Breastfeeding: how to create a milk bank. How can you freeze breast milk? How long to keep expressed milk at room temperature
How the donor breast milk bank works in Moscow daryadarya wrote on September 13th, 2015
Hello, how is it done!
Recently, I had the opportunity to visit the only one in Moscow, but what is there, in all of Russia, a bank of donor milk and get to know its creators. I will now tell you about how it was created, how and where it functions, and who can use the deposits of this bank.
From time immemorial to the present day
The history of milk donation dates back to ancient times. Then, if a woman did not have the opportunity to feed the child on her own, she resorted to the help of a nurse, who could be a relative or just an acquaintance. It is known that similar practice existed in Ancient Egypt, Greece, the Roman Empire, and after the XI century, the services of nurses were used by aristocratic and royal families Europe.
The transition from private services to milk collection and processing points was marked at the beginning of the 20th century. The first such institution was a milk bank, opened in Vienna in 1909 at the St. Anne's Hospital.
In Russia, in the 1960s and 70s, “donor points” operated at children's polyclinics to collect excess breast milk from nursing mothers and distribute it to needy babies under the age of one month. Subsequently, these institutions ceased to exist due to difficulties in milk quality control and the development of the infant formula industry.
Bank opening
In November 2014, a donor breast milk bank opened in Russia. Pilot project was created to help newborns, children undergoing treatment and rehabilitation in the department for premature and neonatal surgical units of the Scientific Center for Children's Health on Vavilov Street in Moscow.
Irina Anatolyevna Belyaeva (left), Dr. medical sciences, head of department for premature babies Research Institute of Pediatrics of the Federal State Budgetary Institution "Scientific Center for Children's Health" and Olga Leonidovna Lukoyanova (right), Candidate of Medical Sciences, Senior Researcher Department of Healthy and Sick Child Nutrition, FSBSI "Scientific Center for Children's Health", doctor the highest category. I took the photos from them. I was so carried away by communication, while in my thoughts I was in a hurry to Varyusha, that I didn’t even think to ask to be photographed with me.
In the department
Children in the wards are with their mothers. How else? Mom takes care of the baby, learns to use the device for food. Premature babies often lack sucking reflex and they are fed through a tube that goes into the stomach through the nose.
It happens that the children are alone, while the mother is on treatment. But the recovery of a weak body in premature babies is much faster when the mother is nearby. And especially if the mother has the opportunity to feed her breast milk.
But sometimes things get better breast-feeding just impossible. The reasons are varied, mainly early birth, resuscitation, treatment or stress. Then donor can come to the rescue. breast milk.
Indications for donor breast milk
Donor milk is prescribed only by a doctor as food and medicine at the same time. Not all children in a row, there are exceptions. A mother has the right to refuse donor milk and feed her baby with a formula for premature babies, but refusals are very rare in this department. At stake is the most valuable - life and health.
Which patients are shown donor milk in cases where maternal milk is not available? First, premature babies. I saw these kids in incubators. There is a tiny one weighing a kilogram and the size of an iPad Mini, or even the size of a palm. He feeds on donor milk while his mother is on treatment herself.
Milk is also indicated for children with metabolic disorders, after operations on the intestines, kidney failure, cardiopathy, immune deficiency and allergies to milk formulas.
When formula-fed, out of a thousand babies born with very low body weight, 21 babies die as a result of the development of necrotizing enterocolitis. If such children are fed with breast milk, mortality from this serious illness is 3-6 per thousand newborns.
How the breast milk bank is tripled
When I began to negotiate the possibility of getting into the breast milk bank, I imagined myself entering a separate building, a large separate building. In fact, the milk bank in this department has an area of twenty meters, divided into three compartments.
Milk is brought to the first compartment of the mother. They can immediately wash their breast pump or take a clean container for collection.
Milk is expressed in such jars. They are reusable and sterilizable.
A bank employee accepts milk for bacteriological testing.
Then sends it for pasteurization. The pasteurization technology is very simple: for half an hour, the milk is heated in a water bath at a temperature of 62.5 degrees. This allows you to secure it, while protein, fat, carbohydrates, oligosaccharides, linoleic and a number of other acids, vitamins A, D, E, B12 are 100% preserved. Milk contains 75% folic acid, 65% vitamin C, up to 70% immunoglobulin A, 91% retained total antioxidant activity.
Milk is stored frozen, but it must be cooled before being put into the freezer.
In the freezer, it is stored in bags. They are disposable, sterile and simply compact. Frozen breast milk can be stored for three to six months.
Security issue
As I wrote above, the breast milk bank project is experimental. So far, you can’t just come from the street to donate or receive milk. There is not the slightest doubt about the effectiveness of treatment and nursing of small patients with the help of milk, and the closest attention is paid to the issue of safety.
A contraindication for donation is not only a history of infectious diseases, but also, for example, tattoos, acupuncture or dental intervention in the last six months.
Mass donation
Learned one interesting fact about mass donation in Brazil, where it is very well developed. Initially, they gave money for the delivery of milk. Thus, donation was encouraged. But after some time, the reward system was canceled. The fact is that low-income mothers handed over all their milk, depriving their own children of the most valuable product.
It is too early to think about when milk donation in Russia will become massive, says Olga Leonidovna. The bank is already ready to expand and accept those who want to donate milk. Mothers who are not able to feed on their own are not yet ready to take this very donor milk. And for those who feed themselves and have excess breast milk, I advise you to create your own bank at home. This requires a breast pump, storage tanks and a freezer. Strained, cooled, then frozen. Within six months after the end of breastfeeding, there will still be an opportunity to make, for example, milk porridge.
