When an infant dies, some women find comfort in donating breast milk to help other babies

Her baby was dead.

There was nothing she could do to change that heart-shattering fact.

But then she learned of a way that other women have found to ease the pain, to add meaning to an unthinkable tragedy.

She began to pump the milk her baby would have had, and she donated it to a nonprofit milk bank, which screens, processes, and distributes pasteurized milk, mostly for critically ill babies.

The woman’s story was among those included in a study published in the journal Breastfeeding Medicine in May that found that for many women who have lost an infant, expressing their milk and donating it, instead of suppressing it, was an important part of their grieving process.

The first U.S. milk bank opened in Boston in 1911, and milk banks have since played a critical role in providing nutrition to sick infants. While the rise of infant formula during World War II contributed to a steady decline in the number of babies fed breast milk, breastfeeding made a comeback in the 1970s.

And now, in a time of formula shortages, medical experts are taking a new look at how valuable these milk banks are.

The senior investigator of the research was Diane Spatz, a professor of perinatal nursing and the Helen M. Shearer professor of Nutrition at the University of Pennsylvania School of Nursing. She also is a nurse scientist focused on lactation at the Center for Pediatric Nursing Research and Evidence Based practice at Children’s Hospital of Philadelphia, where she was instrumental in establishing its milk bank in 2015. She spoke with the Inquirer recently about her research.

It is pretty amazing. As soon as a female goes through puberty, the internal parts necessary for milk production begin to develop. When she gets pregnant, those structures further mature. In the second trimester of pregnancy, the mammary glands are already making milk. It’s kind of like the breasts are in the warm-up mode.

When the baby is born and the placenta comes out, the hormones of pregnancy drop very quickly. That rapid shift is what tells the breasts that they need to really start performing.

A mother can make milk for ever and ever, really, as long as the breast is stimulated and emptied. Clinically, in my role at CHOP, I’ve had mothers who pumped for 12 months, 18 months. And I know one woman who was continuously lactating for 17 years. The breast has unlimited capacity as long as it is stimulated and emptied.

After a woman gives birth, there is a critical window for that milk-making capacity to occur. If the baby is effectively feeding at the breast or a mother is pumping effectively during the first three to five days after birth, that’s how a really robust milk supply is possible.

Milk banking has been around since the beginning of time. Think about wet nurses. Even at the beginning of neonatology, when we started saving smaller or sicker babies, we had wet nurses.

For hospitalized babies, human milk reduces the risk of a particular bowel disease that can cause long-term illness or can be fatal. It significantly reduces the chances of sepsis; another reason babies can die. When you think about a baby, that milk is vital for every single organ in the baby’s body. It helps to develop and protect the baby’s brain, the baby’s eyes, the baby’s lungs, the baby’s GI system.

It’s important for all children. But when we’re talking about sick children, it can be the difference between life and death. Once we understood that human milk is a lifesaving medical intervention, the number of milk banks have continued to increase.

Nonprofit milk banks primarily serve our sickest babies, meaning hospitalized babies and babies in neonatal intensive care. The very best milk for a sick baby would be its mother’s own milk. Even if an infant is unable to go to breast, because of a variety of diagnoses, the baby can be fed its mother’s milk through a feeding tube.

And when that’s not available, pasteurized donor milk comes into play. In 2012, the American Academy of Pediatrics for the first time put in their position statement that, specifically for sick babies in the hospital, if the mother’s own milk wasn’t available, then pasteurized donor milk should be utilized.

The oversight organization for nonprofit milk banks, the Human Milk Banking Association of North America, has a rigorous process. All women go through a detailed and thorough screening process that includes extensive lifestyle and health histories. We do a lot of lab work, testing for HIV and hepatitis and other things. They have to get their health-care provider to verify that they are healthy, not taking any medications. If someone was a smoker, they would be deferred from donating.

Earlier this year, HMBANA announced that in 2021, its milk banks distributed nearly 9.2 million ounces of milk, more than 71,000 gallons.

Through HMBANA and its bereavement committee, we distributed information about our study to all the milk banks across North America to help us identify bereaved mothers.

We learned that milk donation after a perinatal loss is positive, it’s valuable, it’s a nurturing experience. For many donors, it helped them feel connected to their child that died. It enabled them to give meaning to their child’s life. They were helping other families. They were making a difference for other people’s children. Giving them this outlet to grieve was therapeutic.

I cried, listening to these stories. One woman actually had a picture of her baby who died while she was pumping, knowing that she was going to give this milk to another child. “My child did not survive, but the milk my body is producing is going to be a legacy to help other children survive and grow.” It’s so powerful.

Milk banks have historically distributed some milk to outpatient settings. But with the formula crisis, we have seen an increased demand for donor milk. That’s both for hospitalized babies and for babies in the community.

Clearly, milk banks can’t solve the formula shortages. We need to help more families have longer breastfeeding durations, then the need for formula would go down.

In some countries, women do not wean until their child is between age 3 and 5. In the U.S., only about one-third of women who initiate breastfeeding continue for a full year. And our initiation rate is about 84%. The gold standard is for babies to receive human milk exclusively for the first six months. Here, only a quarter of babies get that.

Formula itself is not the problem. It’s how it is marketed, which makes people believe formula is superior to human milk. It is not. We need all families to be making informed feeding choices for their infants.