In the Table 1, the answers are summarized.
Table 1
Results and discussion |
Question 1 1.How did you become acquainted about the possibility of donating milk? | 67,7%: direct information from the bank staff during hospitalization | 16,2% information material in the Obstetrics department | 3,2%: word of mouth between acquaintances | 3.2%: personal research |
Discussion |
The direct information for mothers during postpartum hospitalization, which the bank staff performs in a standardized and widespread manner, is a strength and a model to be exported. | The disclosure in centers other from ours is lacking. | There is little information for women about the existence of milk banks. This gives rise to the need for greater diffusion. |
Question 2: the reason What prompted you to do this noble gesture? | 83,8% altruistic reason | 23% combines altruism with the abundance of milk produced. | 26,9% reports that altruism is derived from a previous experience. | 7,69% combines altruism, satisfaction and pride. 7,6% explains they strongly believe in mother milk. | 16,2% reported the sorrow to throw the extra milk away. |
Discussion |
Datum in line with the literature | Positive datum that gives a measure of the sensitivity of mothers in our area towards premature babies and this should be further encouraged through information campaigns on the reality of prematurity, little known by public opinion. |
Question 3 Is it the first time you donate milk? | 76,86%: first experience of donation | 24,14%: double or triple experience | Mothers who have already donated are a fertile ground to be cultivated because the possibility that a woman who has donated can do it again is high. She instinctively tends to renew the satisfying feeling, and if we succeed in exalting it through moments of awarded private and public recognition, the goal of repeated donation is closer. |
Question 4 Way of delivery | Caesarean section: 54,2% | The type of childbirth does not affect the ability to donate against the idea of a difficult start to breastfeeding, which often affects the continuation for women who are subjected to Caesarean section. The donor recruitment phase is not affected by the mothers' initial difficulties in the first days after the birth with breast attack and the start of breastfeeding |
Average duration of the breastfeeding 5.How long have you been breastfeeding your child? 7. Do you have other children? 8.How long have you been breastfeeding them? | Average duration of the breastfeeding of newborn during the donation: 13,84 months (36 − 2 months) Average duration of the breastfeeding of other sons without donation: 12 months Comment It could be a confirmation of how donation does not undermine breastfeeding but favors it |
Question 6 Average weight gain. How much has your child grown? | 1135 grams per month | The growth of breast-fed infants during the donation was more than satisfactory and this data can be disclosed to dispel one of the mothers' main fears regarding donation that is to say not to guarantee the adequate growth of their child. |
Question 9: When did you pump the milk for the Bank ? |
The milk for donation was extracted from the breast: | After the suckling: 70% Before the suckling: 26,47% | In the morning: 26,64% In the evening: 7,7% In the afternoon: 5,1%. Indifferently: 59% |
Discussion Regarding the timing of the extraction for donation, the time of day was unimportant, while 70% of women who provide milk for donation after nursing is significant. Probably having already nourished his own child creates a greater serenity which is preparatory to the gesture of donation. |
Question 10: The commitment for the donation |
Was it demanding to collect and keep the milk? | No: 61,76% A little: 26,47% Enough: 11,76% A lot: 0 | Discussion The percentage of the interviewees who defined “zero” the commitment necessary for the collection, storage and delivery of the milk obtained for the donation is very reassuring. This is also a key message to dissolve another perplexity that limits the donation: the fear of not being able to honor the commitment with the HMB. The perception of our activity does not have connotations of intrusiveness or insistence but is lived with a certain serenity, ultimately a positive feedback for our team. |
Question 11 | | Discussion |
Do you believe that the donation to the bank has favored the breastfeeding of your child? If yes, how? If not, why? | 75.86% answered in positive explaining that this happened through: greater production due to greater stimulation: 72.7% avoiding the breast engorgement: 9%, greater serenity induced by the gesture of donation: 9% not hindering breastfeeding in any way. | 24.13% of the women answered that the donation did not affect breastfeeding by having plenty of milk. | The donation is considered a method for improving and prolonging the feeding of their child. |
Question 12 On the basis of your experience in all its aspects, do you have any suggestions concerning the promotion of breastfeeding and milk donation for future mothers who will address to our birth point? | Suggestions and impressions - to inform (also before the delivery) women about: the advantages of mother milk, the possibility to breast-feed and donate, the difficulties or the first days, the breastfeeding upon request that promotes the stimulation and therefore the production -information needs to go with support and reassurance and it’s necessary both before and after the delivery, also at home - the necessity to widely promote the reality of the HMB and donation - to share the beautiful experience of the donation among mothers so as to spread it - the donation is a due towards the most fragile newborns and propose to visit the NICU to take account of it - to keep the newborn as close as possible so as to favour the breastfeeding upon request with breast emptying and stimulation - to empty the breast until the last drop and educate other women to do it |
Under point 1 show that 67,7% of women have become aware of the possibility to donate some milk thanks to the direct information of the bank staff during the hospitalization, 16,2% thanks to dedicated posters present in Maternity Unit; 3.2% thanks to the word of mouth with acquaintances and 3.2% thanks to a personal interest.