Question " social life mothers or continued breastfeeding? in the age of new technologies has lost its relevance. The world has long figured out how to make sure that no one suffers - neither the child nor the mother. The solution is to create a breast milk bank. How to set up the process correctly, our author tells together with an expert, a breastfeeding consultant.
There is nothing more valuable and more useful for a child in the first year of life than mother's breast milk - all the pediatricians of the world agree on this. The mother's milk of every woman has a special composition, and no infant formula can repeat it, no matter how innovative it may be. This amazing property determined by the related composition of milk with the body of the child. Therefore, in a situation where the mother needs to leave the child for some time, it is more correct to feed the child with expressed milk than with an artificial mixture.
About sterility and safe storage
Expressing and storing milk should be approached with special care - first of all, everything should be as sterile as possible. And a container for milk, and a device for expressing it, and mother's hands.
The choice of containers for milk is a responsible issue, not every material is suitable here. Most containers and boxes are now made of polycarbonate plastic, which usually contains bisphenol A, a phenol group substance that, when heated, can mix with milk and have Negative influence on the child's urinary tract. Therefore, high-quality utensils for babies, such as bottles, must be labeled BpA free.
To create a milk bank, you need a breast pump, feeding bottles and special storage containers. It is convenient when all the accessories fit together - besides, it is the easiest way to maintain sterility. A popular brand among Russian mothers Philips Avent offers all the necessary solutions for setting up a milk bank. The containers are compatible with breast pumps, feeding nipples and other products of this brand, which will make the process of pumping and feeding as convenient as possible. Moms can be sure that the expressed milk is safely stored, and the baby, if necessary, can be fed by dad or another family member, and the baby will not refuse the breast later.
How much and how to store?
“With a high sterility capacity, breast milk is stored at room temperature three to four hours without losing their properties. Milk in the refrigerator is stored for up to three days, and if the mother carefully prepared a sterile container, then the shelf life increases to eight days.
If a woman works full time or goes on a business trip, then it makes sense to stock up on breast milk - in this case, it needs to be frozen. Breast milk will keep in the freezer for up to six months, provided it is a deep freezer.
Thawed milk can be used within 24 hours and should not be refrozen.
It is not recommended to defrost milk with microwave oven- it gives uneven heating, and the baby can get burned if the milk is not mixed well. It is also not recommended to boil it, because boiling destroys a number of antibodies, maternal immunoglobulins. It is best to reheat frozen milk simply by running hot water.
In general, freezing and thawing does not change the composition of milk, only slightly changes the taste. One way or another, it will be the most healthy and good nutrition for a child".
When freezing milk in a glass container, you should be careful - when freezing, the glass can crack. If milk is frozen in packages, then it is worth considering the fact that packages are sometimes torn. However, by purchasing special packages for storing breast milk, you can be absolutely sure of their reliability. Usually they are equipped with a sealed zipper, made of a two-layer material that does not contain hazardous components for the health of the baby.
Pumping
How often can you express milk if, for some reason, the mother cannot breastfeed at all? In this case, it is recommended to pump every three hours from both breasts. It is better if it is full pumping, that is, the maximum release of the breast from milk.
If the mother is breastfeeding, but she needs to make a supply of milk (for example, she is leaving on a business trip), maximum amount additional pumping will depend on how much milk supply is needed.
A mother must understand that her body produces the amount of milk that a child needs daily, so it will take some time to stimulate the body to produce more.
Galina Valerievna Zemskova, breastfeeding consultant:
“Even if a mother begins to express milk every three hours in parallel with breastfeeding, at first the result of pumping will be small, and this is normal. The "acceleration" of lactation is unpleasant because subsequently the mother may face the problem of producing too much milk.
Therefore, if a mother knows that she will soon have to leave the child, she should start pumping in advance and at those moments when there is the most milk - as a rule, this is in the morning. I note: in order not to provoke hyperlactation, milk should not be expressed throughout the day. This guarantees that after the mother parted with the baby, she will not suffer from discomfort in the chest and congestion.
In general, if the mother's activities involve regular travel, routine pumping in the morning can be introduced in order to create a bank of frozen milk.
It is better to express milk with an electric breast pump - it is gentle, unlike manual method, without injuring the mammary gland, expresses milk.
Using this breast pump good prevention lactostasis, in addition, in parallel, it stimulates lactation.
Galina Valerievna Zemskova, breastfeeding consultant:
“I advise you to choose a model that has two phases of pumping, that is, it imitates the principle of sucking a baby: a more intense and slower phase, when milk is already flowing well from the breast. With such a breast pump, this can be done both at home and at work, and if there is the possibility of quick transportation, then you can feed not with frozen milk, but with the one that mom expressed the day before.
When using a breast pump, it is also important to keep it clean and sterile, otherwise the milk will be dangerous for consumption. Breast pumps usually have a lot of parts and curves, so the importance of sterilization and boiling is in the first place.
Latest Models electric breast pumps they work silently, which allows you to express milk even during the baby’s sleep, and not be distracted during the process by extraneous noises and sounds. Modern breast pumps are comfortable and easy to use, they can also be adjusted to different mode pumping.
With regard to cleaning and storage, these models are easy to disassemble and easy to clean thanks to a small amount details. Moreover, such breast pumps come complete with dishes, so you don’t have to guess when choosing milk storage containers. The bottles are specially designed for specific model breast pump, they are equipped with a sealed lid, resistant to temperature conditions, and most importantly - absolutely safe for the baby. 
