When you think about babies, you think about tiny, helpless humans who rely on their parents or other adults to provide everything for them. Food. Water. Shelter.

Imagine a baby so small he can’t even breathe on his own. Imagine a baby so small she can fit in your hand.

Premature newborn baby girl

These premature babies, the “smallest of the small,” often require vast amounts of medical attention until they are strong enough to survive on their own. The special attention paid to these little ones extends to everything, including what they eat. In 2012, the American Academy of Pediatrics said all babies less than 3.3 pounds should only receive pasteurized breast milk, rather than formula, to supplement their mother’s breast milk.

That’s because breast milk has been proven to be more effective than formula at preventing infectious diseases, ear infections, diarrhea and more. Babies who receive breast milk are less likely to be obese or to die from SIDS (sudden infant death syndrome). For premature babies, the serious intestinal disease necrotizing enterocolitis is a major concern. But, according to Dr. Alan Lantzy, a neonatologist at Allegheny Health Network’s West Penn Hospital, “If you give breast milk to premature babies, they’re much less likely to get this life-threatening infection.”

But not all moms are able to provide all the milk their babies need. Having a small infant in the neonatal intensive care unit (NICU) can be stressful, and this stress and fatigue can impact milk production, especially in the first few days after birth. Not only can it take mothers of premature babies longer to begin producing milk, but stress, certain medications and even bed rest can impact how much milk a mom can make.

That’s where milk banking comes in. A milk bank works similarly to a blood bank: Donors provide milk that is then processed and provided to babies who need it. I spoke with Denise O’Connor, the director of the Three Rivers Mothers’ Milk Bank, to talk about milk banking, donor milk and breastfeeding. She explains, “Today, about 75 percent of level 4 NICUs use donor milk, and 50 percent of Level 3 use it. There’s a huge body of evidence that shows that human breast milk is vitally important for babies that are medically fragile to prevent serious complications.”

History of Milk Banking in Western Pennsylvania

2013 was a landmark year for milk banking in the Pittsburgh region. Previously, all donor breast milk in the area had to be brought in from Ohio — three hours away. Dr. Lantzy explains, “At West Penn, we had not used donor milk. Magee-Womens Hospital and Children’s Hospital had to get theirs from Columbus.”

In 2013, KDKA interviewed Dr. Nilima Karamchandani, former medical director for the NICU at West Penn Hospital, who was discussing a Pittsburgh-area donor who had donated a significant amount of breast milk to the Columbus Milk Bank. Dr. Karamchandani alluded to the fact that it would be great to have a milk bank closer to home for local hospitals.

Enter Denise O’Connor.

O’Connor’s career as a lactation consultant made her extremely interested in connecting babies with the breast milk she knew to be so valuable. She saw the Dr. Karamchandani’s interview and, as she explains, “I cold called her!”

Frozen breast milk in bottlesDr. Karamchandani explained that West Penn’s NICU had tried to create a local milk bank but had not been successful up to that point. But, she says, “Upon further investigating, I saw that it didn’t really take that much money. We needed $800,000, but to open a nonprofit, it really isn’t that much money to raise.” The team at the West Penn NICU donated the first $3,000.

O’Connor asked Dr. Lantzy to join the Board of Directors and in October 2013, the Three Rivers Mothers’ Milk Bank was born — and not a moment prematurely.

What Is Milk Banking?

Preemie's first feedingWhen it comes to premature babies, breast milk can provide amazing outcomes. Dr. Lantzy explains, “It’s almost like a medicine. Breast milk helps the smallest of the small kids avoid surgery or avoid dying.”

Milk banking helps babies by providing safe pasteurized breast milk from donor mothers. Milk from donors is pooled together and heated very slowly using the Holder method to pasteurize it, removing pathogens while preserving its health benefits. At the Three Rivers Mothers’ Milk Bank, the entire procedure is carried out in a lab with big glass windows — potential donors and clinicians are all invited to come view the process.

Most babies who require donor milk are very small — less than 1.5 kg, or 3.3 pounds. They may be in the NICU at a hospital, though babies who’ve gone home from the hospital make up about 20 percent of the Three Rivers Mothers’ Milk Bank’s recipients. In some cases, the milk bank can even provide specialized milk for babies. “There was a child at Children’s who had chylothorax (a complication that can occur after heart surgery) and who couldn’t absorb milk,” says Dr. Lantzy. “The milk bank made a less fatty, more protein-containing milk that was delivered to that child at home.”

HMBANA and Milk Banking

Of course, the Three Rivers Mothers’ Milk Bank might not exist at all without the Human Milk Banking Association of North America (HMBANA). Established in 1985, HMBANA’s mission is to establish guidelines for safe milk donation and banking, ensure an adequate supply of donor milk where it’s in need, and support and promote breastfeeding.

