This story first appeared in How We Care, a weekly newsletter by Spotlight PA featuring original reporting and perspectives on how we care for one another at all stages of life. Sign up for free here.
Eve Lieberum died on her third day of life. But before her death, her mother Abbie Lieberum was able to give the newborn some of her milk.
Eve was born with trisomy 18, a rare and often fatal genetic condition that caused a hole in her heart. Being able to provide her daughter with milk during those precious few days helped Lieberum cope with the loss.
“That was one of the few things that made her birth, made her, like any other baby,” said Lieberum, a social worker who lives in Westmoreland County.
Lieberum continued pumping for months after Eve’s funeral and donated that milk to help other babies.
Her donations were handled by Mid-Atlantic Mothers’ Milk Bank in Pittsburgh’s Strip District. The nonprofit, which feeds babies in the commonwealth and Maryland, New Jersey and West Virginia, is one of 29 accredited banks across the U.S. that provides donor breast milk to families for whom breastfeeding is not possible.
This includes some parents of premature babies, who might have difficulty lactating for reasons such as perinatal complications like preeclampsia, or a lack of skin-to-skin contact with their newborn. That’s concerning because the nutrients in breast milk cannot be replicated in infant formula.
Denise O’Connor, the Pittsburgh milk bank’s co-founder and executive director, described donor milk as “a simple intervention that can have such a profound impact on the health and survival of medically fragile babies.”
The CDC says that babies who are breastfed have better health outcomes, including lower rates of asthma, ear infections and sudden infant death syndrome. But when a parent can’t lactate, leading health agencies recommend that donor milk be given to infants with very low birth weights.
A major concern for premature infants, especially those born before 28 weeks, is the higher risk of developing necrotizing enterocolitis, a condition that occurs when the lining of the intestine becomes inflamed. In severe cases, a hole develops and bacteria leaks through, leading to serious abdominal infections, and potentially death.
But numerous studies have shown that donor milk can protect against this serious illness. One published in the Journal of the American Medical Association found that extremely premature infants who were fed donor milk had less than half the rate of necrotizing enterocolitis compared to babies who were fed formula.
Some infants just don’t tolerate formula well, said Lisa Houlihan, the chief nursing officer at the Children’s Home of Pittsburgh, a specialty hospital that serves kids with medically complex health needs. If a patient has belly pain that disrupts their sleep, she said, that stymies their growth.
The Mid-Atlantic Mothers’ Milk Bank is slated to process some 400,000 ounces of donations this year, said O’Connor. She estimates that 70% of the milk stays in Pennsylvania, while the rest goes to babies outside the state.
This volume and the safety needs of the recipients require the bank to take several steps before milk reaches a baby. Because certain pathogens can be transmitted through breast milk, all donations are pasteurized. This step is a trade-off, as heating the milk to such a high degree — 144.5°F for 30 minutes — removes some nutritional value. After pasteurization, a random bottle from that batch gets tested for bacterial culture. If bacteria are found, the bank discards the batch, or uses it for research.
The milk bank also screens its donors: Tests are done every six months to ensure donors don’t have any bloodborne pathogens, and they’re asked questions about their health histories and medications. Some prescriptions, including those for high blood pressure, are not compatible with donation.
The bank attracts a range of donors. In addition to bereaved moms like Lieberum, parents who produce more milk than what their babies can eat also contribute. This includes Alexandra Graziani of Washington County, who said she has frozen about 750 ounces of unused milk. Graziani told How We Care she was inspired to donate because her nephew needed milk after he was born.
“I know how much it meant to my sister whenever her baby was in the NICU,” she said, referring to a neonatal intensive care unit, “he was in for two months. So for two months, he had milk donated to him because he was so premature.”
When O’Connor opened the milk bank in 2016, her primary focus was serving premature and extremely sick babies. But the organization is now branching out to healthy newborns whose parents have delayed lactation and need to temporarily supplement their infants’ nutrition.
The shift helps address wider needs among families with newborns and can encourage more breastfeeding. Gysella Muniz, a pediatrician and UPMC’s regional director of quality newborn care, said that some parents feel more comfortable giving their babies donor human milk over formula. And she finds that providing this option increases the chances that those parents go on to exclusively breastfeed.
“The populations that have less exclusive breast milk percentages are the minority populations, and this is, for us, a huge way to close that gap,” said Muniz.
So far, donor milk is being used for full-term babies in UPMC hospitals in Altoona and Pittsburgh, and will soon be available in Erie and Mercer County, said Muniz. She would like all 15 of UPMC’s labor and delivery centers to eventually have access to the donations.
Babies born with neonatal opioid withdrawal syndrome are another group that is increasingly being served by donor milk. Exposure to opioids in the womb causes infants to have difficulty feeding, including issues with suckling and swallowing. This results in them struggling to gain weight, and causes gastrointestinal problems such as bloat, vomiting and loose stools, explained the Pennsylvania Chapter of the American Academy of Pediatrics in a statement to Spotlight PA.
These symptoms can last up to months after birth, the group added, so access to safe breast milk is key for their development.
This expanding role of donor milk excites Abbie Lieberum, who continues to be involved with the milk bank and sees the organization as part of Eve’s legacy. In fact, when Lieberum gave birth to her youngest — a healthy girl named Gemma — she had an oversupply of milk. So Lieberum became a donor a second time, which she says created a connection between her girls.
“Gemma shared her milk, just like Eve did,” said Lieberum.
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