As a Certified Breastfeeding Counselor (CBC), you know that breastfeeding is widely acknowledged as the biologically appropriate food for human infants. However, you also know, that for a variety of reasons, breastfeeding is not always possible or desired. Donor milk has grown in popularity in a variety of circumstances.

As a CBC, it is important to understand donor milk and the options surrounding it. As it continues to grow in popularity, you are more likely to get questions from clients regarding donor milk options.

What is Donor Milk?

First, donor milk is breast milk pumped from a lactating person and given to another person’s infant. This can be done informally, such as between friends or through online exchanges. It is also done through milk banks. Milk banks might serve only hospitals and the milk given to babies still inpatient. Or, some milk banks serve anyone, even those outside a hospital.

Donor milk is not necessarily new, but it is growing in popularity. Before pumps, “donor” milk was done via wet nursing. However, it might surprise you to learn that the first human milk bank opened in Vienna, Austria in 1909. Ten years later, the first milk bank in the US opened in 1919 in Boston.

However, in the 1980s, as fear grew regarding HIV, many human milk banks closed. As HIV was new, misunderstood, and safe and consistent testing wasn’t yet possible, it was considered safest to not share breast milk.

As we learned more about HIV, its transmission (possible through breast milk), and how to safely test people, milk banks and informal milk sharing once again grew in availability.

Safety and Screening Protocols For Donor Milk

For milk obtained through a milk bank, all the donor milk undergoes screening and pasteurization. This is important as most milk banks provide milk directly to hospitals. In many hospitals, the milk is given to the most critical infants, those in the NICU for prematurity or illness.

As it is a donor product, this milk is only given to infants with written approval from their parents or guardians. While there is always the risk of a communicable illness through breast milk, donors themselves are regularly screened for illness and risk factors. Then, the milk is pasteurized for safety.

For those utilizing informal milk sharing, it is up to recipients to screen donors. As most donor milk sharing is altruistic, it is highly unlikely someone with major risk factors would intentionally take time to pump and provide unsafe milk to families. Nonetheless, there is always risk. Some recipients request donors share recent lab work (which is typically already done due to their recent pregnancy) to confirm there are no known communicable diseases. Others trust that a parent feeding their infant is already making safe and healthy choices.

Benefits of Human Donor Milk

Donor breast milk is nutritionally rich and provides essential nutrients, antibodies, and growth factors crucial for infant health and development. It is, after all, breast milk. However, milk from a milk bank is pasteurized which can alter the milk slightly compared to freshly pumped milk or milk taken at the breast.

However, in cases where donor milk is used, the alternative is typically formula. Pasteurized donor milk is considered a more nutritionally complete option when compared to formula.

Informal milk, not pasteurized, is the same as any other pumped breast milk. It can be slightly different when frozen or refrigerated rather than consumed at the breast or immediately after expressing. However, most of these changes are considered minor. Breast milk remains a live substance containing antibodies and significant benefit to babies.

Each lactating person’s milk does vary slightly. Milk also varies depending on time of day, baby’s sex, and baby’s age. However, all of these are considered minor. And when compared to formula, it still contains more optimal, easily digestible, and absorbed nutrition.

When is Donor Milk Indicated?

Donor breast milk can be used any time a baby cannot feed directly at its parent’s breast and there is not adequate expressed milk available.

This is most common in NICUs where babies are unable to safely feed orally, and their parents are still working on pumping. Donor milk is also used in well-baby nurseries when there are blood sugar concerns before a parent’s milk is able to be expressed.

Informally, donor milk is used when a parent is unable to lactate, adoption, surrogacy, returning to work and not able to pump, chronic low supply, or maternal child separation (both short term and permanent).

Essentially, except for severe food allergies or intolerances (e.g. galactosemia), anytime formula is indicated, donor milk might be an option.

Supporting Milk Banking Initiatives

As advocates for breastfeeding and infant health, certified breastfeeding counselors can support milk banking initiatives in their communities. We can raise awareness about the importance of donor breast milk, promote milk drives, and encourage parents to consider becoming donors themselves.

We can help bring awareness to the option of utilizing donor milk when there is a need. Formula remains a safe and healthy substitute for breast milk. However, there are parents who prefer an exclusively human milk diet to avoid risks associated with formula feeding.

Donor breast milk is a valuable resource that can provide essential nourishment and support for infants when breastfeeding is not feasible. Certified breastfeeding counselors play a pivotal role in educating and supporting parents in their decision-making process regarding donor milk.