Be Your Own Hero: Kim Updegrove
Kim Updegrove is the executive director at the Mother’s Milk Bank at Austin, which has recently relocated from a small building near the University of Texas campus to a 15,000-square-foot warehouse. On a sunny Friday morning less than a week before their grand opening, I spoke with Kim in her new office as construction continued right on the other side of the door. We discussed grief, power, and how to celebrate National Breastfeeding Month.
Interview with Kim Updegrove, shortened for brevity— July 21, 2017
Can you explain what happens at the Mother’s Milk Bank for our readers who might not know?
So the milk bank is a 501(c)(3) organization. It is a place that was founded in 1999 in order to save vulnerable babies’ lives by providing human milk feedings. That sounds a little magical, right?
So it turns out that if you have a baby who is three and a half pounds or smaller, what we call in technical terms a very low birth weight baby, that baby has a significant chance of dying. And if not dying, then having some very serious disease of the intestinal system directly related to not receiving human milk only feedings. Necrotizing entercolitis (NEC) is an inflammatory condition of the intestines that happens when a baby that small and that vulnerable receives formula, or nonhuman milk feedings. That inflammation kills the tissues of the intestines — that baby then has a 60 percent chance of dying. And if that baby lives, that baby has lifelong medical challenges related to the absorption or processing of nutrients.
Two physicians back in 1998 said this is enough.
We’ve watched babies in the neonatal intensive care unit die just because they were born early and biological mothers of babies born early are significantly stressed, either by their own medical conditions or by the condition of being separated by their infant. The infant may live in the neonatal intensive care unit for months — six months, ten months, a year even. So the stress and separation and sometimes not-so-rigorous support of that woman’s lactation capability leads to her own milk not being available. These two neonatologists, Dr. Rivera from the St. David’s system and Dr. George Sharp from the Seton system, got together and agreed that they could do something about this. They knew that there were a few, not many, milk banks around the country and that milk banks had existed in the US since 1910 and that the supply of safe donor human milk to these babies drastically reduced the rate of that, so they decided to form a milk bank.
How did they do that?
They built up a community support, developed some funding, opened a community based nonprofit milk bank in order to provide milk free of any strings to any particular hospital or any particular industry, to provide that milk to the hospitals caring for these vulnerable infants. Typical of cities of that time, before there was a milk bank we had about a 9% rate of NEC in the city. Within one year, we had a 1% rate. So we can’t eradicate NEC by providing human milk, but we can drastically reduce it.
What does that mean for the community?
What that means is that families who have the delivery of this very tiny baby, yes they’re still separated from that baby, yes it’s still traumatic and it’s difficult right? But while they might start off very fragile, when the milk bank was formed it was to make sure that they, that those babies, those little boys and girls who were so very tiny, survived. That they had a chance to not only survive and leave the NICU, but to walk and talk.
Over time, since our investment in research and the creation of the science to understand how to process milk that was donated from another human being to someone else’s biological baby, tweaking these processes has led us to become a leader in the milk bank industry. We have developed a greater understanding of what’s in the milk naturally, how to tweak the needs of a one pound baby differently to a two pound baby. In doing so we have built the reputation of being the lifesaver of these tiny babies.
But interestingly it’s not us who save those lives.
We couldn’t save one single life if we didn’t have mothers who have given birth within the last year agree that despite their fatigue, their very busy schedules, or their grieving process, despite all of those things, because lactation is happening, because they’re making breast milk, they express and store their milk safely, they go through a screening process, and they donate their milk once they’re approved, and it’s only because of them that we’re able to save these babies.
You say “grieving process,” so are these mothers who have lost their baby to a stillbirth?
About five percent of our milk donors every year are grieving. They have delivered a baby who might have lived for a short time and then died. That baby might have been born premature or vulnerable in some way, lived in the NICU and not survived. That baby also might have been stillborn, not born alive at all. I can’t think of anymore painful situation of losing the baby that you had so much hope for.
But those women decide to donate milk as a means of facilitating the process of their grieving. They find it healing during that process.
The mothers and fathers need to understand what’s going to happen in terms of her milk’s going come in, maybe two or three days after she leaves the hospital, and it’s a surprise to many people. And it’s a surprise that is painful. It can be a painful reminder without preparation that you had intended to have a healthy infant to feed, and you don’t have that baby boy or girl now.
So we built a bereavement program. We have a specific outreach program called “Lactation and Tears”. It walks her through the choices: does she want immediately for her milk to dry up and eliminate that reminder of the pregnancy, or does she want to facilitate that breast milk supply and express it and donate it in honor of the child she lost and save some lives in the process?
We try very hard through our social media sites to promote stories of recipients of donor human milk so that if you are a donor during this time period and we are posting these stories, you can relate to those stories of who you’re helping.
And it’s helpful. It’s a human connection. It’s a glimmer of hope at a time when there’s amazing darkness, because of the child lost.
It’s like this cyclical circle of life thing, as cheesy as it sounds.
It is, actually. You’re grieving and you’re taking the opportunity to donate your milk for these babies; it’s a sense of a power.
You’re powerless in bringing back your child’s life, but you are all powerful to make sure that somebody else’s child survives, somebody else’s child who has the opportunity to survive, if they have human milk, that’s all in your power.
