Questions about Receiving BM (& Pasteurization)

Hello all.

This is such a worthy cause. I am so happy to find this forum.
I am here to seek donated milk, but hope to one day be able to donate as well (even if a few years from now).

I have several questions & maybe doubts...

Are all the donors already screened? Tested? If not, do we ask them... or how do we know?

What is reasonable cost for supplies? I should probably google that...

Some posts are months old with no replies, should I even bother to request this breast milk?

Is the donated breast milk usually raw or pasteurized?

...more later (baby needs a feeding now).

Thanks.

No the donors are not screened. Most have probably had blood work/tests when pregnant. It is perfectly acceptable to ask to see a copy of a donor's blood work results. If you want current or specific tests done you would have to arrange that with the donor and pay for any testing you want.

The cost for storage bags is $ 10- $ 15 for 50 or so bags (depending on the type, brand and store). Anything else you want to help with for supplies is usually appreciated (replacement membranes or tubing for the pump, or microwave sterlizing bags). Each donor is different -- some prefer you buy and give them a specific type of storage bag, some would just prefer you give them cash to cover expenses, others prefer a gift card to cover the supply expenses.

I have never dealt with shipping so I have no input on how that works or how much it costs. But the idea is to make it as easy for the donor as possible.

No the milk is not usually pasterized. Most donors are breast-feeding their own children and either pump extra to keep a stash or just to keep their supply up. The idea is that this is milk they would be feeding their own children. I think their is an "article" with info on pasterizing yourself on the main milkshare.com website. I am a donor so I don't know if most moms who get milk actually go thru the process of pasterizing the milk they get. Most of the milk you would get has been pumped, cooled and then frozen.

It can not hurt to respond to older posts. I think most donors try to go back and show that the milk has been spoken for but everyone gets busy and it does not always happen. Alot of people will send a private message thru the forum instead of posting a response.

Hope this helps with some of your questions.

Thank you for the reply.

I have seen a post from a donor who wrote that they do not have time to go to the doctor to get tests done. Which leads me to ask...

Not knowing any medical history about donors, is pasteurization the solution to ensure safe breast milk?

I don't think pasteurization is going to ensure safe brest milk. I think the pasteurization will take care of most of the bacteria but it will NOT take care of any diseases that the mom might have that can pass thru breast milk. I think the main diseases that can pass thru breast milk are HIV and Hepatitis.

If a donor does not have blood work results and is not willing/able to have blood work done at your expense then you might want to wait for another donor. Alot of the give and take on this forum is based on a certain level of trust. If you don't get a feeling of trust from a donor then try with the next.

for me personally -- I am not willing to get additional blood work done. I have blood work from when I was pregnant. I have an almost 9 month old so my blood work is over a year old. When I found this site and started donating I went to my midwife and got a copy of my blood work results. I am perfectly happy to give or show a copy of my results to show that I was HIV negative and Hepatitis negative. I am up front when I start communication with another mom. If you were not comfortable with me then you would just say so and try with someone else.

Part of the trust is built around the idea that I would not do anything to hurt my own baby so if it is the same milk I would give him then it should be good for your baby too. Keep in mind that you will build some sort of relationship between you and the donors by email or phone or PM or posts before you get their milk.

There is no way to truly ensure safe donated breast milk. You need to figure out what you need to know about your donors that will make you comfortable.

Good Luck.

Thank you. This is very helpful!

BTW, pasteurization should inactivate HIV (not sure if that includes both HIV 1 & HIV 2, I thought it did):
http://www.pronutrition.org/files/Pasteurized%20Breastmilk.txt

I am not yet sure about Hepatitis, Syphillis, and HTLV...

Here's info on the original study that found that HIV was inactivated by flash pasteurization. They also comment that the chances of an HIV infected mother of passing HIV to her baby through breastmilk was 3-4%.

http://berkeley.edu/news/media/releases/2007/05/21_breastmilk.shtml

Oh, and I just found this info from the CDC on Hepatitis and other potential issues with breastmilk.

http://www.cdc.gov/breastfeeding/disease/hepatitis.htm

I honestly feel that you need to hook up with a donor that you feel 100% comfortable with. I am not a fan of pasteurization (even with cow's milk!)-so much is ruined. It was not intended to be that way. Keep looking for someone you trust!

I'd like to give my input on this topic.
We received loads of milk from a wonderful donor who did show me medical records to verify that she was HIV and hepatatis negative. That said, my baby's pediatrician was completely unsupportive of me using donor milk as she considered it a biologically active fluid....which it is.......and as such, there could be unknown pathogens in it that could do harm that are simply not characterized yet. Her advice was to give our baby the hydrolyzed protein based formula.

