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									Mothers’ Milk Bank of Ohio
1087 Dennison Avenue Columbus, Ohio 43201
Office 614 544-5906 Fax 614 544-5907


Dear Donor Mother,

Thank you for your interest in donating your milk. Please complete the following and
deliver or mail these back to the Mothers’ Milk Bank:

         The four-page DONOR INTERVIEW and DONOR CONSENT form.
         Complete the boxed portions of the “MEDICAL INFORMATION REGARDING
          DONOR MOTHER’S CHILD” and the “MEDICAL INFORMATION REGARDING DONOR
          MOTHER” forms. Please return the forms to us and we will have them signed
          by your health care providers.

After collecting 200 ounces of your milk, please call our office to arrange to drop off
your milk and for instructions to have blood work done. Our office hours at this time are
varied, please call before coming.

Also enclosed are important information sheets. The precious milk that you are sending
will be fed to the most fragile and ill babies. Following our instructions will enable you to
provide the purest, freshest, and most carefully handled milk possible. Please carefully
read the DONOR PUMPING INSTRUCTIONS and the MEDICATION INFORMATION, and feel
free to call us if you have questions at any point during the process. We have an
International Board Certified Lactation Consultant available to answer any questions.

After we receive your milk and all of your paperwork and blood test results, we will
carefully pour, mix and pasteurize your milk by gently heating it to destroy any bacteria
and viruses that may be present. Pasteurized donor milk has been found to be almost
as protective against infection as fresh milk because the majority of antibodies survive
the heating and freezing process. Next, we will distribute the milk to premature
hospitalized babies or to sick babies whose doctors have prescribed donor milk for
them. Not only does your milk contain precious antibodies to fight infection, but also it is
easy to digest and full of valuable nutrients. If you have any questions about the milk
bank or about donating, please do not hesitate to call us.
We look forward to having you as part of our team in improving the lives and health of
the babies we serve.
                                             Pro
We thank you for your time and effort on behalf of our recipients, the littlest little ones.
These premature and sick babies will benefit greatly from your gift.




Mothers’ Milk Bank of Ohio                                                                  1
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                             Mothers’ Milk… a gift only a mother can give
                                                                                     Donor # ________________

                                            DONOR INTERVIEW

Date of Application: _________________
Name: ____________________________________                 Age: _______           Birth Date: ___________________
Phone: H(_____)____________________ W (______)__________________ Cell (_____)__________________________
Address: ____________________________________________________              Apt. #: _____________________________
City: _____________________________________                State: ___________     Zip: _______________
E-mail: ________________________________________           Fax: ______________________________________________
Present/Past Occupation(s)? ________________________________________________________________________
Partner's Name: ________________________           Occupation/Company: _________________________________
Baby's Name: ___________________           Sex: _____      Age: _____      Birth Date: _________________________
Birth Weight: ___________       Length: ________ Last Height/Weight: _______/_______         Date: _____________
Was baby full term? ________               If no, gestational age at birth: ____________________________________
Is baby at home? ______            or   Hospital? ______
If hospital, please list name/phone of hospital: ________________________________
Mother's Health Care Provider (OB or midwife):
          Name: ___________________________________ Phone*: ________________________
          Address: __________________________________Fax*: _________________________
          City/State/Zip: ____________________________________________________________
Baby's Health Care Provider (MD):
          Name: ____________________________________ Phone*: _______________________
          Address: __________________________________ Fax*: ________________________
          City/State/Zip: ____________________________________________________________
** It is very important that you provide the Doctor’s phone and fax numbers.** Thank you.
How did you learn about the Mothers' Milk Bank of Ohio?             ___________________________________________
Are you donating milk collected before you contacted the milk bank?              ____ Yes      _____ No
If yes, were you, the baby, and other members of your household healthy during the time you collected
this milk? Yes        No If no, please explain: ____________________________________________________________
____________________________________________________________________________________________________
Did you take any medications, herbal preparations, or vitamins during this time?            _____ Yes     _____ No
If yes, do you know the dates you took them?            _____ Yes     _____ No
If yes, please list what you were taking and the dosages.______________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Do you plan to be an ongoing donor?            _____ Yes     _____ No
What kind of freezer do you have? top of refrigerator ______ side-by-side ______ deep freeze______
Milk will be delivered to Mothers’ Milk Bank of Ohio at 1087 Dennison Avenue Columbus Ohio. Our office
hours at this time are varied, please call before coming.




