to benefit from exclusive human milk feeding.
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
Breastfeeding is one important form of maternal investment that is influenced by support from kin and non-kin. This paper investigates who provides support for breastfeeding mothers and their children, what type of support they provide, and how support impacts breastfeeding duration. The data were derived from a survey of 594 American mothers and were analyzed using quantitative methods, including Cox regression. Analyses indicate that mothers receive significant support, particularly from spouses and maternal grandmothers. More frequent breastfeeding discussions with La Leche League and maternal grandfathers were associated with longer duration, whereas discussions with physicians were associated with shorter breastfeeding duration. Results indicate that consulting others specifically about breastfeeding may influence breastfeeding decisions. The results are consistent with the idea that social support may influence breastfeeding duration and that some types of support are more influential than others. Furthermore, support persons should be educated about breastfeeding to prevent early weaning.
This Policy Statement was revised. See https://doi.org/10.1542/peds.2022-057988
Breastfeeding and human milk are the normative standards for infant feeding and nutrition. Given the documented short- and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice. The American Academy of Pediatrics reaffirms its recommendation of exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant. Medical contraindications to breastfeeding are rare. Infant growth should be monitored with the World Health Organization (WHO) Growth Curve Standards to avoid mislabeling infants as underweight or failing to thrive. Hospital routines to encourage and support the initiation and sustaining of exclusive breastfeeding should be based on the American Academy of Pediatrics-endorsed WHO/UNICEF “Ten Steps to Successful Breastfeeding.” National strategies supported by the US Surgeon General’s Call to Action, the Centers for Disease Control and Prevention, and The Joint Commission are involved to facilitate breastfeeding practices in US hospitals and communities. Pediatricians play a critical role in their practices and communities as advocates of breastfeeding and thus should be knowledgeable about the health risks of not breastfeeding, the economic benefits to society of breastfeeding, and the techniques for managing and supporting the breastfeeding dyad. The “Business Case for Breastfeeding” details how mothers can maintain lactation in the workplace and the benefits to employers who facilitate this practice.
Abstract There is a paucity of literature on the topic of banked donor breastmilk use for healthy newborns. Herein, we describe two cases demonstrating the day-to-day medically indicated use of pasteurized, banked donor breastmilk in the University of Iowa Children's Hospital newborn nursery. These cases may inform scientific opinion about the role of banked donor milk for healthy newborns and may also facilitate research on the use of banked donor milk for this population.
The US Food and Drug Administration recommends against feeding infants human milk from unscreened donors, but sharing milk via the Internet is growing in popularity. Recipient infants risk the possibility of consuming contaminated or adulterated milk. Our objective was to test milk advertised for sale online as human milk to verify its human origin and to rule out contamination with cow's milk.
We anonymously purchased 102 samples advertised as human milk online. DNA was extracted from 200 µL of each sample. The presence of human or bovine mitochondrial DNA was assessed with a species-specific real-time polymerase chain reaction assay targeting the nicotinamide adenine dinucleotide (NADH) dehydrogenase subunit 5 gene. Four laboratory-created mixtures representing various dilutions of human milk with fluid cow's milk or reconstituted infant formula were compared with the Internet samples to semiquantitate the extent of contamination with cow's milk.
All Internet samples amplified human DNA. After 2 rounds of testing, 11 samples also contained bovine DNA. Ten of these samples had a level of bovine DNA consistent with human milk mixed with at least 10% fluid cow's milk.
Ten Internet samples had bovine DNA concentrations high enough to rule out minor contamination, suggesting a cow's milk product was added. Cow's milk can be problematic for infants with allergy or intolerance. Because buyers cannot verify the composition of milk they purchase, all should be aware that it might be adulterated with cow's milk. Pediatricians should be aware of the online market for human milk and the potential risks.
Copyright © 2015 by the American Academy of Pediatrics.
