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May 11, 2018 11:19 AM

It sounds like a relatively simple concept: you give birth to a baby, and then your body produces milk to feed them. But one of the oft-unspoken topics of mothering is that nursing is much tougher than it looks.

“Breastfeeding is a skill that a mom and baby need to learn, and it is hard!” Dr. Elizabeth Murray, a pediatrician at Strong Memorial Hospital in Rochester, NY and member of PEOPLE’s Health Squad, says. “Somehow, people took the idea of breastfeeding being natural to mean that breastfeeding is easy.”

In reality, every woman is different, and some are “super producers,” who create far more milk than their baby needs, some are right on target and others cannot supply enough milk for their child — with plenty of stages in between those three.

And with the societal pressure to only give a baby breast milk, or “liquid gold,” over formula, being unable to produce breast milk can be crushing for new moms. One of the best options, when their own breast milk won’t come, is to use a milk bank. Here’s what you need to know about receiving — or donating — breast milk.

Breast milk
Elise Amendola/AP

Find a Verified Milk Bank

The first, and most important step, is to find an approved milk bank.

“The easiest way to be safe is to contact Nursery or Neonatal Intensive Care Unity at your local Children’s Hospital,” Dr. Murray says. “The American Academy of Pediatrics is clear in their recommendation that on-line, unregulated milk banks or informal sharing of breast milk is too risky and should be avoided.”

All Donors Undergo Screening

Both the donor and the milk itself go through extensive testing before it gets to the baby in need.

“We accept healthy, lactating women with an overabundance of milk as donors, and we have screening guidelines where we discuss her lifestyle and her medical history,” Julie Bouchet-Horwitz, executive director of the New York Milk Bank, tells PEOPLE. “There are some medication and travel restrictions. Once she passes the first screening, she needs her blood tested for infectious diseases such as hepatitis, syphilis, HIV and HTLV. Only if her blood tests are negative, can we accept her as a donor.”

And once the donor is approved, depending on her local milk bank, she can drop off her milk at a collection site, or in some cases ship it in a cooler. The milk itself lasts one year from the day it was pumped.

Then, the milk itself gets its own testing.

“Once milk is accepted we pasteurize the milk, and then test it for bacteria before it is stored in our inventory,” Bouchet-Horwitz says. “With thorough screening methods, a blood test, pasteurization and a milk culture we have found our milk to be very safe.”

Sick and Healthy Babies Can Partake

The milk bank system is largely set up to aid premature and sick babies, but women who are struggling to produce milk can also apply.

“Sick babies may be covered through insurance and parents can call to see if they qualify,” Bouchet-Horwitz. “We have enough donor milk for healthy babies in need too. One needs a prescription from the baby’s doctor to receive donor milk.”

The Medicaid System Can Help

While the milk itself is free, there are processing fees for the testing and shipping costs, about $4 an oz. If the baby is still in the hospital, the fees are covered.

“Donor milk is now a covered benefit through Medicaid and Medicaid Managed Care plans for babies in the NICU, and we work individually on getting reimbursement for donor milk for sick babies who are outpatients,” Bouchet-Horwitz says. “We hope that eventually we can cover more and more infants through insurance reimbursement.”

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