Human Milk Banks

بسم هللا الرحمن الرحيم Breastfeeding and Human milk banks Dr. Mohammed Albar FRCP Medical Ethics Center International Medical Center , Jeddah Breastfeeding Benefits • Breastfeeding is the best way of infant feeding, with short- and long-term benefits for infants, mothers, environment, economy and the entire society. The world health organization (WHO) and other international health bodies have recommended exclusive breastfeeding for six months after birth . It also recommended that breastfeeding continues for two years or longer together with nutritionally-adequate complementary foods. Breastfeeding WHO Definitions • Exclusive breastfeeding: allows the infant to receive breast milk only, with no other liquids or foods, not even water, except drops of syrups, vitamins, minerals or medicines. Breastfeeding WHO Definitions • Predominant breastfeeding: allows the infant to receive mixed feeding of breast milk and other liquids, solid or semi-solid foods. • Any breastfeeding’: allows the infant to receive breast milk (including milk expressed or from a wet nurse) with any foods or liquid, including non-human milk or formula. Breastfeeding in Saudi Arabia Researcher (year) % of Mothers Breastfeeding 1967 Sebai Z (Terba : rural) 90% for 2 years 1981 Sebai Z (Terba: rural) 30% for 2 years 1981 : Abaheseen MA 46% for 2 years (Eastern) 1981: Lawson M (Military 41% bottle and Hosp Riyadh) breastfeeding at 6 months 1988: Al Sukait M (National) Factors influencing Breastfeeding in Saudi Arabia. 1988: Al Sukait M ( National ) Education Breastfeeding Illiterate 1 year and 50 days Primary schooling 10 months Secondary schooling 8 months University 5 months 1988: Al Sukait M (National) Factors determining Breastfeeding • Residence: Rural or Urban • Housewife or working woman • Education • Social status and income • Delivery at hospital or home • Age and parity • Using contraceptives (pill) AL Juaid et al : Breast feeding in Saudi Arabia • A Review International Breast feeding J 2014,9:1-9 • The Eastern Mediterranean (WHO) reported >60% of early breast feeding initiation, with 60% of those continued breast feeding tor 12 months in Middle East and North African countries. • 40% or less of infants under 6 months being exclusively breastfed . 7% for Lebanon , 15%for Yemen and 16%for Pakistan. • The search revealed 17 studies from 1987 to 2012 . Only 5 studies used WHO definitions for breast feeding. • The Review concluded that the poor study designs and sample selection are reflected in the disparities in reporting breast feeding rates. • The duration of breast feeding showed a decline over time. Older, less educated and multiparous mothers living in rural areas and of low socioeconomic class were more breastfeeding and prolonged duration compared with other groups. Education and Breastfeeding • The more educated the mother, the less she will breastfeed her baby and for a shorter period and with mixed feeds. • Similarly working women are less likely to breastfeed their babies. AL Juaid et al International Breast feeding J 2014,9:1-9 How to Improve Breastfeeding • Ban Advertisement for artificial milk • Punish hospitals that give bottle feeding as routine for every delivery and give artificial dried milk as present on discharge • Education in all schools and universities about Breastfeeding • Advertisement through all media for breastfeeding. • Provide and support breastfeeding in work place. Human milk bank A human milk bank is a service which collects, screens, processes, and dispenses by prescription human milk donated by nursing mothers who are not biologically related to the recipient infant. The International Milk Banking Initiative (IMBI), was founded at the International HMBANA Congress in 2005. It lists 33 countries with milk bank programs. Human milk bank • Brazil: 210 milk banks. In 2011, 165,000 liters (5,580,000 fl oz US) of breast milk were donated by some 166,000 mothers, and provided to nearly 170,000 babies. • Donors must be healthy and not taking any medication. It has reduced infant mortality by 73% since the 1990s. • North America: 16 milk banks as of 2014. They collect about 3,000,000 oz per year as of 2013. • Europe : 203 human milk banks with 13 more planned as of 2014, according to the European Milk Bank Association (EMBA). Donor Breast Feeding • Some moms give their milk directly to the parents of babies in need, an exchange known as casual sharing. The intent behind casual sharing is wonderful – it’s a caring act of sisterhood. It’s important to go the extra mile to have the surplus milk tested in a lab to make