It was a new mother’s nightmare that inspired Lupita Carral to donate her extra breast milk to Texas Children’s Hospital. Six years ago, when her first daughter was only 3 days old, Carral found herself looking through the windows of the Neonatal Intensive Care Unit, where her tiny child was hooked up to IVs and feeding tubes. The infant was born with intestinal malrotation, and it took two days of complicated surgery and weeks in the hospital before doctors could be confident that the “miracle baby” would survive.
In July 2011, Carral gave birth to her third child at Texas Children’s, even though the family had since moved to South Florida. By coincidence, the hospital was beginning to accept donations of human breast milk for its own milk bank that week, and Carral, 30, became the first donor. She said she gave “four or five gallons” in total, enough to feed a baby for more than three months.
“People don’t realize that every baby born healthy is a miracle, but once you have a child who has problems, you understand that nothing is for sure,” Carral said from her Coral Gables home , while her three children played quietly in the next room. “I wanted to donate because I knew I had enough milk for my baby, and I realized that not everyone does.”
Almost all doctors agree that mother’s milk is the best option for full-term infants, and many are now beginning to accept human breast milk as the best option for babies born prematurely. The default option for feeding preterm infants — whose tiny bodies can’t handle large volumes of liquid — used to be a high-caloric formula with a concentration of protein and nutrients. Studies show that formula-fed babies do grow more quickly in the short term, but also have a higher risk of developing certain immune system and intestinal problems.
“Human milk is medicine. It’s nutritious and extremely beneficial to babies,” said Dr. Stephen Welty, chief of neonatology at Texas Children’s. “It’s so much more dangerous to give formula, that we’ll get to the point where parents will have to sign informed consent to give formula to premature babies.”
Now, a year after Carral made the first donation, more than 70 mothers have donated their extra breast milk, which has helped nourish 350 infants. The hospital has 8,000 ounces available and uses an average of 25 bottles, or 100 ounces, a day.
The milk is frozen and shipped to Prolacta Bioscience, a California-based company that tests and pasteurizes pooled donations. The human milk product, standardized with 20 calories per ounce, is sent back to the hospital where it is available for every baby in the Neonatal Intensive Care Unit. The company also makes a more concentrated human-milk-based product that has up to 28 calories per ounce, designed especially for preterm or infants with low weight.
Hospitals all over the country are beginning to stock human breast milk. The three children’s hospitals in South Florida — Holtz/Jackson, Miami Children’s and Joe DiMaggio/Memorial — don’t have their own milk banks, but they do have human breast milk on hand from outside sources.
There are 13 nonprofit milk banks in the United States and Canada registered with the Human Milk Banking Association of North America (HMBANA). Most South Florida hospitals get their donor milk from WakeMed Mothers’ Milk Bank in North Carolina or Mothers’ Milk Bank in Austin, Texas.
Fatima Gonzalez, a lactation consultant at Miami Children’s, still encourages breastfeeding as the healthiest option for both the mother and baby, but since 2008 she has been able to offer her patients donated human milk instead of formula if necessary.
“A lot of families don’t realize that formula is derived from cow’s milk, which is not easily digested,” Gonzalez said. “It’s imperative that it is from the same species, because the immunological properties that the breast milk has, there’s no formula that can replicate.”
At Joe DiMaggio Children’s Hospital in Hollywood, lactation consultant Marianne Cesarotti said 80 percent of premature babies get some donor breast milk, even if only for the first few feeding sessions.
“It can take mom three to four days to start producing milk,” she said of mothers who give birth prematurely. “If there’s any delay, we need to use donor milk as that initial bridge until mom’s milk is available.”
Only 5 percent of babies at Joe DiMaggio continue receiving donor milk, Cesarotti said, in the rare cases of “lactation failure.”
Although many studies have proven the beneficial properties of human breast milk, the specifics are still not fully understood. A Duke University study published last month found that human breast milk promotes “normal” growth of bacteria found in the digestive tracts of infants. William Parker, the study’s author, said without these bacteria, immune system development could get “thrown off track.”
“You can put bacteria in a test tube of breast milk and they start growing [normally] in clumps and films. Put that bacteria in a test tube of infant formula and they grow randomly,” Parker said. “A middle schooler could do this experiment and see that this is the case, but we’re still not exactly sure why breast milk has this effect.”
Parker said his next experiment will be to test bacteria growth in pasteurized breast milk to see if it behaves more like raw breast milk or formula.
All human breast milk at HMBANA banks is pasteurized, a flash-heating process that kills harmful pathogens that could be deadly for a fragile infant. In pasteurization, some of the beneficial bacteria are killed as well, which is one reason why a mother’s own milk is always the first option for newborns.
There are some informal breast milk exchanges organized locally or in online forums, but Jean Drulis of HMBANA and other health professionals caution against “casual sharing of milk” that is not screened for diseases like HIV and hepatitis.
Carral gave her first donation while she was still at Texas Children’s Hospital and sent additional donations over the next few months from her Coral Gables home. She is looking into training programs to become a certified lactation consultant because she wants to help mothers who have trouble breastfeeding.
“When my daughter was in the hospital it was really a terrible time for me, but I feel lucky because I had a happy ending,” Carral said. “I hope my donation helped other mothers have a happy ending, too.”