Mothers’ Milk Bank of Ohio                                                                                           2
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                                                                                 Donor # ________________
                                      MOTHER'S MEDICAL HISTORY

 Does any of the below apply to you? Please use another sheet to explain in detail any "yes" responses.
                                                                                 YES     NO
1. a positive test for hepatitis?                                                 ____   ____
2. a history of hepatitis or yellow jaundice?                                     ____   ____
3. liver problems?                                                                ____   ____
4. hepatitis B immune globulin in the last 12 months?                             ____   ____
5. exposure to hepatitis or HIV in the past 12 months?                            ____   ____
6. ears or body part pierced; acupuncture; or tattoos in the past 6 months?       ____   ____
7. been intimate with someone who has had ears or body part pierced;
     acupuncture; or tattoos in the past 6 months?                                ____   ____
8. heart disease or high blood pressure?                                          ____   ____
9. tuberculosis, exposure to TB, or positive TB test or X-ray?                    ____   ____
10. insulin dependent diabetes?                                                   ____   ____
11. sexually transmitted disease (syphilis, gonorrhea, HPV, chlamydia)?           ____   ____
12. genital or oral herpes?                                                       ____   ____
13. cold sores? If yes, how often?                                                ____   ____
14. skin disease or skin lesions?                                                 ____   ____
15. accidental needle sticks in the last 12 months?                               ____   ____
16. unexplained weight loss, fever, or night sweats?                              ____   ____
17. unexplained, engorged lymph nodes?                                            ____   ____
18. white sores or lesions in the mouth?                                          ____   ____
19. history of yeast infections (systemic, vaginal, oral)?                        ____   ____
20. persistent diarrhea?                                                          ____   ____
21. a blood transfusion, blood products, organ or tissue transplant?              ____   ____
22. surgery in past 12 months?                                                    ____   ____
23. history of cancer or lump?                                                    ____   ____
24. a serious illness in past year?                                               ____   ____
25. injected yourself with drugs or been intimate with someone who has?           ____   ____
26. intimate contact with someone who is at risk for HIV (incl. anyone with
    hemophilia)?                                                                  ____   ____
27. been told not to donate blood or milk?                                        ____   ____
28. ever received human pituitary growth hormone?                                 ____   ____
29. Are you under a doctor's care for anything?                                   ____   ____


The information reported on this form is true and correct to the best of my knowledge.


____________________________________                    _________________
Signature                                                     Date




Mothers’ Milk Bank of Ohio                                                                                3
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                                                                                        Donor # ________________
                                              BABY'S HEALTH HISTORY

                                                                                            YES     NO
     1.     Has your baby ever had a yeast infection (e.g. thrush or diaper rash)?         ____    ____
     2.     Has your baby been exposed to any communicable disease, such as
            chicken pox, mumps, etc.                                                       ____    ____
     3.     Does your baby have repeated infections, such as colds, ear
            infections, diaper rash, skin infections?                                      ____    ____
     4.     Is you baby gaining weight and growing well?                                   ____    ____
     5.     Is your baby totally breastfed?                                                ____    ____
            (If not, please describe other food intake. We recognize that a baby’s
            feeding patterns change as she or he grows older.)


                                           MOTHER'S HEALTH HABITS
                                                                                           YES    NO
1.          Are you taking any medications (prescription or over-the-counter)
            such as vitamins, vitamins with herbs, herbs, birth control pills,
            laxatives, or allergy medicine?                                                ____   ____


If yes, please give names and dosages of medication, vitamins, and herbs you are taking. If you took
medication of any kind while storing milk for the milk bank, please indicate the dates taken:
______________________________________________________________________________________________________


     2.     Do you smoke or use tobacco?                                                   ____   ____
     3.     Have you used "recreational drugs" such as marijuana, cocaine,
            ecstasy, LSD, or Dexedrine in the last two years?                              ____   ____
     4.     Describe your present daily use of alcoholic beverages. (After drinking
            an alcoholic beverage, please wait at least 12 hours before pumping for
            the milk bank.)
            _____________________________________________________________________________________________
     5.     Describe your present daily intake of caffeinated beverages (coffee,
            tea, or soda). (While donating to the milk bank, please limit your intake
            of caffeinated drinks to 24 oz. in 24 hours.)
            _____________________________________________________________________________________________


            The information reported on this form is true and correct to the best of my knowledge.


