Antenatal blood tests do not include HTLV (Human T-lymphotropic virus type-1 & 2), Hepatitis C and CMV (Cytomegalovirus). These three additional tests are important for donating breast milk as they can pass through your milk and can affect the receiving baby. You may not know you have contracted a virus, as symptoms could be similar to the flu. Antenatal blood tests are often performed after the 12th week of gestation, in which case they are too old by the time a full-term baby is born. The viruses screened for milk donation have an incubation period of up to 3 months. Antenatal blood tests (Syphilis, Hepatitis B and HIV) and HTLV, Hep C and CMV, will need to be tested just after or just before the donor's baby is born to be accurate. MMNZ recommend blood tests aligned with international milk banking standards, so that recipients can choose to use raw milk knowing that it is virus-free and high in immunity factors and nutrients that could otherwise be reduced using pasteurising methods, so they can use donor milk with confidence. However, if you choose to pasteurise/flash heat your milk, this does not mean all the “good stuff” is gone, not at all. Pasteurised donor milk is still far superior to formula.

All medication and herbal preparations can potentially pass through breast milk in varying quantities, depending on how the body metabolises them. Generally, only small amounts reach babies, and most term healthy babies can continue to be breastfed in most circumstances mothers own milk, and in some circumstances, donor milk. When considering medications in donor milk, it pays to consider who is receiving the milk. Such as; whether the baby is premature, has a health defect or is healthy and full-term. We also need to consider what additional medication, herbs or supplements are present in mother's own milk (if she is providing some milk of her own) or other donated milk supplied for the baby. Contraindications need to be considered, and that there is limited research regarding maternal medication/supplementation for babies. MMNZ promotes informed consent and recommends a cautious approach: consult your midwife or paediatrician first before accepting donor milk with recent vaccines/medications/herbs/vitamin supplementation. For more information, follow Canterbury District Health Board's Guidelines HERE

If you are unwell, please contact your healthcare provider and the receiving family directly, and withhold donations until symptoms have passed for a week. This is to reduce the spread of infection to the recipient baby. If you have taken antibiotics or other medication, please alert the recipient to give them the pharmacological name of the medication and dose so they can consult their healthcare provider and check if you need to separate the milk with these medications present. NOTE If you have taken an antibiotic, this milk will need to be separated as this can give a recipient's baby thrush/candida. Do not donate your milk until you are clear of the infection, and 2 days have passed since your last dose of antibiotics.

You and the recipient can arrange a courier or friend/family member to pick up and drop off the milk. You must pack the milk in a polystyrene box with ice, which you can source for free from pharmacies, vets, supermarket fish departments or some stationery shops. Alternatively, a chiller bag packed with ice and secured in a cardboard box can work too (not recommended in the height of summer).

When storing breast milk, it is important to label the milk properly. When labelling milk include: The DATE the milk was pumped TIME of day/night it was expressed and your NAME. If you have taken a one-off medication, such as Ibuprofen, herbal preparations, a caffeinated beverage or if you are normally allergen free (i.e. dairy free), and you consumed dairy that day, please include this on the label, for full disclosure.

Once milk is collected and placed into a sterile double zip milk storage bag, lay the bag flat for freezing, as this will allow for easier storage. Breast milk for donation can be placed straight into the freezer, stored in a fridge freezer for 3 months and a chest freezer for 6 months. Or you can collect milk over the day and freeze it once your milk bag is full enough. We recommend you store 100ml or 150ml per bag and in a box as shown in the image, to prevent the milk bags from being bumped and splitting. Split milk bags become contaminated and should be thrown out. Read La Leche League International's information page on storing human milk https://www.llli.org/breastfeeding-info/storingmilk/

Power pumping is aimed at mimicking cluster feeding of your baby to increase supply. It is not about the length of time spent pumping but rather the frequency of pumping. Power pumping works best if you have a double pump and massage your breasts gently before starting. You will get the most milk out within the first 10-15 minutes of pumping. *Please remember that a pump is not always as efficient as your baby. Babies are often far more efficient than a breast pump, in the absence of any complications, i.e. tongue tie. How to power pump: Double pump - pump for 10 minutes, rest for 10 minutes x 3. Single pump - pump 10 minutes each side, rest for 10 minutes, followed by: 5 minutes each side, rest for 10 minutes x3. This can be repeated several times per day for about 3-4 days to increase your supply. When power pumping, it is recommended you stay home and reduce visitors to allow time for you to build up your supply uninterrupted. Try pumping after baby nurses, or pump one side while baby nurses on the other side. You might also try pumping while your baby is napping, at night, or when your baby goes longer than usual between nursings. KellyMom.com provides a great resource on pumping HERE