absolutely sure that it’s safe for any baby How long does frozen breast milk retain its value and nutrition? Fresh breast milk, when expressed under clean conditions, can be used safely up to four hours at room temperature, and for 24 to 48 hours when refrigerated immediately. When frozen immediately, breast milk can last up to three months. Some of the immunological, or disease- fighting, components are inactivated by freezing. The health benefits of breastfeeding are important; a mother who breastfeeds should not hesitate to feed her baby frozen, defrosted breast milk during temporary separations.. Breastfeeding in Islam } َوا ْل َوالِ َدا ُت ُي ْر ِض ْع َن أَ ْوﻻ َد ُه َّن َح ْو َل ْي ِن َكا ِم َل ْي ِن لِ َم ْن أَ َرا َد أَ ْن ُي ِت َّم ال َّر َضا َع َة َو َع َلى ا ْل َم ْولُو ِد َل ُه ِر ْزقُ ُه َّن َو ِك ْس َو ُت ُه َّن ِبا ْل َم ْع ُرو ِف ﻻ ُت َكلَّ ُف َن ْف ٌس إِﻻَّ ُو ْس َع َها ﻻ ُت َضا َّر ْ َ َوالِ َدةٌ ِب َو َل ِد َها َوﻻ َم ْولُو ٌد َل ُه بِ َو َل ِد ِه َو َع َلى ا ْل َوا ِر ِث ِمث ُل َذلِ َك َفإِ ْن أ َرا َدا فِ َصاﻻً َع ْن َت َرا ٍض ِم ْن ُه َما َو َت َشا ُو ٍر َفﻻ ُج َنا َح َع َل ْي ِه َما َوإِ ْن أَ َر ْد ُت ْم أَ ْن َت ْس َت ْر ِض ُعوا أَ ْوﻻ َد ُك ْم َفﻻ ُج َنا َح َع َل ْي ُك ْم إِ َذا َسلَّ ْم ُت ْم َما آ َت ْي ُت ْم ِبا ْل َم ْع ُرو ِف َوا َّتقُوا ََّّللاَ َوا ْع َل ُموا أَ َّن ََّّللاَ ِب َما َت ْع َملُو َن َب ِصي ٌر { ] سورة البقرة :233[ Breastfeeding in Islam Mothers should breastfeed their children two complete years for those who wish to complete the nursing period. The father should give sustenance to the breastfeeding mother, even if she is divorced. In all conditions she should be fully occupied for the whole period of breastfeeding and need not search for a job for her sustenance. If however a foster mother is decided upon, then the foster mother should have her sustenance from the father of the child, or his inheritors ( if he died). Breast Feeding in Islam وفي قوله تعالى: } َوأُ َّم َها ُت ُك ُم الﻻَّ ِتي أَ ْر َض ْع َن ُك ْم َوأَ َخ َوا ُت ُكم ِّم َن • ال َّر َضا َع ِة { ]سورة النساء: آية 23[ • Prohibited to you [for marriage] are your mothers, your daughters, your sisters, your father's sisters, your mother's sisters, your brother's daughters, your sister's daughters, your [milk] mothers who nursed you, Definition of Rhida’a (Breast feeding ) • (Suckle, Rhada’a) in Arabic Lexicon : Is to suck the breast of a woman by a baby to obtain feeding. • Breast Feeding in Shariah (Islamic Law): Suckling of the breast of a woman by a baby under two years of age, for feeding. • Even if the lady gave the child her milk through a bottle or spoon or even through nostril (nasogasteric tube )that will be considered as Rhida’a ( milk mother food ). • All the Sunni schools agree to this definition. The Kinship of Rhida’a • If a lady breast feed an under two years child for 5 times then she becomes milk mother for the baby, and her daughters will be his/her milk sisters and her sons will be his/her brothers and so forth. The Kinship will extend to her whole family . • The Hanafi school of jurisprudence considers a single feed as enough for the lady to become his/her suckling (nursing) mother. • The other 3 schools : Maliki, Shafi and Hanbali require five separate feeds to cause motherhood. • Allaith ibn Saad ( 94-175 H/713-792 CE) insisted that sucking from the breast of the woman by the baby as prerequisite for becoming milk mother. If she gives the milk through a bottle or spoon it is not considered as Rhida’a. • Ibn Hazm ( 384-456 H/994-1064 CE ) also agrees to this definition . Age of Viability in Islamic Heritage is 6 months. • This was first deduced by Ali Ibn Abi Talib (the cousin of the prophet and his son in law) from 2 Ayas of the holly Quran : a) “the mothers should nurse (suckle) their offspring for two complete years , for those who whish to complete term” Sura Al Bakara , Aya 233. • b) “The bearing and lactation period is 30 months” Sura Alahqaf, Aya 15. • If a 6 months or more pregnant lady dies and the fetus is suspected living then, she should be sectioned to save the life of the fetus. Viability • If the newborn baby is premature, less than 500 gm, there is no need for heroic measures to save it, as the results are dismal and the quality of life is very poor. Human Milk banks Discussions • Symposium on Reproduction, Islamic Organization of Medical Sciences (IOMS), Kuwait, May 1983 (Milk banks ) • Introduction by Dr. Maher Hatout of USA about milk banks in USA, used for 1% of premature babies . The use of milk banks dwindled by early eighties of 20th century .

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