Audra McNicholas went about her usual Monday routine on May 16, dropping her two daughters off at school before stopping at a store for her weekly grocery haul. Her shopping list typically includes infant formula for her son.
The Greenwood Village mother nursed her girls, but that was not an option with her 11-month-old baby boy, who is adopted.
McNicholas reached the formula aisle and discovered it bare. She tried another store. Then another. In disbelief, she Googled nearby markets and mapped out a route along C-470. McNicholas’ search spanned the suburbs from the north to the south and after scouring eight grocery stores for formula, she gave up.
“I wanted to cry and panic,” she said. “I was like, ‘What am I going to do? I have one can of formula left.’”
She called friends and family, hoping one of them could find some formula at their local stores. They couldn’t locate any either, she said. She put a plea on Facebook and got offers from loved ones in other states or in other parts of Colorado who said they could mail her formula, but that could take days.
Among the dozens of comments on her post, McNicholas saw a suggestion that she thought might be her only option. Contact local goat farms, someone said.
McNicholas and her siblings were raised on goat milk. She had an agricultural upbringing that made her comfortable with the idea of feeding goat milk to her son during the shortage. As someone with a deep appreciation for agriculture, she also liked the idea of supporting a local farmer.
McNicholas made the call.
The day after her marathon of grocery store runs, she picked up bottles of goat milk from a farm in Parker. She stopped worrying about when shelves would have formula stocked and said “that gut-wrenching feeling of, ‘What am I going to feed him? How is this going to work?’” eased.
Addressing the shortage
The formula shortage hitting stores across the U.S. was spurred by a combination of pandemic-related supply chain disruptions and the recall of some formula products.
President Joe Biden launched what was dubbed Operation Fly Formula late last month, which allowed the USDA and Department of Health and Human Services to fly infant formula from overseas in an effort to restock store shelves faster.
The first of three shipments arrived in the U.S. on May 22. In total, the mission will fly 1.5 million 8-ounce bottles of hypoallergenic formula to the U.S. The Biden administration also used the Defense Production Act to give some formula manufacturers priority among their suppliers and speed up formula production.
A fourth phase of shipments has been announced, but the Colorado Department of Public Health and Environment has been unable to confirm whether formula has been delivered in Colorado. CDPHE has created a webpage outlining resources and safety tips for families during the shortage.
But until that aid reaches the masses, the formula shortage crisis has left families grappling. Some, seeing no other immediate option to feed their child, turned to alternatives like decades-old homemade formula recipes or animal milk, amid warnings from medical experts about the health risks those substitutes can pose
But until that aid reaches the masses, the formula shortage crisis has left families grappling. Some, seeing no other immediate option to feed their child, turned to alternatives like decades-old homemade formula recipes or animal milk, amid warnings from medical experts about the health risks those substitutes can pose, such as harmful bacteria or nutritional deficiencies.
Experts instead encouraged parents to keep searching for formula and call their pediatrician if they could not find any. Pediatrician offices might have cached sample formula they could provide to families in a pinch.
Colorado sought to offer a safe solution by imploring lactating parents to become milk bank donors and by partnering with Mothers’ Milk Bank — emphasizing the bank is one resource for parents struggling to find formula for their infants. Gov. Jared Polis announced the partnership on May 17 and also encouraged people to make financial donations to the bank to help families purchase milk.
Polis followed up the partnership by signing an executive order May 25 declaring the formula shortage a disaster emergency. The state will use $220,000 from the Disaster Emergency Fund to subsidize the cost of purchasing and shipping donor milk to families for 30 days. Families can receive up to 40 ounces of milk at no cost. The executive order also makes the price-gouging of formula unlawful during the declared disaster.
Premature, sick and newborn infants will receive the top priority. The remaining milk will be available for babies up to 6-months old, and given to babies older than 6 months on a case-by-case basis.
Rebecca Heinrich, director of Mothers’ Milk Bank, said the governor’s call for donations seems to have worked.
The milk bank typically approves about 100 new donors each month and between 1,100 and 1,200 a year. Heinrich said she can’t estimate yet how many the bank could accept this year, but for heartening reasons — a wave of people who responded to Polis’ call are waiting to be vetted and approved as donors.
“I am very happy to say that our phones have been ringing off the hook,” she said.
Things to know about being a donor
Heinrich said the bank is always looking for “healthy lactating people who have more milk than their baby needs” to become donors.
“That’s a very important component of this,” Heinrich said. “I understand with the crisis people may be swept up in altruism.”
People wishing to donate milk can build their supply by continuing to nurse or pump, Heinrich said. They can speak with their doctors about vitamins and supplements, and she encouraged ample bonding time between a donor and their baby, such as skin-to-skin time.
To ease the process for donors, Mothers’ Milk Bank will supply them with storage and sanitizing supplies. The bank can arrange milk deliveries and send a courier or a shipping box to people outside the Denver metro area. People who already have a freezer stash can also call to see about donating some of their milk.
Mary Jones, a registered nurse and lactation consultant at Parker Adventist Hospital, said breastfeeding can be physically and emotionally taxing on a parent. Lactating parents who want extra support managing their milk supply can work with a lactation consultant or their doctors.