            _____________________________________                 ______________________
            Signature                                                 Date




Mothers’ Milk Bank of Ohio                                                                                    4
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                                                                                    Donor # ________________


                             MOTHER'S OBSTETRICAL AND LACTATION HISTORY

1.        To how many children have you given birth?
          Names:             __________________________       Ages: ________
                             __________________________             ________
                             __________________________             ________
                             __________________________             ________
                             __________________________             ________
                                                                                                YES    NO
2.        During your most recent pregnancy, delivery, and post-delivery period,
          have you had any complications, including infection, excessive
          bleeding or high blood pressure? If yes, please explain:                              ____   ____
          ___________________________________________________________________________
3.        Have you expressed and stored milk before?                                            ____   ____
          If you use a pump, what kind is it? _________________________________________
4.        Have you ever had breast infections with this baby?                                   ____   ____
          If yes, please describe and give dates:
          ___________________________________________________________________________
5.        Are you on any special diet? (e.g. low salt, low dairy products,
          vegetarian, diabetic, weight loss, etc?) If yes, please explain:                      ____   ____
          ___________________________________________________________________________
          ___________________________________________________________________________
          The milk bank sometimes receives requests for milk from mothers on a dairy free or low-dairy diet.
          Please let us know if you begin to eliminate dairy from your diet for any reason.


          The information reported on this form is true and correct to the best of my knowledge.



          _____________________________________                        ______________
          Signature                                                         Date




Mothers’ Milk Bank of Ohio                                                                                     5
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                                                                                   Donor # ________________

                                          DONOR CONSENT


1. I have voluntarily chosen to donate my breast milk to the Mothers' Milk Bank of Ohio. I understand that
   I will not be paid for the milk I donate. I am also aware that my milk will not be sold, but a processing
   fee will be charged to the recipient of the milk. My milk may be used for research purposes, when the
   research is expected to benefit recipients of human milk.

2. I will make every effort to see that my milk is donated according to the instructions provided. I
   understand that it is my responsibility to notify the Mothers' Milk Bank of Ohio:

    a.    in the case of illness involving fever or medications in myself, or my baby
    b.    when I need to take any medications;
    c.    when family obligations preclude continuing donations;
    d.    when I have any questions about being a donor
    e.    when I have been exposed to a contagious illness or disease.

3. I am also aware that once my milk has been donated it becomes the property of the Mothers' Milk
   Bank of Ohio.

4. I understand that a sample of my milk will be tested by a microbiology lab after pasteurization.

5. I understand that a sample of my milk will be tested for nutritional values, specifically, total calories
   and lipids.

6. I understand that, most often, I can donate milk only until my baby reaches one year of age.

7. I understand that all donor information is confidential and I have read the Privacy Statement provided
   by Mothers’ Milk Bank of Ohio.

8. I understand that there is a minimum milk donation expected of 200 ounces.

9. I have read all of the information about HIV and the blood tests done for donors.

10. I agree to have my blood tested as described in TESTING REQUIRED FOR MILK DONORS on page 10 of
    this packet and understand that I will be notified of the results. Blood test results are good for six
    months, at which time I will be notified of my need to either repeat the tests or to stop donating.

11. The Mothers’ Milk Bank of Ohio is sometimes asked to provide milk specimens for research. Milk that I
    have donated       MAY     MAY NOT be used for research purposes.

 I hereby certify to the best of my knowledge that I understand and have answered all the questions
truthfully.



 _____                              _________________________            ______________________
Donor Signature                                                          Date

Please sign and return to us.

Mothers’ Milk Bank of Ohio                                                                                     6
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                               Mothers’ Milk… a gift only a mother can give
                                                                                         Donor # ________________

                                                DONOR CONSENT


1. I have voluntarily chosen to donate my breast milk to the Mothers' Milk Bank of Ohio. I understand that
   I will not be paid for the milk I donate. I am also aware that my milk will not be sold, but a processing
   fee will be charged to the recipient of the milk. My milk may be used for research purposes, when the
   research is expected to benefit recipients of human milk.

