Over 6,000 ounces of donor milk distributed to Alberta babies so far this year

Calgary Mothers' Milk Bank director Jannette Festival
with Alberta Breastfeeding Committee conference
delegate Stephanie Harries

At the Alberta Breastfeeding Committee's (ABC) annual conference, held this year in both of Alberta's major cities, Calgary Mothers' Milk Bank director Jannette Festival provided an update on the status of donor human milk in the province.

When the Calgary Mothers' Milk Bank opened its doors this spring Festival forecast between 80 and 100 donors would provide milk in its first year of operation. The milk bank is on track to exceed that forecast with over half of 160 applicants already approved and dozens more on track for approval. The milk bank moved quickly after setting up operations - they pasteurized their first batch of milk on April 3, 2012 and made their first delivery to the Foothills Hospital on April 13, 2012. The average donation is 400 ounces and the bank had already logged 10,000 ounces by June, 2012. They are on track to process 22,000 ounces this year.

This interactive map shows the locations of the
milk bank, hospitals providing pasteurized
human donor milk, and collection depots in Alberta.

ABC Conference attendees in Edmonton were excited by the news that the Grey Nuns began officially using donor human milk on September 5th 2012, with the Royal Alex coming on board at the end of September, ending a brief period of bureaucratic delay that saw milk available in Edmonton only if families paid the milk bank processing fees directly.

Calgary hospitals have already used 3,600 ounces and Edmonton is close behind with 3,100 ounces. Another 2,000 ounces has been provided to Toronto, which is set to open its own donor milk bank later this fall. There is a small percentage of milk that shows a high bacterial count after processing and  it is not suitable to be used as donor milk in the NICU - that milk is used by researchers.

Donors come from across Alberta, and even as far away as Ontario. The milk bank is always looking for donors and is currently a little short of milk - there is a lag between when they first apply and when they make their first deposit.

A collection depot is set to open in Edmonton early October at the Grey Nuns. This will cut the time and expense of moving each individual Edmonton donor mom's milk down to Calgary. The Breastfeeding Action Committee of Edmonton raised funds for the depot earlier this summer.

Also overheard at the conference - exciting talk of moving to fill the need for collection depots in Grande Prairie, Red Deer, and Lethbridge.

Dr. Karleen Gribble: Biomedical Ethics and Peer-to-Peer Milksharing

Biomedical Ethics and Peer-to-Peer Milksharing

Human Milk News is honoured to host this guest post by Dr. Karleen Gribble, adjunct research fellow in the School of Nursing and Midwifery at the University of Western Sydney. This post is an adaptation of a PowerPoint Presentation outlining Dr. Gribble's application of six ethical principles to health worker / patient interactions in the area of peer-to-peer milksharing. 

Photo: Bart Everson

Health authorities in Canada, the US and France have publicly warned parents not to feed their babies peer-shared milk. Many health workers are unsure about how to respond to mothers who are considering being involved in peer-to-peer sharing of milk. Applying the principles of biomedical ethics to the problem may assist in guiding action.

Biomedical ethics can be used to explore actual or anticipated dilemmas in medicine and find reasoned, consistent, and defensible solutions to moral problems.

Principle 1: Autonomy- individuals should be supported to make health care decisions free from deceit, duress, constraint and coercion.

Health Workers are obliged to provide individuals with the information they need to make informed decisions. Limiting of information for the “good of the patient” is paternalistic and interferes with autonomy. Information should only be withheld in very limited circumstances: if the health worker believes that the sharing of information might seriously harm the physical or mental health of the individual or if the individual states that they do not want the information.


Principle 2: Veracity- patients and health workers must be honest with each other.

When parents seek information about alternatives to a mother’s own milk, health workers must discuss all alternatives including infant formula, banked donor milk, peer-to-peer shared milk and wet nursing in an unbiased and non-judgmental way.

Parents must discuss consideration or actual involvement in milk sharing with their health workers.

Policies that prohibit discussing the option of peer-shared milk with mothers could be considered as breaching the ethical principles of autonomy and veracity. They are also dangerous.


Principle 3: Beneficence- minimization of harm and risk and promotion of good outcomes.

The interpretation of “good outcome” depends upon the specifics of a situation and the beliefs and values of the individual. Individuals seeking health care are those who define “good outcome.”

In peer-to-peer milk sharing, beneficence might involve health workers providing information or directing the patient toward information on the correct way of storing and dispensing expressed breast milk or on flash heating or on medications and milk. It might also involve facilitating the sharing of medical records between milk donor and recipient.


Principle 4: Nonmaleficence- active avoidance of harm to the patient.

A health worker who dismisses, mocks, berates or derides an individual seeking advice or information about milk sharing and so humiliates or belittles them could be considered as having breached the principle of nonmaleficence.

A health professional who withdraws care from a mother or child because they wish to be involved in the peer-sharing of milk and does not ensure that appropriate alternate care is available could be considered as having breached the principles of nonmaleficence and the principle of autonomy.


Principle 5: Confidentiality- health providers must not reveal private information without consent.

While sharing of medical records may assist in reducing the risks of peer-sharing of milk, donor records cannot be shared with a potential recipient without the consent of the donor.


Principle 6: Justice- individuals must be treated fairly.

Aspects of justice to consider in the distribution of resources include: distribution equally, or according to need, effort, contribution, merit or notwithstanding ability to pay.

