Flash heating can be used as a precautionary measure when feeding your baby donated breast milk. The stove-top flash heating method has been shown in international research to kill HIV, HTLV 1&2, E. coli, Staph aureus and Strep A&B and CMV. For more information and for instructions on how to flash heat breast milk, please see the link in the Receiving milk page.

Most antenatal blood testing does not include testing for HTLV, Hep C and CMV. These are all very important when being screened to donate breast milk as they can pass through your milk. You may not even be aware that you have these kinds of infection/viruses. Also as the antenatal bloods may have been done over 3 months ago, we are not able to use them to clear you for donating because most viruses have an incubation period of 3 months.

All medication and herbal preparations have the potential to pass into breast milk in varying amounts, depending on the way the body processes it. Generally, only small amounts reach babies and term healthy babies can continue to be breastfed in the vast majority of circumstances. When thinking about medications in donor milk, we need to consider who is receiving the milk (such as whether the baby is premature) and what other medication, herbs or supplements are taken by anyone else who provides milk for that baby (drug interactions). We promote informed consent and highly recommend that receiving families speak to their health care teams and do their own research into medications in donor milk.. Please tell us if you stop or start taking medication so it can be reviewed case by case.

If you are unwell please contact Mother's Milk NZ or the receiving family directly and withhold donations until symptoms have passed for a week. This is to reduce the spread of infection, even though breastmilk will contain antibodies and other immune factors and to give you a rest too. I f you have taken antibiotics or other medication please alert us and tell us the type of medication and dose so we can ascertain if you need to seperate the milk with these medications in it. However if you have taken an antibiotic this most definitely will need to be separated so as to not give a recipient baby thrush/candida with the possible transference in the donated milk.

We can arrange a frozen food delivery truck to pick up and drop off the milk from/to a business address (e.g. gas station, deli – anywhere with a freezer) for SCREENED MILK only. You must pack the milk in a polystyrene box which you can source from pharmacies and supermarket fish departments. We will send you instructions on how to pack your milk correctly, and the shipping labels needed. If you have not received this, please ask.

When storing breast milk, it is important to label the milk properly. When labeling milk include the DATE the milk was pumped, TIME of day/night and your NAME. If you have a one off only medication such as Ibuprofen, herbal preparations, coffee or if you are normally allergen free such as dairy and you ate a food with diary in it at time of pumping please label these as well.

Once milk is collected, and placed into a sterile double zip storage bag, lay flat for freezing as these will allow a great volume to be stored. Breast milk for donation can be put straight into the freezer, stored in a fridge freezer for 3 months and a chest freezer for 6 months. Check out La Leche Legeau International's information page on storing human milk https://www.llli.org/breastfeeding-info/storingmilk/

Power pumping is aimed to mimic 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 breasts gently before starting. Most people will get the most amount of milk out in the the first 10-15 mins of pumping. Please remember what you can get out with a pump is not always what your baby can get out - they are often far more efficent in the absence of any complications ie tongue tie. A popular timing is: pump for 10 minutes, rest for 10 minutes, pump for 10 minutes, rest for 10 minutes and pump for 10 minutes. If you have a single pump maybe try: pump 10 minutes each side, rest for 10 minutes, 5 minutes each side, rest for 10 minutes, pump 5 minutes each side, rest for 10 minutes, pump each side for 5 minutes. This can be repeated several times a day for a few days to increase supply.

We have breast pumps available that we can lend out to mothers. If you need a pump, please ask us if we have one available. You will be required to pay a returnable bond for your pump, which will be refunded when the pump is returned in good condition.

Places that we have found stock the most affordable milk storage bags are The Warehouse (brand: swisspers $13 for 20), Baby Factory (Brand: Unimom $20.50 for 60), Trademe (Varies but on average around $25 for 120). We have a discount code for purchasing Unimom breast milk storage bags from www.expressthebest.co.nz use this code at the check out to receive 10% off your order, and Express the Best will donate a further 10% of the proceeds to Mothers Milk NZ. CODE: mothersmilk