Stock up, but don't forget to contact
As you know, breastfeeding is an important intimate process for mother and newborn, which provides close kinship, helps to establish such a subtle and necessary contact.
“Sustaining breastfeeding for busy moms working or studying has one big bonus. Both mothers and babies miss each other very much when separated, and feeding gives them the opportunity to maintain contact. Babies may ask for breasts more often if the mother has been away for a long time, because they need to make up for this contact. From my point of view, maintaining contact between mother and child through breastfeeding is very important,” says Galina Zemskova.
In general, the creation of a breast milk bank is far from being as difficult and dreary as it is commonly believed. On the contrary, this is a real lifesaver for both busy mothers and those who devote themselves entirely to motherhood. A modern technologies will always come to the rescue.
Tatyana Butskaya:
The program "Parents' Choice" and I, its author and presenter, Tatyana Butskaya. We will talk about banks. But, this is not just a bank, this is a special bank. Today Yan Bogdanovich, Marketing Director, and Tatyana Kononova, Head of Education, came to visit us. big company that promotes breastfeeding. But what about the banks? Breastfeeding and banks.
As usual, we start with world experience. Jan, please tell me, "breast milk banks" - what is it? What are they needed for? Does it exist in the world or not?
Jan Bogdanovich:
This is already a popular trend in the world. Most major European countries, and especially the US, have breast milk banks. Every state has commercial banks and non-commercial banks. What for? Not all mothers have a lot of milk, not all mothers are fond of this topic. Breast milk bank helps mom get necessary norm milk, give it to the child. We know that breast milk is the most useful substance for feeding a baby. There a large number of vitamins, lots of useful substances. There are a large number of symposiums where new properties of breast milk are still being discovered.
Tatyana Butskaya:
Let's go back to the word "bank". When we say “bank”, we immediately want to know: what deposits exist, what interest rates are growing, how to use them? What is it, tell us about the concept of "breast milk bank"? Is this a safe?
Jan Bogdanovich:
Recently, we talked with colleagues from the United States, they have this phrase: “Breast milk bank is the most profitable investment to the baby's future. This is a certain, let's say, not a bank, but a vault where it is stored under necessary conditions in the right temperature conditions breast milk, which is expressed, let's say, by donor mothers. Mom on a commercial basis or not, relatively speaking, can either buy this milk or take and feed her baby. Let's just say that in terms of interest, investments, mortgages, you don't need to be afraid of anything, this is a very safe solution and very useful in many ways.
Tatyana Butskaya:
I will now translate a little into Russian. Whether you're a breastfeeding mom or a dad and you have a breastfeeding mom and a newborn baby at home, a woman can express milk, put it in the freezer, and create her own breast milk bank. By the word "bank" we mean "vault". If the baby does not need this milk now, then you can save it and use it later. But there are situations when a woman has a lot of milk. Women can donate this milk, and other mothers can use their milk to feed their children. Tatyana, what did you want to add, correct in my words?
Tatyana Kononova:
Not to fix, but really to add. First, let's distinguish between two concepts: "donor breast milk bank" and "personal breast milk bank". Both of them have the right to exist. My colleague Yang was just talking about donor banks of breast milk, the importance of which can hardly be overestimated precisely in social terms. It is very important when the state takes care of the existence of such a bank in order to provide for mothers, especially those in need. What are these mothers? First of all, of course, these are mothers of premature babies. We all know that for these babies, breast milk is not just food, but a real medicine that saves many lives, reduces the risk of disability, reduces the risk of developing enterocolitis and other very dangerous diseases. It also has the right to exist and a personal bank of breast milk. Every mother who cares about the future of her breastfeeding, wants to prevent the risks that may arise along the way, should (the word “should” may not be appropriate here, but she should) as a caring, responsible mother create a personal breast milk bank to your baby in your own freezer.
Both of these are important. When we talk about donor banks of breast milk, you are absolutely right, we are talking about mothers with hyperlactation, hypergalactia, when there is a lot of milk. In order not to pour out this precious substance, it is better, of course, to use the bank, if there is one. It's not so easy in Russia, I think we'll talk more about that today. For a personal bank, even if there is no excess milk, we recommend that mothers take care to develop lactation, and collect one serving a day to save for unforeseen or foreseen circumstances.
Tatyana Butskaya:
With a home bank, everything is more or less clear. I think everything is now modern moms already know for sure that there are breast pumps, there are special containers for pumping, or bags in which milk is frozen. And with this bank, social, which can be both state and non-state, for a woman who has a newborn child in her arms, and suddenly she realizes that she does not have milk - it would be happiness. There are times when there was milk yesterday, but suddenly there is none today. This is a lactation crisis, from which no one is immune. Either a woman develops the same mastitis, she is prescribed antibiotics, and breastfeeding is not compatible with drugs, she needs to survive for a week, go somewhere and buy milk. If these women had the opportunity, if they knew that they could go somewhere and buy one serving, several servings of milk - it would be great! Is this possible in Russia now?
Jan Bogdanovich:
We have, if I am not mistaken, only two cans of breast milk, in Ufa and in Moscow. As far as I know, this is a very successful, already conducted experience. Especially for Ufa, it is developing very actively. I know that at the state level, the launch of another ten breast milk banks in key regions is being discussed. Because now, of course, there is a problem that you mentioned, that many mothers have health problems (mastitis and other diseases), the mother needs temporary help so that she can come to the center and get the necessary, let's say, dose of breast milk for a child.
Tatyana Butskaya:
Tell us more about Ufa. How is it implemented there?
