When Ambreia Meadows-Fernandez was pregnant, she planned to breastfeed. However, when her son was born with medical complications, her milk didn't come in quickly enough to feed him. Yet, her son still got breastmilk in those early days, from a donor.
"I had zero hesitations and was grateful that that was an option instead of formula," said Meadows-Fernandez, who went on to breastfeed her son for 18 months.
Most parents assume that when it comes to feeding they have two options: breastfeed or use formula. However, a third approach is growing in popularity: using donated breastmilk.
"If you can't have your mom's milk, the next best thing is donor breast milk," said Danelle Fisher, M.D., vice-chief of pediatrics at Providence Saint John's Health Center in Santa Monica, California.
Debating the benefits of breastmilk over formula is a fraught topic. However, Dr. Fisher says that while formula is adequate, breast milk is preferential because scientists have not been able to exactly replicate all its components.
"Breastmilk is one of the most complete forms of nutrition on the planet," she said. Formula does not have the same types of fatty acids that breastmilk has (although they're closely replicated). Breastmilk also contains antibodies and prebiotics, which help babies nourish the good gut bacteria that they need for a healthy digestive system.
For these reasons, breastmilk is especially important for premature infants, who are at higher risk of infection. Up to five percent of babies in neonatal intensive care units (NICUs) around the country develop necrotizing enterocolitis, an intestinal disease that is the leading cause of death in premature infants. Babies who receive only breastmilk—not formula— are less likely to develop the condition.
"Breastmilk of any sort, whether it comes from the baby's mom or another mom, can help give premies those things that they really need," Dr. Fisher said.
Because of that, using donated milk has become the standard of care in many NICUs around the country. In January 2017, the American Academy of Pediatrics issued a policy statement recommending the use of donor milk for low-birthweight infants. The law is also catching up, with six states and Washington D.C. requiring insurance companies to cover donated human milk, which has a cost when it's obtained through a milk bank.
While donated milk is becoming more mainstream, there is not currently enough donated milk to meet the need for premature infants, according to the AAP statement. That's something that the Human Milk Banking Association is aiming to change. With 27 non-profit milk banks around the country and a list of milk banks around the globe, the association provides donated milk to NICUs and medically fragile infants. The donors are screened and the milk is pasteurized to kill off any harmful bacteria while retaining the beneficial properties of the milk.
Amy Trotter, community relations director for the Mother's Milk Bank of North Texas, said that as donor milk becomes the standard of care for premature babies, the demand for milk has increased, as has the number of donors. In 2004 the milk bank dispensed 4,000 ounces of milk; in 2018, it dispensed more than 600,000 ounces from more than 900 donors. Considering that one ounce of milk can make up three feeds for a premature infant, that's a very significant amount.
Trotter said that many women who have excess milk are keen to donate when they learn that breastmilk can be lifesaving for a premie, and how far a donation can go.
"A lot of times a mom is pumping, her freezer is filling up, and she realizes there's way more than she needs," Trotter said. "But she doesn't want to throw it away, she's worked really hard for that."
Mothers who want to donate through a milk bank must undergo a blood-screen to check for communicable diseases, but after that, the donation process is simple, with collection depots at many hospitals, Trotter said.
In addition to so-called formal donations through a milk bank, direct donation between parents is also growing in popularity. In the U.S., grassroots organizations like Human Milk 4 Human Babies and Eats on Feets help facilitate milk donation between moms who have extra milk, and parents who need milk for their children, often via Facebook groups. Although this is commonly known as an informal donation and not recommended by the AAP because of risks of bacterial or viral contamination and the possibilities of exposure to medications, drugs, or herbs in human milk, Shell Walker, founder of Eats on Feets, says that the process can be as formal and screened for safety as the donor and recipient make it.
Walker estimates that Eats on Feets has orchestrated more than half a million milk exchanges since it was founded in 2010. As milk sharing becomes more mainstream, she has seen interest grow.
"People are getting it," she said.
Usually, informal donations are for full-term babies, not those in the NICU. Dr. Fisher said that the World Health Organization recommends that donor milk be used for infants who can't be exclusively breastfed by their mother during the first six months of life.
Human milk that is exchanged informally isn't pasteurized. However, the Centers for Disease Control and Prevention says that "very few illnesses can be passed through breastmilk." It is theoretically possible to pass HIV through breastmilk, which is why milk banks require screening. Dr. Fisher said that people using informal donations could ask their donor to get a blood screen and should also ask about lifestyle choices like diet and substance use. Parents are often able to connect with donors who meet their baby's dietary needs by avoiding certain allergens, like dairy, or who adhere to certain diets like vegan or kosher. Of course, these relationships are built on the trust between donor and recipient, since there's not formal testing of the milk involved. Ultimately, what is acceptable depends on the recipient's comfort level.
Dr. Fisher added that milk sharing is an age-old occurrence that our society has only recently become squeamish about.
"One of the big misconceptions is that if it's not from the mom herself it shouldn't be given. [People] think it's only that mom who produces the specific breastmilk for that infant, and that's not true," Dr. Fisher said. "Donated breastmilk is still wonderful."
Of course, donated milk requires the time and effort of women who produce, pump, and ship the milk. While some people do sell their breastmilk, most donors are not compensated. However, many women are willing to sacrifice their time to the cause. Shannon Shelton Miller adjusted her routine after she learned about the importance of donated milk for premies.
"I pumped at work and pumped a bit extra each day, so I would donate the extra to a milk bank," Shelton Miller said. Over a combined 36 months, she donated about 600 ounces of milk, formally and informally.
For Emily Cleaver, donating milk through Human Milk 4 Human Babies was a salve for grief. Cleaver's son died at five months old, after being born with a heart condition.
"For those months my whole life had been taken up with the struggle to get calories into him, to get breast milk into him, and to keep feeding because I believed it was the best thing I could do for him," she said. "I didn't want that love and time to just be thrown away when he was gone. It became very important to me that the milk went to someone who could benefit from it."
Dr. Fisher says that with an increased focus on the benefits of breastmilk, donor milk will likely become more mainstream in coming years.
"We would like it to be the norm, but it's a work in progress as we're discovering more and more how important it is and putting all the regulations in place," she said. "But we're making good progress toward that goal."