As a recipient of donated breast milk, you are entitled to ask the donor information 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 we are sure they won't be turned away if offered. Once you have received the milk it is in your care as per the waiver agreement you are required to sign before receiving donor milk. If you no longer need the milk you have received you are obligated to alert MMNZ immediately so that we are able to relocate the milk before it expires. 3 months in a fridge/freezer and 6 months in a chest or stand alone freezer from the time it was expressed. You will need to assist us with this relocation and possibly ship it elsewhere in the country. MMNZ are responsible for properly screening donors and ensuring their milk is safe, this includes relevant blood tests and lifestyle screening. As a donor you are entitled to ask the recipient 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. You are responsible for honestly disclosing information about your diet, lifestyle, medication intake and medical history. If you are still with your midwife you are responsible for getting yourself screened for donating if you are no longer with your midwife please contact us. MMNZ will select who you donate to however if a relationship issue arises with the recipient please contact MMNZ asap so that we can address the issue or change your recipient. If your blood tests were paid for by either MMNZ or the recipient we ask that you honour that agreement and only share your milk through MMNZ as the facilitator and not with other milk sharing communities etc. If your milk supply drops suddenly due to illness or other reasons please let us know as soon as possible. We understand that your circumstances can change that can't be helped. Blood tests expire after 3 months, if you are happy to continue to donate for a further 3 months or for as long as possible we will require you to get a new set of blood tests done. MMNZ will facilitate the payment for these blood tests, you will not have to pay. As a donor you are required to pump and store your milk following hygiene and breastmilk storage recommendations and guidelines.

CMV (Cytomegalovirus) is in the family of the Herpes virus. 80% of the population has contracted CMV at some point and once you have had it, it can resurface at any time. You can contract this without realising because the symptoms are similar to those of the common cold. For a healthy infant or adult it may not majorly impact on your health. However, for a premature, generally unwell or immune compromised baby this can be detrimental to their health. So we must know the CMV status of all our donors in order to protect our most vulnerable babies.

COVID-19 has been a very tumultuous ride waiting for information around the SARS-CoV-2 virus and more recently, information regarding the vaccines. Our decisions have moved with the tide as new evidence and research is being presented on a regular basis. However, as there is still no conclusive human safety data (either short or long term) from Pfizer for breastfeeding women and their babies - and due to this vaccine still being in late trial phase, we are erring on the side of caution at present. Our decisions may change further down the track once the trial date has ended and the required safety data is released. We are a charity and need to protect ourselves from any liability as best we can whilst protecting the recipient babies as best we can too from any unforeseeable consequences. We prefer to stay as neutral as possible in this world wide debate and cater to all sides so that our recipients have an equal opportunity to choose vaccinated and vaccine free milk MMNZ respect each individuals right to autonomy. MMNZ have a COVID-19 protocol for delivering/receiving donor milk whilst in Level 4 and 3. We ask that you read, answer and sign this declaration to show that you understand our procedure and that you will alert us if you are presently sick and diagnosed with COVID-19. For Donors - If you have taken a COVID-19 Vaccine and are wanting to donate your milk, we ask that you have a stand down period of 30 days post each vaccination. This is to keep our recipient baby safe and to reduce any liability should a particular batch be contaminated. We ask that you send us the Batch numbers with your lifestyle questionnaire, preferably a copy of the card that the batch number is written on to prevent mistakes, or a screenshot of your health record. WE DO NOT have access to your Vaccine passport, so please do NOT send us your individual QR code. For Recipients - You have the right to choose vaccinated or unvaccinated milk. We will send you an email with the donors lifestyle screening questionnaire attached as well as extra notes at the bottom of our template email. PLEASE READ EVERYTHING as it is also your responsibility to ensure everything is acceptable for you. We have endeavoured to put measures into place to ensure you get the milk option you desire. IF there is a bad batch of vaccine we will contact you if your baby received this milk. We do not anticipate that this will happen, this is a precautionary measure we hope we will never need to use. RECENT STUDIES A new 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. www.the-scientist.com Breastmilk Harbors Antibodies to SARS-CoV-2 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.” www.nature.com No infectious SARS-CoV-2 in breast milk from a cohort of 110 lactating women - Pediatric Research

As a recipient of donated breast milk, you are entitled to ask the donor information 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 we are sure they won't be turned away if offered. Once you have received the milk it is in your care as per the waiver agreement you are required to sign before receiving donor milk. If you no longer need the milk you have received you are obligated to alert MMNZ immediately so that we are able to relocate the milk before it expires. 3 months in a fridge/freezer and 6 months in a chest or stand alone freezer from the time it was expressed. You will need to assist us with this relocation and possibly ship it elsewhere in the country. MMNZ are responsible for properly screening donors and ensuring their milk is safe, this includes relevant blood tests and lifestyle screening. As a donor you are entitled to ask the recipient 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. You are responsible for honestly disclosing information about your diet, lifestyle, medication intake and medical history. If you are still with your midwife you are responsible for getting yourself screened for donating if you are no longer with your midwife please contact us. MMNZ will select who you donate to however if a relationship issue arises with the recipient please contact MMNZ asap so that we can address the issue or change your recipient. If your blood tests were paid for by either MMNZ or the recipient we ask that you honour that agreement and only share your milk through MMNZ as the facilitator and not with other milk sharing communities etc. If your milk supply drops suddenly due to illness or other reasons please let us know as soon as possible. We understand that your circumstances can change that can't be helped. Blood tests expire after 3 months, if you are happy to continue to donate for a further 3 months or for as long as possible we will require you to get a new set of blood tests done. MMNZ will facilitate the payment for these blood tests, you will not have to pay. As a donor you are required to pump and store your milk following hygiene and breastmilk storage recommendations and guidelines.