The Committee on Nutrition of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition aims to document the existing evidence of the benefits and common concerns deriving from the use of donor human milk (DHM) in preterm infants. The comment also outlines gaps in knowledge and gives recommendations for practice and suggestions for future research directions. Protection against necrotizing enterocolitis is the major clinical benefit deriving from the use of DHM when compared with formula. Limited data also suggest unfortified DHM to be associated with improved feeding tolerance and with reduced cardiovascular risk factors during adolescence. Presence of a human milk bank (HMB) does not decrease breast-feeding rates at discharge, but decreases the use of formula during the first weeks of life. This commentary emphasizes that fresh own mother's milk (OMM) is the first choice in preterm infant feeding and strong efforts should be made to promote lactation. When OMM is not available, DHM is the recommended alternative. When neither OMM nor DHM is available, preterm formula should be used. DHM should be provided from an established HMB, which follows specific safety guidelines. Storage and processing of human milk reduces some biological components, which may diminish its health benefits. From a nutritional point of view, DHM, like HM, does not meet the requirements of preterm infants, necessitating a specific fortification regimen to optimize growth. Future research should focus on the improvement of milk processing in HMB, particularly of heat treatment; on the optimization of HM fortification; and on further evaluation of the potential clinical benefits of processed and fortified DHM.
Background:
Human milk from the biologic mother (HM) reduces disease burden and associated costs of care during and after neonatal intensive care unit (NICU) hospitalization for very low birth weight (VLBW; birth weight < 1500 g) infants, when compared to feedings of donor human milk (DHM) or commercial formula (CF). However, compared to DHM and CF, little is known about the institutional cost to acquire HM from the biologic mother.
Objective:
This study aimed to determine the institutional cost of acquiring HM for VLBW infant feedings during the NICU hospitalization.
Methods:
This analysis examined 157 maternal pumping records from a prospective cohort study evaluating health outcomes and cost of HM feedings for VLBW infants. The costs for the breast pump rental fee, 1-time pump kit purchase, and disposable food-grade containers for storing expressed HM were evaluated using standard cost analysis techniques.
Results:
The median cost of acquiring 100 mL of HM varied from 7.93 for those who pumped < 100 mL daily. Mothers who pumped ≥ 100 mL daily had lower acquisition cost compared to both DHM (3.18/100 mL). For mothers who pumped > 100 mL daily, the exact day of pumping where the cost of HM was less expensive than DHM or CF was 4 to 7 days and 6 to 19 days, respectively.
Conclusion:
Human milk from the biologic mother has lower acquisition cost than DHM and CF when mothers provided ≥ 100 mL daily and pumped for a sufficient number of days (range, 4-19). Neonatal intensive care units should prioritize resources to ensure that mothers achieve this daily milk volume.
Donor human milk has emerged as the preferred substrate to feed extremely preterm infants, when mother's own milk is unavailable. This article summarizes the clinical data demonstrating the safety, efficacy, and cost-effectiveness of feeding donor human milk to premature babies. It describes the current state of milk banking in North America, as well as other parts of the world, and the differing criteria for donor selection, current pasteurization techniques, and quality control measures. A risk assessment methodology is proposed, which would allow milk banks globally to assess the safety of their process and respond appropriately to differing risk environments.
Donor human milk has been used in the United States for >90 years, but recent advances in human milk science and laboratory techniques have led to increasing use of this resource. Pediatricians began using donor human milk in the 1900s in response to anecdotal observation that premature infants had better health outcomes when receiving their own mothers' milk. Since then, a formalized human milk-banking system developed in the mid-1980s and distributed >1 million ounces of pasteurized donor human milk in 2008. Despite growth in the use of pasteurized donor human milk, there is little discussion in the medical literature regarding the ethical considerations of collection and use of this resource. Key ethical considerations include issues surrounding medical decision-making and informed consent, increasing the limited supply of human milk, how ethically to allocate this scarce resource, and concerns linked to the marketing of a human milk.
Human milk is the preferred choice for infant feeding. When a sick or premature infant's own mother's milk is unavailable, donor human milk is becoming more widely used. Many potential milk donors do not live within close proximity to the 10 North American not-for-profit milk banks. Transporting milk via commercial carriers can be inconvenient and costly for recipient banks. A network of donor human milk depots is one practical way to increase the quantity of available donor human milk. This article provides guidelines and practical suggestions for establishing a donor human milk depot.
To survey pediatricians on their breastfeeding knowledge, attitudes, and practices and to compare these results with those of a 1995 study.
Cross-sectional follow-up survey.
The Periodic Survey of Fellows survey conducted by the American Academy of Pediatrics.
The survey was completed by 875 pediatrician members of the American Academy of Pediatrics from November 1, 2003, through May 21, 2004.
