Thirty-two weeks and two days.

That's how long everything seemed fine before a pregnant Tiffany Tonsager of Oakdale "just felt something was wrong." A clinic visit on Aug. 2 confirmed that "he wasn't moving around like he should." After more tests in the hospital, Tonsager had a Caesarean birth on Aug. 3.

But tiny Ian, who fought so hard, died the next day of hydrops fetalis, a prenatal medical condition in which abnormal amounts of fluid build up, placing tremendous pressure on developing organs.

"We were able to spend a little bit of time with him," said Tonsager, 27, "He held our hands and we sang to him, but eventually it was just too hard for his heart and lungs."

As she and husband, Ben, plunged into grief, Tonsager found comfort by performing a remarkable act of giving. Since early August, she's been pumping — and donating — about 30 ounces a day of life-sustaining breast milk to the Minnesota Milk Bank for Babies (MMBB).

Hers and other donated breast milk is delivered to hospital neonatal intensive care units, special care nurseries and well-baby units, where new mothers use it as a bridge for their medically vulnerable newborns until they are able to breastfeed or breast-milk feed on their own.

"Moms just need a little bit of time for their bodies to figure out how to make milk, and babies just need a little bit of time to learn how to take it," said the milk bank's executive director, Linda H. Dech.

"Research has been more and more clear about the impact of human milk for human babies," said Dech, an international board certified lactation consultant who has worked for more than 20 years in breastfeeding advocacy and support.

"It's only been about 150 years since we started offering formula," Dech said. "Families have realized the importance of human milk for their babies and having that kind of nutrition available to them, particularly in NICUs."

Donated milk from approved donors is collected at about 30 sites, or "depots," around the state — as far north as Roseau and as far south as Fairmont — then sent to the milk bank for pasteurization and distribution across Minnesota and the Upper Midwest. Pasteurization kills many harmful viruses and bacteria but preserves most of the helpful components of breast milk, Dech said.

Mothers on the receiving end are charged a small fee — about $18 for a 4-ounce bottle – which Dech said is standard across the country. She noted that tiny amount "could provide many, many meals for a baby in the NICU."

The Golden Valley-based nonprofit has provided more than 330,000 ounces of donor milk over the past two years, Dech said, and is hoping to expand to include all maternity hospitals in the state.

Donor moms — including birth mothers — are screened and must take a blood test to ensure that their breast milk is safe for preemies. "We do ask in detail about medications, supplements and herbs," Dech said.

Breastfeeding is not a hard sell in this state. Breastfeeding initiation rates, Dech said, are at 90% in Minnesota. "Clearly, it is the norm."

Interestingly, the COVID lockdown was a boon for the bank.

"Because of the stay-at-home orders, nobody could go anywhere," Dech said. "Moms were at homes with their babies, pumping. We couldn't process it fast enough. It was a good problem to have."

'Time to sit down and think of him'

After her older son, James, was born 20 months ago, Tonsager found breastfeeding easy and enjoyable.

"My milk came in right away and I have really fatty milk, which is good for NICU babies," she said.

Now donating gives her something more: a precious opportunity to remain close to Ian.

"Pumping gives me time to sit down and think about him every day," she said. "I can sing to him, talk to him and know that, together, we're helping other people feed their babies and get those antibodies they wouldn't otherwise be able to get."

Husband Ben, she said, "has been really awesome. We bag the milk together and he labels it, so he can be a part of it, too. He fed James one pumped bottle a day, and it was really hard for him that he also didn't get to be a part of that [with Ian]. It's been nice to be able to share that with him."

She's hoping to continue donating for six months.

Charlie Van Pawelk was a fighter, too. Born at 36 weeks and 3 days, he lived for roughly 10 minutes before succumbing July 31 to a rare congenital condition called limb body deformity.

"He was so beautiful and then he just peacefully passed away in our arms," said mom Karilyn Pawelk of Delano. "He fought hard for life, and he was our strength."

A photographer arrived that morning to take family photos, she said. "They were very beautiful and we have those pictures all over our house. Charlie is always with us."

Pawelk, 32, had exclusively breastfed her now 4-year-old son, Leo, and 2-year-old daughter, Winslett. (She is also stepmother to 15-year-old Jackson.)

While she can't remember how she connected with the milk bank, she felt "compelled" to donate. She began pumping in the hospital the day Charlie died and has continued as "part of our daily routine," she said.

"We had a lot of generous people along the way, and this is a way for us to pay it forward," she said. "In the hospital with Charlie, as I was pumping we prayed that it would go to babies who fought for life like Charlie, and we prayed that they'd be able to go home with their moms, that this milk would give them the strength Charlie had."

She estimates that she has donated 2,000 ounces of breast milk since the summer, with another 1,000 ounces in her freezer. She jokes that it needs to be donated "because we're running out of space."

Honoring bereaved mothers

While every donation of breast milk is gratefully acknowledged, MMBB donor coordinator Kris Scott said bereaved mothers are a special group. As co-chair of the nonprofit's bereavement task force with Renee Torbenson, she's developed educational materials that are distributed in hospitals to let bereaved moms know that milk donation is an option.

Scott emphasized that the choice to express and donate breast milk is not the right one for all bereaved mothers or birth parents, who might find the presence of milk upsetting. "There is no right or wrong way to feel," Scott said. "Mothers should be gentle with themselves and know that whatever feelings they are experiencing are perfectly normal and OK."

For some, though, donating the milk that would have fed their baby helps them through their grief, Scott said. To remember these babies and acknowledge this act, Scott and Torbenson launched a memorial program, which features an "Our Forever Butterflies" handmade quilt displayed on the milk bank's wall.

The quilt is adorned with a colorful array of flowers and butterflies soaring skyward. Each of the 37 butterflies has the first name and birth date of a "forever baby" embroidered on it, Scott said. Another butterfly is made and given to the family as a keepsake.

Handmade quilts will be added over time. "It warms the heart to know you are helping families find peace, pull together and recover," Scott said.

Tonsager, whose forever baby is reflected in one of those butterflies, hopes other grieving mothers might experience the comfort she experiences "having that time to pump and to see his name.

"It means a lot to me that he will still be known."

Gail Rosenblum is editor of Inspired.