Round 1 – donor recruitment

RECOMMENDATIONMedian1-34-67-9D/KRec based on medianConsensus based on 75% ruleConsensus based on D9RGDG considerationsRecommendation for Round 2
R1aRecruit donor women from any of the following groups:
  • mothers early in lactation (usually ‘drip milk’)
35300Do not agreeNo consensusConsensusThere was some discussion about the timing of recruitment. This may include the early recruitment of women who have lost their babies. The mother's preference should be respected. The discussion included whether this was about selection or recruitment. It was agreed that the issue was about when women should be approached about donating milk, so the word ‘donor’ was revised to ‘potential donor’ throughout. The general agreement was to recommend a broad recruitment strategy, but with some specific groups named, such as bereaved mothers (see recommendations below).

See R2 which covers all these groups.
R1b
  • mothers whose lactation is well-established
90080AgreeConsensusConsensusSee R2 which covers all these groups.
R1c
  • mothers whose infant has died.
8.50080AgreeConsensusConsensusSee R2 which covers all these groups.
R2Recruit donor women from any mother who has surplus breast milk.90170AgreeConsensusConsensusThere has been a minor word change to reflect recruitment, rather than selection.Recruit potential donor women from any mother who has surplus breast milk.
R3Do not use surplus milk from mothers who have expressed milk for their own babies in the NICU.1.58000Do not agreeConsensusConsensusIt was agreed that the revised recommendation should be a positive one on the use of surplus milk.Use surplus milk from mothers who have expressed milk for their own babies in the NICU.
R4Consider using surplus milk from mothers who have expressed milk for their own babies in the NICU only if milk from other donors is not sufficient to meet demand.27100Do not agreeConsensusConsensusSee recommendation R3.
R5Do not actively recruit donor women.17100Do not agreeConsensusConsensusRevised recommendation to be positive recommendation on active recruitment.Actively recruit donor women.
R6aRecruit potential donors through a variety of channels.This can include
  • providing written information packs to be left in

    doctors' offices

8.50080AgreeConsensusConsensusThere was general discussion about the variety of methods that could be used to recruit potential donors. The approach of each milk bank will depend on local circumstances, including level of funding and need to recruit.

General recommendations were therefore agreed, with a broad strategy overall.

It was decided that minor revisions made to wording should be less specific about the details of how the information should be provided (e.g. the removal of packs in R6a-d).
Recruit potential donors through a variety of channels.This can include
  • providing written information to be left in

    doctors' offices

    hospitals (sometimes provided to mothers in the perinatal period)

    volunteer or health-related organisations working in public health

    infant, children and maternity shops

R6b
  • providing written information packs to be left in

    hospitals (sometimes provided to mothers in the perinatal period)

90080AgreeConsensusConsensusMerged with R6a
R6c
  • providing written information packs to be left in

    volunteer or health-related organisations working in public health

8.50170AgreeConsensusConsensusMerged with R6a
R6d
  • providing written information packs to be left in

    infant, children and maternity shops

80341AgreeNo consensusConsensusMerged with R6a
R6e
  • or through direct referrals or recommendation from

    donor women

90080AgreeConsensusConsensus
  • or through direct referrals or recommendation from

    donor women

    staff at the NICUs

    attending paediatricians when assessing the progress of the infant

    health visitors (or other healthcare professionals providing postpartum care)

    childbirth educators

    organizers and attenders of pre- or post-natal classes

    nursing mothers' groups

    breast feeding support or related organisations

R6f
  • or through direct referrals or recommendation from

    staff at the NICUs

90080AgreeConsensusConsensusMerged with R6e.
R6g
  • or through direct referrals or recommendation from

    attending paediatricians when assessing the progress of the infant

90071AgreeConsensusConsensusMerged with R6e.
R6h
  • or through direct referrals or recommendation from

    health visitors (or other healthcare professionals providing post-partum care)

8.50080AgreeConsensusConsensusMerged with R6e.
R6i
  • or through direct referrals or recommendation from

    childbirth educators

8.50080AgreeConsensusConsensusMerged with R6e.
R6j
  • or through direct referrals or recommendation from

    organizers and attenders of pre- or post-natal classes

90080AgreeConsensusConsensusMerged with R6e.
R6k
  • or through direct referrals or recommendation from

    nursing mothers' groups

90080AgreeConsensusConsensusMerged with R6e.
R6l
  • or through direct referrals or recommendation from

    organisations, such as the La Leche League, or the National Childbirth Trust

90080AgreeConsensusConsensusThe recommendation was made more general, with the removal of specific organisations (in line with NICE policy on recommendations).

