Episodes 114: and 117 Julie Bouchet-Horwitz is a nurse practitioner and international board-certified lactation consultant (IBCLC). She is the founder and Executive Director of The New York Milk Bank and has a private practice specializing in breastfeeding in Irvington, NY. She formed a team of 5 women who over 3 years developed the New York Milk Bank which officially opened its doors two weeks ago in Hastings-on-Hudson, New York . The New York Milk Bank will provide safely pasteurized donor human milk to premature and sick babies in hospitals and in the community throughout New York State and beyond.
Julie Bouchet-Horwitz, FNP, IBCLC:
Yes, I remember taking her to our Dr. and she was 3 pounds over her birthweight at 4 weeks. He said whatever you are doing, keep doing it and I said I must have cream in this milk, it must be pure cream that is coming out as she was growing so rapidly and doing so well.
Background History: Julie was born in Philadelphia and grew up in South Jersey and is one of 5 children. There are 4 girls and 1 boy. Her Dad died when she was 10 and her Mom became the sole provider of 5 children. She describes herself and her siblings as latch key children and mom did a great job. She breastfed her kids and Julie remembers her doing this and saying to her: this is what they are for. This is pretty incredible considering the breastfeeding initiation rate was less than 20%. Her mom is first generation Italian and this is just what her Italian friends and family did, was breastfeed.
Future Goals: Julie knew that when she had children that she would breastfeed but had no particular aspirations to go into breastfeeding and babies.She went to work for an airline get her MBA and work her way up for the ladder. She got married and had a baby, fell in love with breastfeeding and bonding and attachment style parenting. She quickly realized that she want to stay home and now she needed to figure out another career.
I stayed home with my daughter and became a Bradley Childbirth Educator, went to LLL meetings and became a birth doula. I toyed with the idea of becoming a midwife and became a midwifes apprentice. She even “accidentally” caught a few babies. All 3 of these happened to be her friends in which the midwife did not make it to the birth in time. Julie really tried for another child, but was unable to conceive. She decided to look into international adoptions and so she adopted a baby from China.She requested a baby under 4 months. She decided that she would breastfeed her new baby. Julie read as much as she could, however, there was not much information on induced lactation. She rented a pump.
Early days of breastfeeding: It was a planned homebirth which ended up being a hospital birth. She knew enough to keep her in the room with her and she went home the next day. She remembers having nipples so sore that she was biting down and holding onto her fingers. She kept telling people: “When the scabs fell off she felt much better.” There was no woman in 1986 and there was little help and the IBCLCs far and few between. She did get good emotional support from La Leche League. Julie persevered and breastfeeding became much more enjoyable. Her baby gained so rapidly that she was 3 pounds overweight at a month old and her pediatrician told her she was doing great.
Induced Lactation: There was not much information so I went to the Columbia Library and I found information in a journal from 1971, where women induced lactation for other women there and this other women who took her adopted baby to her pediatrician and she told him she converted a pump from a cow to a pump for her. She pumped every 3 hours, from 7 am to 11 pm and once in the middle of the night. That is the routine that Julie followed. This mom said her baby was thriving and she was not supplementing. So Julie rented a pump and started pumping every 3 hours and in the next few weeks got just a little bit before going to China. She was 9# at four months old and did not look good at all. she was fed 8 oz of formula with cereal in it every 4 hours from 6 am to 6 pm and she asked them if they tolerated her feedings and they said No, she vomited almost all her feedings. Julie put her to the breast and she went for it without a problem and she never had a bottle since that time. Back home, Julie used a supplementer nursing system with donor milk and this is how she fed her baby. Julie decreased the volume each feeding session and fed her more often. Initially, she used the SNS while she breastfed. She was learning how to breastfeed and she did not want her to gain weight. It turns out an IBCLC diagnosed tongue tie and she went to a dentist who released her tongue. This made it better and she it took a while, about 3 months to learn how to breastfeed. Olivia thrived on the donor milk and this began her love affair with donated human milk.