The point 2 focuses on the motivation of the donation. The prevailing answer concerns 83,8% with altruistic reasons referred to 23% with the abundance of milk, 26,9% refers that the altruistic boast is derived from a previous experience (during the breastfeeding of other sons with abundance of milk or in case of denied breastfeeding for other reasons such as premature birth), 7,69% combines the altruistic motivation with personal satisfaction and pride and we reported the same percentage in women who strongly believe in the power of mother milk. The remaining part explained the choice in the sorrow of throwing the extra-milk away.
Under point 3, women have been asked if it was their first experience of donation: 76,86% of women gave a positive answer and for the remaining 24,14% it was the second\third experience.
54,2% of women gave birth with vaginal delivery, the others with Caesarean section.
The length of breastfeeding combined with the donation is 13,84 months with a maximum value of 36 months and a minimum of 2 months. The length of the breastfeeding of other sons, required at question 8, was on average 12 months.
The growth of the newborn was on average 1135 grams a month.
The milk for the donation is expressed after the milk feed in 70% and in 26.47% before. The remaining percentage refers to non-answers. 59% of women expressed milk during the day interchangeably, 26,64% in the morning, 7,7% in the evening and 5,1% in the afternoon.
Under point 10 women have been asked if they considered demanding to collect and store the milk, 61,76% answered “for nothing”, 26.47% “a little”, 11.76% “enough” and nobody answered “very”.
Under point 11, evaluating the perception of the donation as a factor benefitting (or not) the breastfeeding, 75,86% answered “yes” explaining, to the following entry that the donation occurred because of a major production following a further stimulation for the majority of women (72,7%), avoiding the obstruction (9%), through a bigger serenity derived from the donation (9%) and the remaining percentage affirmed it didn’t impede in any way the breastfeeding.
For 24.13% of interviewed women, the donation didn’t influence the breastfeeding because the milk was aplenty.
At this point, a comment should be made. The answers to the last three questions are more difficult to summarize and categorize, since they represented a way to widely describe their thoughts, beliefs, acquaintances and experiences regarding the breastfeeding and the donation in all their aspects.
The experience of breastfeeding at point 13, has been described as unique, intense, indescribable and not to be missed, even if in the presence of initial difficulties or after resuming work.
For 15 mothers, it needs to start from the concept that if they want they can breast-feed and donate too.
In particular, a mother who experienced a difficult and painful breastfeeding due to bleeding fissures healed after 3 months (after precluding previous child’s breastfeeding) gives an important suggestion. The frustration for the missing breastfeeding of the first child and the strong motivation with the second one to breast-feed and donate, underlie the achievement of the aim and generates the suggestions for new mothers to find “their way” to breast-feed. Moreover, this can arise only from an accurate information, in other words “there’s no breast without milk... we don’t own milk, we produce it... and the continual sucking of the child is the only way to let it increase: if I succeeded despite having painful fissures, everybody can do it”. On the same wavelength is the answer of another mother who suggests to the HMB team “to let mothers understand and know that the mother milk comes out always and however and that all mothers are able to produce it both with a Caesarean section and a natural delivery, with a big or small breast. Everything, definitely depends on will”. The topic of information was peculiar for this answer.
In detail 50 mothers suggested to inform (also before the delivery) women about: the advantages of mother milk, the possibility to breast-feed and donate, the difficulties (13) or the first days, the breastfeeding upon request (11) that promotes the stimulation and therefore the production.
15 women affirm that the possibility to donate depends on the will.
