Milk banking with Gillian Weaver MBE

For those parents with babies in special care, or those wanting to maintain feeding with human milk while going through their own medical treatment, milk banks are a crucial service. Over the last few decades, they often have Gillian Weaver to thank for that.

My guest this week, Gillian Weaver was president of the European Milk Bank Association from 2012 to 2015. She co-founded Hearts Milk Bank in Hertfordshire, with Dr. Natalie Schenker, after a long career of running milk banks at a hands-on level and also consulting internationally. She has been awarded an MBE in recognition of her services to milk banking and breastfeeding.

We talk about how Gillian got started in the world of milk banks, how the service has evolved, how donations and supply works, and the future of the Human Milk Foundation and Hearts Milk Bank.

My new book, ‘Supporting the Transition from Breastfeeding: a Guide to Weaning for Professionals, Supporters and Parents’, is out now.

You can get 10% off the book at the Jessica Kingsley press website, that's uk.jkp.com using the code MMPE10 at checkout.

Follow me on Twitter @MakesMilk and on Instagram  @emmapickettibclc or find out more on my website www.emmapickettbreastfeedingsupport.com

Find out more about Gillian’s work at 

Human Milk Foundation https://humanmilkfoundation.org/

Hearts Milk Bank https://humanmilkfoundation.org/hearts-milk-bank/

Find a milk bank near you in the UK here: 

UK Human Milk Bank - Breast Milk Donation, BreastMilk Storage, UKAMB

This podcast is presented by Emma Pickett IBCLC, and produced by Emily Crosby Media.

Transcript

Hi. I'm Emma Pickett, and I'm a lactation consultant from London. When I first started calling myself Makes Milk, that was my superpower at the time, because I was breastfeeding my own two children. And now I'm helping families on their journey. I want your feeding journey to work for you from the very beginning to the very end. And I'm big on making sure parents get support at the end to join me for conversations on how breastfeeding is amazing. And also, sometimes really, really hard. We'll look honestly and openly about that process of making milk. And of course, breastfeeding and chest feeding are a lot more than just making milk. 

Emma Pickett  00:47

So the person I'm speaking to today, is a bit modest, and she's not going to let me gush too much, but I'll see what I can get away with before she interrupts me. When I say she is one of the leading experts in this field. I am absolutely not exaggerating. She is absolutely a world leader in the field of human milk banking, and she has been for more than 30 years. She was president of the European Milk Bank Association from 2012 to 2015. She co founded hearts milk bank in Hertfordshire, with Dr. Natalie Schenker after a long career of running milk banks at a hands on level and also consulting internationally, and I know she's still zipping all around the world, helping countries set up milk banks, consulting with them and working out what they're doing day to day. She's supporting research, she's developing guidance, and I managed to do all that without ever mentioning the fact that she'd been she has been awarded an MBE. You haven't hurt your MBE yet? But it's coming soon? 

Gillian Weaver  01:41

It is yes, I've got an appointment at Windsor Castle. Next one's very exciting. It is exciting. Yes, it is exciting. I've got no idea. Who will be doing do you do an investiture? Who will be doing it? Except that I'm assuming it won't be the king because of his prostate problems. So maybe Princess Anne or possibly Prince Edward our? I don't know if Sophie, Duchess of Edinburgh? I think it is, isn't it? I don't know if she if she does them. But it might be quite nice, because they had a I'm sure their first child was born early and was on a neonatal unit. So maybe that maybe they'll have got some knowledge of milk banking, maybe they've maybe they come into contact with donor milk at some time, got no idea, but at least they will know what in the native unit looks like?

Emma Pickett  02:34

Yes, that will be really special. It'd be great if that was the case. Because I presume you'll have a little bit of dialogue where someone's going to say, oh, for milk banking, for services to milk banking, you might have to give your 32nd summary of what that is or something. So yeah, Princess Anne, I'm sure will be interested in that too, because she's someone who appreciates mammals and all mammals get up to so I can see her being supportive of milk banking, definitely. I look forward to hearing hearing about that. And then you can wear that every day. I look forward to seeing you wear that next time I see everywhere, everywhere.

Gillian Weaver  03:04

You go everywhere.

Emma Pickett  03:07

So I know we won't often we use the phrase, the world's oldest profession, we're thinking about something else. But I like to think that you are part of the world's oldest service because babies have always needed milk. We've always needed to help out babies to get them more milk and and you help babies to get access to milk and get fed. And I'm going to hesitate and say that you may be one of the people in the world who's helped the most babies have access to human milk if we're lining up all the people in the world and you just pull the face there because that's a horrible concept. But you must have facilitated a lot of babies getting human milk. What were your very first steps into the world of donor milk and milk banking.

Gillian Weaver  03:43

Okay, well, yes, that's a bit freaky thinking that I've helped helped the most. I'm happy to accept that I've probably facilitated 1000s and 1000s of babies receiving someone else's breast milk. Yes. And hopefully always receiving it in a positive and supportive way. I do hope so. My first steps where it was all a bit accidental, actually, I had a six month old baby who very obligingly my first child, my son are very obligingly. He kind of was born knowing how to breastfeed. I don't know how he kind of went straight on, did what he needed to do. I knew nothing about it. I'd studied human nutrition. And I was a registered dietician. But actually, when it came to breastfeeding, I probably had, you know, in my studies, after lecture, if that if that and so he knew what to do when he was six months old. I wanted to or I needed to and and wanted to get back to a bit of work, but I didn't want to work full time and an advert in a local newspaper that came through the door free paper, the Hounslow informer, and there was a tiny, tiny little advert for a milk bank coordinator at Queen Charlotte's Hospital. So I did what most people do and say what's the milk bank, at that time, never heard of that bank. And applied because as much as anything, it was local, the job was part time, the hours are flexible. And I thought it would be it would be, it would be perfect. And my knowledge, such as it was of breastfeeding, I'm sure helped me get the job. I started within less than a week, I started because the present person was leaving. And I thought, well, this will be something nice and interesting to do. I was terrified to begin with of being responsible for feeding these tiny, tiny babies. I've never seen such tiny babies. And I'd never set foot on a neonatal unit. And by the time my daughter, Nancy, who was born a couple of years later, was ready to sort of go to school. And I was ready to start increasing my hours, I was absolutely hooked on the world of milk, mostly for various reasons, as much as anything else. I mean, what could you not like about working to working with mothers who are donating milk, and working with families that you can help with their breastfeeding? Was my that was my start.

Emma Pickett  06:12

You got sucked in and it never let you go. You still are today. And we're all reaping the benefits of that. So trying to work out timing. So you've been in this field for more than 30 years, were you in the middle banking world during that really difficult phase? So when HIV first hit, and everyone was really panicking about HIV in human milk, am I right in thinking that milk banking took a little bit of a dip in? There was a really a difficult period? Were you around just after that? 

