The Magic of Milk: Preemies, Breastfeeding, and Human Milk Donation

My son’s birth five years ago—in fact, my entire first pregnancy—was a fairy tale narrative, of sorts, and it became the lens through which I viewed what had always been vague and mysterious to me: feeding babies.

I experienced the usual anxiety about feeding him with milk that my body was (typically, agonizingly) slow to produce. But my milk came in, and he sucked and grew. It never occurred to me to wonder: what would I do if it didn't? But following the harrowing birth of my daughter this past February, I realized that for many babies, especially preemies, it’s a matter of life and death. And I learned, through 51 days in the Neonatal Intensive Care Unit (NICU) and in the months since, that my milk—in fact, any healthy, lactating mother’s milk—can be frozen, donated and banked to save babies who need it. But I’m getting ahead of my story.

Back in 2009, though my wife, Carol, and I had decided to give birth at Alta Bates Hospital in Berkeley, our chief desire was to have as little medical intervention as possible. I was 42, old to be doing this in medical terms, but very healthy, and though I wasn’t sure what my capacity for endurance, or my level of pain-tolerance, would turn out to be, I was determined to do what I could to have a drug-free, natural birth. When we checked into the hospital, I refused the standard IV line. My doctor was not on call, so we were assigned Dr. Kurt Wharton, someone we’d never met, which turned out to be the best possible twist of fate, given that, when my regular OB later learned I’d been allowed to push for six hours after a very long labor, said, “I wouldn’t have let you push for more than two.” Exhausted, deliriously happy, and feeling like Athena, I replied, “Well, I’m glad you weren’t here.”

Immediately after Olin was born, I tried to breastfeed him. As is the case with most women, I didn’t have much milk yet, and the boy began howling with hunger. A nurse brought me a breast pump, a bag of supplies, and suggested I get to work. While it’s a given that the sooner you begin pumping, the sooner your milk will come in, a surprising performance anxiety took hold. I pumped for 20 minutes, only to get a thimbleful of colostrum. The nurse encouraged me, as did the lactation specialist available to all new parents at Alta Bates, that my experience was normal, and that this tiny bit of pre-milk was the best thing for my son’s brand-new immune system. After a few days, we were blissfully breastfeeding, and Carol was able to give our son bottles of pumped milk, an important part of their bonding.

Flash forward nearly five years to the birth of our daughter, Djuna, which was as dystopian as Olin’s birth was idyllic. Thirty weeks and four days into this pregnancy, which had been punctuated with severe “epigastric” pain—what I later learned was a hallmark symptom of HELLP Syndrome, a life-threatening condition alleviated only by the birth of the baby—I found myself going from the ER to triage to Labor and Delivery in one fell swoop. And the medical interventions, which were absolutely necessary, but nonetheless terrifying, began. Nifedipine for high blood pressure, magnesium sulfate to prevent seizures and labor. Steroid shots for the baby’s under-developed lungs. Then, two days later, Pitocin to force labor to begin, which is akin to what I imagine a cattle prod to the uterus might feel like.

At this point, we still hoped for a vaginal birth, and all my focus went toward this effort. But it was not to be; the placenta began to detach and an emergency c-section, in which the doctor had 16 minutes to get the baby out, ensued. General anesthesia. Unconsciousness. Complete absence from the birth of my daughter.

When I woke up, I was, at turns, angry, shaky and in pain, and grateful to be alive. It would be a full 27 hours before I got to meet Djuna, our nearly 16-inch, two-pound preemie extraordinaire, and begin our arduous road to health and home. But first, I had to pass through my terror of simply touching her. When the nurse asked me if I wanted to hold her, I said, “Am I qualified?” It was a real question. She was beautiful to me in the way that a primordial creature behind glass in a zoo might be: exquisitely designed and alien. But then our eyes locked, and I knew she was my baby, and that she needed the warmth of my body, however wrecked. Her personality emerged right away. She was observant and patient, and declared herself to be someone who was planning to stick around.

We learned, through a NICU nurse, that breast milk would be an important factor in how well the baby fared overall, how soon she would be released, and her overall prognosis for her early years.