More than half of women suggest that information needs to go with support and reassurance and it’s necessary both before and after the delivery, also at home. It has been highlighted also the necessity to widely promote the reality of the milk bank and donation (35 answers) also in other birth points. Some of them (30) referred that outside the hospital’s walls, little is known about our HMB. On the same topic, 18 answers suggest to share the beautiful experience of the donation among mothers so as to spread it.
4 women write that the donation is a choice to be made with serenity. 3 women retain that the donation is a due towards the most fragile newborns and propose to visit the NICU to take account of it. Another suggestion from two mothers is to keep the newborn as close as possible so as to favour the breastfeeding upon request with breast emptying and stimulation. 2 mothers suggest to empty the breast until the last drop and educate other women to do it. 4 women don’t give a specific answer as everything was excellent; the remaining part didn’t answer.
The question “Could you describe your experience as donor?” allowed mothers to express their opinion in complete freedom. However, we after had to quote entire parts of the stories both because only in this way we could pull out the real sense of donation, and because a summary could have damaged the authenticity of the recordings.
80% of the mothers identified the moment of the milk shipment to the driver as the most satisfactory one because they saw the full bottles and received other empty bottles to fill in. 28 mothers admitting that the donation is a great experience, repeated it also in the following pregnancies.
It’s necessary to do a distinction between those who donated more times. Some of them (around 50%) lived similar and positive experiences with different sons, others found some differences.
A donor, for example, refers that the last daughter came in a stressful period, there was no milk and she had to appeal to the formula; this caused sadness because she felt as she didn’t give the newborn the same opportunities of the previous sons and couldn’t honor the commitment with the milk bank as in the past. But she calmed down – thanks to the support of a friend who gave her hope, patience and strength - and produced enough milk for her daughter and for the milk bank, specifically “for a newborn who didn’t have the same good fortune”. “ I insisted and, when I was waiting for the bottle to fill in, I imagined, as during my pregnancy, the child who would have received my milk. I found myself thinking to him, imagining his future and cheering him.” “I was moved because my milk was nourishment and relief from a life that, reluctantly, made him fight since the early stages of life. This gave sense to my commitment and rewarded me”.
Another mother discusses about pregnancy during a stressful moment: she refers she felt guilty. The pregnancy came after the loss of her 6-year-old firstborn; when she was asked to donate milk, she promptly answered in the affirmative – it was a way to regain self-esteem and to feel “strong and proud”. “When I gave my milk, I felt useful and proud... when they told me that after the sixth month, they wouldn’t have come to take it anymore I was sorry”.
Therefore, a cleansing effect is highlighted in the donation of 2/3 of mothers.
Another woman (to the second experience) reports that she was proud of helping children without their mother milk and encouraged her friends to do the same but with limited results because they always fear to deprive their child of milk.
The pride of donating milk to children in need is given in 60 reports with particular reference to the moment of shipment.
The term “commitment” is found in 15 answers but with different acceptations. Specifically: one of them (at the beginning) was skeptical, she was afraid of not following the rules and that it was a huge responsibility but when she filled in the first bottles, all the fears disappeared. Another woman describes the donation as “demanding” because it requires breast-care, a proper hygiene and diet that she carried out without difficulty even bringing up other children: “every time they came home to take the milk, I felt happy. I knew that my milk was useful to children in need and I thank those who gave me this possibility because I felt twice as woman”.
Another mother talks about little commitment, which is necessary for the care and the storage of the milk in view of a great present, the hope of a major survival for babies and families in difficulties. Another donor, due to the milk abundance, lived the donation in an easy way; moreover, she tells that the collection was easy thanks to the availability of the couriers who arrived in any moment after a call.
“For my part, it was the most beautiful experience I’ve ever had. When I thought that my milk could help someone less fortunate than my son, I felt good; it wasn’t demanding, the only thing you need is the organization.” That’s the experience of a donor that considered the commitment minimal.
Another woman, happy to be part of the project, considers the donation something natural and a right and duty for each woman; she says “my commitment with the pump and the bottles which are useful to the collection and storage of the milk made me feel mother of other children” and “giving the mother milk is a marvellous love feast that is good for the heart of donors”. She also thanks the drivers because they planned days and times for the collection, always meeting her needs. The combination “motivation to do good-not onerous commitment” is reported in 62 answers.
Outside the box there’s a mother, already mentioned, who says that the breastfeeding and, consequently, the donation was not simple: actually, during the first months “it was a Calvary with painful fissures and recurring mastitis... the donation was the reward for all my efforts”.
