A hospital’s experience of working with the Hearts Milk Bank

We’ve been busy recruiting donors and pasteurising milk for 4 months, and have built up large stocks. Milk is now leaving our doors to hospitals for use on neonatal units, and also to mothers in the community who have medical reasons that mean they cannot breastfeed. We are delighted, and so grateful to all who have supported us to get to this point.

One of the first hospitals to contact us for donor milk was Luton and Dunstable NICU. We wanted to know how the Hearts Milk Bank supports staff and patients on this busy neonatal unit. Lauren Wong, Senior Sister, spoke to us earlier this week.

Where do you work, and what is your role?

 

 

 

I work in the NICU (Neonatal Intensive Care Unit) at Luton and Dunstable Hospital.  We are a busy Level 3 unit, which means that we are able to care for babies who are very sick, or extremely premature (from 23 weeks gestation upwards).  My role is as a Senior Sister and Infant Feeding lead nurse for the NICU.

How is donor milk used on your unit?

Our primary use is for babies born at less than 32 weeks gestation, either to supplement mother’s own milk production (for example if mother is very unwell or having difficulties / a delay building her supply), or very occasionally in situations where we cannot give mother’s milk (for example due to chemotherapy). We also sometimes use donor breast milk for older babies who are very sick (for example those undergoing cooling therapy) or those with digestive issues.

We see breast milk as being like a medicine for our babies.  It contains important factors for brain development, antibodies to fight disease and infection, and helps protects against allergies.  However, the most important issue for our premature and sick population is that breast milk reduces the risk of a gut condition called necrotising enterocolitis (NEC) which can be very serious for babies.

There is strong evidence that increased use of breast milk saves the NHS money in the long term, by reducing the incidence of hospital admissions in babies (gastroenteritis, chest infections etc) as well as lowering the chances of many other conditions affecting older children and adults.  We see demand for donor breast milk increasing, and being more widely used as the importance of breast milk is better understood.

When did you hear about the Hearts Milk Bank?

I first heard about the Hearts Milk Bank through a friend who had seen an article online about a new milk bank for the region. We are very excited to be involved with the HMB.  It is wonderful for us to have a regional milk bank where our NICU mums can easily donate their expressed milk without having to travel (the amazing SERV motorbike team will collect their milk).  Mums are always glad to know that some of this milk may come back to us and be given to new babies coming in (some of their own babies may have also received donor milk for a while).

What support does the Hearts Milk Bank offer?

The staff at HMB are incredibly knowledgeable about milk banking and all things breast milk-related, and are always happy to answer our many questions.  Gillian has visited the unit to give us some teaching about the processes involved in providing donor breast milk.  This was a fascinating talk, and an excellent opportunity for doctors and nurses to ask any questions they had around milk banking.

We are now able to simply give the HMB contact details to our mums with excess milk, and they will guide them through the donation process.  The HMB team also sensitively deals with bereaved parents who wish to discuss donating expressed breast milk.  It may offer some small comfort for these parents to know that they have helped another family in a similar situation.

It is reassuring for us to have a local and reliable source of donor breast milk, rather than having to obtain milk wherever it is available.  Also, as there is no courier charge for the Hearts Milk Bank, we are able to order small amounts as needed, rather than trying to predict long term use and order in larger volumes. They can provide us with larger or smaller bottles to suit our requirements (this helps us to avoid wastage), and they also provide a simple form for each batch to help us record information about who has received the milk.

How do you see the future?

Here at Luton, we are currently working towards accreditation from the Baby Friendly Initiative.  Working with the HMB helps support us to do this through improved education, awareness, and support. We’re also really excited about the research looking into the epigenetics of breast cancer risk, and we look forward to hearing more about this and all the other plans for research that the team has.

 

Help us to do more!

This is Naomi and Jo. They have been volunteering at the Hearts Milk Bank since May. They check, sort and pasteurise the milk donated by scores of wonderful mums, so that it is ready to feed tiny babies in neonatal units across our region. They have been very busy. In the last three months, they have pasteurised over 150 litres of donated milk, and so much is coming in that we have almost run out of freezer space!

At the moment, the SERV Herts and Beds riders keep the Hearts Milk Bank going by picking up and delivering donated milk, alongside their vital work couriering blood products. They are simply wonderful volunteers, who drop everything to help out for nothing more than a cup of tea and a biscuit. However, if we increase our workload any more, we will place an unreasonable burden on these wonderful bikers.

