Aim Outlining ethical dilemmas in special care baby unit (SCBU)—distinguishing between formula and expressed breast-milk, addressing a mother's claim that bottles of milk were breast-milk.

Background/Method A premature baby in SCBU was subject to Child Protection Plan under “neglect” prior to birth. His mother felt pressurised to demonstrate she was a “good” mother, having experienced the consequences of parental inadequacy: her first child was placed in custody through failure to provide adequate care. The father was assessed by Social Services as irresponsible/unsupportive. Initially the baby was fed maternal expressed breast-milk. By day 19 minimal amounts of breast-milk were expressed, feeds consisted primarily of formula. Day 20, mother returned to SCBU with four bottles (400 ml) of what parents claimed was expressed-breast-milk. Quantity and appearance raised suspicions. Three experienced nurses thought the milk smelt and appeared to be formula. Mother expressed only 1 ml breast-milk under nurse-supervision. Staff explained their concerns to her non-confrontationally; inappropriate to feed baby an unknown substance. It was agreed that the milk be analysed biochemically. Samples of claimed breast-milk and breast-milk collected under supervision were sent to the laboratory for identification: detecting presence of cells in breast-milk.

Results Both parents felt the need to perform under constant monitoring/scrutiny by health-professionals, assessing their parental capability. Testing milk samples was challenging: clinical laboratories are not set-up to undertake this type of identification. Haematologists were unable to detect white-blood-cells in either sample. Results were inconclusive. The samples appeared different clinically (colour/smell/consistency). On analysis, the undisputed sample contained large numbers of bacilli not present in claimed breast-milk. Samples were not identical although evidence was insufficient to refute mother's claim. External confounding parameters were not limited.

Conclusion For safety, unknown substances cannot be fed to baby. However, was it ethical confronting the mother, mistrusting her word? Was she pressurised to make false claims to be perceived as an adequate mother? Are techniques/initiatives employed to promote breast-feeding ethical—celebrities advocating benefits, positive reinforcement through patient-education from healthcare professionals. This initiative to promote positive social reconditioning may evoke negative emotive responses. Mothers unable to produce sufficient breast-milk should not feel inadequate/uncaring.