Case Report: I feel like a mother to other babies: experiences and perspectives on bereavement and breastmilk donation from Vietnam.

There is a growing recognition globally that care regarding lactation following a perinatal death needs to potentially offer the opportunity for maternal donation. This article discusses this experience and perspectives from a human milk bank (HMB) in Vietnam. This is a descriptive exploratory case study that has a long tradition in both the social and health sciences. Triangulated data collection involved a review of video data, interview data with the donor, and data review for the Da Nang HMB, a Center for Excellence in Breastfeeding. We found that although it is common for mothers in Vietnam to donate breastmilk to HMBs, it is less common for this to occur following perinatal loss. We offer a descriptive case study of the maternal loss of twins and a subsequent choice to donate for approximately 1 month to the Da Nang HMB, the first HMB in Vietnam. We discuss four reasons derived from this case regarding donation following perinatal loss. (1) A strong motivation to donate breastmilk when aware of the service, (2) donating breastmilk helped her deal with grief, (3) family members supported her through this tough time and supported her decision, and (4) health staff supported her decision. While human milk sharing (e.g., wet nursing) has been practiced in Vietnam, breastmilk donation from bereaved mothers has neither been discussed nor well-researched. Because maternal grief is complex and individual, deciding to donate breastmilk is a personal decision that needs to be supported, without creating guilt for those who do not wish to donate.

Characteristics and factors influencing the volume of breastmilk donated by women to the first human milk bank in Vietnam.

Background: Donor human milk (DHM) is essential to the operation of human milk banks (HMB). This study examined characteristics and factors associated with higher volumes of DHM donation at the first HMB in Vietnam. Method: Data from an online HMB monitoring system collected between February 2017 and July 2022 included demographic characteristics, child information, the timing of donation, and the volume of DHM. Higher volume is defined as equal to or greater than the median DHM volume per donor of 14.4 liters (L). Potential contributors to higher DHM volume were examined using the chi-square test in univariate and multivariable logistic regression analysis. Results: During the 5.5-year operation, this HMB recruited 517 donors with an average age of 28.6 years. Approximately 60.9% of donors had a college or higher degree and 97.3% gave birth in Da Nang city. Of these donors, the prevalence of cesarean birth was 48.2%, preterm births was 40.2%, and 27.9% had babies with a birth weight of less than 1,500 g. There was a similar proportion of donors between the hospital (48.2%) and community (51.8%). On average, hospital donors started their donations 15 days after birth when their newborns were 33.9 weeks corrected age compared to 63 days and 47.7 weeks among community-based donors. The overall median volume of DHM per donor was 14.4 L over a period of 46 days. The amount and duration were higher in community-based donors (17.5 L in 72 days, 300 ml/day) than those in the hospital (8.4 L in 30 days, 258 ml/day). More than 37% of donors contacted the HMB themselves; the remainder were introduced by health professionals. Factors associated with higher volumes of DHM included higher education (OR: 1.77; 95% CI: 1.09, 2.87), having a full-term newborn (OR: 2.46; 95% CI: 1.46, 4.13), and community-based donors (OR: 2.15; 95% CI: 1.22, 3.78). Conclusions: Mothers with higher education and from the community donate more breastmilk over a longer duration than those with lower education and from the hospital. Breastfeeding protection, promotion, and support should be offered to all mothers with specialized breastfeeding support for mothers of preterm and sick infants. This will ensure mothers have sufficient breastmilk for their newborns and potentially surplus breastmilk for donation.

Differences in the Microbiological Profile of Raw and Pasteurized Breastmilk from Hospital and Community-Based Donors at the First Human Milk Bank in Vietnam.

