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…

Come and see a film to support the Hearts Milk Bank

With one week to go, we ask you all to come and see Milk – Born into this World with us – hear about our work, the progress as we get everything set up, and the research we will be starting up this year:

MILK – Born into this World

a film by Noemi Weis

The Lexi Cinema, 194B Chamberlayne Rd, Kensal Green, London NW10 3JU

Wednesday 17th May 2017: 11am to 1pm

Through an intimate and artistic lens, Milk brings a universal perspective on the politics, commercialisation and controversies surrounding birth and infant feeding over the canvas of stunningly beautiful visuals and poignant voices from around the globe. Inspiring, informative, provocative and sensitive, Milk celebrates bringing a new life into this world with a strong call to action and reflection.

 http://www.milkhood.com/

Tickets are £15 per person, babes in arms are very welcome

Any profit will go to the Hearts Milk Bank!

To buy your ticket, please email cordeliauys@gmail.com.

 

Setting up

All has been quiet recently on our blog, as we have been rather busy. The Hearts Milk Bank signed our contract with the University of Hertfordshire 2 weeks ago, and moved into the Biopark straight away. The set-up plan that had been waiting then swung into action!

Equipment has been bought, delivered and installed, and supplies are now filling every available cupboard. And most importantly, our first donors have been recruited and their milk is starting to fill up the freezers. After a deep clean next week, and a last deep breath, the first donor milk will be processed and shortly after available to hospitals.

If you are a breastfeeding mum and have a lot of milk stored, or would like to donate over a number of months, please get in touch – we would love to send you more information about the process of becoming a milk donor if you email us at info@heartsmilkbank.org.

Thank you for reading, and to all of you who have supported us over the last year!

Natalie and Gillian

One girl takes fundraising to new heights

At the end of 2016, Gillian and I had a very special afternoon when we were invited to a gymnastics display organised by Ruby Robinson, a member of the Richmond Gymnastics Association.

We were not quite sure what to expect, but the hour that followed went beyond our wildest dreams! Gymnast after gymnast came tumbling out, sometimes with as many as 20 on the mat at one time, performing balletic pieces to dramatic music with incredible tumbles and throws. I have to confess I watched one small boy being repeatedly thrown 20 feet in the air through my fingers, but am glad to say he was caught just in time every time, with a massive smile on his face!

The gymnasts included the RGA display team, the current national champions in acrobatics and tumbling, several GB squad competitors and the trio who represented Great Britain at the Olympic Gala in Rio (pictured).

Britain’s acrobatic group Jennifer Bailey, Katrina Fearon and Roxanna Parker perform during the gymnastics exhibition gala at the 2016 Olympics in Rio, 2016. (AP Photo/Dmitri Lovetsky)

But the real star of the show was Ruby. Her mother told us, “She started doing gymnastics when she was five and has gone on to compete regionally and nationally with the acrobatic gymnastics squad. When her aunt Naomi told her about Hearts Milk Bank and what they do, she decided this was the cause she wanted to take on.”

Ruby herself said, “It was fun because I really liked balancing on someone’s shoulders,” she said. “I made a speech to everyone about the Hearts Milk Bank and RGA. My friends were there and they liked it and I feel happy that I can help children and babies.”

The RGA is a charity itself, with an extensive programme for gymnasts with special needs or disabilities, in stand-alone classes or integrated into the main programme. The RGA has a number of Regional and National Disability Acrobatic Champions, alongside medallists from the London Disability Floor and Vault Championships.

Ruby’s fundraising continued after the display, with family and friends raising a grand total of almost £1500 for the Hearts Milk Bank. This fantastic amount will be massively useful as we start setting things up, and we will be making sure every penny is spent to get us off to the best start possible.

Natalie

MassChallenge UK – we won Gold!

Almost the whole HMB team was out in force last night (missed you Silke) to attend the MassChallenge UK Awards ceremony,

As part of the final cohort of 20 finalist organisations, Natalie gave a final 1-minute pitch to an audience of 500 journalists, investors, academics and supporters. Graeme, our Board Chair, was also there, as well as Naomi, milk bank supporter and volunteer, and Dr James Flanagan from the Imperial College Epigenetics Unit. And yes, she really was 20 feet up on a stage…

The tension mounted throughout the evening as speeches were made, and then the awards of the night were announced. We were astonished to hear the words Hearts Milk Bank announced by sponsors VIIV Healthcare as one of the three Gold Award winners for £10,000! The award was presented with Queen belting out ‘Don’t Stop Me Now’ in the background – a fitting theme!

