Most mothers are able to breastfeed their infants when they head home from Hawaii’s busiest newborn intensive care unit at Kapiolani Medical Center.

But for those who can’t, the hospital relies on breast milk donations — acquired from a human milk bank all the way in Austin, Texas.

That’s because Hawaii hasn’t had a local facility for the testing and pasteurization of donated breast milk for more than three decades.

So Breastfeeding Hawaii is instead trying to recruit more Hawaii mothers to donate breastmilk. Lea Minton, Breastfeeding Hawaii board president, says it’s a first step to resurrecting a milk bank in the islands.

Breast milk can be critical to the healthy growth of infants, but Hawaii hospitals must rely on donations sourced from the mainland.

Mother's Milk LLC

The lack of a local milk bank means more reliance, with associated shipping costs, on milk donations sourced from the mainland.

Hawaii’s former human milk bank closed in the 1980s when a pesticide linked to pineapple production was found to be present at unsafe levels in the milk supply — both in cow’s milk for consumption and in nursing mothers’ breast milk.

The technology also didn’t exist back then to properly test for certain diseases, said Minton.

Hawaii Mother’s Milk, the nonprofit that operated the former milk bank, transitioned to lactation consulting, which it still offers for free at Kapiolani Medical Center.

Milk Call-Out

Minton is looking for more Hawaii mothers to donate their extra milk to mothers and infants in need — via California.

Minton has partnered with the Mothers’ Milk Bank in San Jose and helped to designate two sites as shipping supply sites. After a screening and blood work, registered mothers may pick up coolers at either the Waimanalo Health Center or from Mother’s Milk LLC in Kamuela on the Big Island and then ship their donation to California.

Some of it will come back to Hawaii, since the Mothers’ Milk Bank in San Jose supplies milk to Kaiser Permanente. But much of it will be sent to other hospitals and families around the country.

The San Jose milk bank has screened 41 donors from Hawaii since 2017.

Since the shipping supply sites in Waimanalo and Kamuela opened, 22 more mothers began the process to become donors, but only two have been approved to date. A handful were disqualified, and a dozen more Hawaii mothers are still in the process, according to Minton. Mothers may be disqualified or deferred if they’re taking medication or supplements or are ill.

Amber Granite, WIC Breastfeeding Coordinator at Waimanalo Health Center, has been eagerly waiting for mothers to donate ever since the site was equipped with the coolers this summer.

Two sites in Waimanalo and Kamuela have been designated shipping supply sites for mothers who want to donate breast milk.

Le'a Minton

“Milk supply is the main issue we see with why moms give up so early within those first weeks,” Granite said.

“If they’re not trying really hard to put baby to breast every two hours, their supply tends to go down, or if other family support says, ‘Oh, just give them the bottle this time,’ that turns into a bottle every time and the baby gets used to the bottle.”

When she helped one Waimanalo mother exclusively breastfeed her fifth child after the mother had raised her other four children on formula, she considered it a big victory.

Doctors recommend breast milk as the best option for infants, as it has been shown to lower the risk for obesity, diabetes, respiratory or ear infections and bowel inflammation.

Most Hawaii mothers initiate breastfeeding, but sticking with it for the recommended six months is not as common, Minton said.

“That tells us we need more support in our community,” Minton said.   

‘Liquid Gold’ Marketplace

Both Minton and Granite have noted a growth in the sharing of breast milk via online platforms, mostly Facebook.

“When you have what everybody calls liquid gold, you cannot imagine throwing it out,” Granite said. “The milk sharing does happen but this process we’re trying to start is just a way to ensure the pasteurization and ensure the screening of the milk.”

Even mothers visiting from out of state offer their extra milk to local moms.

Mothers with extra breast milk often inquire online to see if other mothers would like to use it.

“I will be visiting Maui… I’m still breastfeeding, I’ll be pumping on the trip and want to extend the message,” one mother wrote.

“I’m traveling to Honolulu from North Carolina,” another mother wrote. “Our daughter was adopted at birth and has always been on breast milk. Would anyone possibly be willing to pump/donate while we are in the area?”

Donated milk from friends and other mothers comes with some risk since the milk hasn’t been tested or pasteurized.

The Price Of Donor Milk

There’s another product on the milk market for mothers, but it’s pricey.

Southern California-based company Prolacta Bioscience Inc. sells a fortifier that offers more protein, calories, and carbohydrates for medically fragile infants. The company uses donated milk for its product. 

The Los Angeles Times reported that a bottle of the fortifier can cost $125 to $312, depending on the caloric intake. Per hospital stay, it can cost insurers $5,600 to $10,000. Minton estimates it costs as much as $36 per ounce today.

“Not all mothers realize that the place their milk is going to is a for-profit company,” Minton said.

Kaiser Permanente Hawaii’s newborn intensive care unit began to use Prolacta in June.

“They’re finding it’s better for the NICU kids who are really frail and vulnerable and need all the nutrition they can get,” said Kaiser spokeswoman Laura Lott.

But Kaiser still acquires milk from San Jose for infants that are not as medically fragile.

Donor milk usually runs at about $4 per ounce, Minton said. Mothers are never compensated for their donation, but nonprofit milk banks set the price to keep their testing pasteurization and distribution services.

Former Mothers’ Milk San Jose executive director and now consultant Pauline Sakamoto says there are many Hawaii families who rely on donated milk, even after they leave the hospital’s NICU.

“A lot of NICU babies go home and fail to thrive on formula, so the pediatricians will order human milk for them until they mature enough to take formula,” she said, recalling recent orders from Maui and the Big Island.

To ship a box with 50 4-ounce bottles of frozen milk from California to Hawaii overnight as required costs about $150, she said. Shipping to families on neighbor islands takes the price up to $180. Human milk is not always included in health care insurance coverage.

Can A Bank Come Back?

If Hawaii were able to reopen a human milk bank, it would be more efficient, accessible and less expensive. But it will take resources.

“It’s almost like opening up a laboratory,” said Karen Tao, the clinical manager of the Neonatal Intensive Care Unit at Kapiolani Medical Center. “Because donor milk is considered a bodily fluid, it gets classified as something kind of like blood or tissue.”

Currently, there are only 22 states with milk banks, according to the Human Milk Banking Association of North America. Brazil, by comparison, has more than 200.

For now, when new mothers at Kapiolani Medical Center want to donate, Kapiolani will continue to connect them with the Mother’s Milk Bank in Austin, Tao said.

In the coming months, Minton will be searching for sites to house human milk “depots” with refrigeration capacity so mothers may be able to drop off donations with ease. She also wants to add more shipping supply sites across all islands.

“Opening a donor bank is totally different than when they ran it in the 1970s and 1980s,” Minton said. “We are still driven toward that goal.”

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