Julie explains why she went through such great effort to breastfeed her baby. Breastfeeding is the nourishment we give our babies and Julie wanted the bonding experience with her baby who was abandoned at 1 month old and left at a police station, left at an orphanage and ignored and clinically depressed. Julie felt this 1-1 relationship would help to erase the early months of her life. Julie felt that it would heal her disappointment in not being able to have another biological child, however, she is grateful for this as she would not have had her daughter Olivia. Julie went on to breastfeed Olivia for a very long time. She breastfed both her babies for quite a long time.
Milk Bank History: The first one in US was in Boston in an actual orphanage. At that time babies who were fed formula were dying of diarrhea at the rate of 6 times more than babies who were nursed. Excessive dehydration and fluid loss was caused by the formula and this is why the babies were dying. Two doctors took note of this and they started giving babies human milk, donor milk and babies started to thrive. In 1919.. first one in Vienna in 1909. In 1943, AAP started developing guidelines for milk banking and they started popping up throughout the United States and they provided to the hospitals. In the 1980s, the AIDS epidemic hit and in the US the milk banks started to close overnight, rather than make the milk safe. In Brazil, decided to make the milk safe and they became leaders in milk banking and they still are.
In 1985, The human milk Bank of North America started issuing guidelines and establishing standards of operating milk banks in the Us and more milk banks became back on the scene. New York State lagged behind as the Department of Health has determined that milk is a tissue rather than a food so it is regulated by the blood and tissue resource department inn the DOH. There are stricter guidelines and the hospitals need a license There were 2 banks, 1 in North Carolina and 1 in Delaware that acquired a license to provide milk to NY. The milk was going to outpatients not going to the hospital and both of the hospitals let their license lapse. Ohio came on board in 2010 and Massachusetts followed in 2012 New Yorkers had to get milk from these 2 milk banks out of state and if a mother wanted to donate her milk it had to be shipped out of state to be processed. Most of the neonatologists said they wanted more research so there were few, if any hospitals using donor milk at the time. Most of it was going to outpatients. Then in 2012, the AAP issued in their breastfeeding policy statement now that the research was there and they recommended donor milk for preterm infants and that was a real game changer.
At this time, Julie was on call to go to births. At some point, her husband said we can’t live like this with you running out the door day and night and going to births. So she decided to go back to school in 2000 to become and RN. She had already become an IBCLC and in 2003 when she graduated, she accepted a job as a LC at a community hospital. She knew about donor milk and brought it up to neonatologist. She was like: Let’s get donor milk and she was turned down very quickly. He said there was not enough research; we are not doing it, that’s it. Julie does tell the story though of a mother of a 29 weeks old infant who took some medication and had to pump and dump for 72 hours and was distraught at not being able to breastfeed. The nurses asked Julie to help her. Julie asked the mom if she would try donor milk. The mom said yes. So, Julie asked the physician and she realizes it was probably a moment of weakness where he said yes. She immediately ordered 6 oz, it came the next day and the physician immediately said No, we are not going to do that. Sitting unused, the nurses threw it out and Julie just could not believe this.
We continue with Part 2 of my interview with Julie Bouchet-Horwitz, FNP, IBCLC, as she talks about the volunteer work involved in opening up The New York Milk Bank. What a go-getter she is and how she was able to bring on a group of volunteers to open up the milk bank is quite an amazing story.
The need to offer donor milk to our most smallest and sickest of babies: These babies are being saved at 23 weeks gestation and they have a very, very immature digestive system. Their moms have not gone through 40 weeks gestation which prepare their mammary glands for milk production. This means that many of them don’t have milk available for their new baby – just yet. We have had to give them cows milk formula. This formula is meant for cows and this is great for calves and grows them very rapidly from 65 pounds to 400 as quickly as possible, but it is not meant for our human infants. Human milk was meant to double the brain size in the first year of life and it is filled with all the components that can do this. There are Growth hormones in human milk for all different systems in the body. The milk of a women is different at different weeks gestation. The milk changes according to the age of the baby.