There are breast pumps for hire or purchase throughout New Zealand. The list below is not extensive, there are pharmacies and baby stores that may also hire breast pumps in your local area. You might try a Haakaa pump or breast inserts to collect your let-down milk before moving on to a pump. Pumps for hire littlemiraclestrust.org.nz - Auckland and Wellington babybunting.co.nz - Auckland and Christchurch mybreastpump.co.nz - Nationwide breastfeedingmanawatu.co.nz - Manawatu region lifecycles.nz - Auckland mamaaroha.co.nz - Tairawhiti region breastfeedingeastcoast.nz - Tairawhiti region bellamama.co.nz - Auckland and Christchurch Pumps for purchase Breastmates.co.nz expressthebest.co.nz freemiebreastpumps.co.nz haakaa.co.nz milkbarnewzealand.com morethanmilk.co.nz tinybloom.co.nz unimom.co.nz

Stores that we have found to stock the most affordable milk storage bags are: The Warehouse - Maxcare - $11 for 100 x 250ml bags The Chemist Warehouse Swisspers $10.49 for 20 x 200ml bags Baby Factory - Various brands from $19.95 Online Unimom - 30 x 210ml bags - $12 60 x 210ml bags - $23.50 Breastmates - 20 x 300ml $9.99 (multibuy discounts apply) expressthebest.co.nz - Unimom 30 x 210ml bags - $12 60 x 210ml bags - $23.0

As a recipient of donated breast milk, you are entitled to ask the donor for information (lifestyle screening) about their diet, lifestyle, medication intake and medical history. You may accept milk offers at your own discretion and do not have to accept every offer. You have the right to decline an offer of donated breast milk without giving a reason. You should not pay any money for breast milk, but you may be asked to contribute to the costs of donating e.g. milk storage bags, ice, packaging/delivery costs, petrol costs for delivery, pump replacement parts, fees for blood tests. It is nice to send a thank message or card to your donor, gifts are not expected but is a nice gesture. Once a recipient has received the milk, it is now in their care. If you no longer require the milk and it is stored as recommended, you could offer it back to the donor, as she may have someone else she is donating to or would like to donate to, who could use the milk. STORAGE REMINDER: 3 months in a fridge/freezer and 6 months in a chest or stand-alone freezer from when it was expressed for newborn infants, up to 12 months for healthy full-term older babies as supplementary to their mother's milk or solid food and formula. The recipient is responsible for lifestyle screening your donors and ensuring their milk is safe, which includes relevant blood tests and lifestyle screening. Donors are entitled to ask the recipient to contribute to reimbursement costs of donating, e.g. milk storage bags, ice, packaging/delivery costs, petrol costs for delivery, and fees for blood tests. As a donor you are responsible for honestly disclosing information about your diet, lifestyle, medication intake and medical history. If you are under midwifery care, you are responsible for getting your blood tests (free until you get discharged from midwifery care) If you are no longer with your midwife, then the responsibility rests between you and your recipient - who pays. If your blood tests were paid for by the recipient, we recommend that you honour that agreement and not share your milk with others, as this can cause stress for both you and the recipient concerned. If your milk supply drops suddenly due to illness or other reasons, please let the recipient know as soon as possible. Understandably, your circumstances can change which can't be helped. Blood tests expire after 3 months, if you are happy to continue donating for a further 3 months or more, MMNZ recommends you redo your blood tests to keep them current. As a donor, you are required to pump and store your milk following hygiene and breastmilk storage recommendations and guidelines. See FAQs for further details.

CMV - Cytomegalovirus is part of the Herpes family of viruses. 50-80% of the population have come in contact with CMV at some point, and once you have contracted CMV, it can resurface at any time The symptoms are similar to those of the common cold or flu. For a healthy infant or adult, it may not significantly impact their health. However, for a premature, unwell or immune-compromised baby, contracting congenital CMV can have lasting effects on their health. Therefore, it is important to know the CMV status of the donor to protect vulnerable babies. "Postnatal infection is usually asymptomatic in full-term babies. This is due to the protection conferred by maternal IgG antibodies, passively acquired after 28 weeks of gestation. Very preterm babies do not have this protection, and therefore result susceptible to develop a severe infection both acquiring the virus through BM [breast milk], both via cervical secretions during delivery." Bardenzellu, Fanos & Reali (2019). It is important to note that in some studies CMV can be killed after freezing breast milk for 10 days or longer at -20 degrees, other studies suggest that freezing only reduces viral load rather than killing off the virus completely. Flash heat pasteurisation /short-term pasteurisation or long-term/Holder pasteurisation can eliminate CMV, whilst still maintaining important breast milk constituents such as beneficial nutritional and immunological properties. CMV result interpretation Result Interpretation IgG negative Not previously CMV - infected IgM negative At risk for primary infection IgG positive Recent CMV infection IgM positive IgG positive Past CMV infection that is not recent IgM negative In short, if you don't have a blood test result stating your donor's CMV status you need to weigh up the risks with your healthcare professional. If your baby is premature, we recommend you only accept tested donor milk that is both IgG and IgM negative or IgG positive IgM negative and pasteurise the milk.

