Hello, my name is Hannah Van Houten, and I was an Intern with the Mothers’ Milk Bank of
TN (MMBTN) in the final spring semester of my master’s program at Middle Tennessee State
University.
While I grew up around the world of breastfeeding and milk banks (my mother is a lactation
consultant and nurse, and she also donated to milk banks) there was a lot I didn’t know going into this internship. The extent of my understanding of breastfeeding and milk banks was basically as follows:
● Breast milk was really good for babies- the number one choice for feeding them, if
possible
● Breast milk often changes to fit the needs of the baby
● Milk Banks took donated human breast milk and made it available to babies who
needed it
● Women often have trouble breastfeeding
● Some women produce too little breast milk, and some produce an overabundance of
breast milk.
After working with the MMBTN for around 5 months, I realized there was a lot more to the story than that. Because my background was mainly in nutrition, that is where my knowledge was focused. But my eyes were opened to the other sides of the story during my time with this milk bank. There are so many organizations and groups involved in the process whether it’s from the breastfeeding side, like lactation consultants, or from the milk bank side, like the Human Milk Banking Association of North America (HMBANA) and the Tennessee Initiative for Perinatal Quality Care (TIPQC).
Here are a few of the things I learned, and areas my eyes were opened to, during my time with MMBTN.
● Most milk banks are HMBANA certified, but not all of them are
The Human Milk Banking Association of North America (HMBANA) mobilizes the healing power of donor milk by accrediting nonprofit milk banks in the US and Canada and setting international guidelines for pasteurized donor human milk( HMBANA). Non-profit milk banks, like Mothers’ Milk Bank of TN, are accredited through HMBANA and are required to follow their standards. Not all milk banks are accredited through HMBANA. Some milk banks are for-profit and pay mothers to donate their milk.
● What is HMBANA?
HMBANA, or the Human Milk Banking Association of North America, is a group of nonprofit Milk Banks that chose in 1985 to join together and focus on 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. HMBANA advances the world of nonprofit milk banking through member accreditation, development of evidence-based best practices, and advocacy of breastfeeding and human lactation to ensure an ethically sourced and equitably distributed supply of donor human milk. HMBANA believes in a world where all infants have access to human milk through supporting breastfeeding and the use of donor human milk when milk from the babies’ own mothers is not available.
● What TIPQC?
TIPQC or the Tennessee Initiative for Perinatal Quality Care is an organization that seeks to
improve health outcomes for mothers and infants in Tennessee by engaging key stakeholders in a perinatal quality collaborative that will identify opportunities to optimize birth outcomes and implement data-driven provider - and community-based performance improvement initiatives
● How is breastmilk pasteurized in an HMBANA Member Milk Bank?
Before milk can be accepted at a milk bank, each donor mother is required to undergo
screening and approval. This screening process involves the medical and health history and
status of both mother and baby, to ensure that no diseases are present. Once a mother is
approved to donate, her milk can be pasteurized. HMBANA Member Milk Banks, like MMBTN, follow a carefully standardized protocol for pasteurizing the breastmilk donated.
When donated, the breastmilk is frozen and unpasteurized and will remain that way until
it is ready to be pasteurized. Pasteurizing the milk ensures that any bacteria or viruses
are removed. It is an important step in the PDHM process and must be carefully
followed. To begin the pasteurization process, the breastmilk is allowed to thaw either in
a refrigerator or outside a refrigerator, as long as it is prevented from being altered or
contaminated. Is it then run through a filter to remove any foreign objects that might be
present. Cultures are taken of the milk from each mother and sent to a lab for testing.
The next step is the pooling process, in which the breastmilk is thoroughly mixed to
ensure an even distribution of nutrients the milk contains. Each bottle is filled, leaving
enough air space for expansion during heating and freezing, and all bottles are filled
with the same amount. Bottles are carefully examined, and each one is closed tightly to
prevent leakage. Once the bottles are prepared, they can be pasteurized. The bottles of
breastmilk are submerged in a pre-heated water bath, and a temperature probe is
attached to a ‘control’ bottle of milk. This control bottle is for quality assurance purposes
and allows for careful monitoring of temperature. The standard of pasteurization is for
the temperature of the milk to reach 62.5°C for 30 full minutes, and to ensure quality, a
temperature of 64.5°C is never exceeded. If a batch of milk fails this, it will be discarded.
After the milk is removed from the water bath, it is rapidly chilled in an ice bath. Once
chilled, the bottles of milk are immediately transferred to a holding refrigerator or
freezer. Finally, the pasteurized breastmilk will remain in the freezers of a milk bank
before it is properly packaged to be sent or delivered to babies in need.
● PDHM is made available first to high-risk babies by prescription
For member HMBANA milk banks like MMBTN, the milk pasteurized in the facility is sent to
hospitals for use in feeding babies in the NICU, per a doctor’s prescription. The reason for this is that NICU babies are the top priority for a milk bank. As a milk bank, like MMBTN, grows and develops, it will have ample milk to help out-patient babies as well.
● Why milk banks were started
Years ago, artificial milk- like formula, was associated with a negative impact on infant mortality and morbidity. In response to this, 2 physicians founded the first U.S human milk bank in Boston. At first, this bank provided a home for lactating women to wet nurse infants in need, while also breastfeeding their babies. These women were screened and examined to rule out diseases like tuberculosis and syphilis, to ensure their milk was safe. Within a short time, this milk bank evolved into what we now know as a milk bank, with donors providing milk and no longer wet nursing. The 1970s saw a revival in donor milk banking, due to the increase in breastfeeding among new mothers and advances in neonatology, which led to improved survival rates for sick and premature infants. Unfortunately, even with the growing trust for human milk for human babies, safety concerns started to creep in in the 1980s due to the transmission of viruses, such as HIV and hepatitis. These concerns negatively affected donor milk banks. Combined with the economic factors and the marketing of preterm infant formulas, there was a closure of most milk banks. 1985 is when the official formation of HMBANA happened. They supported the remaining milk banks and began developing the screening and processing guidelines that ensure the safety of donor milk. Thankfully, since the 2000s there has been a re-growth 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. 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.