 

We have some ambitious plans for how this can be combined with the crowdfunding sum raised at the end of last year that we can’t wait to share once the details have been worked out, and are incredibly grateful to have had the chance to take part in such an energising process as MassChallenge. But before any more calls or emails could be sent this morning, the award had to be thoroughly examined by the smallest Team HMB member….

Onwards and upwards!

Breastfeeding and breast cancer risk: what are the facts?

A very happy new year to you all! I’ve been writing this blog over Christmas for the new GP Infant Feeding Network’s website, and wanted to share it here too. The GPIFN is a fantastic organisation, founded last year by Dr Louise Santharam, which aims to enhance medical education around breastfeeding issues so that all doctors, and GPs in particular, have more expertise to deal with lactation problems in the community.

One of the reasons why breastfeeding is important for maternal health is in the reduction in risk of breast and ovarian cancer (World Cancer Research Fund, 2014; Lancet breastfeeding series, Jan 2016).

My PhD at Imperial was in breast cancer risk and focused for the last couple of years on looking for biomarkers of risk in breast milk – could we find markers in the genetic material found in cells from breast milk that could confirm the changes we were seeing in blood cells from women at high risk of breast cancer? If we could, then a new tool to enhance screening women could be developed.

Doing a PhD means a lot of reading around the main subject you are working on, and allowing yourself to be led down some interesting paths as a consequence. I rapidly became fascinated with the papers I was reading about the possibility of reducing the risk of cancer by breastfeeding, as it just didn’t match up with my medical training. When I was at medical school, we were taught about breast cancer by breast surgeons, who would write up a list of risk factors on the board – high risks were age, family history, etc. Moderate risk factors included hormonal factors (early menarche, late menstruation, parity, age at first child). Breastfeeding was classed as a low risk modifier – the published estimates back then were a reduction in risk of only about 4-5% for every year a woman breastfeeds over a lifetime (Lancet, 2002).

Biology moves on though, and since 2002 molecular medicine has been able to look at cancers from thousands of different women. These studies have shown that ductal breast carcinomas, the most common form of breast cancer (>95%), cluster into five main biological types: luminal A, luminal B, HER2 positive, basal and the claudin-low/normal type (Perou, 2000; Sorlie, 2003 [figure of dendrogram showing clustering below]).

Many, many more subtypes are and will be discovered as genetic and pathological checks get even better, but these five subtypes are important, as they likely indicate tumours that originate from different cells of origin within the breast ducts (Visvader, 2014; see figure below).

It became apparent last year that these subtypes were also important for the impact of breastfeeding. A meta-analysis of case-control and cohort studies that divided studies of risk according to breast cancer subtype showed no effect of breastfeeding on the hormone receptor subtypes (luminal A, B and HER2), which make up 70-75% of breast cancers (Islami, 2015). However, it did show a 16-24% risk reduction for triple negative breast cancers (TNBC, tumour cells do not express oestrogen and progesterone receptors or HER2/ERBB2 receptors; shown in the Forest plot below reproduced from Islami’s paper).

This systematic review looked at ‘ever breastfeeding’, rather than the duration of breastfeeding, as there were not enough studies that had recorded that to be analysed. Given that most studies have shown breastfeeding to have a dosage effect (the longer a woman breastfeeds, the lower their breast cancer risk), future studies that look specifically at these tumours may show a greater effect with prolonged breastfeeding duration.

TNBCs are one of the most aggressive forms of breast cancer. These tumours tend to occur in younger women and those with genetic mutations. Pregnancy-associated breast cancers also tend to be TNBCs. These are cancers that are diagnosed during pregnancy and, although the cut off is unclear, for up to 5 years after birth.

The mechanism, or mechanisms, that explain how breastfeeding reduces TNBC risk are not clear, but are the subject for a future blog and a great deal of future research, some of which we are hoping to facilitate in the future at the Hearts Milk Bank. However, a small number of women (approximately 100-120 each year in the UK) who breastfeed will still develop aggressive breast cancers. As with everything in medicine and public health, breastfeeding protects some, but in others the mechanisms will a) be inadequate and the cancer would develop anyway, or b) the molecular and cellular mechanisms that occur in preparing for and performing lactation may trigger some women with a specific genetic make up to develop a cancer.

___________________________

So, is breastfeeding protective from breast cancer? For the majority of tumours, perhaps not, but more research is needed to look at the effect of long-term breastfeeding on the other subtypes of breast cancer. However, for the 20-30% of TNBCs with the worst prognosis, which affect premenopausal women, breastfeeding is probably a very powerful way to reduce risk. At the Hearts Milk Bank, we will be working with scientists across a range of fields to facilitate research that can determine how this effect happens.

Natalie