Benefits of PDHM
By Student Intern Hannah Van Houten
Pasteurized donor human milk (PDHM) is human breast milk that has been donated to a milk bank, like the Mothers’ Milk Bank of TN. Before it can be distributed to babies in need, PDHM is run through an extensive process to ensure that it is safe. Involved in this process are several organizations, protocols, and steps that must be carefully followed.
HMBANA (Human Milk Banking Association of North America) was founded in 1985 with the goal to mobilize the healing power of donor milk by accrediting nonprofit milk banks in the U.S and Canada, as well as setting international guidelines for pasteurized donor human milk.
It all started when artificial milk was linked negatively to infant mortality and morbidity. In response to this, 2 physicians started the first U.S human milk ‘bank’, in Boston. This first milk bank provided a home for lactating mothers and their own infants, where they could also act as wet nurses for babies in need. These women were screened for diseases like tuberculosis and syphilis to ensure the milk was safe. After a short time, this first milk bank evolved closer to what we now know as a milk bank, with donors providing milk and no longer offering wet nursing. It’s important to note that wet nursing and a practice called milk-sharing (sharing of breast milk without involving a milk bank, and not pasteurizing the milk) are still practiced today, and it is not endorsed, as it does not ensure the safety of the milk.
1943- In 1943, an organization called the American Academy of Pediatrics (AAP) Committee on Mothers’ Milk published guidelines for milk bank operations. These guidelines included proper methods for collecting, processing, storing, and dispensing donor milk. Unfortunately, after World War II, the interest in donor milk started to decline, as well as breastfeeding in Canada and the U.S. During this time formula use continued to be popular.
The 1970s- In the 1970s there was a revival in donor milk banking, due to the increase in breastfeeding among new mothers and advances in neonatology, which led to improving survival rates for sick and premature infants. With this increase, medical facilities and volunteer organizations for breastfeeding women created distributing banks in communities across North America, and some hospitals set up in-house banks to meet the needs of babies in the neonatal intensive care units (NICU), who did not have access to mother's own milk.
The 1980s- By the 1980s there were 23 active milk banks in Canada and 30 in the United States! The AAP published an updated policy statement where they supported human milk banks, and it was followed by a similar statement from the Canadian Pediatric Society (CPS) in 1985.
Unfortunately, even with the growing interest in human milk for human babies, safety concerns started to creep in in the 1980s due to the concern for transmission of viruses, like HIV and hepatitis. These concerns negatively affected donor milk banks. Combined with economic factors and the marketing of preterm infant formulas, there was a closure of most milk banks.
This is where the official formation of HMBANA comes in. They supported the remaining milk banks and began developing the screening and processing guidelines that ensure the safety of donor milk. Even with this support, by 2000, there were still only 5 HMBANA banks operating in North America.
The 2000s- Since the 2000s there has been an increase in the number of milk banks. This is due to the increase in scientific evidence for the use of pasteurizing and freezing human milk to kill viruses and bacteria, as well as its benefit for babies. Throughout the early 2000s, there were numerous publications from respected organizations, promoting donor human milk. These organizations included the World Health Assembly, the American Academy of Family Physicians, and the CPS.
The American Academy of Pediatrics published a policy statement regarding breastfeeding in the early 2000s (16), and the Academy of Breastfeeding Medicine was in its early years of existence (17).
In 2010 the U.S Food and Drug Administration (FDA) endorsed donor milk banking, and a statement in 2012 from AAP recommended donor milk when mothers’ own milk is not available.
Since then, human milk banking has seen some ups and downs, especially the recent COVID_19 pandemic, but despite this, they have continued to thrive! HMBANA now has 31 Member Milk Banks in Canada and the United States combined.
HMBANA Member Milk Banks
Mothers’ Milk Bank of TN (MMBTN) is one of HMBANA’s 31 Member Milk Banks that help mothers across North America donate their extra breast milk to be prescribed to infants in need. This means that MMBTN is certified by HMBANA and required to pasteurize their milk according to the quality standards set by HMBANA. By being a member of HMBANA, hospitals receiving milk from MMBTN can be assured it’s safe for babies in need. The efforts of HMBANA ensure that the process of donating, pasteurizing, and giving PDHM to infants is evidence-based and clinically sound. They advocate for donor milk as a universal standard of care when Mothers Own Milk (MOM) and Mothers’ Own Pumped Milk, is not an option. HMBANA strongly believes in a world where all infants have access to human milk through supporting breastfeeding and the use of donor human milk. MMBTN shares those beliefs and strives to serve the infants of Tennessee that, without safe human milk, may not survive. (1)(2)
Another organization important to PDHM is TIPQC or The Tennessee Initiative for Perinatal Quality Care. Since the beginning of TIPQC in 2007, the Tennessee Initiative for Perinatal Quality Care has promoted collaborative statewide inter-institutional projects. These projects are designed to improve perinatal outcomes for both the mothers and babies of Tennessee.
TIPQC acquires funds through a grant awarded by the State of Tennessee through a program called TennCare. There are also federal additional matching funds through the Department of Health.
The mission of TIPQC since the beginning has been to improve health outcomes for newborns and mothers throughout Tennessee. ** TIPQC does this by engaging key stakeholders in a perinatal quality collaborative that will help to show opportunities to optimize birth outcomes, as well as implement data-driven provider and community-based performance improvement initiatives.
TIPQC goals include:
· Establishing a statewide storehouse of prenatal data for quality improvement initiatives
· Foster state-wide quality improvement initiatives to lower maternal and infant mortality and morbidity and improve outcomes<