Tatyana Kononova:
Ufa and the Center for Children's Health, NCCH in Moscow work on the principle of donor selection. This is a lot of work that is being done in advance. Firstly, not every mother can donate milk, only with ideal tests. It first goes through the stage of questioning, then it is checked, of course, with the help of various analyses. After that in laboratory conditions, that is, not at home, but in a clinical setting, the mother collects milk using clinical equipment, everything happens with clinical breast pumps in clinical containers. The milk is then pasteurized using the Holder method. It heats up to 62.5 ℃, at which, unfortunately, the content of such substances as water-soluble B vitamins, antioxidants, vitamin C is partially reduced, only about 70% remains. However, all fat-soluble vitamins remain intact, lipids remain intact. In any case, it is certainly much better than artificial substitutes. Nevertheless, a very large number of valuable nutrients, for which we value breast milk, are stored in breast milk. With the help of pasteurization, we reduce the risk of cross-contamination through milk.
Tatyana Butskaya:
To complete the thought with the experience of Ufa and the NCCH, let's say that these are banks for children, I don't know how in Ufa, but in Moscow it's definitely for children who lie in the center.
Tatyana Kononova:
Which, first of all, are in the clinic. These are the primary recipients, say, who receive donor breast milk. And, as I said, premature babies.
Tatyana Butskaya:
And from the side can get?
Tatyana Kononova:
From the outside, they can apply, but here it is already the bank managers who decide how much they can use the available reserves to meet the needs. Two donor banks are not enough for either Ufa or Moscow, absolutely, not to mention other regions. Therefore, of course, we have to make a choice in favor of especially needy children - premature babies, with pathologies, and so on, whose mothers are being treated and cannot provide them with milk.
Tatyana Butskaya:
It turns out that "from the street" it is very difficult to contact the bank. In Ufa, the situation is the same, right?
Tatyana Kononova:
You can apply, but not the fact that you will get milk.
Jan Bogdanovich:
No clear regulation this issue. So far, these are, so to speak, more individual initiatives. I wish there was some kind of government program. I think if we have a state program and support, for example, the initiation of a breast milk bank, when each mother will understand what she needs to do in order to get the necessary portion there. Now, Tatyana is absolutely right, in many respects it happens so that yes, if the child is in the clinic, he receives breast milk, but it is extremely difficult for a mother “from the street” to do this, because the mother does not know the input, the mother does not understand what she make. There is, of course, a problem here. In Russia, this is still an individual initiative. In the United States, every state has breast milk banks. Mom knows: either I can buy it with my own money, or I get it under the program, or under the insurance program. Mom knows the steps to get her the right amount.
Tatyana Butskaya:
How do they function there? How is milk collected there? How is it checked?
Jan Bogdanovich:
Every breast milk bank has government regulations. As Tatiana has already said, mother is being tested for diseases. The same thing that happens with blood, because there are also risks of infection infectious diseases, cross-contamination occurs. The same risk for the mother and for the baby, first of all, is to consume untested breast milk. There are many standards in the USA. Now, if I am not mistaken, an even greater number of banks are opening in the United States, because this problem is coming to the fore: the number of premature babies who are born is increasing. ahead of time they are in particular need of this project. This is especially true for Russia.
Tatyana Butskaya:
What is the asking price, do you know? How much does milk cost?
Jan Bogdanovich:
No, I don’t know the price of the issue, because it varies a lot, it happens. If I'm not mistaken, I read, I think, yesterday that $35, in my opinion, is worth, for 10 or 1 gram. I could be wrong. Or $3.5. I can not say exactly. Let's double-check the data, look and tell.
Tatyana Butskaya:
Yes, I really want this data to be sent to us by the end of the program.
Tatyana, you said that now there are prerequisites for the opening of 10 new banks. What system will they use? Will they also be only for those who lie in the center, or will they be for everyone?
Tatyana Kononova:
As with any project, we cannot yet talk about this program as a fait accompli. The program is still in the draft stage. You are also doing a great job now, raising this topic in your program. Also, the leaders of pediatrics, neonatology in Russia are now very great attention They pay attention to the fact that the state supports such banks, because it is very important. You are right when you bring up the topic of costs, because the costs are really quite high. Not only for the storage of banks, but also for the collection of information, for the creation of conditions where mothers can decant and so on. That's pretty serious money. It is clear that the state should take care of this and subsidize funds here. So far, unfortunately, this program has not yet been given the go-ahead. The project Yan spoke about, about 10 banks, yes, it is being promoted, it's good if they meet halfway. The state today is turning its face to breastfeeding. The campaigns that are now unfolding for breastfeeding, I think, will still be supported by monetary injections, not only in words will be supported. Then, indeed, the project can be promoted.
Tatyana Butskaya:
If we don't create official breast milk banks, there will definitely be a black market. I am sure that he exists, that he exists, that they sell untested milk. Do you have any data on it?
Tatyana Kononova:
He is. It exists, of course. I can say, by the way, about the prices that exist in this spontaneous market. 100 ml of milk costs about 500 rubles. This is the average price in Russia. There are 300 rubles and 1000 rubles. Approximately so. However, hand-buying milk from unverified mothers is always big risk for the mother of the recipient, because milk is a carrier. It is non-sterile, it is a carrier of viruses, bacteria. The bacterial flora of one mother may not be entirely suitable for another child. Then the question arises: how relevant are milk banks in general? There is a certain gradation that the WHO has created, and we must adhere to it. The number one nutritional preference for a baby is direct breastfeeding. The second is the freshly expressed breast milk of the mother. The third is the frozen breast milk of the mother, a personal breast milk bank. Then freshly expressed milk from a donor mother, frozen milk from a donor mother, and only then artificial formula. Whenever we decide on the risks, treatment, management of children (breastfed or not), we must take this gradation into account. She is really, really important. Even taking into account the fact that there are some mismatches of the mother's flora to someone else's child, nevertheless, this milk is always preferable to artificial formula, because artificial mixture will never repeat those necessary nutrients. There are no active immunoglobulins, growth enzymes, stem cells and many, many others. important components, which are artificially irreproducible and will probably never be reproducible.
