The only time I ever spent in a NICU was 3 weeks in May-June of 1985 when my
son Peter was a patient at Riley Children's Hospital in Indianapolis.  I was
very pleased with the care he received there *except* for when they ran out
of my milk to give him because they had accidentally given a lot of my milk
to some other child in the NICU!

I agree that with very premature babies or babies with different sorts of
conditions, oxygen is the number one concern, and of course the babies must
be kept warm, and some of them need antibiotics or immediate surgery, etc.
Some, like my son, can't take any food by mouth at first and must be
hydrated and fed via intravenously.  But as soon as ANYTHING can go in by
mouth, it should be breast milk -- not glucose water, not plain water, not
formula.  If the mother can't provide breast milk, then breast milk from a
milk bank should be available.

I agree that if the baby is dead, it doesn't need breast milk.  But if the
baby dies of NEC because of getting formula, it won't need breast milk.
Formula harms babies -- the evidence is clear.  There is really no excuse
for NICUs not to have banked human milk available.  I am *not* blaming
individual NICU nurses -- we have heard on this list over the years that
sometimes if you complain too much, you get fired.  There is an entire huge
beaurocracy of nurses and doctors and administrators who set up the rules,
the protocols, the standards, the attitudes for whether a NICU will do
whatever it takes to make sure premature and sick babies get the breast milk
they need -- or whether they won't.

But I can't agree that the choice of how to feed the infant is EVER a low
priority -- it may mean the difference between life and death, and impacts
the health of the child throughout life.  A NICU that was dedicated to "best
practice" would have dedicated IBCLCs to help mothers breastfeed, and
dedicated social workers to spend time with grieving parents convincing them
that it is absolutely essential for their baby to get breast milk -- if not
the mother's own milk, then another mother's milk, REGARDLESS of how they
had planned on feeding a healthy, full-term newborn.  They would also have
places for the mothers to pump, and pumps, and places for the parents to
stay on site.

I've heard a number of women over the years say "I hadn't intended to
breastfeed, but the baby was born early (or with a problem) and the
neonatologist told me I HAD TO, so I did."

If a baby is capable of taking formula by mouth, then he is capable of
taking breast milk by mouth.  If the breast milk needs calorie
fortification, then it should be with human milk fortifier made from human
milk, not cows' milk.

Katherine A. Dettwyler, Ph.D.
Associate Professor of Anthropology and Nutrition
Texas A&M University
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