2. I will make every effort to see that my milk is donated according to the instructions provided. I
   understand that it is my responsibility to notify the Mothers' Milk Bank of Ohio:

    a.    in the case of illness involving fever or medications in myself, or my baby;
    b.    when I need to take any medications;
    c.    when family obligations preclude continuing donations;
    d.    when I have any questions about being a donor;
    e.    when I have been exposed to a contagious illness or disease.

3. I am also aware that once my milk has been donated it becomes the property of the Mothers' Milk
   Bank of Ohio.

4. I understand that a sample of my milk will be tested by a microbiology lab after pasteurization.

5. I understand that a sample of my milk will be tested for nutritional values, specifically, total calories
   and lipids.

6. I understand that, most often, I can donate milk only until my baby reaches one year of age.

7. I understand that all donor information is confidential and I have read the Privacy Statement provided
   by Mothers’ Milk Bank of Ohio.

8. I understand that there is a minimum milk donation expected of 200 ounces.

9. I have read all of the information about HIV and the blood tests done for donors.

10. I agree to have my blood tested as described in TESTING REQUIRED FOR MILK DONORS on page 10
   of this packet and understand that I will be notified of the results. Blood test results are good for six
   months, at which time I will be notified of my need to either repeat the tests or to stop donating.

11. The Mothers’ Milk Bank of Ohio is sometimes asked to provide milk specimens for research. Milk that I
    have donated      MAY      MAY NOT be used for research purposes.

I hereby certify to the best of my knowledge that I understand and have answered all the questions
truthfully.



                             This copy is for your records.



Mothers’ Milk Bank of Ohio                                                                                      7
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                                Mothers’ Milk… a gift only a mother can give
                                                                                    Donor # ________________


                     MEDICAL INFORMATION REGARDING DONOR MOTHER’S CHILD


Instructions for the Health Care Provider:
        The mother of your patient has volunteered to donate milk to the Mothers’ Milk Bank of Ohio.
        Please complete the following and either mail or fax back to us at 614.544.5907. Please call us at
        614.544.5906 if you have any questions or concerns. All donor records are confidential. Thank you
        for your assistance.

                                                                      Donor mother: Please complete this section only.

Date: ______________


Baby’s Name: _________________________            Baby’s Date of Birth: ____________________
I authorize Dr. __________________________ to release the requested medical information to the Mothers'
Milk Bank of Ohio. I acknowledge and consent to the release of information that may contain alcohol,
drug abuse, psychiatric, HIV testing, HIV results, or AIDS information. I acknowledge that I can refuse to
sign this document and that I can have a copy of it by request.


________________________________                    _________________________________
Donor Mother’s Name (please print)                  Donor Mother's Signature




                             INFORMATION REQUIRED FROM HEALTH CARE PROVIDER:


                                                                   ___________________________
                                                                   Date last seen in this office

Is baby gaining weight appropriately? Yes / No Other:_________________________________

If preterm, is mother producing in excess of baby’s needs? Yes / No

I am aware of no adverse effects for the health of baby _________________________ if his/her mother
donates milk to the Mothers' Milk Bank of Ohio.



_________________________________________________________                   _____________________________________
Physician Signature                                                         Date




Mothers’ Milk Bank of Ohio                                                                                           8
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                                  Mothers’ Milk… a gift only a mother can give
                                                                                  Donor # ________________

                             MEDICAL INFORMATION REGARDING DONOR MOTHER

Instructions for the Health Care Provider:
        Your patient has volunteered to donate milk to the Mothers’ Milk Bank of Ohio. Please complete
        the following and either mail or fax back to us at 614.544.5907. If you have not done the tests
        listed below, during this pregnancy, we will do them at no cost to the donor before she begins
        donating milk. You will be notified of any positive test results. Please call us at 614.544.5906 if you
        have any questions or concerns. All donor records are confidential. Thank you for your
        assistance.