COVID-19 was a very tumultuous ride, waiting for information about the SARS-CoV-2 virus and, subsequently, information regarding the vaccines was an interesting time. Our decisions moved with the tide as new evidence and research were presented. We preferred remain neutral during this worldwide debate and cater to all views so that our recipients have an equal opportunity to choose vaccinated or vaccine-free milk, MMNZ respects each individual's right to informed decision making. For Donors - If you have taken a COVID-19 Vaccine and would like to donate your milk, we ask that you have a stand-down period of 30 days post-vaccination. This is to keep your recipient baby safe and to reduce any liability should a particular batch be contaminated. We suggest that you keep the vaccine batch numbers with your lifestyle questionnaire. For Recipients - You have the right to choose vaccinated or unvaccinated milk. STUDIES A study of 15 women who had recovered from COVID-19 and who were breastfeeding babies at the time had antibodies to counter SARS-CoV-2 infections , researchers report in the November issue of iScience. Breastmilk Harbors Antibodies to SARS-CoV-2 www.the-scientist.com An abundance of immunoglobulin antibodies, and a paucity of viral RNA, in breastmilk offer evidence that women can safely continue breastfeeding during the pandemic. 2. Breast milk from 110 lactating women was analysed by scientists at The University of California - published 19 Jan 2022, They concluded that “SARS-CoV-2 RNA can be found infrequently in the breastmilk after recent infection, but we found no evidence that breastmilk contains an infectious virus or that breastfeeding represents a risk factor for transmission of infection to infants.” Impact for babies receiving breast milk: The research “goes beyond prior small studies to provide evidence that infectious SARS-CoV-2 is not present in the milk of lactating women with recent infection, even when SARS-CoV-2 RNA is detected. “Recent SARS-CoV-2 infection or detection of its RNA in human milk is not a contraindication to breastfeeding.” No infectious SARS-CoV-2 in breast milk from a cohort of 110 lactating women - Pediatric Research

Information for donors and recipients of breast milk about Variant Creutzfeldt Jakob disease (commonly called “mad cow disease” that occurred during the 80s-90s in the UK) UPDATE: In August 2024, the New Zealand Blood Service removed the restriction previously held over residents living in the UK during 1980-1996. We have left information below so you can understand better what the big deal was all about. In health questionnaires, you might have noticed a section about living in the UK for more than six months between 1980 - 1996. This may have affected a potential donor’s ability to donate bodily fluids and tissue, including blood and breastmilk. This runs in line with NZ blood bank screening due to the outbreak of “mad cow disease” during this time. Even though it has been 45 years, it had still posed a public health impact across the world. https://www.nzblood.co.nz/give-blood/donating/am-i-eligible/variant-creutzfeldt-jakob-disease-vcjd/ Provides some further Q & As for NZ blood services. What is ‘mad cow’ disease? The first thing to know is that ‘mad cow’ is not the official name of the disease. In cows, the disease is called Bovine spongiform encephalopathy (BSE). In humans it’s called variant Creutzfeldt-Jakob disease (vCJD). In humans, the symptoms of vCJD are similar to BSE in cows. Early symptoms include changes in personality and behaviour, difficulty thinking, muscle weakness and loss of control over movement. A person might experience confusion, speech abnormalities, agitation and hallucinations; the symptoms can be similar to dementia. Eventually, they will become comatose and die. There is currently no cure for vCJD, with treatment focused on making the unwell person as comfortable as possible. Humans contract vCJD after eating the meat of a cow with BSE. Caused by misinformed proteins called prions that affect the brain, in both cows and humans the disease can be dormant for a long time before symptoms begin to show. Some studies indicate that it might be possible for symptoms to develop up to 50 years after infection. There is currently no test to indicate whether a person has vCJD while they are still alive – a definite diagnosis requires examination of brain tissue conducted after the person has died. It’s possible for the prions that cause vCJD to be transmitted through donated blood even if the donor shows no signs of disease. This has happened four times in the UK. Current estimates are that around 30,000 Britons – or 1 in 2,000 people in the country – carry the prions that cause vCJD, and there’s no screening blood test available for vCJD. The United Kingdom does accept donations from people who lived in the country during the ‘mad cow’ period. If they didn’t, there simply wouldn’t be enough donations to provide medical care to people in need. This presents a us with much frustration with donor milk in NZ. There is such a limited supply of screened donor milk here in NZ. This is why the choice is yours to make around the very small but real chance of passing this to your baby through donated breastmilk.