Gillian Weaver  06:38

So you're absolutely right. So Arthur was born in the end of 88. So I was I started in the middle of 89. And around 8889. Obviously, HIV aid had been coming along throughout the 80s. But 88 and 89, there was some edicts that were issued from the Department of Health, about milk banks that stated that all, all donor milk had to be pasteurised, and all donors had to be screened for HIV. And so as a result of that milk banks closed throughout the UK, but similarly around the world, and literally milk banks closed overnight. The idea of being screened being tested having a blood test for HIV would put anybody have wanting to donate milk, because if you'd had a blood test or HIV, you couldn't get life insurance, irrespective, irrespective of the of the reason why you couldn't get you couldn't get life insurance. And in order to get a test you you had to go to a Gu M clinic. So it was a big obstacle and having to pasteurise milk because not all milk was pasteurised, at that time in milk banks, a lot of the donated milk or the or the milk banks where it was all quite rudimentary in terms of auto at a ward level. So mothers who were in the postnatal ward, if they had surplus milk would be asked if they minded expressing and collecting some, and then it might have been heat treated in a pan, or it might not. And it was shared with babies that might need it. So there was a there was a lot of kind of informal and very low key sharing going on. There was some milk banks at the time in the UK that did that did pasteurised and that worked on a on a more sort of operational level, more like as similar to how milk banks operate today. But not all a lot of the milk that was shared was done in a very informal.

Emma Pickett  08:31

Yeah. So gosh, I'm thinking how different things are now I know with your past risers and digital temperature checks. And it's also complicated. I'll ask you a bit more about that in a minute. But gosh, you really has been going through a transformation hasn't it the whole time, the tech side and the checking side of things.

Gillian Weaver  08:46

We've just moved the hearts milk bank has just moved. So we're setting up all their computer systems and so on. And I was telling my colleagues, because they were saying well, about you know, well, how did you use to label everything? Everything was handwritten. I had no computer it was it was a fair few years before there was a computer in the milk bank, no printer, no emails,

Emma Pickett  09:10

God, things are so different. So tell me a little bit about hearts commitment. You mentioned it a couple of times. Congratulations on the move. By the way, I should just declare that I am a trustee of Human Milk Foundation who run the hearts milk bank. I don't do a sliver of what you do. And I don't have a sliver of the understanding that we have what you do. So I'm looking forward to asking lots of Daft questions today but tell us a bit about why did you and Natalie start hearts milk bank or how did you get started and why did you feel it was needed? 

Gillian Weaver  09:38

Okay, well, if I can just go back maybe maybe a little bit. So when I first started it at Queen Charlotte, we just recruited mothers who had babies on the neonatal unit or within the hospital. We didn't recruit any mothers in the in the community and the donor milk only went to the babies on the neonatal unit. So that's that's how it worked it was very much an in house thing. And then we moved sites and the milk bank started to grow in the demand for milk bank and the Queen Charlotte's was was linked up became part of a trust with Hammersmith hospital and other hospitals. And so the demand for donor milk grew. And after HIV, when when there'd been this great drop in milk banking, but also drop in the demand for donut, there was a realisation. In the early 90s, some some research was published, that showed that that babies that were born premature preterm babies were less likely to develop a potentially devastating gut condition if they were exclusively fed human milk. And that led to an increase in demand. So other hospitals were wanting access to donor milk new milk bank started to be formed. And that was where I was able to share my knowledge that I'd learned in working at Queen Charlotte's with, with other hospitals to set up banks. And so over time, more and more hospitals were using down the milk. However, the milk banks that were operating, most of them were really only funded in resource to supply not to their own hospital, and if they had surplus, like to others, and that was fine, as long as they had surplus, but they might not always have it. And so there was no equity, there was no assured supplies. And it was to really address that, that not just myself but others working in the field of milk banking, we kept thinking about and meeting and talking about how we could how we could address this how we could have an A nationwide service services, so that babies weren't treated differently according to where they lived. At the time babies that were born in, I don't know, the Northeast of England, for example, identical babies or very similar babies, you know, babies in the Northeast wouldn't have access to donor milk babies in the southeast would and that never sits easily with me. So not just myself, but colleagues around the country, we're looking at it, we talked about developing a milk bank or milk banks as a social enterprise would be a good way to do it so that they were on a sort of independent footing, they weren't dependent on the resources of an individual trust with its own often financial problems. So I talked to this, I talked about this with Natalie, Natalie had come into my working life one day when she contacted me wanting to donate milk. And we started to talk about research, which she got very, very interested because at the time she was, she was a researcher at Imperial College, she was doing a doctorate working on research into breast cancer. And she became very interested in an invest milk and the work of the milk bank. And we started to support her work. And so over quite a few a few years, we were working together. And then as I started to think about leaving working in the NHS, we talked about, you know what the future could see. And the idea of milk banks that were run on a business footing, but they were completely nonprofit seemed to us to be the ideal. And so after I left, and after we kind of realised that really, particularly in the south of southeast of England at the time, a lot of hospitals never knew whether they were going to get down and melt the next week. And we wanted to be able to address we were aware of the of the rise in the commercialization of human milk, and wanted to try and ensure that there was a service that was a not for profit service that could hopefully help to stem the tide in the UK of incoming commercialization. So that was where it came from. I was sitting on on a beach in Australia when she contacted me to say, You know what we've been talking about, well, let's do it.

Emma Pickett  13:49

You certainly did do it and you've been doing it ever since so. So even though it's called Hearts Milk bank, and it's based in Hartfordshire. It's not just heart for tourists. It tell us a bit about how the hub's work.

