The History of Milk Banking

Introduction

At the dawn of the twentieth century, nearly all children were human milk fed - either maternally breastfed or provided with donated human milk. Over the next one hundred years, a number of dramatic changes took place including the replacement of human milk by artificial feeding products. By the beginning of the twenty-first century, human milk feeding was once again the recommended method of infant feeding. Experts recommend breastfeeding exclusively for six months and the introduction of age appropriate foods with breast milk to remain in the diet for two years and beyond. When maternal milk is inadequate or lacking particularly for high risk or premature infants pasteurized donor milk is the next best option. Donor milk banking plays an important role in meeting these recommendations.

Wet Nursing

The roots of donor milk banking reach back to earlier times when children were either breastfed by their mothers or breast fed by friends, relatives or strangers - a practice referred to as "wet nursing". Evidence of the support for "wet nursing" is present in the Code of Hammurabi from 2250 BC where the attributes needed for good wet nurses are described. In those early days, children were thought to inherit the physical, mental and emotional traits of their wet nurse through the breast milk so selection of the nurse was felt to be very important. In the 13th century, European women made more money working as wet nurses than any other occupation open to women. By early in the twentieth century, awareness of the possibility of disease transmission, difficulty finding wet nurse particularly in North America and an increasing number of artificial feeding products resulted in increasing interest in artificial feeding.

Artificial feeding
Throughout the ages, when maternal milk was unavailable and wet nursing not possible, many different substances were tried in order to feed young babies. Prior to the mid 19th century most of these products resulted in the death of the infant. By the late 19th century, with the beginning of milk analysis, the first infant "formulas" were developed. Due to its availability, cow's milk, although very different to human milk, was used in the development of these "formulas." These early infant "formulas" often provided by the individual physician, involved complicated methods of modification of cow's milk. Improvement in food processing led to the development of condensed and powdered formulas which were easier to use. "Formulas" have continued to evolve and are still a "work in progress" over one hundred years later.

During the first half of the twentieth century a number of cultural changes resulted in the replacement of human milk by artificial feeding as the normal method of infant feeding. These cultural changes included medicalization of birth, changing physician and women's roles, increasing influence of science and increasing advertising of "formula." By the 1950's, most hospitals and health professionals in the developed world promoted artificial feeding as the feeding method of choice.

The marketing of artificial feeding products, begun in the late 1800's, has continued until the present day with the consistent message of physician endorsement, scientific development and good nutrition. This is the most successful marketing campaign ever undertaken resulting in the complete cultural acceptance and the perception by both the general public and many health professionals of a safe optimum product equal to or better than human milk.

Donor Milk Banking
Over the last hundred years, breastfeeding and the use of human milk has been promoted by various groups. The emphasis on use of human milk including donor milk banking has waxed and waned throughout this time. Early in the twentieth century, milk banking blossomed and grew with increased use of donor milk for ill and premature infants. Mothers with abundant milk supplies were asked to provide milk for ill infants by either nursing the babies directly or expressing milk. With technological and hygienic advances, milk banks were established as collection and storage of milk was possible with the development of refrigeration and a greater knowledge of safe food processing. In 1909, the first milk bank was established in Vienna, Austria. By 1919, two additional banks opened - one in Boston and a second in Germany.

Some of the most famous North American consumers were the Dionne quintuplets, born premature in northern Quebec, Canada in the 1930's and provided with 8,000 ounces of donor milk from both Canadian and American donors. A year later, British quadruplets received donor milk from the Queen Charlotte Milk bank which is still in operation today. Most of these early banks collected and distributed unprocessed milk to ill and premature infants.

Throughout the developed world, donor milk banking grew as pediatrics progressed and increasing numbers of ill and premature infants survived. In some cases mothers provided donor milk by nursing babies directly but in many other cases, there was no contact between donor and recipient.

In 1985, the Human Milk Banking Association of North America (HMBANA) was established with one of the main goals being to establish standards for all North American milk banks. These standards, first published in 1990 form the basis for many other milk banking documents around the world and are reviewed and updated annually by HMBANA.

Also in the mid 1980's, with the advent of AIDS, the number of milk banks was dramatically effected. Concern for the unknown and the need for increasing complex screening of donors and milk processing resulted in many banks closing, almost overnight. Donor milk banks in North America were reduced to about eight or nine banks by the end of the 1980's.

By the 1990's with evidence of safety and increased research on the benefits of human milk, donor milk banks are again increasing globally. Many developed countries around the world either have established donor milk banks or are considering the establishment of donor banks. In North America, the interest in donor milk banks is also growing. Many families, aware of some of the problems associated with artificial feeding products, are requesting donor milk, particularly when they have an ill or premature infant and maternal milk is insufficient or unavailable. In addition, with increasing emphasis on informed choice, family centered care and best practice, health professionals are also seeking information on establishing banks.

Over the last one hundred years, the interest in human milk has come almost full circle with the understanding that although artificial feeding products are continually improving, human milk provides factors not replicated in any other source of nutrition. In addition, provision of a safe source of donor milk, supports breastfeeding by clearly indicating that human milk cannot be replaced. In the twenty-first century, donor milk banking is once again blossoming.

F. Jones
October 2003