I knew that breast milk is helpful in the development of the immune system for all babies, but preemies are even more susceptible to infections—and what I didn’t know is that the body automatically produces milk that is for your preemie’s specific gestational age at birth. It has more calories and protein than the milk the same mother would produce for a full-term infant. Because Djuna would be fed through a tube until she could begin “recreational” breastfeeding at 34-35 weeks when her “suck-swallow-breathe” reflex kicked in, it was all pumping, all the time. And it was hard. My body was sluggish from the anesthesia drugs, still reeling from the burn of magnesium sulfate, and hurt from being sliced open. But we were lucky. The NICU and lactation staff knew how to support me in eking out the few drops of milk I got with each attempt, every two hours. At first, I was wheeled up to the NICU carrying my syringe half-full of colostrum, and was always greeted by an eager nurse, saying, “Oh, Djuna will love this,” or some other word of encouragement. The NICU nurses treated this early breast milk like liquid gold.

If not for the patience of hospital staff and my family, as well as my memories of having experienced the long ramp-up to full milk production before, I seriously doubt I would’ve been able to provide milk for baby D. But soon, I was gathering quite a collection in the NICU freezer, up to 24 ounces per day. Since the baby started with scant 5ml servings, I quickly got ahead of her needs. My confidence that I might actually be able to take care of this baby grew, and the pumping became synonymous with my own drive to get the medication residue out of my system and return to equilibrium, a state whose nature I sometimes forgot.

When Djuna began taking in more quantity, and finally, at around 38 weeks, began breastfeeding, I thought we were out of the woods as far as basic nutrition went. Then, shortly after we brought Djuna home, Carol discovered that my frozen milk—all 300-plus bottles of it—was high in lipase, an enzyme that, when frozen, imparts a sour, even spoiled, taste to the milk. It isn’t harmful to the baby, but most babies refuse it. In that moment, I envisioned thawing and dumping all that beautiful milk down the drain. What else could be done?

Two of our mainstay nurses, Stacey and Nieves, had suggested we look into donating it, but I was certain that I wouldn’t qualify, given the number of drugs I had been on for the first month of pumping. So, I didn’t think much more about it, just let the bottles sit in the freezer, taking up space. Then I got a call from the lactation specialist at Alta Bates, who needed us to retrieve our milk that was stored in the NICU’s freezer—200 bottles. When she sensed the despair in my voice, she asked, “Why don’t you donate it to the San Jose Mothers' Milk Bank?” I let her know how many drugs I’d been on when all that milk had been pumped. She pulled out her sheet of donor criteria and, to my surprise, none of my medications was on the forbidden list. My wife and I decided to pursue this idea.

The San Jose bank was founded in 1974, as a non-profit tissue bank, to process and provide human donor milk to babies in need—more than 570,000 ounces in 2013. There are currently 16 similar banks in North America that are recognized by the Human Milk Banking Association of North America (HMBANA). The national premature birth rate is 7.6%, and mothers of these babies are often the most compromised in terms of their ability to produce milk. And their babies are at the highest risk for digestive problems, infections, and health problems later in life, such as asthma, diabetes, and Sudden Infant Death Syndrome (SIDS).

During the 51 days we spent in NICU, I learned about families whose babies depended on donor milk for their survival. One family was so devastated by the loss of one of their preemie twins that the mother was unable to provide milk for the surviving sibling. Another had a chronic illness that prevented her from breastfeeding. One young mother had died of a pulmonary embolism shortly after giving birth.

The earliest babies often have trouble digesting formula, and this can lead to consequences ranging from mild discomfort to a life-threatening condition known as NEC (Necrotizing enterocolitis), an inflammatory disease that kills intestinal tissue and often requires surgery to repair perforations. Processed human milk, which has been pasteurized to eliminate potentially harmful bacteria, is the ideal first food for these little ones. And though pasteurization kills some beneficial antibodies, the milk still contains immune-boosting properties that formula does not.

Peggy Lindsley, NICU Manager at Alta Bates, says that between 10 and 15 percent of preemies born before the gestational age of 32 weeks who are admitted to the NICU receive donor milk. Occasionally, there is a shortage, and in these cases, babies who are most in need are prioritized.

The process for donation is easy and efficient. I was required to have a blood test for several infectious diseases, as well as disclose any medications I had been taking. In about an hour after my results came back clean, my frozen milk was packed up and shipped to the San Jose bank. I love knowing that it will go to a preemie, who, much like my daughter, needed human milk to get her through the difficult first months of life.

For more information about milk donation, and the various ways you can help, contact Mothers' Milk Bank; (408) 998-4550.