Gillian Weaver  13:59

And it never was because although it's hearts milk bank, it's heart with an A in it because we didn't want it to be sort of a parochial service that was that was just based in a certain part of the country. When we started and we started so small, we won, we won a prize. We won a prize as something called mass challenge, and it was a startups and we won enough money to be able to rent a facility and to buy either to buy some buy some equipment, very quickly, we started to have more milk, then we actually need it because although there were lots of hospitals that were were saying they wanted donor milk promise it takes quite a while to get things set up and organised and consciousness and all rest of it. So we started to provide donor milk to families in the community as well. And partly as a result of that word spread, but also as we were able to grow and I have to say at this point, the reason we were able to grow was largely because of volunteers like yourself, Emma, everybody came and joined as we were volunteers at the time, we worked for quite a long, long time without any income associated with it. And everybody came as volunteers and helped us. So we were able to able to grow and provide donor milk further and further afield to hospitals that needed in a short supply. And throughout that it didn't make sense it very quickly didn't make sense to be having all the milk going up and down the up and down the country length and breadth of the country all the time. So we started to set up what we call hubs. We have one up in Northumberland to supply lots of the hospitals up in the Northeast there, the far northeast, we've got one in Norfolk, in Norwich, and one in Kent, and one down on the south coast in Sussex, and one in Wales. And as a result of these, it means that mothers in those areas are able to donate out quite often for the first time in that in that region. And the milk can be stored and then travel and then come in bulk to the milk bank. But equally we can store pasteurised screened donor milk in those hubs so that when a hospital wants it, it's a question of it can go out the same day, we're able to respond. So logistically, it makes a lot of sense economically, it makes a lot of sense. But also it means that we can take the heart's milk bank to parts of the country where there wasn't either ready or assured access. It's

Emma Pickett  16:31

a brilliant achievement. I mean, so all this milk is whizzing around sometimes in local areas, sometimes doing a bit more of a journey. How is it travelling? Tell us about the team that helped that have helped that to happen?

Gillian Weaver  16:42

Okay, well, we honestly couldn't, and I'm talking for all millwrights we couldn't do it without volunteers. And in particular, the well we call them they're called the blood bikes. I call them the milk but actually most people know them as the blood bikes. And since the 1970s, I think was was when they first started. They've been volunteer motorcyclists. And nowadays it's not only motorcyclists, they have cars, they have four by fours, and, and so on as well. But mainly motorcyclists, they're volunteers. And they started off by transporting out of normal working hours, blood, some tissues, emergency products, for the NHS, they're organised usually one or two, sometimes three counties, one. Often they have the name Serb, which stands or used to stand for service by emergency rider volunteers. I think it's changed now. They have other other names in Yorkshire. They're the White Nights. There are lots of different names back about 1213 years ago, a donor to the Oxford milk bank. I think she had a problem with a freezer and she needed a collection of her milk because the freezer is broken. And she must have known about the blood banks and she contacted them to see if they would help. And they were the Local Group OPN stepped in and did this and then the guy who was running that that group at the time, John Stepney, remember his name very well contacted me at to say because at the time I was the chair of UK, the UK association for milk making, you know, was this something that would would be helpful. So, the idea of having volunteer motorcyclists to be able to pick up donor milk from home, bring it into the milk bank and to be able to take pasteurised milk out to hospitals. It was just incredible. I mean, I used to love it. I used to spend my my, my evenings and my weekends and days, collecting milk myself in my car on the way to work on the unit, whatever we would we would work it out and then used medical couriers, but that didn't really work so well. The volunteer motorcyclists are just unbelievable. It revolutionised milk banking in the UK, and many other countries are very envious of our loved bikers or our or our milk. They've just phenomenal. 

Emma Pickett  19:08

I've been honoured to meet many of them at your summer parties and things. They're a very special bunch of people. So yeah, if anyone is listening who knows a blood biker, please give him a big hug from us. Pretty amazing.

Gillian Weaver  19:18

You'll see them out on out on the roads out on motorways. Give them a wave don't put them off they're off their motorbike riding during COVID They were phenomenal you know we couldn't have we couldn't have collected milk without them. 

Emma Pickett  19:31

Yeah, so when milk arrives at the milk bank I feel like we should make a little picture but yeah, the milk bank with lots of lovely illustrations and you know page by page explain what happens and it'll end with a little baby at the end having the milk so lovely Mr. Bill blood biker or Mrs. Blood biker turns out knocks on the door. Hands over a insulated bag to you what happens to that milk next in the milk bank

Gillian Weaver  19:55

before the milk comes to us. We will have had a phone call from somebody data from a mother, she may be at home with a thriving two month three month old baby, she may have a baby in hospital that is on a neonatal unit that's maybe going home breastfeeding, and she's been expressing storing milk for that baby. And now the baby's going on breastfeeding, and she's got more milk stored that she can either take home or that her own baby would need. in very difficult circumstances, her baby may have died or her baby may be extremely ill. So they will still we never, we never know. somewhere, somehow that mother will have been put in contact with us we'll have found out and she will have gone through a whole recruitment and screening process. So that happens before the milk comes to us. So first of all, we've got to do some checks. Ultimately, it needs to get very quickly into the freezer, we have a limit of about the about them then of time that the milk can be out of the freezer in the insulated bags, which is one of the reasons again, why we have hubs because it can break the journey. So it will be checked to make sure that the that the milk is all properly labelled. As you said, we have very fancy barcode track traceability systems these days, which make life so much easier. We don't have to handwrite labels anymore, we'll check that the milk is label because that's very important. And then we will check the documentation that comes with it. When the nice guy, there's a nice guideline from the back panel banks for the operational side of knockbacks. And when that was published in 2010, we introduced a checklist by which we could make sure that that donors were still meeting the criteria because someone wants they recruited as a donor, you know, there may be donating for weeks, months, occasionally a year or even or even longer. So we need we need something to check that they still comply with and criteria for being a dentist. So we need to check any medications they may have taken. So we check we check everything against that the milk goes into a holding freezer, all our freezers are you know remotely monitored, as you said for for temperatures. So they go into a holding freezer, and then it will be weighed so that we know exactly how much there is. And then that will all go onto our onto the system. So it will go on to we use a system called lie look, which is specifically developed. And Natalie and I were very involved in the development of that. And then the team in the lab. So we have the the milk lab, they at some point will decide which milk they're going to thaw ready to be tested, we take a test sample from the milk that goes to microbiology lab transported by the blood bikers or the milk bankers, and then it will be tested and it will go into the pasteurised as for the special heat treat. And then it will go back into a holding freezer. Always different freezers always very clearly marked all the milk has unique IDs on it so that any any container of milk at any time we know exactly whose it is and what stage of the process it's in. And it will stay there until we get the microbiology results back. We need to test the milk to make sure that it doesn't have too many bacteria or potentially pathogenic bacteria.

Emma Pickett  23:12

So sometimes, if that result doesn't come back with great news, you do sadly have to discard milk that's come in if the standard isn't met, how often does that happen? 

