Human milk banks?

While milk banks abounded in the GDR, they're now almost a thing of the past. But recent research on babies' nutritonal needs and a rise in premature births could ensure the survival of the milk bank.

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No, this is not a Children of Men-style sci-fi scenario. Actually, Milchbanken belong to Germany’s history. The lab-like institutions, which collect, control and enrich breast milk, abounded during the GDR… until profit-hungry baby formula manufacturers and revengeful capitalists brought about their demise. But recent research on premature babies’ nutritional needs could ensure their revival, says Nele Obermueller.

Monique Richter watches her baby daughter Jeanne through the glass of an incubator. Born prematurely at 31 weeks of pregnancy, Jeanne needs warmth, a monitored environment and breast milk to survive.

But the 29-year-old does not have enough to sate her newborn. Instead, Jeanne is fed with milk donated by other mothers to the Ernst von Bergmann children’s hospital in Potsdam, which runs one of the last surviving milk banks in Germany. Jeanne is not the only one.

Germany has a growing proportion of ever-smaller pre-term babies. With women waiting longer before having children and the increasing popularity of in vitro fertilisation, premature births rose from seven percent in the 1990s to nine percent last year – which translates into 60,000 babies.

Improved incubators and breathing machines make the survival of smaller premature babies likelier than ever. “But as I always say to my students,” says Prof. Dr. Michael Radke, who runs the Potsdam milk bank, “nutrition isn’t everything, but without nutrition, everything is nothing. All of this technology is worthless without the proper food for these infants.”

This proper food is human milk enriched to meet premature babies’ nutritional needs – something that can only be provided at a hospital with a milk bank, where the mother’s milk can be taken from her, enriched and processed according to her premature infant’s needs (unlike at a regular hospital, where premature babies are given enriched formula).

Milk banks are especially valuable for mothers who can’t produce breast milk in the first place. Sometimes the abrupt end to pregnancies brought on by pre-term births means mothers’ milk production hasn’t kick-started.

Ensuing fear, stress and frustration only further stem milk flow. Monique Richter can empathise: “It’s not easy when you have family members who’ll ask why someone like me who has big breasts doesn’t have enough milk.”

Even with her previous four children, nursing was difficult, and it’s a struggle she’s had to come to terms with. “But I never knew institutions like this milk bank existed”. What little milk Richter has now, Jeanne gets.

The rest has been donated. “I don’t find the thought of Jeanne getting another woman’s milk strange. For me, it’s more important that my daughter is drinking breast milk, which, all mothers know, is better than industry milk.”

According to surveys, 90 percent of mothers-to-be say they plan to breastfeed their babies, but after six months – which is the amount of time the World Health Organisation recommends as a minimum – only around 12 percent of them have not switched to formula.

Powdered white lies

There was a time when mothers did not even intend to breastfeed, let alone accept donor milk. The history of human milk banks in Germany dates back to 1919, when Dr. Marie-Elise Kayser founded the first one in Magdeburg.

By WWII, 11 milk banks were running (including one in Berlin), and in 1943 a law concerning hygienic standards of donated milk was passed. But in West Germany their success was not to last. Industry milk manufacturers’ aggressive marketing campaigns in the 1960s eroded peoples’ trust in breast milk.

As the threat of HIV and other viruses entered public consciousness, formula milk companies pounced on the opportunity to sell their product as ‘cleaner’ than mother’s milk – until eventually people saw it as safer.

A witness to this shift is lactation consultant Erika Nehlsen, whose daughter was born in North Rhine-Westphalia in 1976 by caesarean. “I’d wanted to nurse, but she was slight, and doctors automatically put her on formula. She never saw a drop of breast milk,” Nehlsen recalls. Thus the rise of industrial milk brought the demise of milk banks in the West, with the last one closing in 1972.

Milk banks galore in the GDR

While profit hunger drove intercompany competition in the West, state-run GDR industrial milk manufacturers felt no such pressure. Instead, their biggest problem was unreliable delivery dates, and milk banks remained an important component in GDR neonatal care.

A directive was issued in 1952 obliging each city with a population greater than 50,000 citizens to have a milk bank. By 1989, 60 banks collecting 200,000 litres of milk dotted the landscape.

“Breast milk was highly valued in the GDR,” says Dr. Skadi Springer, who managed Germany’s biggest milk bank in Leipzig for many years. “Women nursing received 10 eastern marks a month in support, and donors received 12 marks per litre.” A pretty penny, considering that rents generally lay under 100 eastern marks.

Keeping these milk banks in fresh supply were strict nursing guidelines, which state-regulated lactation consultation ensured everyone knew about. Newborns were to be fed every four hours, excess milk to be pumped and donated.

Maternity leave was brief, and babies were often put into nurseries before they reached toddlerhood. While breast milk was medically (and economically) valued, the GDR’s regimented lifestyle was hardly nursing-friendly.

Not a cash cow

After the Wall fell in 1989, and GDR milk banks lost state support, they were faced with the hard truth of their inability to turn a profit. “Half-baked financiers quickly noticed they could save a few bucks by closing the banks,” Radke says. “This was during the economisation of medicine era, when patients became customers and so forth.”