An artificial formula will never replicate the essential nutrients found in breast milk.
Tatyana Butskaya:
Every time I hear that a woman needs to be checked, or someone needs to be checked, I think that today we checked, and tomorrow she got sick with something. How often should you check? What are the criteria? How often are tests taken? How often are women tested?
Tatyana Kononova:
Unfortunately, you are right. But, on the other hand, we are talking about some short period when the mother gives milk. It is believed that for three to four months, when the mother is a donor, it is safe enough to take her milk during this period, let's say, after a single analysis that was carried out before such an agreement was concluded with her. Repeated analyzes are not performed. If further the mother is already donating milk, probably, we are already talking about repeated analyzes. But, as a rule, the period of agreement with the mother is limited to this period. Yes, you are right, for example, the same blood bank is obliged to take new analysis. But at least a month must pass between them if we are talking about a blood bank. When we talk about a breast milk bank, this is a daily and, in general, continuous process, the mother comes every day and gives milk. We cannot torture a mother by taking tests from her every time.
Tatyana Butskaya:
I wanted to tell you that I have a foster sister. Who knows what it is, he will understand that I have literally been with the topic of breast milk banks since birth. A milk sister is a child with whom we drank the same milk together. When I was born, my mother had problems with milk, there was not enough milk. My mother found a woman who had a lot of milk. I grew up on this breast milk for several months, and by the way, I still communicate with Marina, my breast sister. Therefore, the topic is not so new. Unfortunately, to my great regret, I did not manage to sit for a long time either with the first or with the second child. I at least fed the first one up to 7 months, and with the second one I had to immediately go to work. She also decanted, had her own, individual breast milk bank.
I remember one day I, with the dominant breastfeeding, come to negotiations in one largest company, which produces breast milk substitutes, and during negotiations I say: “How so? Why is it now the 21st century, and still there are no milk banks anywhere?” I thought that this should be their social project, the producers of breast milk substitute. Companies that make probably billions selling breast milk substitutes as social project should support banks of expressed breast milk because they will never compete with them. Women will never express as much milk as the industry will produce.
Who is now leading the breast milk banking movement? Which companies?
Jan Bogdanovich:
Are we talking about companies that advocate breastfeeding? This is a well-known world brand "Medela", which is very actively investing in the creation of banks, investing a lot in research. In Russia, there will also be a study on breast milk banks. This is about double, single pumping and storage of milk. In Russia, this topic is also developing very actively, it is now being studied how the composition of milk remains useful for the child after the passage of the N-th amount of time, the difference between double and single is compared. Why between double and single? I'll give you an example. In Norway, if a baby is born prematurely, then the baby's mother is immediately given a clinical double breast pump, because double pumping produces more milk and more fat.
Tatyana Butskaya:
The three of us understand what “double pumping” is. Decipher.
Jan Bogdanovich:
Double pumping is when a mother pumps from two breasts at the same time. Milk is expressed simultaneously from two - not from one breast, but from two. This allows the mother to express more milk, and the milk is fatter, more nutritious. Therefore, clinical breast pumps are double. It is imperative for a child to immediately receive milk, let's say, top quality in terms of nutrients. In Norway (just about the price) expressed milk costs $20 per liter and is given a clinical breast pump. This is a government program. This year, the state has turned its face to breast milk and breastfeeding, in addition to the initiative of breast milk banks, the state seems to be very actively going to invest in perinatal centers. Because of this, there is help for mothers, this occasion in Russia, a law was passed on supporting families, about feeding a child. There are steps to help. Now more is being done to ensure that a child who was born prematurely, who does not receive enough milk, so that the mother has the opportunity to feed the child with breast milk.
Tatyana Butskaya:
Did I understand you correctly that now at the state level the idea of creating breast milk banks is being lobbied by companies that are actively engaged in the production of breast pumps and freezing agents? This also has its own truth, because if you do not use what the 21st century gives us, then it will be difficult even to create breast milk banks, which, as it turns out, have existed for many, many years.
Here's what I wanted to clarify. I'm interested in facts. You said about pumping from two milk breasts at once. What research is there to support your claim that pumping from two milk breasts at once makes the milk more nutritious? As a pediatrician, I remember that first the first liquid milk comes out, with which the child gets drunk, only then comes thicker milk, with which he is saturated. Refute me.
Jan Bogdanovich:
I will give the floor to Tatyana, who snatches the microphone from me, taking the second one for herself.
Tatyana Kononova:
Yes, I will talk about this study. It was conducted at the University of Western Australia, a leading university in the study of lactation and infant suckling, under the guidance of Professor Peter Hartmann. The study of double pumping versus single pumping was conducted by Daniel Prime. How exactly did it go? Women who were mothers of full-term, healthy babies with established lactation came to the research center twice. On the first day, these volunteers came in and pumped one breast on a special device called Show Milks using a clinical breast pump. Every minute of the time, the device displayed the separated milk, the flow rate, its composition, fat content, etc. Second day: The same mothers came to the research center and pumped two breasts, pumped for the same 15 minutes as on the first day. During these 15 minutes, starting from the first minute of milk separation, the Show Milks device showed that more milk is separated into the device, and after 15 minutes of time, 18% more milk was released from each breast during double pumping. This is an average.