                                                                     Donor mother: Please complete this section only.
Date: _________________


I authorize _______________________________________ to release the requested medical information to the
Mothers’ Milk Bank of Ohio. I acknowledge and consent to the release of information that may contain
alcohol, drug abuse, psychiatric, HIV testing, HIV results, or AIDS information. I acknowledge that I can
refuse to sign this document and that I can have a copy of it by request.


___________________________________             ____________________      ______________________________________
Donor Mother’s Name (please print)              Date of Birth              Donor Mother’s Signature



                             INFORMATION REQUIRED FROM HEALTH CARE PROVIDER:

To the best of your knowledge, does this patient have a history of:
                                                                                          YES      NO
          1.   Genital herpes?                                                            ____     _____
          2.   Blood transfusion in the last 12 months?                                   ____     _____
          3.   TB, hepatitis or prenatal viral infections?                                ____     _____
          4.   Taking any medication on a regular basis?                                  ____     _____

Please report test results below:
                             Results                               Date

          1.   RPR                 ______                          ___________________
          2.   Rubella             ______                          ___________________
          3.   HIV I & II          ______                          ___________________
          4.   HTLV I & II         ______                          ___________________
          5.   HbsAg               ______                          ___________________
          6.   Hepatitis C         ______                          ___________________

To the best of my knowledge, _____________________________________ is in good health and
would be an appropriate donor to the milk bank.

_________________________________________________________                  _____________________________________
Physician Signature                                                        Date
Mothers’ Milk Bank of Ohio                                                                                          9
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                                 Mothers’ Milk… a gift only a mother can give
                                                                                  Donor # ________________

                                     TESTING REQUIRED FOR DONORS


WHAT IS AIDS?

AIDS, or Acquired Immune Deficiency Syndrome, is a condition caused by HIV (the AIDS virus) in which
the body's normal defense mechanisms against certain infectious diseases are severely reduced. As a
result, patients develop unusual infections and cancers, and they ultimately die of these complications.
There is no known cure for AIDS. Although some people may be infected by HIV and have mild or no
symptoms, it is believed that anyone infected by the virus may infect others by certain routes.

WHAT DOES AIDS HAVE TO DO WITH DONATING MILK?

Many infants who receive donor milk are extremely vulnerable to infections. It is known that HIV can be
spread via body fluids. HIV can be found in the milk of infected women. Therefore, if you are in any of
the high-risk groups listed below, we are asking that you voluntarily refrain from applying to donate milk.
We truly appreciate your willingness to understand the critical need for these voluntary screening
procedures. Sometimes the best gift is no gift.

WHO IS AT RISK?

It is known that certain groups are at high risk of contracting HIV as well as passing it to others:

    Those with a positive result when tested for HIV
    Those with symptoms and signs of AIDS (unexplained enlarged lymph nodes, unexplained weight loss,
     night sweats, chronic diarrhea, fungal and viral infections of the mouth, unexplained dark skin
     nodules)
    Sexual partners of HIV-positive individuals, or those who are at risk for HIV infection
    Men who have ever had sex with another man since 1977
    Present or past abusers of non-medical, injected drugs
    Persons with hemophilia who have received clotting factor concentrates
    Sexual partners of individuals in any of the above categories
    Men or women who have engaged in sex for money or drugs within the last 12 months and persons
     who have been their sexual partners

TESTING REQUIRED FOR MILK DONORS

Each donor to the Milk Bank must have negative blood tests for HIV-1, HIV-2, HTLV1+2, Hepatitis B,
Hepatitis C, and syphilis. If you have not been tested for these diseases in the six months prior to
donating, a blood sample will be drawn to do these tests. There is no charge to the donor for the tests.
You will be tested for these viruses every 6 months as long as you are donating. All test results are
confidential. While the test for antibodies to the HIV-1, HIV-2, HTLV, and Hepatitis B and Hepatitis C viruses
detects almost everyone who carries the antibody to the virus, the test occasionally is falsely positive. If
this occurs, a second test will be done to verify the results of the first test. If any of these tests are positive,
you will be confidentially notified and the health care provider named on your screening form will be
notified.