“I think that moms who are doing this for the good of others, the extra steps you have to take can be more physically draining, but it probably is emotionally beneficial,” Jones said. “It kind of balances out.”
A healthy mother with a healthy baby can donate from their child’s birth all the way to 18 months old. Some parents donate only small quantities, perhaps a bag or two, while others bring in coolers filled with milk. Any amount helps, Jones said.
“The formula shortage thing is just beyond me. It’s a really scary thing,” Jones said.
Jones has heard about parents in the community trying to revive their milk supply months after they stopped nursing. There is no harm in trying, she said. Lactating parents can resume pumping or nursing in an effort to restart their production, but she cautioned it’s highly unlikely to happen.
“I’ve never seen it,” she said. “Breastfeeding and producing milk is something that takes work and you have to continue to do it, or it just doesn’t happen.”
She also cautioned against parents obtaining donor milk outside of milk banks. Diseases such as HIV can transmit through breast milk, and unprocessed human milk can carry harmful bacteria.
Milk banks interview donors, ask which medications they take — some are harmful for infants or immunocompromised babies — and conduct blood tests, among other screening steps. Milk given to a bank undergoes specific heating and cooling processes and is tested for bacteria, Jones said.
“It is a very well-oiled machine. There are no limits to the extent they go to to make sure that it is safe,” Jones said.
There are limits to the resources a bank can provide, Jones said.
Donor milk is expensive — typically costing between $3 and $5 an ounce — and that can pose a barrier to families who might turn to banks when they can’t find formula. Even if families could afford large quantities of donor milk, she said that is not in the spirit of a bank’s mission.
“They are not somewhere to go buy 40 bottles,” Jones said.
Each baby’s needs will differ, but a newborn infant might eat roughly 1 ounce each feeding, and need eight feedings in one day. After a couple of weeks, babies might begin eating anywhere between 2 and 5 ounces per feeding.
A milk bank’s priority is providing milk to hospitals taking care of premature infants in the neonatal intensive care unit or supporting mothers whose milk supply has not come in and their newborn needs milk in the meantime. That support can’t fall away during the crisis, Jones said.
In a typical month, Mothers’ Milk Bank would serve roughly 60 families.
“It’s only been a couple weeks since this has really hit home with everyone,” Heinrich said. “We’ve gotten a lot of requests that probably would not have normally come to us, and we have to assume that’s because of the shortage.”
For now the bank is rationing how much milk it provides families. People can purchase up to 10 bottles, which contain 4 ounces of milk, each day. Heinrich was not sure how long the cap will be in place, but the bank wants to ensure everyone in need can receive some milk, she said.
Heinrich said the bank is hoping to spur enough donations that it stores up more donations than what its hospital and NICU clientele needs, as it seeks to serve members of the broader community during the formula shortage.
“Even in this crisis we have to prioritize our NICU customers. We have to make sure that our hospitals are getting the milk that they need to feed premature babies, because it is absolutely life saving,” she said.
Before launching its partnership with the state, Mothers’ Milk Bank contacted its existing donors to ask for any milk stores they might have. Donations were up the week of May 16 by about 10%, she said, and she hoped they would climb another 10% the week after.
“And just keep going as fast and as quick as we can, in a safe and effective manner,” she said.
Answering the call
Joining the effort are Erin Vagias and her sister Erica Boniface, who is close friends with McNicholas. Knowing stories such as McNicholas’ is one reason the two immediately signed up to become donors after the governor’s announcement.
“Moms are literally doing what you never thought you would do,” Boniface said.
Vagias said her pediatrician’s office has started asking families if they rely on formula, and if parents think they will have the resources they need to continue nursing once returning to work, like a secure space to pump.
That was a different experience from what Vagias had during her son’s birth in March, she said. She heard about formula recalls in February, but hospital staff did not address how to prepare for a formula shortage.
Boniface has past experience donating milk, and suggested that parents interested in becoming donors talk with their doctor about ways they can increase their supply. Being organized is also paramount throughout the process, she said. Milk needs to be accurately dated, including the time it was pumped.
“There’s a proper way to store it,” Boniface said. “You have to be very careful with handling.”
Vagias and Boniface worried lactating parents are not being provided with enough information about how to become a donor, how to prepare for the process or even what to do with a freezer stash of milk they might already have and be able to donate.
“I’ve been kind of shocked at the education pieces out there for people at this time,” Vagias said.
Nearly two weeks after contacting local milk banks, neither sister had heard back or been screened to become a donor. That concerned them, they said, because they expected more of an urgency toward approving eligible donors during the crisis and educating the public about milk donor banks.
Heinrich said her team of lactation consultants who screen potential donors is small but working as swiftly as possible. The bank’s goal is to contact prospective donors within two business days.
“We are just absolutely grateful to everyone in the community who has come together to try and make this work,” she said.
CORRECTION: This story was updated at 10:56 a.m. on June 2, 2022, to correct misinformation provided by the Colorado Department of Public Health and Environment. Though shipments of infant formula are being distributed in some states, CDPHE has been unable to confirm whether any have reached Colorado.