Gillian Weaver  23:21

It varies. And this is this is the case for all milk banks, between about 567 percent. And 15% of the milk is usual sometimes it's sometimes it's it's more that has to be discarded. But usually it's around, it's around that sort of level. Quite often actually, if a mother has been expressing and collecting milk before she's been recruited as a donor or before she's had the conversations with our lactation team, about the things she needs to do to make to minimise the possibility of it having too many bacteria in it, then that's often the milk that fails because maybe the equipment wasn't being cleaned as much as it needs to be. Or she might have had a toddler that's been you know, handling the milk and helping helping her as as you would do if you're expressing milk for a baby and you've got to, and you've got a three year old, you know, you get them involved because you're sat there and you can't do anything else. And we do have conversations and they are very difficult sessions because it doesn't mean that that milk would be problematic for the mothers own baby. Even usually, if that baby was in hospital, it just means that because when we hit treat them out, we need to ensure that it meets quite strict criteria because we're not just killing the bacteria in the mouth. We are inactivating certainly a small part but a part of the anti infective components that are in the milk, the things that prevent those bacteria being problematic. Human Milk, you know more than anyone and that is an amazing fluid that's a balance between it's good that it's got micro organisms in it, it helps the baby to develop their immune system they, their gut needs those fantastic healthy bacteria. And if it's got less helpful bacteria in it well then that helps them usually often to kind of develop their immune system. But if there are too many or if the balance of within the milk has been disrupted by the pasteurisation, the situation is different. And if there are too many bacteria, you can't guarantee that the pasteurisation will inactivate them all. The great thing about being a milk bank that is so involved in research is that we often are able to use it for research and we get obviously consent from from donors initially to be able to do this, we try and use it.

Emma Pickett  25:46

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Emma Pickett  26:32

So I remember when I was doing my lactation consultants exam, we talked about Holder pasteurisation and milk being held at 62.5 degrees for 30 minutes or whatever it is, I don't if that's necessarily what you guys are still doing. But when we say pasteurisation, we're not talking about Super boiling, we're talking about bringing it just up to enough of a temperature to to kill some of the bad stuff. And as you said that potentially would inactivate some enzymes or some white blood cells and things that are part of the living fluid of breast milk and some milk banks around the world don't pass. Dr. So you'd mentioned that we used to be historically what happened in the UK, but also, right now it's my understanding that there are some European countries who just use what we might call raw milk. Why do they do things differently? Is that just they've made a decision that they can test more carefully? What's going on that they feel they can do that and why don't we do that?

Gillian Weaver  27:20

Well, like most things in life, it's down to a bit of history. There are two countries in Europe, one Norway, most of their milk is used raw, not all of it, but most of its use raw. And in Germany, they use the milk raw for the very tiny sickest babies, but the milk that doesn't meet the extra criteria that are needed for it to be used raw is pasteurised, and then that's used with a bigger well a baby. So the bigger well are babies get pasteurised milk and the very tiny sick as babies get raw milk in many of the milk banks in Germany. In Norway, the aim is for all of the milk to be used or in order to be used raw, you need to do not only more tests, more tests on the microbiology stricter criteria for the microbiology tests on the milk, but also more blood tests on the on the donor. So I haven't really talked about that yet.

Emma Pickett  28:12

Yeah, let's talk about that. So if someone wants to become a donor, what is that process? What do they have to go through.

Gillian Weaver  28:18

So while they'll go through conversations with with our staff who will help them out and help to explain the rationale behind why we are so many nosy questions about their health and their health history and about their baby and about various other things. And that is to ensure that there's nothing about their their health, sort of medication use, it's that sort of thing that would make the milk suboptimal for the babies. So we're about making sure that the donor milk is as as the quality of it and the safety of it or as high as as high as possible. So we do that. And then the additional test that needs to be done is that everyone has to have a series of blood tests. Now we screen for the obvious things like HIV, but we also screen for less well known infections, HTLV, we screened for Hepatitis B and C, and we screened for syphilis. And that is a blood test that needs to be done. We make it very straightforward for donors, we send them a kit that they can just take to their GP or to the botany service, blood testing service in the hospital or wherever. And then those their blood samples get posted to the lab. But we need to know that they're negative for those infections. 

Emma Pickett  29:33

And it's my understanding that within the UK, despite kind of, you know, there is obviously some national guidance, there are nice guidance, we still have variation between different milk banks in terms of who they take milk from and who they don't take milk from. What are some of the decisions that you've made at hearts that aren't necessarily in line with everybody else's decisions around who you'll accept as a donor?

Gillian Weaver  29:51

There are several things and one of the things that's always been a real bugbear for me is that I think if we're going to tell someone that you can't do it But we've got to have a very good reason we've got to have evidence for that. So well, caffeine is an example. So the hearts milk bank, I don't believe there is evidence. And certainly it's not in the nice, it's not in the nice guideline that women should have to restrict their caffeine intake. I think also it from a pragmatic point of view, if you're going to if you're going to include some sort of stipulation, it's also got to be sensible and measurable and all the rest of it. And one person's cup of coffee can resemble the not resemble another person's cup of coffee in terms of its caffeine intake. So if you're going to talk about cups of coffee, or chocolate, or caffeinated drinks, or whatever, it's got to be evidence based. But the big difference, I suppose with hearts is is and this has come about because almost uniquely, we routinely provide donor milk to families in the city where it's the mother who's ill rather than the baby. So in these instances, the baby isn't the very tiny, very premature, very vulnerable, baby. And so we have a separate criteria separate list of medications, drawn up with a very expert, Dr. Wendy Jones, and also with the UK DLs, which is the UK drugs in lactation. So looking at medications that we would exclude for donors who are donating milk that's going to go into hospital neonatal units for very tiny sick babies from milk that can be used for bigger Weller babies at home, it means that we can recruit mothers that other milk banks can't recruit. And we work with with the other milk banks who will if they've got somebody who they're saying, Sorry, we can't recruit you. But you can, you can contact the hearts milk bank, and they may be able to, it's really only on the grounds of medication, except also for the age of the baby. Now, we thought that again, because we're providing donor milk, for a much wider criteria, we don't have a cut off for months or six months or nine months, as do some milk banks in terms of when they will or won't recruit, we don't recruit mothers during the first four to six weeks of lactation. So when their baby's very young, because we want them to be able to establish their lactation and their breastfeeding for their own baby without the additional impetus of expressing milk. And certainly without depriving those babies and we don't accept stored colostrum we want mothers to be able to feed that to their, to their to their own babies, unless it's milk, this has already been collected and this is not going to be usable, then then we will we will accept that we don't recruit moms to start expressing milk in those early weeks. But later on, we're happy to to accept donors, irrespective of how old their baby.

Emma Pickett  32:57

Yeah. Which is great. I mean, I know that Natalie did a piece of research with the parenting science gang, looking at how milk continued during the duration of lactation and found a remarkable consistency. That was the phrase from the research in terms of the quality of milk, possibly even suggesting higher fat content as as children got two and and two years. 

Gillian Weaver  33:18

So yeah, protein goes up. You know, milk is incredibly variable. So it's so it is quite hard to kind of lay down hard and fast rules. But it's very interesting. I know that for many of the years when I was working in milk banking early on that, you know, we did say, if your baby was more than six months old, we wouldn't we wouldn't recruit you because of the nutritional content of the milk. But actually, we now know that once you get beyond a year, that the protein levels the levels start to increase. Again, the milk seems to sort of get more concentrated, which, which, which kind of makes sense, because babies at that age, are feeding less feeding less less frequently.