Another woman was not so confident because she was afraid of not honoring the commitment. But she succeeded with a kind of success.
There’s also someone who saw something positive in this commitment: “it was amazing to be committed... a sort of appointment with suckling and shipment... a feeling related to the act of donating and being useful to those in need. It was very rewarding and I’d like to repeat this experience during the next pregnancy”. Others felt free since “the commitment didn’t seem onerous. I was happy because my milk could help other children to grow up. I’ve never considered it as an onerous commitment and the staff never pushed me to meet certain standards, so this freedom contributed to the successful outcome of my commitment”.
The mothers who had a direct or indirect experience of a pre-term delivery deserve a separate chapter: “ when you feel guilty because you failed to protect your (pre-term) baby and you donate your milk, you are in a team that does good (Neonatology Department)” or “ I was happy to help helpless creatures because I knew what meant to have a premature baby on your hands feeling powerless... Hoping for the best and be sure that, thanks to my donation (that didn’t hurt me), a newborn could have survived”, or yet, “Direct experience: in my room there was a mother and we gave birth on the same day... she underwent an emergency Caesarean section. I was thinking to them... to that child that was upstairs in an incubator, who needed milk and to her mother who was bedridden”. Ultimately, a woman gave birth to a daughter with problem in a hospital far from our HMB and donated us the milk she wasn’t able to give to her baby.
Analysis of responses and discussion (Table 1)
The answers point out our local reality and are particularly rich of useful cues to improve our activity. Specifically, let’s start from the first operational steps: the information about the possibility of donating. We can affirm that the direct information during the hospitalization and after the delivery (performed by the bank staff in a standard and capillary manner), really works: thank to it, 70% became aware of the bank. This is certainly a strong point which is possible because the bank is equipped with dedicated staff and also for the number of births, compliant with a personal systematic approach and a recruitment method that could be exported. The downside is represented by the awareness (coming from this survey) that the divulgation in other hospitals is lacking. It’s necessary to put in place some initiatives for mothers who don’t give birth in our department. Only 3,2% was informed about the existence of the HMB and worked to find one on the territory. From this, comes the need of a major divulgation through media and the Net.
The second question about the reason of the donation is the altruism which is prevailing in 83,3% of answers. This datum is in line with the literature [19–29] and is a positive one even if we consider it together with the abundance of milk produced (23%), because it sheds light on mothers’ sensitivity regarding pre-term babies; we should encourage them through information campaigns on this reality which is little known by the public opinion except for anecdotal cases that get into papers, media and on the Net.
24,4% of women is not at the first experience. The datum contains some indirect conclusions about the perception of the previous experience that affects the following one and our work. Mothers who have already donated their milk are breeding ground that is to be cultivated because there’s a high possibility that they would do it again. Instinctively, a women tends to renew the feeling of pride and satisfaction and if we succeeded in gratifying it through moments of worthy public and private appreciation, the goal of multiple donation is closer.
The answers to the forth question are related to the kind of delivery that does not influence the possibility to donate despite the idea of a difficult start (of breastfeeding) that often influences the continuation of women who underwent caesarean section.
The point 5 concerns the length of the breastfeeding in the puerperium where the donation has occurred. We also analyzed the length of breastfeeding not related to donation comparing it with babies who didn’t receive donated milk. In the first case, the length was superior of about two months - a satisfying datum if combined to the growth of newborns. It can be disclosed to dispel one of the main fears related to the donation that is to say not guaranteeing the intakes suitable for the child growth.
The moment, during the day, is not important while 70% of women pull their milk out after breastfeeding. Probably, the fact that they’ve already fed their child creates a major serenity which is a prerequisite of the donation.
It is reassuring that about 62% defined as “ zero” the commitment necessary for the collection, the storage and the shipment of the milk to be donated. This is a key-message to spread so as to unravel one of the most common perplexities inherent to the donation that is to say the fear of not honoring the commitment with the milk bank.
This is perfectly linked to another message retrievable from our questionnaire, related to the answers about the favouring effect of the donation on the newborn. 76% of answers is affirmative and motivated with subsequent breast simulation and major production of milk. The donation is considered a method to improve and extend the breastfeeding. This is one of the most important data and deserves the largest diffusion.
The suggestion given by mothers concerns the information: the will to breast-feed and donate can do everything, can overcome also the most demanding difficulties.