In response to the questions about donor milk...
I am the Lactation Program Coordinator at a community hospital in Boulder, Colorado. We do about 130 births/month and have a breastfeeding initiation rate of 95%. Our population tends to be primarily highly educated (we're a college town) and motivated to breastfeed.

About 2 years ago we started stocking donor milk from the Mother's Milk Bank in Denver. We had a freezer because we have been a depot for them for years. We had a mom due to give birth whose first baby was given formula for (I believe) hypoglycemia and went on to develop allergies and the mother felt the formula played a role in the allergies. So she wanted to make sure there was no need for formula with this baby and arranged for the Milk Bank to have milk at the hospital for her baby in case it was needed. At that time the Milk Bank was offering hospitals 30 oz free to use and see if they wanted to stock it. One of my LC's heard about it and said (unbeknownst to me) "Sure, bring us the 30 oz." And there it was one day. This was not an ideal way to do it, because I had to scramble to educate the nurses about it and also make sure that it was not used up before the mom who had requested it gave birth. 

In all honesty, if I had tried to plan for it, it would have taken a lot longer to happen, and while having donor milk makes my life much more difficult, it is wonderful for our babies.

For the first two years parent paid for the donor milk used. The Milk Bank required a written order or RX for donor milk, so we pretty quickly got it as part of our standard orders. Families would fill out the paperwork and most times give a CC for payment. Sometimes they paid with check or cash. Occassionally the Milk Bank would bill them, and if a lot was used they sometimes tried for insurance coverage. This was between the parents and the Milk Bank though.

Towards the end of last year two things happened. One of our NNP's went to the auxillary and got a grant for $1000 for donor milk for low income families. Also, the director of the Milk Bank sent our director a letter and said they were going to start billing the hospital for the donor milk as opposed to billing the individual pt's. The reasoning being that no ther pt is expected to pay for their food while a pt in our hospital. It's a sound rationale. And so we decided to buy the milk from the Milk Bank and not charge the pt's. 

Apparently some hospitals buy the milk and then they (the hospital) charge the pt's.

The donor milk is available for any baby that needs supplementation. It is not supposed to be used for non-medical supplementation, but this has been hard to manage. A doctor told a mom to send the baby to the nures's station for the night and just have it fed donor milk so the mom could sleep (we don't have a nursery, it is expected babies are going to room in 24 hours a day). And we still get the mom who wants to supplement because the baby must not be gettign enough because it is eating all the time. Education is an ongoing thing, as it is everywhere. 

I am thrilled we have donor milk, our pt's are thilled we have donor milk. But right now I am seeing an increase in supplementation because people don't get it, and think it is okay because it is donor milk.

As an added note, we have had a couple peds pt's who were breastfed and needed more than their moms had and we provide those babies with donor milk also.

We use ALOT and it is very expensive. If a baby has been using donor milk, when the family goes home we will give them one 4 oz bottle to go home. We also tell them to call the Milk Bank to arrange for more milk if needed and then it becomes their financial responsibility.

Long answer to your question. Happy to provide any more information if needed.

Andrea Tran RN, IBCLC
Boulder/Erie, Colorado

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