We have learned that when we give newborns formula, we are introducing a foreign antigen ( something that causes a bad reaction to the baby) that they were not meant to have. The rate of necrotizing enterocolitis (NEC) increases, which is a really bad infection that causes their gut to slough off and die. Premies are more susceptible to this then full term babies. The cells in the intestinal tract are widely spaced at that point so the human milk can have direct access to other parts of the body, the lungs, the heart, the liver and start off by putting protective factors in those places. It is life saving, it has long term benefits. It has been documented that their hospital stay is at least 4 days shorter, they go home sooner, they are healthier, less likely to have complications that go along with NEC and it is medicine for them. It is necessary for their survival and their long term health.
Becoming a Nurse Practitioner, NP: Julie graduated as a Nurse Practitioner and opened her practice in 2007. In 2009, she realized was a licensed provider and could have donor milk in her office. She set out to work. She first filled out the application. She then bought a small freezer and put 12 bottles of milk in her freezer from North Carolina. Julie started lecturing, going to conferences and talking about the benefits and that there was donor milk in NY if anyone needed it. The lactation consultants were going back to their neonatologists and telling them they could get donor milk now. This was in 2012 and the research was now coming out. The first call came from Winthrop Hospital on Long Island and they called and wanted donor milk for a sick baby. That was the beginning and they never turned back because they see the results.
Neonatologist from Winthrop Hospital: called Julie and said he had a baby that had two episodes of NEC and said donor milk is the only chance for the babies survival. Julie’s role was in facilitating how they could get the milk. NYU called and then another hospital called and this started the ball rolling. Julie’s milk bank was getting milk to outpatients and to private patients whose babies were in hospitals that didn’t have donor milk. Westchester allowed a mom to bring in donor milk for a baby there. Then Westchester Medical Center obtained a license and is now using donor milk for all babies under 1500 gms. A lot started changing during this time and then Julie felt she really needed to open a milk bank in NY.
North Carolina and Delaware had let their license lapse, Ohio came on board and Massachusetts opened up a milk bank, but she felt driven that New York, which at the time, was the third large state by population in US, and were behind CA and TX and both had milk banks and yet NY still did not have a milk bank. With 235,000 births per year it did not make sense that we were relying on milk banks in other states and that mothers would have to send out their donated milk, have them processed elsewhere and sent back to NY.
Julie started putting the word out that she needed a medical team: She started with a team of 3, a medical director, a neonatolagist, and a pediatrician, who said they wanted to help her put it together. She was able to observe a physician in a hospital milk bank in Syracuse, since 1985, He would take leftover of mothers milk on the unit, after their consent and pasteurized it and fed it to the babies of the mothers who did not have enough milk. He only needed 6 – 12 donors a year to feed all the babies on his unit, because the new babies only needed small amounts of milk.
She added another women to their team, who were all volunteering their time doing all they could – web sites, and logo and colors and brand name. This fabulous team met weekly, at a diner, all on their own time and hashed out all they needed to accomplish to get a milk bank opened. People started donating their services. It took 3 years until it finally opened. When Julie talks about all the work that went on behind the scenes to get them to the Grand Opening, it really gave me goosebumps.
They were responsible for getting and implementing everything it takes to run a business from the ground up. Filling out applications. All the equipment and funds and staffing. NY has a giving Tuesday campaign which happens the Tuesday after Thanksgiving in which people give money to a cause and they developed a campaign for Giving Tuesday.
They needed things like: pasteurizers. furniture equipment and a location, computers, etc.
The momentum began to build:
Two very generous donors enabled them to get a place.
Now they needed to find the place
They needed staff. They needed to establish depots, which is a milk collection site, which is a place where a donor milk could bring or ship her milk to.
By the time they opened, they had 17 depots already opened.
The women wanted their milk to stay in NY. They were actually getting calls with women who were saying they wanted their milk to go to NY babies.