I considered her thoughts and did my own research to find out about pasteurization as a means to inactive viruses in breast milk. As some of the other posts for this topic state, pasteurization (either flash...for 5 mins at almost boiling temp), or more conventional methods at lower temps for 30 mins are very efficacious for killing HIV and hepatatis. In fact, in Africa, HIV positive women are now encouraged to continue nursing but to do a 5 minute high temp. pasteurization prior to administering the milk. Previously, they had been advised to stop nursing. Even more astounding, many HIV positive women in Africa who have breastfed do NOT have HIV positive babies....presumably due to the astounding anti-pathogenic properties of breast milk, though this varied depending on the overall health of the mother....i.e., healthy HIV+ women often did not have HIV+ babies while their unhealthy counterparts had higher rates of HIV+ babies, which makes perfect sense. If you're not completely helathy yourself, then the anti-pathogenic properties of the breast milk is reduced. Anyway, all of this I found fascinating and reassuring.

I also researched the effects of pasteurization on immunoglobulin levels in human milk...I think I got one this info. from one of the 'commercial' milk banks that pays individuals to donate and sells their pesteurized milk. There were also published reports that were independent of any commercial interest. From what I can recall, there was approximately a 30 -40 % reduction in IgA quantity after conventional pasteurization and some other components also decreased, but not below 50% of their original level. Reassuringly, a lot of the anti-viral and anti-bacterial components in human breast milk were not dramatically affected after pasteurization. Thus I felt confident that while pasteurization did denature some of the important proteins, the milk was still biologically active and therefore beneficial.

So now comes the actual experiment........the baby and the taste test using the donor milk!!!!

We first tried conventional 30 minute pasteurization and give our baby the cooled milk. She would not drink!!! Then we tried rapid 5 minute pasteurization at in amost boiling water............she still would not drink!!!! At this stage, we were getting desperate as I was going out of town for a long time and the baby needed to eat (she takes bottles fine but I never made enough to have a stash of pumped milk...she drank everything I pumped).......so, we just offered her the unpasteurized milk and she DRANK it fine...no problems. So, it depends on your baby...ours is a finnikey little one!. The pasteurization may have dramatically altered the taste of the milk from our donor, but this may not be the case for every donor......we have noticed a big difference in the composition of my milk versus the donor milk.

Bottom line.....if you have doubt....by all means pasteurize but be aware that the baby may not like the taste (this may not be an issue with a younger baby). Otherwise, I feel confident that giving donor milk is fine, as long as you have good intuition and rapport with the donor.

Wow, mcdaidwiley. Your LO is a finnicky one! You are right, a younger baby would not likely have this problem. Our DD took to the bottle easily (probably b/c she was famished and we didn't know I wasn't producing enough)... and she's also had different formulas so BM, pasteurized or not, will probably not be a problem.

I haven't felt the need to pasteurize any BM - yet. Seeing bloodwork surely gives peace of mind.

Thank you for sharing your comments, especially interesting were the anti-viral & anti-bacterial components of pasteurized milk and anti-pathogenic properties of 'raw' milk. If you have links to these, it would be great if you could post them!

Links to online resources as requested:

http://www.prolacta.com/quality.php
Information about human milk compostion after pasteurization from prolacta company.

Also from prolacta:
Pasteurization Validation
The high temperature short time (HTST) pasteurization process utilized by Prolacta was validated in four studies completed by the Central Laboratory of Dutch Red Cross (Sanquin). Whole pasteurized human milk and versions of our preliminary fortifier were evaluated. The results demonstrated a complete kill of HIV, HBC and HCV (>5.8->7.7 logs). It also showed a kill of HAV (>2.6 logs) using HTST. Finally a complete bacterial kill (E. coli, S. aureus, and S. agalactiae: (>15 logs->32logs) was shown.1 Similar data was also obtained as part of the same set of experiments for a vat pasteurization process also used by Prolacta.2
1 Terpstra FG, Rechtman DJ, Lee ML, Van HoeJ K, Berg H, Van Engelenberg FAC, Van’t Wout AB. “Antimicrobial and antiviral effect of high-temperature short-time pasteurization applied to human milk.” Breastfeeding Medicine 2007, 2(1) 27-33.

2 Data on file, Prolacta Bioscience (2002-2005)


Go to the research and development section of their website....there's a tonne of interesting info.
I found this study particularly interesting since we have noted a big difference in the compositon of my milk versus our donors...........I am just interested in this from a scientific perspective (I am a research scientist) as we all have such different metabolisms andit makes sense that the compostion of milk from individual to individual will vary. Below is the abstract.......

Macronutrient Analysis of a Nationwide Sample of Donor Breast Milk
As part of routine QA activity, incoming donor milk was tested for macronutrient content. Upon arrival, each donor’s milk was pooled into 10 liter aliquots, unique to that donor, and a sample of each aliquot was taken for testing. A total of 415 sequential samples from 273 donors were tested. A large variation in caloric and fat content was noted and a substantial proportion of donations tested had a caloric density of less than or equal to 17 calories/oz. The mean caloric density and the mean protein content were also found to be lower than generally assumed.
Wojcik KY, Rechtman DJ, Lee ML, et al. "Macronutrient Analysis of a Nationwide Sample of Donor Breast Milk" J Am Diet Assoc. 2009; 109: 137-140.

This also interest me from a pumping perspective, since pump milk is probably not as rich in fats as the milk a baby would extract itself.