Background: Microbiological quality is one of the key safety standards in human milk bank (HMB) operations. We describe the profiles of bacteria in donor human milk (DHM) before and after the pasteurization of samples collected from breastfeeding women in the hospital and from the community in the first HMB in Vietnam. Methods: Data were collected between February 2017 and January 2022 from an online HMB monitoring system. First, DHM samples were cultured, and the number of colony-forming units (CFU) were counted before (n = 708) and after pasteurization (n = 1146). The gram-staining method combined with the Vitek 2 Compact system were used to identify types of organisms at the Da Nang Hospital for Women and Children's Laboratory. Passing criteria for DHM included pre-pasteurization samples had a total colony count <105 CFU/mL and post-pasteurization was <10 CFU/mL. Results: During five years of operation, Da Nang HMB had 491 donors (48.7% were hospital and the rest community donors) who donated an average amount of 14.2 L over 45 days. Of this DHM volume, 84.9% of donor samples passed the pre- and post-pasteurization microbiological tests. DHM from community donors had a higher pass rate (87.8%) compared to that from hospital donors (79.5%). Before pasteurization, 15.4% of DHM samples had a bacteria count <103 CFU/mL, 63.0% had 103-<105 CFU/mL, and 21.6% had ≥105 CFU/mL. Most of the unpasteurized DHM samples (93.0%) had microorganism growth: with one organism (16.4%), two (33.9%), three or more (43.6%). After pasteurization, 17.9% samples had a bacteria count of 1−9 CFU/mL and 7.2% had ≥10 CFU/mL. DHM samples from community donors had a lower bacterial count and number of organisms than those from hospital donors both before and after pasteurization. The highest microorganisms from unpasteurized DHM samples were Staphylococcus epidermidis (74.2%), Acinetobacter sp. (52.1%), gram-positive bacillus (51.7%), Staphylococcus coagulase-negative (15.8%), and Staphylococcus aureus (10.5%). Common microorganisms from pasteurized DHM were gram-positive bacillus (21.0%), Staphylococcus epidermidis (3.9%), and Acinetobacter sp. (0.9%). Samples from the hospital tended to have a higher contamination with those microorganisms than those from community donors. Conclusions: The majority of DHM samples in Da Nang passed microbiological testing criteria. DHM from community donors had higher pass rates than hospital donors. Corrective actions are needed to improve HMB operations and hospital microbiological quality standards, as well as general improvements in water and sanitation.

Trends and Dynamics in the First Four Years of Operation of the First Human Milk Bank in Vietnam.

BACKGROUND: Since 1979, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) have recommended the use of pasteurized human milk from a human milk bank (HMB) to feed low birthweight (LBW) and preterm newborns as the 'first alternative' when mothers are unable to provide their own milk. However, they have not issued any guidelines for the safe establishment and operation of an HMB. This gap contributes to the demand for gathering experiences from HMB networks, especially those from lower-middle income countries. To fill this knowledge gap, this study examines the characteristics of donors, donation, pasteurization, and recipients during the first four years of operation in the first HMB in Vietnam. METHODS: Data about the donors, donation, pasteurization, and recipients were extracted from the web-based electronic monitoring system of the HMB from 1 February 2017 to 31 January 2021. RESULTS: In the first four years of operation there were 433 donors who donated 7642 L of milk (66% from the community) with an increased trend in the amount of donated milk, donation duration, and average amount of milk donated by a donor. Approximately 98% of the donated milk was pasteurized, and 82% passed both pre- and post-pasteurization tests. Although the pass rate tended to increase with time, a few dips occurred. Of 16,235 newborns who received pasteurized donor milk, two thirds were in the postnatal wards. The main reason for the prescription of pasteurized donor milk was insufficient mothers' own milk in the first few days after birth. There was a decreased trend in the amount and duration of using pasteurized donor milk in both postnatal wards and the neonatal unit. CONCLUSIONS: The HMB has operated efficiently in the previous four years, even during the COVID-19 pandemic, to serve vulnerable newborns. Ongoing evidence-based adjustments helped to improve the operation to recruit suitable donors, to increase the access to and quality of raw donor milk, to improve the pasteurization process, and to meet the need of more newborns.