Mothers’ Milk Bank of Ohio                                                                                        10
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                              Mothers’ Milk… a gift only a mother can give
             MEDICATION INFORMATION AND RESTRICTIONS FOR MILK BANK DONORS

Occasionally it may be necessary for you to take some type of medication. The following list and
guidelines include some common medications and the time you must wait after taking these
medications before pumping milk for the Milk Bank.
For any other medication, illness or situation, please call the Mothers’ Milk Bank for clarification.
Medication:                                            Time to wait after last dose:
Advair                                                No waiting period
Allergy shots (serum)                                  No waiting period
Aspirin                                               24 hours
Benadryl                                               12 hours
Claritin                                               5 days
Cortisone shot                                         24 hours
Colace                                                 No waiting period
Echinacea capsules                                     24 hours
Eye drops                                              No waiting period
Fenugreek                                              24 hours
Flexoril                                               7 days
General anesthesia                                     24 hours
Hydrocodone/Vicodin                                   12 hours
Ibuprofen (Motrin, Advil, etc.)                        8 hours
Imitrex                                                8 hours
Immunizations, including flu                           No waiting period
Inhalers (asthma)                                      No waiting period
Insulin                                                No waiting period
Lecithin                                               No waiting period
Local anesthetic (e.g. Lidocaine, Novocaine)           24 hours
Mini-pill progesterone only birth control              No waiting period
Motilium                                               7 days
Mylicon                                                No waiting period
Naproxen                                               2 days
Omega 3 Fatty Acids                                    No waiting period
Omniscan (xray prep)                                   24 hours
Pepto Bismol                                           24 hours – single dose
Phenylpropanolamine (Dexatrim)                         48 hours
Rhogam                                                 No waiting period
Prenatal Vitamins without herbs                        No waiting period
Reglan                                                 No waiting period
Robitussin (guaifenesin)                               48 hours
Singulair                                              No waiting period
Sudafed (pseudoephedrine) (Actifed)                    24 hours
Synthroid                                              No waiting period
Topical antibiotic or hydrocortisone                   No waiting period
Tums (calcium carbonate)                               No waiting period
Tylenol (acetaminophen)                                24 hours
Vacinase/Nasonex                                       No waiting period
Valtrex                                                48 hours
Vicodin                                                12 hours
Vioxx                                                  3 days
Zyrtec                                                 24 hours



Mothers’ Milk Bank of Ohio                                                                          11
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                             Mothers’ Milk… a gift only a mother can give
                      Medication Information and Restrictions for Milk Bank Donors


Medication NOT to be taken by donors:

Albuteral - taken orally                                 Freeze dried nettles
Anti-anxiety medication                                  Inderal
Anti-depressants                                         Neurontin
Anti-cholinergics                                        Oxytocin
Anti-seizure medication                                  Prenatal Vitamins with any herbs
Baby aspirin                                             Prevacid
Birth control pills (combination pill)                   Volmax

 * If your medication isn’t on this list, please call the Mothers’ Milk Bank of Ohio – 614.544.5906.

Do Not Donate If:

1. You, your baby, or any household member becomes ill. The exception to this is an uncomplicated cold,
   or seasonal runny nose, or allergies, in which the sick person's temperature is no higher than 100o F orally.
   The sick person must not be in the same room with you while you pump milk. With all other illnesses, we
   cannot accept milk collected in the 24 hours before the person became ill and until 24 hours after they
   are well. Illness includes active herpes, any sore in someone’s mouth (even a cold sore), or thrush in the
   baby's mouth. If you have questions about this, please give us a call and we can discuss it further.

2. You have ANY breast tenderness. In the presence of plugged ducts or breast infection, unacceptable
   bacteria may be present in the milk. DO KEEP NURSING YOUR OWN BABY and collecting milk even
   though it cannot be used by the Mothers’ Milk Bank of Ohio.


3. You smoke cigarettes or use tobacco on a regular basis.

4. You use recreational drugs such as marijuana, amphetamines, cocaine, etc.

5. If any of the above circumstances has occurred and your milk has already been sent, please call the
   Mothers’ Milk Bank of Ohio immediately if you think there might be ANY reason to put a hold on
   distribution. Each situation is different. Sometimes your milk may be perfectly safe to use. We want
   you to keep in close touch with the Mothers’ Milk Bank of Ohio.