Emma Pickett  34:01

Yeah, I mean, I was once told and correct me if I'm wrong, that some milk banks have that cut off of six months, because it's expensive to do all the blood testing. And if you test someone at seven months, they may or need lactate for another two months, and you've haven't really got value from doing all that testing. So it's not necessarily the quality of the meal. There are all sorts of different considerations. 

Gillian Weaver  34:21

That is a factor. So we do we do ask donors to provide at least two litres of milk now, two litres of milk because the milk has to be used has to be pasteurised before it's three months old. It means that the donors have at least two months in which to collect the two litres. So expressing every day and collecting 3040 mils something like that means that you would get your two litres and we've worked out that if donors donate two litres of milk, then it means that we are able to charge the hospitals to cover our costs, covers the blood tests. Blood tests are very expensive. So we're not, it's not costing us more to recruit some, than we're able to get reimbursed from the hospital,

Emma Pickett  35:06

it's good to hear that two litres. I think sometimes on social media, we see images of American moms with like, massive, you know, juggernauts full of milk. And yet you imagine that milk donors can only be people that produce an extra litre a day, and you've got to have like, whopping great gallon jugs of it. 

Gillian Weaver  35:21

But you know, over two months, I absolutely hate it. And I hate the I hate the competitiveness, I hate the kind of Guinness Book of Records type, you know, and actually, that's a really problematic situation for somebody with a young family, we take supporting donors incredibly seriously. And one of the things that we do is help donors to be able to down regulate their milk supply. So women who've got hyper lactation, who are who are finding that, you know, they can barely leave the house, and often struggle with the breastfeeding because their supplies, because they have so much milk, you know, they fill up so quickly that the babies can't latch on and it becomes such a problem. I remember the first time that colleague, Joe, head of our lactation services, helped her mother in that situation. So once again, be able to leave the house and to be able to downregulate her milk to just about what her baby needed from being really handicapped in terms of her life. And that to us was a was a real success, it's often assumed that most donors are in the happiest situation of breastfeeding is gone, gone are going very easily. And they have extra milk, and everything's hunky dory, but actually, very many of our donors, you know, face difficulties that they need support with. And so having the lactation support team is is really important. And it's one of the criticisms that we make of the sort of commercialization of human milk is that there isn't that support for donors, you know, if somebody's expressing milk every day, and then they suddenly have to stop because of the baby's ill, or they're ill or whatever. So they need some supporting through that time, because their milk supplies more than their baby needs. And so they may, you know, if they don't express or know, or bring the milk supply down a bit, they may end up with blocked ducts with mastitis with worse, you know, so it's a question of ensuring that everybody can get that support that they need. 

Emma Pickett  37:24

Yeah, and you are an ethical organisation, which is why you support donors to, you know, you're not gonna take advantage of some type of lactation, we're gonna get to a place where the, you know, the family is supported as well. And obviously, you're not only talking to donor mums, you're talking to recipient families as well. Let's just spell out the super obvious, why is it so important that these babies who are receiving this milk as recipients, what does it do for those babies? 

Gillian Weaver  37:50

Okay, well, first of all, the most important thing is that the families are receiving every support and help they need to ensure those babies get as much as possible at their own mothers. Do you know you assumed that that would that would be a given, but it is the bottom line in banking, that the donor milk is there in support of the family, ensuring that the baby gets the mother's own milk. The reality of life on a neonatal unit when a baby is born early and or very ill is that the mother may not necessarily be able to express and collect enough of her milk to meet her baby's requirements, temporarily. So there's a big difference between a healthy Well, in a term baby being able to spend a few days building up the mother's supply, and a baby that's born preterm that needs set volumes of milk every hour or every few hours. And that that needs to increase gradually. And so the fact of life is that for some mums, it may take them, you know, 345 days until they're collecting enough. In the meantime, if there's donor milk available, it means that those babies Well, a the babies can be fed according to the clinical requirements, how the clinicians want them to be fed, because it's important for their gut maturation, that these that these babies are, are afraid that they're not just you know, left receiving intravenous nutrition, and that the milk, the donor milk can be there as a bridge. Now, in some circumstances, the mothers never catch up and aren't able to provide provide enough irrespective of all the support and help that they may be given, potentially because of their own health problems, situation, whatever it might be. There are all sorts of reasons why that may be the case, in which case, babies may need donor milk, you know, most of their milk or all of their milk as donor milk for days, weeks, sometimes sometimes moms in one instance in my working career, several years, you know, there are differences for most babies. It's a bridge during those first few days that they that they need. 

Emma Pickett  39:58

You mentioned this gut condition That is fatal if baby's potential potential human milk. Yeah, and we know better brain development, better AI development outcomes, we know we could have a whole nother hour on the benefits of human milk rather than giving an alternative product. 

Gillian Weaver  40:14

For example, to me, the most important benefit for everybody of having done the milk is that we know that it's supportive of mother's lactation, and breastfeed. When donor milk is introduced to units that don't use it, it's very unusual for the breastfeeding rates at discharge. So for the numbers of babies being fully breastfed, or partially breastfed, when they go home goes up, and certainly our experience with hearts, and one of the best things that's been able to provide donor milk to hospitals that have never used it before, we're still recruiting new hospitals that haven't traditionally used donor milk, to be able to supply it. And then to see, their breastfeeding rates go up, sometimes, sometimes really, markedly. Now, it isn't just the donor milk, it's the change in ethos, and it's the whole belief on the unit. And obviously, it comes down to the support, being there optimal support for mothers to be able to, you know, provide enough and to be able to provide their own their own breastfeed, that's the most important thing don't milk is, is is heat treated. And it's, it's not the mother's own milk. So it's not a replacement for and it shouldn't be. But it does mean that those babies can remain exclusively breastfed, it means that you don't have to introduce formula that lots of babies on neonatal units do, do get formula. And if they're, if that's the choice of the family, they will, they will be moved on to formula before they go home, if that's their choice, but to be able to avoid it, especially for families have wanted to breastfeed and that that's their choice.

Emma Pickett  41:51

It's about mental health.

Gillian Weaver  41:54

And, you know, we work we work Natalie and Natalie and I work with Professor Amy Brown in Wales, and the work that she's doing, and the realisation of the impact, not just on the families who are receiving the milk, but also the impact on donors in terms of their mental health. I was just working on a new paper for publication. Now, I was just reading through it last night, actually. And when you read the things that donors say about the difference it's made to them, it also brings home the importance of making sure that if you're telling someone they can't donate, you have a very good reason for doing so. Because actually, that may well impact that mother and that family for years and years to come. And some of the statements that I was reading last night about the the impact it had on them of not being able to donate their milk when they wanted to is as devastating for them as it is for families whose whose babies aren't or don't, or didn't receive donor milk, when when that was their parental wish.