Pediatricians' recommendations on management, opinions about the benefits and promotion of breastfeeding, and relationship to personal breastfeeding experience were compared with the results of the 1995 survey.
Compared with the results of the 1995 survey, in 2004, pediatricians were less likely to believe that the benefits of breastfeeding outweigh the difficulties or inconvenience (adjusted odds ratio, 0.60; 95% confidence interval, 0.47-0.76), and fewer believed that almost all mothers are able to succeed. More pediatricians in 2004 reported reasons to recommend against breastfeeding. Pediatricians in 2004 were more likely to recommend exclusive breastfeeding (adjusted odds ratio, 1.55; 95% confidence interval, 1.23-1.94) and follow supportive hospital policies. Respondents with personal breastfeeding experience were 2.3 times more likely to recommend supportive policies (adjusted odds ratio, 2.3; 95% confidence interval,1.74-3.08) in 2004 than in 1995. Those with no personal breastfeeding experience were also slightly more likely in 2004 to recommend these policies (adjusted odds ratio, 1.49; 95% confidence interval, 1.09-2.03).
Although pediatricians seem better prepared to support breastfeeding, their attitudes and commitment have deteriorated. Personal experience mitigates poor attitudes and seems to enhance breastfeeding practices among those surveyed.
Public awareness of the benefits of breastfeeding is expected to increase during and after the national, federally funded Best Start Breastfeeding Promotion Campaign. It is anticipated that this will result in more breastfeeding-based interactions between families and pediatricians. The American Academy of Pediatrics conducted a survey of its members to identify their educational needs regarding breastfeeding to assist in the design of appropriate information programs.
An eight-page, self-administered questionnaire was sent to 1602 active Fellows of the American Academy of Pediatrics.
The response rate was 71%. Breastfeeding, as the exclusive feeding practice for the first month after birth, was recommended by only 65% of responding pediatricians; only 37% recommended breastfeeding for 1 year. A majority of pediatricians agreed with or had a neutral opinion about the statement that breastfeeding and formula-feeding are equally acceptable methods for feeding infants. Reasons given for not recommending breastfeeding included medical conditions with known treatments that did not preclude breastfeeding. The majority of pediatricians (72%) were unfamiliar with the contents of the Baby-Friendly Hospital Initiative. The majority of pediatricians had not attended a presentation on breastfeeding management in the previous 3 years; most said they wanted more education on breastfeeding management.
Pediatricians have significant educational needs in the area of breastfeeding management.
This study was designed to verify if breast milk collected at home is appropriate for raw consumption by neonates in a Brazilian public neonatal intensive care unit (NICU). From May 1998 to February 2000, microbiological characteristics of breast milk samples collected at home were analyzed. The milk samples were considered appropriate for raw consumption if mesophilic bacteria count was < 2500 CFU/mL and potential pathogens were not detected. Of 90 milk samples collected from 32 mothers of hospitalized neonates, 36 (40%) were rejected because of potentially pathogenic bacteria (72.2%), mesophilic bacteria count > or = 2500 CFU/mL (13.9%), and both conditions (13.9%). The most frequent nonpathogenic and potentially pathogenic bacteria isolated were Staphylococcus coagulase negative and Klebsiella pneumoniae, respectively. Using univariate analysis, demographic, socioeconomic, educational, and house characteristics were not found to be associated with milk contamination. Breast milk collected at home may not be appropriate for raw consumption in Brazilian NICUs. Pasteurization could improve its microbiological quality. Further studies are needed.
The primary objective of this research was to create a detailed characterization of human milk donors, including descriptive information about demographics and lifestyle, involvement with the milk bank, reasons for donating, problems encountered while breastfeeding and pumping milk, barriers to donating milk, affective experiences, and personal values. Data were collected via telephone interview of 87 donors and 19 nondonor controls. Few relationships were found between the descriptive information and amount of milk donated. Donors reported fewer problems pumping milk than nondonors. Strategies for recruiting new donors and strategies for increasing donation amounts are presented.
Pediatricians and the promotion and support of breastfeeding
- L B Feldman-Winter
- R J Schanler
- K G Connor
- R A Lawrence
Human milk bank network: A trajectory of Brazilian origin. University of Brasilia, Institute of International Relations
- E Frietas
- Zd