world prematurity awareness day 2015

Breastfeeding, with a drop to spare? It could save a life.

Not all babies are born strong. Not all people have the chance to save a life.

Not everybody has the same start in life. Aside from the man-made structures and systems that prevent different groups of children from having equal access to housing and health care and education, there is also plain bad luck. Babies born prematurely are a victim of this, of an often poorly-understood series of events for which nobody is truly to blame, which results in them leaving their mothers’ bodies and entering the world long before their own developing bodies are ready. Modern medicine has made it possible to give ever-tinier preemies a chance at a normal life: there are children who weighed no more than a block of butter when they were born walking among us. Their survival is thanks to a combination of excellent medical care and very, very dedicated parenting.

Intensive medical care is extremely expensive the world over. From the large numbers of trained professionals required to care intensively for these tiny patients, to the equipment required to support and monitor their organ systems, to the drugs and operations required to treat their complications: the funds required to nurse a preemie from birth to discharge home are immense. There is, however, one thing that can make a huge difference to a preemie’s outcome, that costs nothing more than the time and energy of another mother, and that is donated expressed breast milk.

EBM picDonated expressed breast milk (or Donor EBM) is milk that is given very generously by breastfeeding moms who have a little to spare. Any lactating woman who does not have Hepatitis or HIV can donate, and even the tiniest volumes of milk can make a big difference in a small baby’s life. Donating milk is physically not as easy as other charitable donations can be: any new parent knows that breast feeding is hard, tiring work, and that expressing milk is no fun. In South Africa, there is no remuneration for donating breast milk. It is a laborious and selfless act of giving, and the only reward is knowing that you have potentially made it possible for a preemie to grow into a full-sized baby, avoiding a painful and life-threatening complication along the way.

As a person specialising in paediatric surgery, one disease that I frequently treat is called necrotising enterocolitis (NEC). This is a condition that pretty much only affects babies born prematurely, before their lungs are ready for air and before their intestines are ready for food. NEC is a disease that we doctors still don’t fully understand, but it has devastating consequences for our tiny, fragile preemies. It is ‘an acquired, inflammatory disease that affects the gut of newborn infants’ and is still a major cause for illness and death in Neonatal Intensive Care Units. Essentially, the baby’s gut becomes inflamed, and the intestinal walls become infected by bacteria. Sometimes, the inflammation and infection settles down with a period of gut-rest and antibiotics, but sometimes the gut perforates and leaks into the abdominal cavity, or sections of it become necrotic and die off. That’s where I come in. My job is to take these tiny babies who often weigh less than a kilogram to theatre, open their bellies, and try to fix what’s inside. Outcomes after a bout of NEC vary: some babies will recover after a course of antibiotics and some will recover after a series of major operations, but many will die as a consequence of the disease. NEC is always serious, and is never taken lightly.

We don’t know exactly what causes necrotising enterocolitis, but we do know that it’s far more likely to happen in babies that are fed formula milk. Formula feeds are what dieticians and doctors resort to when there is no breast milk to give to a premature baby. A baby’s mom may herself be too sick to produce breast milk, may be absent for any number of reasons, or may simply not be producing enough milk to breastfeed herslf. In such cases, something other than her milk needs to be given so that the baby can grow and become strong. Whilst formula feed is always easy to get hold of, we know that Donor EBM, the supply of which is dependent on the generosity of other lactating women, is not only much safer to give to preemies, but comes with all the short- and long-term benefits that breast milk usually does. Babies who are given Donor EBM rather than formula suffer from far less feed intolerance, and are also much less likely to develop NEC.

As a mom who has breast fed and expressed herself, I know how precious every drop of milk is. As someone who has donated breast milk, I know how hard it is to give something away that you slaved to produce and that you know your own child would benefit from. As a paediatric surgeon in training, I realise that I have a personal, vested interest in getting as many people to donate breast milk as possible. I can offer you no tangible reward for donating milk: it’s not going to help you lose your baby weight, help you pay for the groceries, or help your own baby to sleep better at night. But I can tell you that your milk is seen as beyond valuable in the units where it is used. It is a drug that costs a burdened system nothing, that comes only with benefits and no adverse effects. It is a gift from one mother to another, and from one baby to another. I’m not going to tell you that if you are breast feeding you should be donating some milk, but I would love it if you would just think about it.

Where to Donate

Cape Town 

  1. Milk Matters: / / 021 659 5599
  2. Groote Schuur Milk Bank: / 021 404 6299

Rest of South Africa

South African Breastmilk Reserve: / / 011 482 1920

If you enjoyed this article, take a look at A Small Loss, another fab piece by the lovely Karen Milford.

Authors Bio

Karen Milford

‘Karen lives inworld prematurity day Cape Town where she is trying to be a good mom, a good doctor, and a connoisseur of good food and wine. On most days, she’s a distracted mom, a passable doctor, and is happy to eat fish fingers with tomato sauce and beer. She writes when she has time and when she has something she really wants to say.’

You can find more of her articles on her Medium collection, called The Baby Test.



  1. Quigley M, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants (Review). The Cochrane Collaboration, 2014.
  2. Sylvester KG, Liu GY, Albanese CT, 2012, ‘Necrotizing Enterocolitis’ in Coran AG (ed), Pediatric Surgery 7th edition, Elsevier Inc, pp. 1187–1207.

With thanks to:

Dr Amy Reid – MBChB (UCT), FC Paed (SA), Fellow in Neonatology (Groote Schuur Hospital)

Professor Chris Scott – Associate Professor Paediatric Rheumatology, Red Cross War Memorial Children’s Hospital, Cape Town


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