All HMBANA member milk banks, including the Three Rivers Mothers’ Milk Bank, use HMBANA’s guidelines for processing donors, screening milk and recruiting new donors. Because there is no national legislation guiding milk banks (although several states including California, Maryland and New York have regulations in place), HMBANA’s regulations and accreditation have filled the gap. As O’Connor explains, “They set those guidelines decades ago and they have an exceptional record. Millions of ounces have been distributed in the U.S. and there’s never been a single issue with a child reported. Their protocols work — they’re the gold standard in the U.S.”

HMBANA member milk banks have other benefits as well. Because they share screening processes and standards, the 20 other member milk banks can share donor milk. They can also collaborate and come up with programs and ideas to promote breastfeeding and donation. O’Connor says, “Because we’re HMBANA members, milk can go from a place of plenty to a place of scarcity.”

Who Donates Breast Milk?

Today, western Pennsylvania is one of these places of plenty. That’s because community response to the milk bank has been overwhelmingly positive. O’Connor says, “When we started the project in 2013, no one on this side of the state was using donor milk. Now, we’ve converted half of the state.”

The community of milk bank donors is made up of three different types of mothers:

  • Mothers who have extra stored milk
  • Surrogate mothers
  • Mothers whose babies have died

This last category of donor has a special place in the hearts of the staff at Three Rivers Mothers’ Milk Bank. O’Connor says, “5 to 10 percent of our donors are bereaved mothers. We have a bereavement wall in our hallway and we’ll memorialize babies on that wall.” For some mothers, milk donation can be a way to give babies the gift of life.

Interested donors can learn more at the Three Rivers Mothers’ Milk Bank website.

How Can It Help the Community?

The Three Rivers Mothers’ Milk Bank helps more than just the babies who receive the milk. As O’Connor points out, donor milk is helpful for mothers of premature babies, too. “It’s a relief to these families to have donor milk. It ‘fills in the gaps’ if a mother is unable to produce enough milk,” says O’Connor. She says mothers think of it as a stress reliever: “Donor milk is there to help prop mothers up until they can provide everything.”

Baby holding a baby bottle with breast milkA community milk bank can also help to promote breastfeeding, says O’Connor. “Having a milk bank changes the culture in an area. In places with longstanding milk banks, it acts as a breastfeeding promoter. When you bring a milk bank into an area and a hospital starts using it in their NICU, people think it will decrease breastfeeding rates, but it doesn’t.

“There’s no more powerful message than a hospital saying it’s important to breastfeed — that [breast milk] is so important that if a mother can’t provide it, the hospital is going to find a way to provide it. You can see the cultural shift.”

This positive message, says O’Connor, encourages women who are on the fence about breastfeeding to become motivated to pump breast milk and bring in their own supply. Ultimately, she says, “Donor milk is great, but mom’s milk is better. There’s nothing better for baby than mom’s milk.”

And the Three Rivers Mothers’ Milk Bank doesn’t just talk the talk — it also walks the walk. It has classroom space and a cafe to provide a breastfeeding-positive community space. O’Connor outlines just a few of the events for me: clinician education, nonprofit use, breastfeeding classes, childbirth classes, La Leche League meetings and a new bereavement support group for families who have lost babies. There are lactation consultants who can help answer questions for pregnant or nursing moms, and can even screen interested donors on-site.

All of these initiatives boil down to one thing: “We’re hoping milk donation is woven into the fabric of maternity care here,” says O’Connor.

Milk Banking in the Future

“Milk banking is where blood banking was a generation ago,” O’Connor says, referring to the regulations that apply to donor milk banks. “There’s no regulation in our state, but some states are looking into regulation. New York, for example, requires milk banks to hold a tissue banking license.”

“There are a lot of developing milk banks and I’d guess that in another year or two, HMBANA would be able to have enough so that everybody who wants to use donor milk, can. Now that our donor response has been so robust, we’re able to branch out,” explains O’Connor.

Currently, the Three Rivers Mothers’ Milk Bank works with UPMC and Allegheny Health Network hospitals, The Children’s Home, Conemaugh Health System in Johnstown, Pinnacle House in Hershey, and St. Luke’s Hospital in Wilkes-Barre. They also distribute donor milk in New Jersey and West Virginia. “We’re growing very nicely; every month a little more milk is going out the door and we’re adding a couple more hospitals,” says O’Connor.

And as for the first batch of babies who used donor milk from the Three Rivers Mothers’ Milk Bank? “We know we can’t wait to see what those outcomes are,” says O’Connor. The babies are just now going home — as the first in a very long line of healthy, happy babies.