White gold

Camilla Kingdon has cause to celebrate. As a consultant on the neonatal intensive care unit at Guy's and St Thomas' in London, she has been instrumental in setting up the hospital's new human milk bank. Breast milk is particularly important for premature babies: it is much better tolerated than formula milk and contains vital antibodies that help them fight infections. But until now if a mother of a baby on the unit could not get her milk going - something fairly common after a traumatic early birth - there was no option but to put the baby on to formula unless breast milk could be shipped in from somewhere else in time.

"Having trained at a unit with a milk bank, it just felt wrong to be giving tiny babies formula when there is unequivocal medical evidence that breast milk is far superior," says Kingdon. "Ideally the baby should have its own mother's milk, but if that is not possible, donor milk is the next best thing. At this hospital, we deal with a deprived inner-city area and a vulnerable population. Many of the babies we see have failed to grow in the womb and are tiny even by pre-term standards. Their need is critical."

About 45,000 babies are born prematurely (before 37 weeks gestation) each year in the UK. Many would undoubtedly stand a better chance of survival if they had access to breast milk - but they don't. The Guy's and St Thomas' bank is one of only 17 in the country, meaning that the needs of many tiny babies cannot be met. There is no milk bank in Wales or the west country and only one in Scotland and Ireland respectively. It is an injustice that many involved in milk banking are working hard to rectify.

"There is a growing demand for donor milk," says Gillian Weaver, chair of the United Kingdom Association for Milk Banking. "There has been an increase in the number of sick and premature babies who have been able to benefit from the donor breast milk. So many more could be helped if it was available throughout the UK. Without a much expanded and reorganised service, many babies will inevitably miss out."

Missing out can have grave implications: premature babies are particularly susceptible to the infection necrotising enterocolitis, a serious illness in which the tissues in the small intestine become inflamed and start to die. Breast milk helps prevent the infection. A study in the Lancet in 1991 concluded that exclusive formula feeding in neonatal units could account for around 500 extra cases of the condition each year, and that about 100 babies would not survive.

But it's not just about the babies. Milk banks play an important role in alleviating some of the maternal stress that accompanies a premature birth. If the baby can be fed donor breast milk, the mother - who may be sick, who has probably had a caesarean, and who is almost certainly already under extreme stress - is not under the added pressure of supplying a certain amount of milk each day.

Some women, such as Tracey Mills, experience delayed lactation when their baby is preterm. She used a milk bank as a stopgap until her milk got going. "I always intended to breastfeed, but when Joshua was born eight weeks early, it took a while to establish my milk supply," says Mills. "Knowing Joshua has been getting breast milk has been a great comfort."

While some women struggle to produce enough milk in such circumstances, others, such as Dana Walfisz, express vast quantities. She ended up filling the freezers on the neonatal unit at Barnet Hospital after the birth of her daughter Erin. "It was so important to me that Erin had my milk," says Walfisz. "I felt like it was the only thing I could do for her." Erin was born 14 weeks early, weighing just 1lb 8oz. She has made remarkable progress, which Dana puts down to all the milk. Unaware of milk banking before her own traumatic experience, Dana donated her surplus milk to the nearby Queen Charlotte's and Chelsea bank.

Breastfeeding mothers of both term and pre-term babies may consider making donations to their local bank, if there is one. Potential donors undergo rigorous screening, and as added safeguards, donated milk is tested for bacteria and pasteurised. The women receive no payment for donating: it is felt that someone genuinely wishing to help is more likely to give milk in the best condition.

Things have come a long way since the dark days of the 1980s, when fear of HIV transmission, coupled with a move towards using pre-term specialised formula milk, closed all but six milk banks in the UK. However there is still a long way to go before all premature babies have access to human milk. While some milk banks receive funding from their trusts, others rely heavily on charitable contributions.

"Ideally, I feel there should be a national system that ensures that donor milk is available for all babies with a clinical need," says Weaver. "At present, work at looking at such a system is still in its infancy."