Every mother who took part in the study produced more milk with double pumping. For what? You know that during one pumping (session) there is not one flush, but several. On average, this is 4.3 tides. 4 - 5, let's say. Excess separated milk occurs due to the fact that there is an extra tide. You knowingly took the topic of "forward" and "hind" milk. Just what is additionally allocated? "Rear", of course, more milk is released. This contributes to the fact that the total fat content of portions increases. We understand that fat content by itself cannot increase, but due to the fact that the best is coming the separation of the “hind” milk and the additional tide due to it, the fat content of the portions increases. From 7.3 in control group up to 8.3. 7.3 is with single pumping, 8.3 is the fat content that was obtained with double simultaneous pumping. In this way, not only can we quickly increase the volume of milk and its fat content, but we can also help prevent congestion in the breast. In addition, receiving discharge, we better free the breast from milk. Like these ones amazing facts were obtained from the study.
It is clear that one of the recent trends is double pumping, which helps, first of all, mothers with hypogalactia and mothers of babies who are not gaining weight. After all, as you know, the first reason why a mother begins to add a mixture to a baby’s diet is a lack of weight, weight gain. Mom starts to worry, which is understandable. Of course, we always worry if the baby does not gain weight. At us at once: the hungry, malnourished child. In fact, this way you can instantly increase the fat content of milk and quickly achieve good weight gain.
Tatyana Butskaya:
Friends, remember this advice, because you constantly ask me on my Instagram blog. There are already more than 1.5 million subscribers, and I still answer questions. Very often you ask me about how you can increase, what products can increase the fat content of milk. Experts say that products, as such, will not increase fat content, no matter how much you eat. walnut, drinking it with milk with condensed milk. Most likely, the child will have an allergy, rather than your milk fat content will increase. And this one is very interesting advice: the more hot flashes you have, the more hot flashes you feel, the more “back” milk you get, the more the child receives, the more satisfying he eats, the better he, respectively, sleeps, grows and becomes smarter.
I'm generally interested in the latest data, the latest that scientists have found. Share something else in terms of breastfeeding.
Tatyana Kononova:
Probably one of the latest interesting discoveries is stem cells. They are still being researched for what they are needed. But one of the versions that is now being tested and is being confirmed in research at the University of Chicago is that stem cells are a kind of reserve building blocks from which cells of the brain, liver, fat can be formed, that this is a building material from which other fabrics. This is very important for the growing body of the baby, when it is very quickly necessary to satisfy the needs of the same, for example, the brain, which develops very intensively, rapidly, in the first two years. After two years, the baby's brain is up to 80% of the volume of an adult. Of course, its construction requires very large, colossal reserves; it is mainly created from lipids. Stem cells are the very building material that can be reborn into other cells as needed.
One of the latest interesting discoveries is the presence of stem cells in breast milk.
Tatyana Butskaya:
So stem cells are in breast milk?
Tatyana Kononova:
Yes, absolutely right.
Tatyana Butskaya:
There is no way they can be put into any mix.
Tatyana Kononova:
No, of course, definitely not possible.
Tatyana Butskaya:
Accordingly, there are stem cells both in mother's breast milk and in breast milk, which was deposited in the bank.
Tatyana Kononova:
Yes, in any mother's milk, of course. Just mother's milk mother, of course, perfectly balanced, because it meets the needs precisely this baby. It is clear that donor milk is better than a mixture. But, if the mother has the opportunity to feed her own milk - this is always the most good decision, because it corresponds not only to part of the day (for example, milk is different in the morning and evening), but also to the age of the baby, his condition. The baby is sick - we change the milk in accordance with his condition. It becomes more water, because the body of a sick baby needs more fluid. It's unique.
Tatyana Butskaya:
At this point, I want to say that true hypogalactia is when mom says: “I don’t have milk. I have nothing to feed the child”, is very, very rare. According to various sources, from 1 to 5%. I don't know, maybe you can tell me your percentages, but 5% is, I think, already a very inflated figure.
Jan Bogdanovich:
Maximum.
Tatyana Butskaya:
Rather, it is about 1%. I again recall the history of my family, for me it is somehow very closely connected with breastfeeding. My grandmother told how she gave birth to her child during the war. A bomb shelter, she fed him, dried diapers on herself, but, nevertheless, she fed him only breast milk, because there was nothing else to feed. It has already been proven, and there is confirmed data, that everything is from our head. At the moment when you realize that the child has no other food than your milk, that he is either hungry or you are feeding him, at that moment you will still have milk. And now we are in a relaxed state, because we sell mixtures, unfortunately, just within walking distance, we can come not only to the pharmacy, but also to the grocery store, buy a jar. I am very worried about questions like: “How to choose a breast milk substitute?” Buying such a jar, or another, without realizing that this is a treatment, is a huge responsibility.
What am I leading to? While we do not have state official breast milk banks, is there an opportunity for mothers who could not cope with their psychology, could not convince themselves that milk will come(But it will definitely come, friends, it will definitely come. There are very few states when it does not come.) So that they don’t immediately run to buy the mixture, but could turn somewhere. Let's come up with some life hacks. What would you do, Tatyana, in the place of a mother who has a newborn in her arms, and now there is not enough milk, you see: the child does not get enough. Would you go somewhere? Would you search on the Internet?
Tatyana Kononova:
Donor milk, you mean? You know, probably not, unfortunately. Because there is a risk of infection from an unfamiliar mother, it is still quite high.