Other peer-reviewed published literature: (ABSTRACTS)

Adv Exp Med Biol. 2001;501:485-95.
Fat content and fatty acid composition of fresh, pasteurized, or sterilized human milk. Fidler N, Sauerwald TU, Demmelmair H, Koletzko B.
Dr. von Haunersches Children's Hospital, Ludwig Maximilians University Munich, Germany.

Abstract
In hospitals, human milk is subjected to heat treatment to reduce risk of transmission of infectious agents such as human immunodeficiency virus (HIV), hepatitis B, cytomegalovirus, and bacterial contamination, especially during feeding of banked milk to preterm infants. Fat losses due to heat treatment have been extensively studied in cow milk but have received little attention in human milk. We studied the effect of human milk pasteurization and sterilization on total fat content available to the infant as well as on fatty acid composition. Milk samples from 12 mothers (days 5-35 of lactation) were divided into three equal parts: one remained fresh, one was pasteurized (62.5 degrees C for 30min), and one was sterilized (120 degrees C for 30min). Fat content was determined gravimetrically, and the contribution of 30 fatty acids was determined by gas chromatography. For investigation of loss of available fat in sterilized milk, milk was collected from two additional mothers and analyzed with a modified extraction method. Total fat content was the same in fresh, pasteurized, and sterilized milk. The available fat content was 3.1+/-0.4g/dL (mean +/- SE) in fresh human milk, 3.1+/-0.4g/dL in pasteurized human milk, and 2.7+/-0.3g/dL (P < 0.001 vs. fresh) in sterilized human milk because of formation of a surface skin and fat adherence to the vial wall after sterilization. The fatty acid composition of 10 saturated, 10 monounsaturated, and 10 polyunsaturated fatty acids of both the n6 and n3 series was not affected by pasteurization. In sterilized milk there was a slight decrease of linoleic acid (C18:2n6; -0.7% vs. fresh; P = 0.006) and arachidonic acid (C20:4n6; -2.5%; P = 0.045). Pasteurization and sterilization do not affect total fat content of human milk, but sterilization may reduce available fat content by >10%. Fatty acid composition of human milk is not changed by pasteurization, but is slightly changed by sterilization.

Bull Soc Pathol Exot. 2010 Jul 7. [Epub ahead of print]

[Fate of children born to HIV positive mothers followed in the context of preventing mother-to-child transmission of HIV in Togo. Study of 1042 infants.]
[Article in French]

Lawson-Evi K, Mouhari-Toure A, Tchama R, Akakpo SA, Atakouma DY, Beauvais L, Pitche P.

Service de pédiatrie CHU de Tokoin, université de Lomé, Togo, France.

Abstract
The purpose of this study is to analyze the fate of children born to HIV-positive mothers and to determine the impact of feeding options on the HIV status of the children in preventing mother-to-child transmission sites (PMTCT) in Togo. It was a retrospective and descriptive study, focused on medical files of 1042 children of both sexes aged from 0 to 59 months born to HIV-positive mothers and registered in the PMTCT sites between January 2004 and December 2008. Our study was conducted in seven PMTCT sites located in four of the six health regions in the country. We analyzed a total of 1042 medical files in seven PMTCT sites selected. The majority of children were born vaginally (77.4%). Antiretroviral prophylaxis most used in the mothers and/or the children was nevirapine in 86% of the cases. Breastfeeding (49%) was dominated by milk substitutes (50%). Globally, dropout rate was 52.2% (525), with 44.9% (408) at six months and 65.09% (483) at 12 months. At 12 months, 196 of 742 children (26.4%) had their retroviral serology. Among them, we have 5.6% overall rate of HIV infection. The transmission rate in the group of children breastfed was 5.9% (six children infected out of 102) and 8.5% in the group of children fed by formula milk (seven children out of 82). Death occurred in half of the cases (8 of 16) during the first two months of life. Follow-up was the major issue in monitoring children born to HIV-infected mothers. The HIV transmission rate is very high, irrespective of the feeding method.
Basically this article supports breast feeding as a means to prevent death due to non-HIV infections......the rate of HIV infection was less in HIV+ mothers who were on antivirals, compared to formula fed babies, BUT the survival tends to be higher on breast fed babies due to prevention of other diseases.


FINALLY, I also found this powerpoint presentation from the FDA debunking a lot of the commonly touted myths associated with pasteurization. This presentation pertains mainly to cows milk and starts off with a warning that raw cows milk is not safe and contains a lot of harmful pathogens (makes sense if you think about how the cows are housed, milked etc....fecal matter is everywhere.......Assuming that we all follow sanitary procedures when we pump milk, raw human milk should in theory be less dangerous than the pumped cow version!!! Of course, direct feeding from the breast to the baby is sanitary.
The link is
www.fda.gov/downloads/Food/FoodSafety/.../UCM166067.ppt
There are a lot of slides with the interesting stuff about pasteurization at the end.

Warning: It'll take a while to get through this lot!!
Happy reading!