“I wanted to complete the circle: receive and give,” says Anabel Roman. Her son Àngel was born prematurely at week 32 and during his first four days of life he was fed with donated breast milk, an option recommended by neonatologists for premature babies when breastfeeding is not possible or desired. Anabel's milk ended up coming in, but this crucial food that her baby had thanks to an altruistic mother also encouraged her to donate. Diana and the 700 donors who annually contribute to the breast milk bank in Catalonia did the same. In Spain there are currently around twenty banks that collect, process and offer human milk to hospital maternity wards.
This chain of solidarity in which hundreds of mothers and milk banks participate is essential for the health of hundreds of premature babies, since a multitude of studies support the benefits of breast milk. Neonatologists are clear: it is the best option in the case of premature babies. For these babies, donated human milk is prescribed if the mother's milk is not possible. “Breast milk is the best food we can offer a premature baby,” says Vall d’Hebron neonatologist Fátima Camba. Because it not only nourishes, he continues, but also helps reduce the risk of suffering from some diseases associated with prematurity such as bronchopulmonary dysplasia or retinopathy of prematurity. And some studies associate breast milk with better neurodevelopment, she says. To this we must add the digestive benefit because it reduces the risk of necrotizing enterocolitis.
For all these reasons, in maternity hospitals like Vall d'Hebron, the first option is always the mother's own milk. If this is not possible, donated “human milk” is recommended, explains Carla Balcells, a neonatologist at Sant Joan de Déu, a center where they follow the same methodology as Vall d'Hebron. In cases in which it is known in advance that there is a risk of prematurity or some malformation, neonatologists already address this possibility prenatally in consultation. And in most cases the families agree. “We find that many mothers do not know about the benefits of breastfeeding in general and specifically in premature babies,” explains Fátima Camba.
In December 2022, the son of Anabel Roman, 38 years old, was born and has been a recipient and donor of breast milk. The baby came into the world prematurely at 32 weeks due to preeclampsia and a fissured sac. He weighed 1.3 kg and was admitted to the ICU for four days and 18 in intermediate care. Two hours after birth, the Vall d'Hebron hospital in Barcelona recommended that the little one drink donated milk. She wanted to give him her own milk but until this was possible she was clear that it was the best option. There she began the circle that she would later complete. “If my son is like this, it is thanks to the donated milk,” says this early childhood education teacher who is a single mother by choice. Àngel ate every three hours through a tube. After four days, Anabel was able to start feeding her son with her own milk and after three weeks, with the little one weighing 1.8 kg, they went home. The baby with the task of continuing to grow and the mother with the task of taking care of her child and also preparing to donate milk for other babies who needed it, as she had done with Àngel. In March she started donating it, making it compatible with breastfeeding.
The last recommendation from neonatologists is artificial milk because it nourishes, but "breastfeeding protects the digestive system and carries antibodies," says hematologist Joan Ramón Grifols, director of the Blood and Texits Bank, on which the Catalan milk bank depends. Dr. Balcells goes further and states that “formula milk harms very premature newborns (or babies) in the first weeks of life.” Also at the Madrid Regional Milk Bank, which emerged at the 12 de Octubre Hospital, they give donated milk to premature babies, says Beatriz Flores, neonatologist, pediatrician and quality manager of the Madrid milk bank.
Diana González's son was born at 31 weeks weighing 1,270 kg by cesarean section due to preeclampsia. He came into the world so advanced that Biel had no name. Her mother, who is 46 years old and works in the human resources department of a supermarket chain, had not yet decided whether she was going to breastfeed her son. At La Maternitat, where he was born, they recommended that as long as he did not have milk, the best thing was to donate. And Diana was clear. She claims that this gave her “peace of mind” to be able to dedicate herself to breast stimulation. “When I got a drop, I took it to the baby,” she recalls. Biel was hospitalized for 35 days and fed on Diana's milk and supplemented with donated milk. But after 15 days the mother was already producing enough for her son. The “gratitude” that Diana had pushed her to breastfeed and donate.
In Catalonia, the first initiative to have a breast milk bank arose in the Vall d'Hebron hospital, explains Grífols. And it has been 13 years since the bank was officially created. This is where all the milk arrives, which has previously been collected from the donors' homes, to be treated.
Once expressed, the donor keeps the milk in a part of the freezer separate from the rest of the food. And she notifies the milk bank to come pick her up. The valuable food lands in the basement of the Banc de Sang i Teixits in some refrigerated boxes that indicate that there is human milk inside. Here it is analyzed and subsequently subjected to a pasteurization process to avoid any pathogens. The milk is preserved at -80 degrees or -20 degrees and each bottle can last from three months to a year depending on the temperature at which it has been preserved waiting to be distributed to the maternity hospitals that need it and that pay for it. service.
It is precisely the cost that forces hospitals to limit the indications for this milk, explains Dr. Camba de Vall d'Hebron. The prematurity figures remain the same, but as the birth rate has decreased, so have the premature births, points out the neonatologist. Thus, when the bank started, in this hospital they had about 150 premature babies a year and now there are about 120. This allows that if before it was prescribed during the first week or 15 days, now it can be given until the baby reaches 32 weeks if He was born at 24. It means he can give this food for two months.
In Vall d'Hebron they explain that they have expanded indications due to the benefits that this milk has and now they can give it to late premature babies of 33 weeks who may have low weight. “It is an added cost to use this milk for the hospital, but the benefit is global,” explains Camba, who assures that if it were not a limited resource they would give bank milk to all the babies in the unit who did not have the option of Breastfeeding. Beatriz Flores, from the Madrid bank, values donation, always behind the mother herself, and explains that there are countries like Brazil in which artificial milk is replaced by donated milk in hospitals. In Madrid they offer this milk to babies less than 34 weeks old or weighing less than 1.8 kg. Also to babies who are born with low weight without being premature or in some cases of heart disease.
Mothers who decide to donate are usually very well informed. The children of many of them have needed donated milk in their first days of life and this motivates them to be supportive. There are also cases like that of Lorena Valverde, who donated when her sons, Roger, 3.5 years old, and Oleguer, 1.5 years old, started kindergarten. She had a lot of milk, she saw information from lactation consultant Alba Padró and was encouraged. She explains that in her last donations when she was breastfeeding for her little son Roger, in each collection she gave more than two liters of milk. A huge amount considering that there are babies who start drinking one or two milliliters. For a woman who has just given birth, reaching the 12 or 24 ml that she can take with an extremely premature baby is difficult because the extraction is more demanding when the mother is tired, says Dr. Camba. That is why she believes that the support of professionals is important to give the baby the value of receiving that food.
Neonatologists explain that the best milk that a baby, especially a premature baby, can drink is that of the mother herself and that occasionally using milk from a bank does not stop breastfeeding; on the contrary, it contributes to raising awareness of its importance, especially in mothers. that they didn't have it in mind. “The bank is a good resource but we must help mothers to have their own milk,” warns Dr. Camba.
Donor mothers remember with emotion the first message that notifies which maternity hospital their milk has gone to. This is the case of Lorena and also of Anabel, who has had to stop donating because she takes incompatible medication, but she continues to breastfeed Àngel and whenever she has the opportunity she encourages other women to donate.
Diana will continue breastfeeding for the first year and then until the baby wants. As long as she breastfeeds, she ensures that she will continue donating to help other babies like Biel or Àngel.