Nehlsen says that after the Wende misinformation further instilled public distrust of milk banks, calling their hygiene into question. “We were lied to, told that the milk banks pooled all donated milk.”

With no financial and little public backing, only nine milk banks survive today (all in the former East). One of these is Radke’s, which he has been running for 14 years. “I’ve fought hard,” says Radke, whose own wife donated milk in the 1980s.

“This is the third milk bank I’ve set up.” Maintaining a milk bank is more expensive than producing formula milk. In Potsdam three nurses work full time in the lab-like environment, their hair disappearing in hairnets before they set to freezing, pasteurising and enriching milk and sterilising bottles.

“Donor milk has to be pasteurized – always,” nurse Verena Herklotz says. Tolerance levels depend on each infant and are monitored by doctors. “Then they give us instructions on how to prepare each baby’s milk.” No charge befalls mothers whose babies receive donor milk.

Donor plight

“What remains a challenge is finding these donors,” Radke says. Mothers are approached directly and flyers displayed. €10 compensation per litre of donated milk is offered.

Yet numbers remain modest. Last year, 1003 litres of the milk processed by the bank came from mothers for feeding their own infants, compared to only 95 litres of donor milk from seven women.

“I’m not sure why so few women donate,” Herklotz says. “But it might be because a mother’s priority is to feed her own child. There’s a fear that her milk production might let up, so she often freezes milk at home first.”

So far in 2012 only Luise Luczkowski (27) an agriculturalist from Werder, near Potsdam, has registered as a donor. “I’m not scared my milk will let up. I actually find it encouraging to see how much more there is than my Mathilda needs.”

Luczkowski’s daughter was born at the end of 2011, joining her brothers Oskar (2) and Friedrich (3). “Donating is a lot less effort than I thought. I just pump while I’m nursing. And I’m careful with my diet anyway because of Mathilda.”

Every week a man collects Luczkowski’s milk and brings it to the bank. Luczkowski feels good as a donor. “Just recently I saw something in the news about a 600g baby being fed with donated milk, and I thought to myself, ‘that could be mine’.”

But she consulted her midwife before registering. As Luczkowski’s midwife formerly worked in East Berlin, she was able to competently advise her. “This is not true for all health professionals,” Springer says.

When milk banks began disappearing from Germany’s landscape, they were also largely erased from public knowledge. “Especially among health professionals, this difference in awareness is important, because how can you give advice about something you don’t know?” Springer asks.

Nehlsen believes that once mothers are made aware of human milk’s health benefits, they are likely to accept donor breast milk, regardless whether they come from the former East or West.

“And ask yourself, what’s the difference between donor milk and milk from some anonymous cow? It’s not as if you’re on a first-name basis with the cow, nor do you know what kind of antibiotics it’s gotten.”

Liquid gold rush

A discussion about the merits of donor milk would never have occurred without the renaissance of nursing since the 1990s. Recent research findings about breast milk’s astounding power have led to it acquiring the alias, ‘liquid gold’.

Importantly for pre-term infants, human milk reduces the chances of necrotizing enterocolitis (NEC), a potentially fatal condition where intestinal tissue dies. “Put simply, human milk is made for humans, and cow milk – on which formula is based – is made for cows. The two are as different as an electric and a petrol engine,” Radke says.

Katharina Eglin, a spokesperson at Das frühgeborene Kind e.V., an association focused on the welfare of pre-term babies, agrees. Though for Eglin milk banks are an “annoying detour” that distracts from focusing on proper “lactation coaching”.

Yet Radke is adamant that “running a milk bank and supporting nursing do not contradict each other, because we’re talking about pre-term babies that can’t be put to the breast!”

A new age

It’s the study of these pre-term infants that, according to Radke, has put us on the brink of a new age in neonatology. “We know now that a 600g infant cannot be compared with an 800g infant in terms of dietary requirements,” he says.

“Each has its particular tolerance levels and needs regarding energy and nutrients. So we’re seeing an individualisation of nourishment plans, different modules, so to speak, for these premature babies. And those modules are only made possible on the basis of human milk.

A full-term baby whose mother has trouble nursing could also safely be fed with modern industry milk, according to Radke. “But not these premature infants. They’re a lot more sensitive.”

It remains to be seen whether Germany will be hit with an explosion of private breast milk sales as in the US. With sites like Only the Breast, where mothers can sell their milk for up to $90 per litre, there is an unsettling sense that a return to wet nurses is just a hop, skip and nipple away, and Nehlsen says she has noticed an increase in private trade.

“But I think German women are a lot more aware of the risks.” Whereas in America, human milk is seen as food and left to personal responsibility, here it is treated on par with blood donations. “Each donor is screened extensively at two points in time before her milk is used,” Herklotz says.

Radke’s prognosis is that understanding human milk’s benefits and ever-smaller pre-term infants will lead to a new dawn for milk banks. With the scheduled spring opening of the first human milk bank in almost 100 years in western Germany – at Munich’s Großhadern clinic – Radke’s forecast seems right on track.