And I think that feeling that power, being in power to save other people’s lives, says okay, bad things happened here, but I can do good things for somebody else in honor of my child because my child was real, my child’s not here. But that child’s impact on the world is bigger than the length of the pregnancy or the length of the stay in the neonatal intensive care unit. The impact is now even minus that child, the continued gift of milk to another’s child. And that I think is enormous.
So are most of the babies that receive the donor milk preterm babies?
About 80% of our babies who receive donor human milk are preterm. But there are unfortunately, because science is not perfect and because humans are far from perfect, there are reasons why babies are born even full-term or light-pre-term who are very very vulnerable. Babies who are born with congenital heart defects, or intestinal defects. Babies who are born having been exposed to street drugs. So babies who have something we call neonatal abstinence syndrome, babies who are addicted to the toxic substances they were exposed to in utero now are very very sick. Those babies benefit from human milk feedings and yet you can imagine their mothers are not able to provide milk to them. There are tragic circumstances of mothers who are lost at birth, there are tragic circumstances of mothers who are lost after birth. The prioritized recipients of donor human milk through the milk bank are those with a medical need.
Every once in a while, we have a supply of donor human milk that is large enough or healthy enough, if you will, that we can supply milk to healthy babies. Healthy babies whose moms don’t or don’t have their own breast milk supply, or for some reason have decided not to provide milk to their babies. That is a really good day when we provide that supply — we currently have that supply, we’re able to provide that milk to a number of healthy infants. We cannot provide that milk to all healthy infants however because we don’t have enough supply. So like with any other scarce resource, we have to have some gatekeeping in place we have to say that ok, if there are 60,000 very low birth weight infants born in the US each year, we have to prioritize them to make sure that they have all of the human milk that they need.
And if we know, from looking at average statistics, that about 50% of those very tiny babies’ milk needs will be met by their biological mothers, then the other 50% has to be met by the milk banks. So we can forecast how much milk is needed for them and take care of them. In an ideal world, we can provide milk to all human babies who don’t receive human milk. We only do that if every single lactating mother says I want to be a life saver too.
How can we make it easier for them to do that?
I am absolutely convinced that if we improved breast feeding support in our communities… If we had employers who formally allowed breastfeeding to continue at least for that first year and maternity leave allowed for time to build a sufficient milk supply… If your return to work didn’t harm your ability to breastfeed your baby, but rather supported continuing that relationship by either allowing your baby to be on-site — intermittently or continuously — or allowed you a clean, safe place to express your milk as you needed it…
If we improve our breast feeding support, we’ll have more moms breast feeding, we’ll decrease the need for donor human milk, and therefore increase the amount of milk that’s available to the milk banks, decrease the number of babies who need it, and therefore have milk for all babies who don’t receive it from their mothers.
That’s the ideal world and that’s the vision of the milk bank: that we become part of the solution to the problem of not every woman being able to meet her breastfeeding goals. We aren’t looking to strong-arm people into breastfeeding as a rule. We are looking for a solution to the problem of having you setting a breast feeding goal based on your understanding or informed consent about pregnancy and what your baby needs and what your body benefits from.
The problem of having so many people, almost 80% of mothers not meeting their breast feeding goals, is a societal problem.
And the milk bank is intending to be a part of that solution. I think we’re going to change things in Austin and I think we’re going to be a model for the rest of the nation and show that with support — accessible to all — we can change the statistics that differentiate populations and their health outcomes.
Shifting gears, there’s this stigma about breastfeeding in public or at the office. Do you have a favorite way to promote and encourage widespread acceptance of breastfeeding among our communities?
Yes! So National Breast Feeding Month is like a freebie from the nation to say we can talk about breastfeeding all we want. We are a society that loves breasts.
We love to see Victoria’s Secret ads, we love to see movies with women without their shirts on, and the sexualization of breasts is accepted by this culture. The problem with that though is that breasts actually weren’t made for those things. Breasts were made to feed our infants.
Every mammal feeds their infants their milk and that’s how the species survives. And somehow when commercial formulas became available in the 1950s, we got away from that. We bought the marketing approach that science was better than nature and we lost the idea that breasts are actually responsible for promotion of a healthy population.
So throughout the year we have marketing campaign or outreach campaigns that try to normalize the words “breastfeeding” and “breast milk.” We have cheeky posters in gyms that say “if you pump gold instead of iron,
So in the same vein of stigma, why do you think there’s such a stigma against mothers who can’t, or choose not to, breast feed?
It should never be the case that one human is picking on another human for their choices or their circumstances or their opportunities. And I’ve seen chatter of breast feeding women pick on non-breastfeeding women, and this picking on people is out for the public to see, thanks to social media. Why do I think it happens? I think humans are insecure and when we pick on other people it’s an attempt to raise ourselves up, to justify the decisions we made ourselves.
We seem to lose sight that we’re all in this together and if we would all agree that we’re all in this together and agree that each person has different opportunities and challenges and makes different decisions, I think we’d be a much better society.
To learn more about the Mother’s Milk Bank at Austin and the various ways you can contribute, visit their website. For more stories and interviews like these, as well as ways to take action to support breast feeding and other women’s rights: subscribe to our once weekly Deeds Digest newsletter and follow us on social media: