At the Lokmanya Tilak Municipal General Hospital, more popularly known as Sion Hospital, in Mumbai, Dr Fernandez is known for many things. In her three-decade-long career in the neonatology department, she chaired countless seminars and presented dozens of papers on neonatal care and breastfeeding at medical conferences, both nationally and internationally. But amongst the mothers she treated, she is called their babies' silent crusader-sometimes the only champion of poor, sick babies. In 1989, she set up a human milk bank in Sion Hospital, the first of its kind in Asia, to help provide breast milk to premature babies whose mothers were unable to lactate. Slowly, the country followed suit. In a three-part interview with yowoto, she answers all the questions regarding banking breast milk-for your own baby as well as someone else's. Here, in part one, she explains the process.
How did you come up with the idea of breast milk banking?
Actually, we started even before that, somewhere in the late 70s and early 80s. I worked at Sion Hospital and we were losing a lot of babies. There were a large number of high-risk babies, premature babies and sick babies, so were many babies with infection, mainly diarrhoea. We were trying to find out what caused this and how we could overcome the problem. We soon realised that the mortality rate amongst breastfed babies was much lower and that fewer breastfed babies suffered from diarrhoea. In the early 80s we got rid of formula milk and put all babies, as far as possible, on breast milk. We also got rid of the bottles, as they are often a source of infection and gave babies breast milk with a spoon and a bowl. Having done that, we had to make sure that we had enough milk for all the babies. We began to use milk from different mothers. But that was neither scientific nor correct-we were just taking the milk, storing it in the fridge, and giving it to the babies. That is when we began thinking about how we could ensure a safe and constant supply of milk to feed all the babies that came to Sion Hospital.
The answer was obvious-to start a human milk bank. We had to ensure that we collected sufficient milk, pasteurised it, and stored it at the correct temperature so that it did not spoil. If we managed this, we could ensure that at any point of time, any baby needing human milk could be fed.
How did you go about it?
Before collecting the milk from the mothers, we screened them to ensure that they did not have any infection, like HIV and tuberculosis; that they had no history of jaundice; and that they were healthy and not malnourished. Milk was then collected from the mothers who made the cut.
We also had a method of screening and collecting the milk. We used autoclaved and labelled containers to collect the milk. The milk was then pasteurised, which we collected in stainless steel containers, and then froze it at -20°C.
For how long would this milk be okay?
We pasteurised the milk at 65°C for 30 minutes to kill the germs while preserving the wholesome components of breast milk. Then we froze it. It would stay fine for up to a period of six months. We labelled and stored it. But do you know what happened? We never needed to keep it that long because of the high demand.
Were mothers okay with donating their breast milk?
Somehow at Sion Hospital, I think it was more of a philosophy-every mother who came was lactating. Their babies needed breast milk and they got it, so when they had enough breast milk they were willing to give. We never came across any mother who refused. Actually, I asked a nurse to find out ifany mother was reluctant to express breast milk and give it to another's baby, as well as if any of them were reluctant to accept another's milk. There was just one who was apprehensive.
The other thing is the way we dealt with it. Initially, on the first and second day the mother does not get much milk, but after the third day she gets so much milk that the breasts can get congested, so they would actually call nurses and ask for help in expressing the excess milk.
Premature sick babies are given the mother's expressed milk. 90% of babies were given their own mother's expressed milk, only in 10 to 20 per cent cases, did a baby receive another's milk.
What about mothers who are not well?
Though there are very few conditions in which a mother cannot feed the baby, there are certain diseases that can be transmitted through breast milk and one of them is HIV. If the mother is HIV positive, she should not be a donor at all. So, what do we do for the baby? WHO, Unicef and other such organisations have said that there is 18 to 30% chance of a baby developing HIV through breast milk. If a baby is already HIV positive, which anyway puts it at a higher risk of getting an infection, feeding him/her a healthy mother's milk can lower the risk of infection and increase the chances of survival. So, you need to counsel the mother and let her decide.