Tatyana Butskaya:
What if you find her and check the milk?
Tatyana Kononova:
Milk is difficult to test. It is necessary to check the mother herself, to do a blood test. You can check your mother, although this, of course, is a slightly unrealizable plot. Why? Because a rare mother will be able to provide fresh tests for her milk. If this happens - yes, probably, I will still make a choice in favor of donor breast milk.
Of course, you are right, starting with the fact that this is a temporary phenomenon, you need to deal with the implementation of your own lactation, the activation of lactation, as soon as possible. It takes just a few days, during which the baby will not suffer much, especially if we are with him. A mother can lose milk for various reasons. There may be, for example, stress factors, or, for example, the failure to develop timely lactation, when there was a separate stay of the mother and baby. After that, you need to feed, and the mother really does not have milk yet. The main advice that we give is that it is necessary to organize a so-called feeding nest, in which you can literally lie down with the baby, disconnect from the whole world, the husband will wait with his dinners. Sorry, of course, but now it needs to be like this, because priorities need to be set. Take care of the baby only. Give breasts on demand, and not 8-10 feedings per day, but 20-25-30. Literally, you hang with your breasts day and night, especially at night, because it is very important, as you know, for the milk-forming hormone prolactin. Literally, after a few days of such intense, persistent attachment to the breast and being with the baby, milk will appear, for sure, it will not go anywhere.
Jan Bogdanovich:
Mom should do everything possible to ensure that there is lactation of her own milk. Yes, it often happens that this is a problem of psychology. We often receive such questions. But subject to certain rules and steps, as Tatyana said, most mothers, in 90 cases out of 100, milk appears again. Therefore, the mother, probably, must first do everything possible to ensure that her milk comes.
Tatyana Butskaya:
Friends, let's sum up the results so that the most important facts that we talked about today remain like points in the heads of our radio listeners, viewers.
The first thing we want to convey is that the 21st century is not the time when you have a problem and you give up. Always know that you can spread straws and create your own breast milk bank. Start from the very first days after discharge from the hospital to express excess, save, freeze. On the websites of the respective companies, everything is very clearly spelled out. It is better to refer to the official websites, where it is written how to use breast pumps, how to freeze, how to defrost. By the way, we didn't talk about it. Very interesting. You can’t defrost in the microwave, as it seems to us, you can’t immediately boil. This is very hard way. Pay attention to this. This is really a bank where you can turn if any problem suddenly arises.
If you suddenly have not created such a bank, know that if you live abroad, you have the opportunity, especially in America, to contact these banks (we already know approximate price: $20 for 100 ml) and buy milk. If you want to find such a bank in Russia, then they exist, but so far they exist only with scientific centers, state institutions, and they can only be used by mothers who are in this moment there are, or can be allocated on a specific request for premature babies. There is no official bank of expressed milk, but, in principle, there is a black market. If you really want to go there, then at least ask for tests, this is very important. I would personally take this woman by the hand and do an analysis to be sure that the certificates were not bought. Because, as Tatyana told us, first, the most important thing is breast milk, expressed mother's milk, frozen, then there are cans of milk, only then substitutes. This is very important to know.
Jan, Tatyana, thank you so much for being with us today!
Jan Bogdanovich:
Tatyana Kononova:
Mom's milk is perfect food for the baby, especially the first months of his life, and therefore it is worth doing everything possible so that no circumstances prevent him from receiving it. Expressed breast milk can be stored frozen for a long time, but it must be collected and stored properly.
Why create a milk bank and when you might need it, how to properly collect, pack and store expressed milk and how to feed a baby, said breastfeeding consultant and dairy blogger Nina Zaichenko.
When is expressed milk useful?
First of all, if trouble has happened to you and you need to take medications that are not compatible with breastfeeding. Of course, you should try to avoid such a turn of events, for example, together with your doctor, pick up safe alternative drugs. But, alas, this is not always possible, and for the period of treatment, milk expressed in advance will save you.
You plan to go to work, and a person you trust remains with the child - it is quite possible to express milk for 1-2 feedings on the same day, as well as use the saved one.
If a baby under 9 months remains without a mother’s breast for several days: for example, you are in the hospital or you are leaving as needed.
Anticipate everything possible options difficult, but it would be nice to know about them in advance, if possible, this will allow you not to transfer the baby to artificial mixtures and feed mother's milk until he can get back on his chest again.
How to feed your baby with expressed milk
There are several rules that are important for mom to know and teach the person who will feed the baby in her absence:
Understand yourself and teach the breadwinner to notice when the baby asks for food - feeding "on demand" should be maintained even if the baby does not receive milk from the breast
Feed your baby as much as possible alternative ways- from a spoon, cup, syringe without a needle. If you still cannot do without a bottle, try to choose a nipple that resembles your breast in shape, or rather the nipple. The hole in the nipple should be minimal, and the shape of the nipple should force the baby to open his mouth wide, as if latching on.
When to express milk for storage
As a rule, most milk in the breast occurs in the morning, you yourself noticed this, this is how our The biological clock. Therefore, try expressing milk from one breast during the morning feed. Nina Zaichenko recommends putting the baby to one breast at the same time expressing milk from the second.
If you cannot get the right amount in one pumping - from 60 ml, then you can add it to the same container throughout the day until you get as much as you need for one feeding. Store milk in the refrigerator in between.
The container in which the expressed milk will be stored must be sterile and tightly closed with a lid. Before you put the jar in the freezer, sign it: when the milk was expressed.
When feeding a baby in the mother's absence, use the freshest milk first, then taking into account the date of pumping.