It was noted, however, that the ‘Understanding NICE Guidance’ would include some named organisations.

Merged with R6d.
R6m
  • or through mass media contact, such as

    newspaper

81061AgreeConsensusNo consensusThe recommendation was revised to reflect that it refers to publicity for the donor milk bank and its work – it is not a paid advertisement.

There was agreement that any mass publicity or advertising would need to be balanced with increased workload, and that it should be focused to try to limit interest. There was also a question about whether donors recruited in this way would be as informed as others.

Overall, donor breast milk is a public health issue, and so it does need to be in the public domain.

Anecdotally, such publicity may work better at local rather than national level, and there are good reports from experience in local areas.

All strategies were deemed to be appropriate, depending on local circumstances. And as with any strategy, the confidentiality and wishes of any potential donor or donor would need to be respected.
  • or through mass media contact, such as

    newspaper articles

    newletters

    magazine articles

    TV and radio

    internet

R6n
  • or through mass media contact, such as

    newsletters

90161AgreeConsensusConsensusMerged with R6m.
R6o
  • or through mass media contact, such as

    magazine articles

80161AgreeConsensusConsensusMerged with R6m.
R6p
  • or through mass media contact, such as

    TV

81160AgreeConsensusNo consensusMerged with R6q

Again this refers to publicity for the donor milk bank and its work – it is not a paid advertisement.

Merged with R6m.
R6q
  • or through mass media contact, such as

    radio

81160AgreeConsensusNo consensusAlthough the evidence did not refer to the use of the internet (owing to the age of the publications), this was agreed to be a valuable area for recruitment and general publicity.

Merged with R6m.
R7aProvide other services to encourage donor women
  • such as breastfeeding support
81250AgreeNo consensusNo consensusThere was agreement that support and other services could be given as needed, but that this was not the key role of the milk bank.

Also, donors should not be given access to services that would not otherwise be available to them, because this would breach all principles of donation. Recommendations will be made on the ongoing support needed by donor women, but not the provision of additional services to ‘encourage’ donors.

It was decided to remove this recommendation because of the principle of donation.
R7b
  • other relevant services
61331UncertainNo consensusNo consensusSee above.
R8When recruiting donor women, aim to reach all women through a broad strategy with no targeting.72240AgreeNo consensusNo consensusThe wording was revised to make a general statement on the need for a broad strategy See also R1a.When recruiting potential donor women, aim to reach all women, including mothers whose baby has died, through a broad strategy.
R9aTarget women who
  • do not work in the health or social sectors
52420UncertainNo consensusNo consensusIn the situation where there are limited resources, is there a principle that one needs to focus on those groups where recruitment is likely to more successful?

Often, there is a perception about a ‘type’ of donor, but there are many exceptions. So a broad approach should be used, within resources. The provision of clear, accurate information then allows women to select themselves.

There was agreement that all lactating women have a right to be considered as potential donors, and therefore any strategy should be broad and not target specific groups based on attitudes or beliefs.

See R8.
R9bTarget women who
  • have a positive attitude to breastfeeding
81070AgreeConsensusNo consensusSee above.
R9cTarget women who
  • express the ‘need to help others’
7.51070AgreeConsensusNo consensusSee above.
R9dTarget women who
  • have support and time to donate milk.
81160AgreeConsensusNo consensusSee above.
R10aCommunicate the need for donor milk banking, and the process in clear, non-technical language,
  • using either written or verbal communication.
90080AgreeConsensusConsensusThe GDG agreed some revised wording.Communicate the need for donor milk banking, and the process in clear, non-technical language, using either written and/or verbal communication.
R10b
  • using written information alone.
3.54130UncertainNo consensusNo consensusSee above.
R10c
  • using verbal communication alone.
3.54220UncertainNo consensusNo consensusSee above.
R11Do not elicit the beliefs and attitudes of the potential donor in any discussion of donor milk banking.24211Do not agreeNo consensusNo consensusAlthough there may be different cultural beliefs and attitudes to donor-milk banking, there was general agreement that, by using a broad strategy with clear information, any women, regardless of religion, socioeconomic class etc., would have access to information and could decide, with support from milk-bank staff if needed, whether she wished to be considered as a potential donor.

From: Appendix 3, Methods of guideline development

Cover of Donor Breast Milk Banks
Donor Breast Milk Banks: The Operation of Donor Milk Bank Services.
NICE Clinical Guidelines, No. 93.
Centre for Clinical Practice at NICE (UK).
Copyright © 2010, National Institute for Health and Clinical Excellence.

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