Emma Pickett  43:04

I know you've touched on them before. But we have a very special group of donors that the snowdrop donors who are the mums who've who've experienced losses and are continuing to donate beyond that moment, which must be very, very difficult for sure to state the obvious, those are some of the most precious donors that the organisation have. But am I right in thinking that some milk banks don't accept donors who've had a loss?

Gillian Weaver  43:26

Very, very few and it is changing. And I take my hat off to my colleagues at the Chester milk bank, who have started the memory milk gift initiative, which is helping to support milk banks to be able to recruit or read donors that otherwise didn't feel able to, or if nothing else, are able to put donors in contact with milk banks like hearts like Chester, where were we we always we always have to some of the most poignant memories for me are picking up the phone to a mother whose baby has died. And her wanting to talk to me about the possibility of donating her milk. And the first time it happened. I remember just being so worried that I couldn't because I hadn't done this before. support her and her partner to provide the care and support that they needed. Fortunately, I was able to reach out to colleagues in the United States actually who were able to, to guide me into and to help and to help me and very sadly, babies die sometimes before they're born sometimes after equally devastating and for those families for those mothers to be able to a manage their lactation because they've got to make milk, they're making milk, you know, so to be able to manage it according to how they want to to gradually reduce their NOx Applying they've been expressing milk and storing it or feeding a baby who then subsequently dies, to be able to make a decision to initiate their lactation. Knowing that that was that is something that is the sort of natural part of the of the whole reproductive cycle if you like that's, you know, the lactation to not very quickly and suddenly stop them stop their milk supply to be in control of it, it can make such a such a huge difference. And to be able to donate the milk and to get the recognition of the fact that this milk is there as a result of this, this baby who is no longer with them, and that that that milk can have such a such a positive impact for other families and save other babies lives can can can make other mothers lives easier, and can make a real difference. The best thing that we can we can do is working with these with these families and enable them to fulfil their own wishes. It's not for everybody, it's not for everybody by any means. But what the memory milk gift initiative is doing is helping to raise the profile, which is which is so important, so that families know about it. And other people like me, don't pick up the phone to a mother, who says that when her baby died three years ago, you know, and she was told she couldn't donate, and now wishes so much. And remembers in tears telling me about having to disappear, throw her milk away because able to do anything with it. We call them snow drop down as it was the choice it was the name that was chosen by about by a group of Aboriginal bereaved down as the snow drop is called the milk flower. And it's also a sort of symbol a symbol of hope. That's right, this rather lovely, yes.

Emma Pickett  46:49

And if anyone's listening to this, and they're a midwife, or somebody who works in a hospital, you have to be quite brave, to talk about donation with somebody in that moment. And you have to be able to give somebody the right information and their hearts have leaflets don't use it there. There's things that ways to support health professionals to have these conversations, I guess someone would like to start doing this, they could perhaps get in touch with hearts to get some guidance on how to have these conversations with families.

Gillian Weaver  47:18

Yes, yes, do so yes, you need, you need to have the confidence to be able to and to be able to frame and to not, you know, to have the language to be able to be able to use, but these conversations are essential about lactation anyway. So every every mother in the situation should be having a conversation about about what she can expect with milk and milk supply. And you know, the impact it's it's going, it's going to have certainly contact us and we can we can put with other more local resources as well. Sans is now much more able to provide information to the other thing we do at Hearts is every every bit of information that we put out, or like questionnaires, and so we have very different ones, for bereaved families, from the standard documentation. 

Emma Pickett  48:12

So you mentioned earlier that Hearts is unusual in that it sometimes does give milk to babies in the community. Now, I don't want someone listening to this thinking, Oh, I've got a bit of a problem with my milk supply my baby's weight gain, let me give hearts a ring. Tell me a bit more about how that works and what the capacity is for her. So at the moment to give milk to community. 

Gillian Weaver  48:31

The difficulty is that in the hospitals, the hospital reimburses us for our costs babies in the community, we get no reimbursement. So we set up the Charitable Foundation, The Human Milk Foundation, in part to be able to fund supplying donor milk to families at home. The reason we do this is because there are so many families for whom breastfeeding is not or for whom breastfeeding is incredibly challenging, or who may need some temporary support. Now you're absolutely right, because there is a limit to the amount of support that we're able to give. But our aim is to be able to increase this and one of the reasons for our recent move is in order to be able to to be able to grow our organisation the rationale for for needing milk the most, I suppose the most striking reasons are for the very many women actually who get a cancer diagnosis antenatally or, you know, just after their babies born and who are told that they because of the treatments that they're going to receive can't breastfeed their babies. And so to be able to provide donor milk for a limited period of time and it's usually it's usually four weeks, four to six weeks, provision of down and out to be able to provide that to the to the family so that the baby can start there. Feeding journey on breast milk. But there are lots of other reasons as well, it may be because the mother isn't able to breastfeed because she's taking certain medications, there aren't very many, very many medical medications that are completely in the country indicated for breastfeeding. But there are a few mothers who are HIV positive, and who who aren't breastfeeding, to be able to provide those babies with with donor milk for a for a period of time. And families where maybe the baby's being discharged from hospital and they haven't quite got enough of the mother's own milk to be at or have been maybe receiving donor milk to be able to extend that for a little bit, to give the mother time to catch up with her lactation, when you've got a baby in the hospital and you're having to visit and you've got other children at home, potentially, you're maybe travelling quite a long way to, to, and I shouldn't use the word visit because you don't visit your own baby. But to spend time with you. You're not a visitor, you know, to spend time with your and to care for to care for your baby, it can impact on breastfeeding. And of course, if the baby is physically feeding at the breast, then you don't get as much as they should. And for a lot of the time that babies are on neonatal units, babies often wanted the attribute that usually starts to happen often just before they go home. So once you get the baby home, and you can just, you know, feed the baby, feed yourself sleep and, and so on, then your milk supply will hopefully go up. So instances like that to be able to provide donor milk to those families. We know from the response that we've had, what a huge difference that makes to those families. And it's something that we're really pleased, delighted to be able to do. We couldn't do any of this if it wasn't for the amazing generosity of so many, so many women. I used to when I worked at screenshots for many, many years, I worked on my own I did, I recruited the mothers, I pasteurise the milk collected, I delivered it, I did it whatever. I walk into the hearts milk back now when I see I see the team, and I see them there and I see and I hear them on the phone, all the mothers phoning in volunteering to donate their milk contacting us to help in other ways. And I can't tell you how it makes me feel just to see the expansion of this, that and the milk going out and motorbikes coming in and out. Honestly, I know it's a bit hacky. But I'm, I've been so fortunate considering I came into this completely by accident that with no plan, anybody is thinking about changing a career or something and thinking, you know, Can I do it, you know, things fall into fall into your path and and change the course of your life. Overnight, tiny little advert. And what's what's really important also is that other milk likes to growing as well, back home, which is the British Association for perinatal medicine last year, published a framework, which now gives a framework of recommendations to enable units and neonatal staff about the use of donor milk recommending the use of donor milk and recommending it up to and beyond for two weeks. And also how best to ensure that the availability of donor milk doesn't undermine support for that mother to provide her own milk and to establish breastfeeding herself because that is so important.