The application of Justice to milk sharing has proven contentious in North America where donor milk banks are experiencing shortages of milk.

Milk banks distribute according to need but payment is required.

Peer-to-peer donors distribute for free and to those who do not qualify for banked milk.

Both groups are applying justice but neither application is unproblematic. Such conflict is not uncommon in biomedical ethics and indicates that further discussion between the players involved is necessary.

Health workers cannot ignore, dismiss, discount or demonize peer-sharing without acting unethically. What then should they do?

• Educate themselves about the various options for infant feeding including the benefits, risks and costs of each option and the ways in which the risks and costs might be managed, reduced or eliminated 

• Be open and honest with mothers about each option and refrain from using pejorative terminology in relation to any option 

• When speaking to the media ensure that information is provided in such a way that it cannot be used to portray breastmilk as inherently dirty and dangerous and that the risks associated with other alternatives to mothers' own milk are considered.

Dr. Karleen Gribble is an adjunct research fellow in the School of Nursing and Midwifery at the University of Western Sydney. Dr. Gribble's research interests include adoptive breastfeeding, long-term breastfeeding, the impact of culture on breastfeeding, non-nutritional aspects of breastfeeding and models of care for newly adopted post-institutionalised children. Karleen speaks and publishes widely on these subjects to lay and professional audiences. Karleen is also active in advocacy and teaching in the areas of infant feeding in emergencies and the marketing of infant formula. In 2011 Human MIlk News profiled Dr. Gribble's research on infant feeding in emergencies in the developed world in #FirstWorldProblems, Are We Doing Enough to Protect Infants in Emergencies? Dr. Gribble has co-authored several papers on milksharing:

Biomedical Ethics and Peer to Peer Milk Sharing - Karleen D. Gribble, BRurSc, Ph.D., Clinical Lactation 20212

Milk sharing and formula feeding: Infant feeding risks in comparative 

perspective?  

Karleen D. Gribble, Bernice L. Hausman,  Australasian Medical Journal, 2012

Milk sharing: from private practice to public pursuit James E Akre, Karleen D Gribble and Maureen Minchin International Breastfeeding Journal, 2011

The World Milksharing Week 2012 Blog Carnival is hosted by Milk Junkies blogger Trevor MacDonald.

Participants:

Milk-Sharing: Safe Infant Feeding and Being a Human - Sustainable Mothering - Jake Markus 

The Lorax and Other Milksharing stories - MatriciativismoenelsigloXXI Jesusa Ricoy-Olariaga

Winning the milk lottery - PhD in Parenting,  Diana West, BA, IBCLC

Scared Milk-less - Peaceful Parenting - Lisa Van den Hoven

Overcoming Difference Through Milksharing - Milk Junkies, Trevor MacDonald

Biomedical Ethics and Peer-to-Peer Milksharing - Human Milk News, Karleen Gribble 

A Story of Peace and Healing - Normal, like breathing, Diana Cassar-Uhl

Milksharing and La Leche League - Feed the Baby LLC, Laura Spitzfaden

Supporting Families in Milksharing as an International Board Certified Lactation Consultant -  Nourish Breastfeeding Support, Amber Rhotan McCann 

"I wish I'd Known About Milksharing When..." - Complete Wellness Concept, Dinnae Galloway

Waiting for Milk Banks: A Matter of Life or Death - Human Milk News, Jodine Chase 

Powerful Images: Supplementing with Donor Milk - DoubleThink, Paa.la, Paala Anderson Secor

What is World Milksharing Week - Dinnae Galloway

 

Roby's Story - mom regains supply and goes on to donate

Human Milk News is featuring a milksharing story every day leading up to

World Milksharing Week 2012 (Sept. 24-30)

This story (which is posted in Spanish but you can use Chrome's translate feature to read it in English) is about a mom who used an at breast supplementer when her milk supply wasn't sufficient. She received donor milk and at the age of five months her child started to refuse the supplementer but still wanted to breastfeed. She discovered she was able to meet all his needs at the breast. Then, as time went on she discovered she has a surplus and was able to donate to another family!

Roby at his mother's breast, donor milk via an at breast supplementer.

Roby's StorySeptember 5, 2012 | Filed under: Stories and tagged with: WMW 2102My story begins with shared milk natural birth of my son, Roby. I suspected that perhaps would not have enough milk for him (never produced enough milk for my first baby), but I had a natural birth to increase chances of success in breastfeeding.He grabbed the breast immediately after birth, and was nursed when wanted from that time forward.... more

Surrogate mom describes her milksharing experiences

Human Milk News is featuring a milksharing story every day leading up to

World Milksharing Week 2012 (Sept. 24-30)

A surrogate mom provides milk for the child she birthed, and has milk to spare for the child of an adoptive mom. She also donates and wet-nurses a child whose mother cannot produce milk. Read what happens when she runs into this milk baby a year later!

Tiffany ~ Surrogate Mother and Donor (Canada)
September 7, 2012 | Filed under: stories and tagged with: WMW 2012It all started with a beautiful baby girl, S. As a gestational surrogate, I gave birth to S in 2010. S’s parents and I agreed enthusiastically that breastmilk would give S the best start in life, so after nursing S at the breast for the first 8 days of her life, I committed to pumping for the next several months. So began a daily routine that totalled 3 hours of pumping time, and weekly trips to the courier depot, to ship the Liquid Gold half way across the country. But my milk came in with a fury, and I had milk to spare.