Amazingly, we have been given the opportunity to convert a car into a freezer vehicle, which could deliver milk to hospitals across the region at short notice. For £3000, we could relieve the burden on SERV, and use it to pick milk up from our Expresso Clubs (coming soon), where donors can come together to be recruited as milk donors, and mums can get free advice from a lactation consultant (watch this space!).

Please help us – if we can raise the grand sum of £5000, we can not only buy two freezers large enough to store all the milk we are receiving, but also convert a car into a Milk Mobile!

Make Jo and Naomi even happier, and click here to help us to help even more babies.

https://www.justgiving.com/crowdfunding/heartsmilkbank/

 

PS We would really like one of these, but probably not quite the image we are looking to portray!

Announcing our team of expert advisors

The Hearts Milk Bank is proud to be supported by a host of leading professionals from a range of different backgrounds. These experts lend their knowledge and guidance pro bono, and we are incredibly grateful for their support.

Microbiology and Donor Screening

Dr Jim Gray has been a Consultant Microbiologist at Birmingham Children’s and Women’s Hospitals in England since 1995. Since then he has maintained research and clinical interests in the prevention and management of obstetric and neonatal infections. Jim has worked on several programmes with the National Institute for Health and Care Excellence (NICE); he is currently a standing member of a Rapid Clinical Guideline Updates Committee and the Diagnostic Assessment Panel, but his introduction to working with NICE was as a member of the Donor milk banks: service operation Guideline Development Group. Jim is Editor-in-Chief of The Journal of Hospital Infection (the official journal of the Healthcare Infection Society) and has editorial responsibilities with a number of other academic journals.

 

Social Enterprise and Governance

Mark Goodson has been a business advisor with Cambridge Social Ventures (part of the University of Cambridge) since its inception in 2014. During that time, he has worked with over 100 social ventures, supporting their growth and helping them make a positive impact in the world. Prior to this he spent over 30 years in technology, co-founding venture capital funded start-ups, taking on senior positions at companies such as Cambridge Silicon Radio and acting as a consultant to technology companies. He has founded a number of ventures, both commercial and social, and is also a post-graduate qualified coach and mentor.

Pharmacology

Wendy Jones was a community pharmacist and also worked in GP surgeries supporting cost effective, evidence-based prescribing. She qualified as a pharmacist prescriber. Wendy left work in 2011 to work on writing her book Breastfeeding and Medication (Routledge 2013), developing information and training material on drugs in breast milk.  She also recently published Breastfeeding for Dads and Grandmas (Praeclarus Press) and Why Mothers Medication Matters (Pinter and Martin). Wendy runs a helpline service on the use of medication in breastfeeding mothers for a UK charity, responding to healthcare professionals and mothers.  She has been a breastfeeding supporter for 30 years. Wendy is passionate that breastfeeding should be valued by all and that medication should not be a barrier. The importance of breast milk for vulnerable preterm infants whose mothers are unable to breastfeed, for a variety of reasons, is an extension of this. Wendy has three daughters, all breastfed and as passionate about breastfeeding as her, and three grandchildren who seem just as keen!

Neonatology

Dr Merran Thomson.

 

Accreditation and professionalism

The NICE Guideline includes an audit tool for milk bank teams to complete, which is currently the way the milk banks self-accredit throughout the UK. On busy units, self-accreditation can sometimes be an afterthought, creating extra work for staff who are already stretched. The development of a milk bank-specific tracking system, being piloted at the Hearts Milk Bank, will hugely simplify the process. It will not only ensure the safety of donor milk, but enable the necessary statistics to be at our fingertips.

Dr Natalie Shenker, as a Trustee of the UK Association for Human Milk Banking (UKAMB), is part of the UKAMB Accreditation Working Group, formed earlier this year, which is developing an external accreditation process for each milk bank in the United Kingdom External accreditation is the gold standard for ensuring safe milk banking practices, and we are working with all other milk banks to drive this forward to ensure that safe practices are embedded in every milk bank in the county.