Emma Pickett  53:28

Yep. So I'm going to ask a question you now with your your dietitian hat on nutritionalist, dietitian hat. So one of the things that I come across a lot is there are lots of confusing messages out there about quality of milk and how some people have better quality milk than other people and and also how a mums diet might affect her milk and the quality of her milk. What sort of messages do you want mums and lactating parents to have around how their diet is important or how their diet affects milk or what they what considerations they need to have. 

Gillian Weaver  54:00

It is a tricky one this I have to say I was very struck back in the early days starting to get involved with BFI baby friendly, and listening to the advice you know, not to worry about about your diet, which is kind of counterintuitive when you've studied nutrition. And dietetics telling people don't worry about your diet, but understandably for the reason that I know that thinking that you have to have a very nutritious, well balanced, well planned diet full of, I don't know organic foods or freshly cooked foods or so on that if you don't have that, that will impact on your on your milk supply is detrimental to encouraging everybody to as many people as possible to choose to breastfeed because Because clearly, you know, new family life. There ain't a lot of time a lot of hours in the day to be pursuing all of that. And it's absolutely true. But the nutritional content of your milk is not dependent on your diet, but certainly not for a certain length of time. But ultimately, if you've used up your own body stores of certain minerals and vitamins, nutrients, then unless you're getting them from your food, you won't have them to be able to get into to get into your, your milk. Now, that's, that's after quite a period of time. So what I would say is know what you do not have to worry about choosing achieving the healthiest diet possible, you need to be eating food that you enjoy. And that is manageable in terms of shopping and preparation and so on, according to your circumstances. Having said that, I do think we have a responsibility to provide the information so that we can all make. So he says within the constraints that we have within within our life. But I do also think that, given that there are there are very many now women who breastfeed for much longer than maybe was the norm. Certainly I was I was a complete, I was almost an an outcast in terms of in terms of the length of time, I breastfed, my two, four, I mean, I used to get absolute shock horror from Health Visitors GPS, my GP told me to stop breastfeeding when my son was two because I was pregnant. So things have changed fantastically clearly. Breastfeeding for for several years is a long, long, long way away from being the norm. But more and more women are doing it. So they're getting pregnant. They're breastfeeding, often tandem feeding these days, maybe breastfeeding or pregnant for many years. And I have to say that in those circumstances, that unless nutritious food, or indeed a supplemented diet is what's going into the body, then something somewhere we'll have to get it will either be in the nutritional status of the mother, or in the nutritional content of the milk. First of all, everyone who's pregnant or breastfeeding, should be should be taking the appropriate substance.

Emma Pickett  57:19

And that's, that's vitamin D, isn't it in the UK, 

Gillian Weaver  57:22

it's vitamin D. And there are, you know, the multivitamin, pregnancy and breastfeeding, multivitamin mineral supplements that that are out there. And they're kind of a catch up so that if you if your diet isn't optimal in terms of the nutritional complexities, well, then it gets supplemented. And and they're there. But absolutely, definitely. Vitamin D. 

Emma Pickett  57:46

Yeah, and vegan mums there will already be taking B 12. If you're vegan, you will know that already, presumably, and you'll already interestingly, so

Gillian Weaver  57:53

vegan mums, yes. Because because by and large, that's as you say, they will know that they're likely to beach, you know, that oh, that potentially will be deficient in in B 12. Because you only get that from products of animal origin. And some other nutrients, iron maybe. But interestingly, I found out and I didn't, I didn't notice that, that actually vegetarians are more likely to be deficient in these in these nutrients and vegans, because vegetarians because they're eating some, some animal products, they're having some dairy or some eggs or whatever, they may not be having them very often. So they may not be getting enough to be able to maintain the amounts that they need. So So in studies that have been done across Europe, that actually it was vegetarians, who were more likely to to be to be deficient. The other thing is the Omega fats that are obtained from from oily fish, and that we know, if you're not eating any sources of these, then they won't be in your milk, in which case and if you're not supplementing them at your milk won't have these very special very importance in them. So it's important to to supplement to take appropriate steps.

Emma Pickett  59:12

I'm going to ask a question with my lactation consultant hat on so in formal milk banking, you know, milk sharing mums on the internet saying I've got a freezer full of milk, who fancies it, I'm swinging by next week, I'll come and get it. That sort of informal milk sharing is something I'm not allowed to facilitate. As a lactation consultant. I'm not allowed to it's not within my remit. But mums will come across it, they'll talk about it and it's suddenly obviously part of the discussion in the community in the breastfeeding world. What do you want parents to know about informal milk sharing and what do you normally say when that conversation comes up?