Location: One of their recipients, who gave birth at 24 weeks at a hospital that did not allow donor milk helped them find a location. This mom moved her baby to Westchester Hospital where they allowed her to bring in donor milk that she purchased. When Julie called to thank her, she said you know I am at a nursing home. They have a nursery school and there is space here. Julie contacted their medical director and both felt it was a good match. She was looking for some other non-profit location and it was a great match. They had a 850 sq. feet space for the milk bank, which was perfect. Things began to move fast. They bought refrigerators and dishwashers, counters, sinks, desks to get it all going.
The nursing home: Was started by a philanthropist who wanted to provide rest for the elderly. In this space, their are pre-schoolers, the elderly and now the premies, all in the same place. It is intergenerational and is part of a real community. We are right outside Yonkers which is right outside of Manhatten. Julie talked about how great it all felt.
Motorcycles and Milk: In Brazil, the postmen are delivering pumps on motorcycles. In London, blood is being delivered on motorcycles. The Sirens motorcycle club of NYC held their fundraiser at the milk bank. They did a benefit ride for them. 13 female motocycle went to New Paltz and picked up milk from one of their depots. The formed a caravan bringing them the milk and they dubbed them the Milk Riders. There is also a male Milk Rider who volunteers to pick up milk at depots and delivers the milk where they need it.
Donor Screening: Milk is licensed as a tissue so you need a prescription for it. You need to get a prescription for it from your pediatricians. If the baby is in-patient, it goes to pre-term infants. We have over 25 hospitals in NY hospitals providing donor milk that goes to pre term infants. Some are using it as a bridge until their mothers milk comes in. Rather then feed baby formula, the baby usually just needs a day or two of donor milk until moms milk comes. This goes a long way in helping to reduce the risk for full term babies. Foster babies and Adopted babies and babies who are survivors of NEC can also benefit from donor milk.
Insurance reimbursement: Julie talks about the price of donor milk. The market price of donor milk is $4.50 and ounce. It is cost effective in hospitals because of shorter stays and healthier babies, but it is way too much for the average person who just cannot afford it themselves. A days supply could be for a full term 20-25 oz a day makes it unaffordable. So, the “Nicholas Bill” which will require insurance coverage for donor milk for all premature babies born under 1500 gms and babies that are sick, and for any baby in need. As far as Julie is concerned, and I agree, All babies are in need. Not every baby can breastfeed and not every mother wants to breastfeed, but every baby deserves the best. Human milk is species specific and we owe it to our littlest most vulnerable citizens to give them the very best.
Donors: Donors tend to be women who are copious milk producers. They are pumping because they are trying to manage their huge supply, or they are already pumping for their babies already. They are calling because their freezers are full of milk and they want to donate it.
They start out by filling out a Pre-screening questionairre. After she passes this 15 minutes screening session, there are more questions. Then she gets a 17 page questionnaire which is more detailed, about her whole lifestyle, then they need a letter for her Dr. saying she is healthy and a letter form her pediatrician saying that the baby is healthy and thriving. Then once she passes, she gets sent to a lab to test her blood and then when labs come back negative, now they can accept her milk.
This is a whole process that a donor needs to go through before being accepted into the program. Going through this process tells you that she is really motivated and committed to want to do it. They had one mom donate an incredible 4000 oz at one time. They took pictures and put it on their facebook page. There was not enough room for it. When it arrived at their facility it took them a long time to process the milk as they had to put it i groups, and by pump date. They literally had to shute down the milk bank while they did this work. The realization at how far and wide this milk will reach and how many babies lives it will save just gives me goosebumps. Just 10 oz a day, means saving 400 babies. While this has been their largest donor so far, the average donor gives 600 oz. It is all volunteer and they are not paid for their milk.
Bereaved Donors: Some moms find that it helps them to pump milk, after they have suffered a loss. One mom pumped for a year, as this has helped her knowing her milk is helping hundreds of babies.
Milk Bank Future – The Opening: They had about 100 supporters and Lots of press!
Milk Banking in Brazil: Julie is quite enamored with what is happening in Brazil and strives to be just like Brazil. They have over 230 milk banks, the billboards are everywhere looking for donors. Everyone knows about donor milk. It is accessible everywhere. We need that kind of culture here as we are not quite the breastfeeding culture here but we are working on it.
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