In Norway the standard of care is to provide donor milk as supplement to
mother's own milk, to the greatest extent possible.  If there isn't enough
for all babies who might need supplementation, it is given to those with the
greatest need first, normally the tiniest and most premature babies.
Availability varies by region.  In my area we are once again fortunate
enough to have a local system for collection of donor milk and a plentiful
supply.  We had a staff meeting yesterday where the latest guidelines for
who can get donor milk were presented.  
At present we simply document in the mother's chart that she has requested
or accepted the offer of donor milk.  This is the same thing we do if the
mother requests breastmilk substitutes.  There are occasionally mothers who
object to the use of donor milk, usually on religious or cultural grounds.
They are concerned that the donor may have eaten foods proscribed in their
religion, thus polluting the milk, or that the donor will become part of the
baby's kinship group and this is not acceptable to them if they do not know
who the donor is.  (On the other hand we have also experienced wet-nursing
between two immigrant women from Chechnya, where a mother whose baby was in
NICU borrowed her friend's baby to relieve her own engorgement.  This was
discovered when a staff person came in to speak to the NICU mother and found
her breastfeeding a term baby like nothing was out of the ordinary, while
the baby's mother sat with her, happy to take a break from feeding this
voracious and obliging newborn.)
Here is who gets donor milk in my unit:
All very premature babies, who in my hospital would not be on the postpartum
ward, but in our Level III NICU.
All other babies in the NICU who need supplementation, for example if they
are on antibiotics or under lights and their own mothers' milk is not
present in the requisite volume to meet the needs according to our
neonatologists' guidelines.
All babies born with gestational age under 37 weeks, if they need
supplementation to maintain normal blood glucose levels.
All babies of diabetic mothers, whether or not they have been on insulin, to
maintain normal blood glucose levels.
All dysmature babies, as needed to maintain normal blood glucose levels.
All babies with increased needs due to things like phototherapy.
All babies with strong family history of food allergies, if they should
require supplementation for any reason, such as an abnormally high weight
loss in the first few days.
Basically this was all the babies who ever need supplementation for medical
reasons.  The donor milk is not available to them after hospital discharge
but by that time virtually all babies are getting plenty of milk from their
own mothers.

I reiterate, for those of you who have tuned in since last time the subject
was raised, that our donor milk is frozen fresh, and not pasteurized.  The
donors are screened for tobacco and medication use, otherwise as for blood
donation plus several extra virus tests, and the milk is tested for bacteria
content, and returned to the donor if bacteria counts exceed the limits
established by the national group working with donor milk.  Mothers who test
positive for cytomegalovirus may donate but their milk is not used for the
extremely premature babies.  We do not restrict the use of a mother's own
milk for her baby, however.  All the milk 'banks' are based in regional
hospitals, which are all part of the universal public health system.  No one
is charged for the milk individually; the cost of having a donor milk system
is part of the costs of having health services.  The donors themselves are
compensated for their time and trouble, and are supplied with a pump and
collection containers.  Transporting the milk to the hospital is a shared
responsibility between donors and hospital, where local conditions determine
what is the most practical method.

Rachel Myr
Kristiansand, Norway

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET email list is powered by LISTSERV (R).
There is only one LISTSERV. To learn more, visit:
http://www.lsoft.com/LISTSERV-powered.html