Gillian Weaver  59:50

Well, like you I don't recommend it. I suppose it fits into my general philosophy of life is that give Everybody the information they need, and let them make their own decisions. I would never say to somebody, you know, you shouldn't do this, it's you know, and I certainly don't think it's the level of danger that it's sometimes portrayed. Because if it was, and I'm going to, I'm going to put caveats in here. But before, before I do that, if it was, there was so much milk sharing going on, that we would be seeing instances of harm in babies that were not inherently, breast milk is safe. However, like everything else that you do, when you're making decisions about how you bring up your, how you really your babies, and bring up your children, there are always the potentials for harm. And certainly, within milk sharing, there is the potential harm if the person whose milk you're accepting and that you're going to feed to your baby, you know, hasn't gone into or you or you don't know about the medications, they were taking other things that they might, they might be doing that could that could impact on the safety of their milk, you know, for some drug use is the nominal in their daily life. So may not see it as something very, very different. It's a bit less time of extreme extreme, but there have been instances and how the milk is stored, breast milk is very good at it's got bacteria have static systems within it that stopped bacteria growing, but once they do start growing, they can multiply, they can multiply very quickly. And you can find that the milk has got pathogenic bacteria in it, that's so harmful bacteria in it or is or was very heavily contaminated with bacteria, potentially something someone could do something accidentally, you don't know now. So it's a question of making sure that you have a conversation that enables you to find out about all of these things from the person that you would be accepting the milk, the milk from. And wherever possible, it's better to accept it from somebody that you know, that you could trust. Nobody knows what they're really knows what their, you know, status is in terms of different infections, there are new infections, when COVID first came on the scene, we didn't know whether COVID was transmitted by breast milk or not, there are always new infections. And there are infections that you know you can have. And you can have had a long time and not know about. So I've talked about the screening that we do in milk donors, occasionally, we find mothers who have had no idea that they've been infected at some point in their recent or sometimes, you know, distant past with life threatening infections. I mean, Hepatitis C is the is the classic example you can have hepatitis C, not know about it. And it's not something that's routinely screened for usually antenatally. You know, it is something that potentially if it was, if that milk was being given to another, someone else's baby, then it could be problematic. What I would love to see would be that if people are choosing to share milk, that the person who's donating the milk could very easily access blood tests, and do the sort of screening that we do for milk donors to the to the milk banks, I think that that would be really helpful rather than telling people not to do it, to show them how to do it more, more safely. We've adopted this in lots of other realms of family health. Having said that, I think the other thing is, and this is where the work of lactation consultants is so important, that rather than invest so much time and energy that many, many people in this situation do trying to access someone else's milk, get support to be able to increase your own milk supply and to find out what it is that is preventing you from being able to fully breastfeed your own baby. So that if nothing else, if you are using someone else's milk, then you use it for as shorter time as possible. 

Emma Pickett  1:04:24

Yeah, yeah, I'm glad. I'm glad you mentioned that. Definitely. I think I think just like using formula can reduce your milk supply using somebody else's, to reduce your own milk supply. And if you've got perceived insufficiency of milk supply or lack of confidence around your milk supply that isn't necessarily justified. It's support you need rather than just adding in somebody else's milk. So you definitely won't definitely want people to reach out for support hunters how

Gillian Weaver  1:04:47

you supplement it as well, because we know that you know, giving milk via via bottles isn't going to be supportive of breastfeeding, particularly if you've got a new baby and you haven't got breastfeeding. stablished you know, obviously there are ways to bottle feed and for it to be far less interfering with breastfeeding. But you know, you don't need me to say that, but it's making sure that that this information is available and the support is is available. And also, if you do need to, if you do need to introduce formula that it can be done in a way that's, that's still supportive of breastfeeding, and be able to increase your own milk supply at this at the same time. 

Emma Pickett  1:05:28

So in the show notes for this episode, I will put links to the Human Milk Foundation website in the hearts website, there'll be information there for people who want to possibly become donors. Also, information for people who might currently be financial donors are very, very, very important. Very, very, very, very important. I know you're just literally plugging in machines and, and sweeping your new new rooms and sorting out your Wi Fi. But what's next for hearts, what's next for the hearts in the next few years? 

Gillian Weaver  1:05:55

for at least a couple of months, we're going to be regrouping I think and getting our heads around. So we've moved we've moved into a health centre. It's called gosens. And it's rather lovely. So we're surrounded by GPS and health visitors and midwives and physiotherapists and, and all sorts of things. So so it's going to be great for us to be to be back in the midst of all of these all of these services and coming into contact with commissioners, because getting donor milk commissioned for families in the community would be a real is a real goal of ours so that it can be funded because we spend so much time getting and pursuing getting the funding to be able to support the foundation to provide donor milk to families in the community, it would be so amazing to be able to access funding for that. We'll be working with Natalie to develop and explore the next three years of her Ukri fellowship, Natalie is a future leaders fellow. She's recognised as being one of the leading researchers with with this exciting programme of research that will help us to understand, you know, milk banking, not just in the UK, but further, further afield and how we can all optimise it, the sort of the sorts of things that are such as so important. She's working with lots of other researchers, lots of other lots of universities, on different projects, looking at the economic impact, you know, the health economics of it all. Working with me, as I said, on the psychological impact the mental health impact of all that we do so a very exciting and working, we've got a team, we have been working on her research colleagues working on milk kinship, we've just put something on the website that they've developed around Ramadan, and support for and advice for mothers during Ramadan and fasting and so on. So So all of these things, looking at what's needed and being able to develop the best resources to fill that gap. And to help to spread the word. I think all of us we believe implicitly that the availability of safe screened high quality donor milk and by haggard by high quality. I mean, you know that it that it is the least likely to have any contaminants and anything that makes it suboptimal. So the pursuit of that and increasing the accessibility making it much more equitable, is what we're, we're going to be pursuing one way or another, for sure. 

Emma Pickett  1:08:38

And biggest facilities, more volume of milk potentially over the next few years. Now we've got recommendations for more babies needing it more and more babies are going to be asking, not the baby on their behalf and more community work and we're looking at, I know you had to deal with hundreds and hundreds of litres of milk we're talking about hundreds and hundreds of more litres of milk coming and,

Gillian Weaver  1:09:00

and bigger babies Brilliant stuff need more milk, the beauty of very tiny babies, they don't need very much. The bigger they are the length, the longer the gestation when they're born or when they're receiving the milk. You know, it doesn't just double or triple the amount of milk that they might need it it can you know much, much more than that. So and certainly in the community, we're kind of talking gallons, sometimes. Yeah, not even litres. Brilliant

Emma Pickett  1:09:25

well, so we'll visualise all those gallons whizzing around on their milk bikes in the years to come. I've been delivered by drones. And also I know you do all sorts of clever tech stuff. You haven't even touched on that. But I'm incredibly grateful for your time today. Julian, thank you so much for joining us and the work of the Human Milk Foundation and hearts melt bank is incredibly impactful. So please do go and check out the websites and think about how you might be able to spread the word even if it's just following on social media and popping the hearts milk bank story into your story every now and again. We'll help get the word out and and help more people to hear about the work that we do. So thanks Thank you for your time today, Gillian, really appreciated

Gillian Weaver  1:10:02

As you've probably been able to tell, it's been my absolute pleasure. I love talking to you the best ever, but to be able to talk for so long about my passion has been just wonderful. And if anybody has further questions, you know, feel free. You can email me at the human milk foundations is happy to answer.

Emma Pickett  1:10:22

That's very generous of you. Thank you very much. 

Emma Pickett  1:10:29

Thank you for joining me today. You can find me on Instagram at Emma Pickett IBCLC and on Twitter @MakesMilk. It would be lovely if you subscribed because that helps other people to know I exist. And leaving a review would be great as well. Get in touch if you would like to join me to share your feeding or weaning journey, or if you have any ideas for topics to include in the podcast. This podcast is produced by the lovely Emily Crosby Media.