Table 3.

Talking Points for NICU Clinicians about DHM Feeding Consent.

Subtheme	Goal	Talking Points
“It’s somebody   else’s milk”	Help the mother understand   that her reactions are normal.	Lots of mothers who first hear about donor milk use these same words   and feel the same way. It is only natural to want to be the only person   providing milk for your baby. We have known for over 100 years that   many mothers tell us that providing their milk is the only thing they feel   they can do, so it is really hard to think you have to share this special   task—even if it is just for a short time.
	Clarify the NICU’s preference   for mother’s HM.	Donor milk is not the same as your own milk. It is safe and preferable to   formula early in life, but your milk has special nutrition and protection   that cannot be provided by donor milk. Donor milk helps us avoid the   use of formula until your own milk is established, and then we won’t   need the donor milk anymore.
DHM quality	Reinforce information that   the mother may have missed   during initial discussions   about DHM.	All of the donor milk that we use in our NICU is from an accredited   donor human milk bank. This means that all of the milk donors have   passed health and blood tests and their milk has been tested, too.   Even after testing, the milk is pasteurized—just like milk you buy in   the store—to make sure that it does not have germs. It comes to us   frozen and we defrost it as we need it for our babies. We handle it very   carefully and make sure that it is safe for your baby. Most important,   donor mothers are or were breastfeeding their own healthy babies and   just want to help other mothers who might have trouble getting their   own milk established.
Paternal hesitation	Reinforce the fact that fathers   often question why DHM is   necessary.	Lots of fathers have concerns about donor milk. Do you know why he   has doubts? Would it make it easier if we can talk to both of you at the   same time?
Sufficient HM   volume	Help the mother plan ahead for   the contingency of not having   enough of her own milk if it is   likely that the infant will need   more than she has available.	Right now, you have enough milk for your baby and that is just great! As   your baby grows, we will continue to increase the feeding volume. Have   you thought about what you would like to do if your baby’s feedings   increase and we would need to give some extra milk until you can catch   up with him or her?

Abbreviations: DHM, pasteurized donor human milk; HM, mother’s human milk; NICU, neonatal intensive care unit.