Alongside the Accreditation Working Group, Natalie is also putting together a team of experienced advisors to establish a Professional Development Framework for milk bank personnel. This Framework will aim to ensure that all milk bank staff, from the junior apprentice to the most senior regional milk bank manager, are appropriately trained, informed, and able to work in any aspect of the complex and fascinating world of milk banking. Continuing professional development will be at the heart of the Framework. Crucially, the Framework will build towards the registration of milk banking as a profession in the UK, acknowledging the specialised knowledge and skills of milk bank staff, and create a career path to inspire the next generation.

Safety

Although there has not been a single documented case of a baby becoming infected with a transmissable virus from screened donor milk, a theoretical risk of such an infection exists. Therefore, the safety of donor milk is the paramount concern to every milk bank. At the Hearts Milk  Bank, we have adopted the highest standards of safety from the outset.

The National Institute for Health and Care Excellence (NICE) aims to improve health and social care through evidence-based guidance. The NICE Guideline for the Operation of a Human Milk Bank was developed over a 2-year period by a working group that included Gillian Weaver, HMB cofounder, and Dr Jim Gray, Expert Advisor on Microbiology to the HMB. It was published in 2010. Guideline #93 has been fully adopted by the HMB, and referred to daily as a minimum standard of safety. We aim to exceed the safety parameters in the Guideline, and inform its future iterations by conducting carefully designed research studies alongside our routine work that aim to enhance safety, efficiency and cost-effectiveness of the service.

For information on the NICE Guidelines for operating a human milk bank (Guideline #93), please click here.

At the Hearts Milk Bank, we strive to go even further for safety. We have invested in state-of-the-art equipment, such as this Class 2 Biosafety Cabinet, which uses an ultra-microfilter to remove particles as small as viruses from the air within the cabiinet. During processing, milk containers are only ever opened within this cabinet, minimising the risk of any contamination. 

The ESCO biosafety cabinet is equipped with an ultraviolet light, which effectively sterilises the cabinet before and after use, as shown here. 

One area that needs close attention regardless of the scale of a milk bank’s operation is the tracking and traceability of donor milk. Large scale milk banks can struggle with the processes required to make sure that milk is only issued to hospitals once all of the safety checks have been carried out. When thousands of litres are passing through a milk bank, it can be an enormous but incredibly necessary administrative burden. We are therefore proud and excited to be piloting the Savant LiLac Donor Milk Tracking System this Autumn – Savant are the leading UK company that develop tracking systems for human tissues, and work closely with the NHS Blood and Transplant Service.

 

 

Thoughts at the start of World Breastfeeding Week

It is World Breastfeeding Week, and in her ever-timely manner, Dr Amy Brown has just published her paper on “Breastfeeding as a public health responsibility: a review of the evidence” in the Journal of Human Nutrition and Dietetics.

We wanted to draw your attention (and any passing Department of Health ministers or civil servants) to this part:

“Investment can and does work. Brazil, for example, is an excellent example of how implementing such a society wide approach significantly increases breastfeeding rates. In 1986, the median duration of breastfeeding was 2.5 months but, by 2006, it had risen to 14 months. Exclusive breastfeeding rates to 4 months also increased from 4% to 48%.

 “To undertake this, the government invested heavily in promoting breastfeeding at the societal level, including multi-organisation working, media campaigns, training for health workers and the development of mother-to-mother support groups. Policy wise, a strict enforcement of the International Code was introduced, maternity leave was extended from to 6 months and more than 300 maternity hospitals gained Baby Friendly Hospital Initiative certification.

 “Investment in over 200 human milk banks led to Brazil having the highest number in the world. These interventions were successful as a result of their combination, as well as the fact that they did not focus solely on maternal knowledge, instead focusing on a mother’s wider environment and support system, enabling her to breastfeed her baby.”

Elsewhere in the world, the development of initiatives to support the establishment of milk banks and increase the availability of safe donor human milk is gathering pace. A growing recognition of the role of milk banks in promoting, protecting and supporting breastfeeding, as evidenced by increased rates of breastfeeding at discharge from neonatal units, has been instrumental in garnering support for milk banks in India, China, Vietnam and in several African countries. The numbers of milk banks are growing across the globe, including in Europe where milk banks can now be found in Russia, Lithuania, Poland, Portugal, Estonia, Croatia and soon also in Slovenia.

However, the answer to the demand for increased availability of donor milk isn’t always to create more and more milk banks. When logistical influences such as good transport links and proximity of milk banks to multiple neonatal units are in play, alternative models are more appropriate.