Additional Dietary Instructions and Restrictions:

1. All nursing mothers need to eat a balanced diet and drink to satisfy thirst.
2. Vegans should be taking a daily multivitamin which includes B12.
3. Any alcohol intake requires a 12-hour waiting period before pumping.
4. Caffeine from tea, coffee, soda, or chocolate is acceptable if no more than 24 ounces per day.
5. Herbal teas are okay, but limit to one cup per day. If greater than 1 cup, vary the type of herb.
6. Vitamins are acceptable in usual dosages. No mega-dosing and no herbal supplements.




Mothers’ Milk Bank of Ohio                                                                                     12
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                               Mothers’ Milk… a gift only a mother can give
                                     DONOR PUMPING INSTRUCTIONS


Thank you for taking the time to share your precious milk with our special babies! Please follow the
following steps and call us if you have any questions, 614.544. 5906.


1. Wash hands thoroughly with soap and warm water. Dry with a clean towel.
2. If you are pumping directly into the collection container, open it and place the cap inside up on the
   table. If you are collecting into another container, please leave the container closed until you are
   finished pumping and are ready to pour the milk into that container. Do not touch the top lip of the
   container or the inside of the cap or container.
3. Do not fill the container to the top because when frozen, milk expands. It is safe to fill to 4oz (our
   containers), but no higher. Please do not give us any cracked or leaking containers; we would have to
   dispose of them.
4. Mark each container with the following information, using a permanent marker:
        Your donor ID number
        Date of collection
        Amount collected, e.g. 1 oz, 2.5 oz, etc.
        If you are donating milk collected before contacting us, please make sure your name or
         ID# is clearly marked either on each container of milk or on the outside of a bag that
         contains your containers of milk.

5. Refrigerate or freeze your milk within 30 minutes of pumping. Place the milk in the rear or bottom of your
   freezer, wherever it is coldest. If necessary, you may refrigerate your milk for up to 24 hours before
   freezing.

6. Cleaning Your Pump

   Wash and rinse the pump parts after each pumping. Sterilize the pump parts once a day.
   Follow this procedure for sterilizing your pump parts:

        Sterilize parts by placing clean, disassembled parts in a saucepan. Cover with water and
         bring to a boil. Begin timing for 5 minutes after the water boils. Microwave pump
         sterilization kits are acceptable to use instead of stovetop boiling.
        Drain water off over a colander and allow parts to cool in open pan until you can remove
         them with clean hands to a clean towel or new, clean plastic bag.




Mothers’ Milk Bank of Ohio                                                                                  13
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                              Mothers’ Milk… a gift only a mother can give
              PUMPING MILK ESPECIALLY FOR PREMATURE AND SICK BABIES

               You can help provide higher calorie milk that will help our tiny babies grow.

After we receive your milk, we combine 300 – 400 ounces from several donors and then
run a small sample through a creamatocrit machine. This machine reads the amount of
fat and calories that is in the milk. The milk bank uses this information to help doctors
deliver the right nutrition to the babies.


We know that pumped milk changes during the course of a single feeding. Milk
pumped from a full breast starts out as lower calorie “foremilk”. It is normal for it to look
thin. As the breast empties, the fat content of the milk increases. The “hindmilk” is
higher in calories. This creamier looking milk helps small babies gain weight. It is very
important to include hindmilk in each container to help the babies receiving donor milk
to grow well.

WAYS TO INCREASE THE HINDMILK IN YOUR PUMPED MILK:

                 Pump milk after you have fed your baby.

                 If you pump from a full breast, pump until you empty the breast. This will
                  make sure that both the foremilk and hindmilk has been removed. Use as
                  many containers as you need.

                 Massage the breast gently before and during pumping to help stimulate the
                  let down reflex and release more fat in to the milk

                 Encourage letdown by relaxation techniques.

                 Milk expressed in the morning may contain more foremilk since it has had
                  time to collect in the ducts overnight. Milk expressed in the afternoon may
                  be higher in hindmilk.


                        Please do not hesitate to call us if you have any questions!
                                               614.544.5906




Mothers’ Milk Bank of Ohio                                                                      14
2/7/05 FNL
                                Mothers’ Milk… a gift only a mother can give

								
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