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) In the health questionnaire you will notice a section about living in the UK for more than six months during 1980 - 1996 and if you were a consumer . This may affect 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 16 years it still has a public health impact across the world. This information is provided so you can make a decision around a risk/benefit equation. We all have our own level of risk we are comfortable with for example doing extreme sports vs playing lawn bowls. The aim of providing information is to allow you to make an assessment whether the potential risk of passing this condition to your baby via donated breastmilk out weighs the benefits of your baby receiving donor milk. This decision to take this on is yours. 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. Information taken from https://www.health.qld.gov.au/news-alerts/news/mad-cow-disease-why-cant-donate-blood-breast-milk-tissue-UK-Britain

There may be costs involved but they are directly related to either blood screening or the shipping of milk. Mother's Milk NZ is a non profit organisation and charity for facilitating safe milk sharing and we endeavour to keep any cost transparent and as low as possible. For the donor: Midwives can arrange your blood tests free of charge if still within her care. There may be costs involved seeing a GP (a baby visit is free) to get blood test forms and a possible charge for the blood screening, please let us know before you go ahead with the blood tests if you are requested to pay. MMNZ have a discount with most blood labs across NZ. Please contact us before having screening to see if your area is grant funded, if we have donations that can cover this cost or if the recipient is able to pay. you have any concerns around this please contact us. There may be a cost if you are shipping milk to a receiving mother outside your local region, ice is about $3 a bag in most supermarkets. Polystyrene boxes are usually found free via supermarket, Vet or Pharmacy. If you would like a reimbursement for the cost of the ice please let us know BEFORE we ship your milk off, likewise if you live MORE THAN 15min away from your Pick up destination where reasonable, then please send us your mileage if you would like this reimbursed to you too, we pay 50c per Km and on charge the recipient. For the receiving family: The main cost is for the shipping of milk, and this cost is passed to us from the shipping company we use (Provida, freeze store trucks). There may also be travel mileage and ice costs incurred by the donor or volunteer ambassador if they have collected and shipped the milk to you. Please do not hesitate to contact us if you have any questions around possible costs. We do endeavour to milk match within the same area to reduce this cost. To assist with our funding we have introduced a one off milk matching fee of $10 per donor allocated to you and a freighting fee of $5 per shipment of milk. An example of freight costs Auckland to Christchurch = $42.01 + Shipping Fee $5 and on off Milk Match feeper donor $10 = $57.01 + mileage if any and Ice cost if any. Hamilton to Palmerston North = $14.54 + Shipping Fee $5 and one off Milk Match Fee per donor $10 = 29.54 + mileage +ice cost if any. Some Regions have freight truck depots, we aim to us these destinations first, the freight between depots is currently free. These costings are an estimate as freight on road charges fluctuate. We aim to ship a minimum of 4 litres of milk at a time.

Antenatal bloods are usually only taken once at the beginning of your pregnancy, and the results are too old for donating milk, this is because most viruses have an incubation period of 3 months and therefore we need blood tests to be no older than three months ago. Antenatal blood screening does not include: HTLV, Hep C and CMV. These three tests are important when screening for milk donation as they have a chance of passing through your milk. You may not even be aware that you have had these viruses. MMNZ have chosen to incorporate blood tests to align with international milk banking standards, so that recipients can chose to use raw milk knowing that it is virus free and high in immunity factors and nutrients that is otherwise depleted using flash heating or pasteurising methods and so they can use donor milk with confidence. However, if you chose 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 than formula and is recommended in particular with immune compromised babies.

Yes both the Recipient and Donor sign a disclaimer. Recipient - You sign a Waiver and COVID-19 Declaration to show that you understand our process, potential costs, and to let us know other information such as Why you require donor milk, if you need specialty allergen free milk etc. Donor - You have a Lifestyle Screening Questionnaire (LQ) and COVID-19 Declaration to complete. The LQ will have questions pertaining to your lifestyle such as: Smoking status; allergen free - gluten, egg, dairy, nut, soy free; have you had a blood transfusion at your baby’s birth?, taking Medication, etc