BACKGROUND: The Human Milk Banking Association of North America (HMBANA) is a nonprofit association that standardizes and facilitates the establishment and operation of donor human milk banks in North America. No study has characterized the demographics, characteristics, and geographic distribution of its donors. MATERIALS AND METHODS: Donors were eligible for inclusion if they were donors at MMBNE, provided a gestational age for their infant, and donated between 1/1/2011-9/1/2019. Data collected from donor surveys and milk collection procedures were analyzed using descriptive statistics, chi-square tests, t tests of independence and Mann-Whitney U tests. RESULTS: Data were analyzed from 3767 donors. On average, donors were 32.5 years old (range 17-52) and donated more than once (mean 2.8; median 2; IQR 1-3; range 1-41). The majority of donors gave birth to term infants, lived in New England, and were not bereaved. Massachusetts had the largest proportion of donors (40.9%), however donors were located in 39 states and four countries. The median total volume donated per donor was 21904mL (741Oz). The average volume of donation per donor increased over time. Mothers who had preterm births were more likely to be bereaved (66% vs. 13%; p<0.01) and the volume of donation (mL) was associated with term versus preterm birth status respectively (p<0.01). CONCLUSION: Donors to MMBNE were generally older, repeat donors with term infants, and broadly geographically distributed. Further research is warranted to understand additional characteristics associated with milk donation and any characteristics of mothers who are and are not able to donate milk in accordance with milk bank protocols.

Premature newborns’ medical need for donor human milk surpasses the supply and the demand for it continues to increase. Lactating mothers with a surplus can help fill the gap and give fragile infants a better chance to grow by donating breast milk. This thesis project examines challenges in the human milk donation process and observes general milk donation operations. It seeks to answer what kind of tools and support are needed to streamline the human milk donation process for lactating mothers who voluntarily donate their extra milk supply. Looking closely at information and communication technologies, the project notes design implications for the development of donor-supported digital tools. Through a user-centered design approach, qualitative interview strategies, and feedback from a milk bank, mockups of a digital waiting room were created to provide informational and social support for donor mothers.

With approximately 24,500 preterm children born annually in Canada and an estimated shortage of 6 million ounces of breast milk, the distribution of donor milk must be time-sensitive yet safe to efficiently meet this demand. Donor human milk banks take the greatest precautions to protect their users, but some of these microorganisms manage to circumvent the employed methods. The consumption of contaminated donor milk has the potential to be fatal particularly to the vulnerable, immunocompromised premature infants. The tools used by milk banks to ensure safe distribution rely heavily on the culture plate. It has been the gold standard in screening for microbiological specimens due to its wide availability, low cost, and simplicity. However, the procedural times for bacterial culture plates are tedious and long, lasting a minimum of 48 hours. Advances in microfluidics, particularly in combination with the concept of monitoring metabolites to indicate bacterial viability, hold much promise to significantly reducing the long processing times of culture plates. Combining the concept of compartmentalized culture and a chromogenic optical dye for the detection of metabolic changes as a diagnostic sensor would simplify the identification and quantification of microbial presence. The updated Rapid Culture Detection system is a nanowell device fabricated using polydimethylsiloxane (PDMS) that uses the oxygen-sensitive redox indicator Methylene Blue to determine the presence of bacteria. Preliminary studies have shown to detect bacteria in as little as 3.33 hours using these nanowells compared to the 24 hours required for microwell liquid culture (620%). Initial studies have also been conducted with human milk, indicating a slower detection than in LB media. The novel easy-to-use and low-cost Rapid Culture Detection system is a promising alternative detection tool for protecting infants from pathogenic illnesses caused by contaminated human milk and shortening the time required to access lifesaving nutrition. / Thesis / Master of Applied Science (MASc)

abstract: In this study, I used critical, qualitative methods to explore how the material and symbolic dynamics of milk banking complicate expectations of organizing and (in)effective lactation. Guided by theories of alternative organizing, in/voluntary membership, the structuration of d/Discourse, and corporeal commodification, I conducted document analysis, fieldwork, and interviews with hospital and milk bank staff and maternal donors and recipients. Results trace the (her)story and protocols of the milk banking industry and examine the circumstances of donation and receipt; the d/Discourses of filth, suspicion, and inadequacy that circulate the lactating, maternal body; and the presence or resistance of commodification within each organization. Milk banking occurs when mothers provide excess breastmilk to parents with low supply or compromising medical conditions. “Milk banking” is used as an umbrella term for different ways of organizing donor milk; organizing evolved from wet-nursing to a continuum of in/formal markets. Formal markets include for-profit and non-profit milk banks that pasteurize and/or sterilize breastmilk for Neonatal Intensive Care Units. Informal markets involve self-organized exchanges online that are driven by monetary ads or donation. Both formal and informal markets elicit questions regarding flows of capital, labor, reproductive choice, and exploitation. However, current research resides in medicine, law, and popular press, so we know little about how milk banking happens in real time or how participation affects maternal identity. My analysis makes four contributions to organizational communication theory: (1) alternative organizing punctuates the construction of and conflicts between in/formal markets and shows why such theories should be represented as cyclical, rather than linear; (2) membership in milk banking is unintentional and distinct from in/voluntary membership; (3) the obscured organization is a necessary alternative to Scott’s (2013) hidden organizations; and (4) d/Discourses of “safety” are used to discipline and indict, not just represent operational differences. Social-rhetorical implications reveal how milk banking operates as an affective economy (Ahmed, 2004) and mark where privileges and inequalities are present in the absence of data; practical implications suggest consideration of policy changes. Methodologically, this study also offers insight into crystallization (Ellingson, 2009) and participant witnessing (Tracy, forthcoming) and challenges the hegemonic underpinnings of fieldwork. / Dissertation/Thesis / Doctoral Dissertation Communication Studies 2019

Mothers are known to have an emotional attachment to their infant; however, some mothers also experience an emotional attachment to their own milk. Exclusive breastfeeding in the first six months of life, followed by continued breastfeeding with complementary solids are recommended by the American Academy of Pediatrics and the World Health Organization. Some mothers produce enough surplus milk to donate to a human milk bank. This thesis considers the emotional attachment to milk experienced by women who donate milk to a milk bank. This research is based on participant observation in a human milk bank in Florida and interviews collected from 14 milk bank donors. These methods were informed by the frameworks of moral motherhood and emotive value to foreground and enhance understanding of mothers' experiences. The results of this study show that mothers do not emotionally attach to breastmilk itself, but rather what the breastmilk represents. This study starts a conversation and brings awareness to women's emotional experiences at the beginning of motherhood, especially as they pertain to breastfeeding and human milk.