In the UK, as in other European countries, the emphasis should be on ensuring ease of access to safe and sustainable supplies of donor milk that is then used in the most equitable and appropriate way to support mothers and their infants. The potential for donor milk to protect and support breastfeeding is far wider than its current limited use for preterm and very sick infants, but advances will only happen as the result of the development of centralised, appropriately staffed and resourced centres that recruit donors more widely and provide donor milk fairly.

Along with our colleagues in U.K.A.M.B., we are passionate about innovating and driving forward change, and look forward to the challenges beyond WBFW!

Gillian and Natalie

Milk ‘donation’ in the news

Elisabeth Anderson-Sierra, a mother from Oregon, has been hailed as a ‘miracle mum’ following her collection of over 3,500 L breastmilk (5000 pints). Elisabeth has provided half of this amount to the Californian bioscience company Prolacta, and has shared the rest with parents in her local community.

Prolacta Bioscience is one of a number of commercial organisations that pay mothers for the milk that they receive. In common with blood and tissue donations, human milk banks globally recruit mothers to donate their milk. Expenses may be reimbursed in some countries and by some milk banks, but the provision of milk is overwhelmingly an altruistic act.  Both UKAMB and the European Milk Bank Association endorses the donation of milk for a number of reasons linked to safety and security of supply. Both organisations also provide recommendations around the safe sharing of human milk.

Having this amount of surplus breastmilk is an unusual situation, in which the mother may be spending huge amounts of time and energy managing her oversupply. In the article, Elisabeth states that she spends 10 hours a day expressing her milk. Milk banks have a responsibility to mothers and their babies to ensure that there is no encouragement placed upon the mother to produce milk, beyond what is good for her and her own baby or babies. We recommend that mothers do not start to express milk for the milk bank until their breastfeeding is fully established, although there are situations where mothers need to express for other reasons.

 

Gillian Weaver, Natalie Shenker

SME Herts Awards – we won!

Team HMB had an evening off to attend the Small and Medium Enterprise Awards at the Watford Coliseum last night – the event was sponsored by the Federation of Small Businesses, Regus, Clydesdale  Bank and a number of local organisations and councils, with over 300 guests and finalists. The opening speech was made by the inspirational David Clarke, British team football captain and three-time Paralympian, and we enjoyed chatting to some amazing people from businesses across Hertfordshire.

Against eight other finalists in the Best New Business award, we took the runner-up spot. Thinking that was it for the night, Gillian kicked off her shoes and I started texting the babysitter to say we would be back soon. When the Hearts Milk Bank was read out as the winner of the Best Not-for-Profit organisation in Hertfordshire, our table erupted! After the presentation and photos were taken, we celebrated with cups of tea, delighted that another room full of people now knew about the work of milk banks. 

So it is back to work with a vengeance this morning – catching up on everything that has happened in the last week with Gillian manning the fort alone (the Shenker tribe took a much-needed break to lovely Wales), and excited for all the plans unfolding. More news coming soon!

Awards sitting in their new home in the HMB office at the UH Biopark!
             

Natalie

Up and running!

After 3 months of hard work in the lab, and thanks to the help and support of so many hundreds of people, we are up and running! We have recruited scores of wonderful milk donors who are sending milk into the bank via the fab SERV volunteer couriers, and the team has been working flat out to process it and make sure our systems are robust and safe. So much good stuff is happening, and we will fill you in properly over the next few days and weeks as it all settles down (um, if it ever does settle down…). But tonight was a night to pause, celebrate our team and eat!

(PS Sending love out to the missing Gillian Weaver, who is currently in Kenya working with PATH to finalise the establishment of the first milk bank in East Africa!)

A wonderful day at the Lexi

We are so grateful to Cordelia and all in the NWL Breastfeeding Group who put on such a fantastic event today at the beautiful Lexi Cinema in Kensal Rise.

The venue was almost sold out with old friends and new, in addition to whatever the collective noun for a plethora of lovely babies is (answers below to that one please!).

The stunning film and gentle soundtrack seemed to lull the babies to sleep, and it was the women shedding tears throughout rather than the babies.

Together, everyone raised almost £600 today! This will make a massive difference, and we are hoping to talk with the film-maker, Noemi Weis, so that we can organise our own screening of the film later this year in Hertfordshire. Watch this space!

Natalie and Silke after the film, still a bit red-eyed…