More important to know:
- At room temperature (18-24 degrees), breast milk does not spoil until 10 hours, but you should not leave it for so long without urgent need.
- In the refrigerator, expressed milk can be stored for 5 days, according to some recommendations up to 8.
- In a conventional freezer, breast milk can be stored for 3-4 months, in a deep freezer for 6 months or longer.
- Breast milk should not be thawed in the microwave and should not be refrozen.
Hear what else you need to know about starting a breast milk bank
Over twenty five years World Organization health care Special attention the importance of breastfeeding for the health and well-being of the baby and mother. Not breastfeeding can lead to a variety of negative consequences among which are an increase in cases of obesity, diabetes, and developmental disorders. For a baby, mother's milk is especially important in the first six months of life. The importance of breastfeeding, pumping and an individual breast milk bank told Olga Koreneva, specialist in breastfeeding of the department of neonatology and pediatrics NMICAGiP them. Kulakova, perinatal psychologist.
Breastfeeding in Russia: Moms ready, but little support
In Russia (GV) may differ in different regions and strata of society. The prevalence and duration of breastfeeding is strongly influenced by social and cultural aspects. In large cities, for example, they are fed less than in the provinces. Often, medical staff are aware of the benefits of breast milk, but they are not always able to support the mother and help her properly.
WHO has developed programs for medical institutions to support breastfeeding, training courses for doctors, there is an excellent WHO / UNICEF initiative “Baby-friendly Hospital”, but, unfortunately, this is very little used in Russia. Today there are many scientific research, but Russian recommendations are often based on or personal experience. About 90% of mothers are determined to breastfeed at the time of delivery, but not everyone manages to maintain this attitude when faced with the first difficulties and a large number of conflicting recommendations. Over the past few years, breastfeeding statistics in Russia have not changed, everything remains at a low level.
How to set up a home breast milk bank
The idea of stockpiling your own milk is now very popular, with many mothers asking specialists about it. If a nursing mother plans to occasionally or regularly leave the house, a so-called “milk bank” may be useful to maintain breastfeeding. This is a supply of frozen breast milk that will allow the father or other relative who stays with the baby to feed him.
Photo credit: comzeal images/Shutterstock.com
Stock preparation: From the moment lactation is established, express milk 1-2 times a day and freeze it in the freezer. Usually, the morning time is good for collecting milk "in reserve" when the breast is more full after night, but you can choose another convenient time. You can give one breast to the baby, and express the milk from the other for storage.
Freezing and thawing: It is advisable to freeze fresh milk as soon as possible after pumping. Before freezing, it is better to cool it in the refrigerator. It is most convenient to freeze in small portions, you can use different ones, from 40 to 80 ml. Before giving milk to the baby, defrost the milk quite smoothly (first it is advisable to move it to the refrigerator, you can overnight), and then warm it in warm water. If time is short, a container with warm water or special heaters. But slow defrosting in the refrigerator results in less fat loss.
Storage: For storage, special bags or containers made of safe plastic are suitable. The shelf life of breast milk is quite large - from 3 to 6 months in the freezer of a two-chamber refrigerator (-18 0 C). On the short term milk can not be frozen, but stored at room temperature (4-6 hours) or in the refrigerator (24-72 hours).
When expressing, it is important to observe hand hygiene and properly handle the parts of the breast pump. According to many scientific studies, breast milk has a number of properties that protect it from bacterial contamination, allowing it to be stored for a long time. It practically does not lose its properties, with the exception of a slight decrease in the activity of some components.
When pumping is especially important
Modern mothers are active, they do not sit at home, and they do not always have the opportunity to take the baby with them and apply it to the breast. Then a breast pump comes to the rescue, which allows you to effectively collect breast milk. But this is not the only situation where pumping may be required. It is important for a mother who is preparing for breastfeeding to know in what cases it may be required.
Popular earlier recommendation pumping after feeding "to the end" is a thing of the past. Modern Recommendations prescribe to feed the baby on demand, according to a “free” schedule. By the end of the second or third week after birth (maximum by the fifth or sixth), lactation is established in full. The baby and mother adapt to each other, and the woman's body produces as much milk as the baby needs. A fairly stable supply-demand balance is formed.
However, there are situations when you need to express milk. For example, in the case premature birth the baby is born and feeds on expressed breast milk for some time before he can begin to actively suckle the breast. A full-term baby also cannot always be fully fed from the breast, if there were difficult childbirth, operations are required, there are various pathologies, etc. Departments of resuscitation, surgery and pathology of newborns in the Center. Kulakova are equipped with special pumping rooms, and the ability to express breast milk is a real salvation for mothers of such babies.
Mothers of healthy babies also have a need to express milk, for example, in the first days after childbirth, when milk “comes”. Often, women experience discomfort: the breasts become very full, and it is more difficult for the baby to cope. Additional pumping is indispensable even with a separate stay after childbirth. Then the breast pump in combination with gentle massage allows you to quickly establish lactation. Breast pumps are becoming more and more modern - they do not injure the breast, they allow you to collect milk immediately in a bottle or storage container. Now moms can choose between simpler yet functional manual breast pumps and electronic, imitating the process of natural sucking of a child. Such devices include, for example, the Ultra Comfort breast pump from Philips Avent, created on the basis of the results of a study of the physiology of sucking a child. When establishing breastfeeding, it is important for a mother to believe in herself and not be afraid of difficulties, seek support and help, read more about breastfeeding before childbirth. This process is very flexible, and there are no irreversible situations and dead ends. There is almost always a chance to establish exclusive breastfeeding even in difficult cases.