“Breastfeeding” Carries Different Connotations for Mothers in N/IICU

Researchers Focus on Setting Attainable Breastfeeding Goals for Mothers of Children in Intensive Care

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For mothers of children in the Newborn/Infant Intensive Care Unit (N/IICU), breastfeeding not only provides their child with vital nutrients and immune components, it can also be a powerful way to bond with their babies. However, given the medical fragility of these infants, the path to traditional breastfeeding is not always attainable. Researchers at Children’s Hospital of Philadelphia (CHOP) set out to understand what breastfeeding means to these mothers and how setting attainable goals can help their babies in the N/IICU.

The findings were published in the Journal of Human Lactation.

For this study, researchers worked with 11 mothers of infants with congenital diaphragmatic hernia (CDH). CDH occurs when the diaphragm muscle fails to close during prenatal development, and the contents from the abdomen (stomach, intestines and/or liver) migrate into the chest through this hole. It affects one in every 2,000 to 4,000 live births.

“We found early on that ‘breastfeeding’ didn’t necessarily mean holding the baby to the breast,” says Elizabeth Froh, PhD, MS, RN, clinical supervisor of the Lactation Team at CHOP and lead author of the study. “For the most part, mothers felt happy as long as their baby was getting their milk, whether by pumping or traditional breastfeeding.”

One mother, Tessa, expressed her “breastfeeding” goal as getting her son to drink human milk, no matter how he was able to:

“I think [breastfeeding and bottle feeding are] the same, right? Because he’s getting potentially…the exact same thing. He’s getting breast milk, still. I feel like if he can take a bottle before we go home, then that’s fine. My goal is to get home with a feeding tube and with something else; I want him to be able to either take a bottle or breastfeed — whichever one. That’s my goal before we go home.”

The researchers argue the terminology of “breastfeeding” needs to be expanded to include possibilities outside of direct feeding at the breast. Clinicians should make sure mothers of infants with CDH understand that direct breastfeeding won’t be possible at first but the provision of human milk is essential for an infant with CDH. Spatz developed a 10-step model that starts with informed decision and sets the mother up on the pathway to be able to breastfeed her child.

“If a mother in the N/IICU wants to one day breastfeed her child in the traditional sense, they need to be taught the importance of pumping early and pumping often with a hospital-grade electric pump,” says Diane Spatz,PhD, RN-BC, FAAN, Director of the Lactation Program at CHOP and study co-author. “The benefit is two-fold: the mother’s body is learning how to produce milk, and the baby is able to get all the benefits of human milk although being fed through a feeding tube.”

The Breastfeeding and Lactation Program also works with patients within the Center for Fetal Diagnosis and Treatment (CFDT) at CHOP, home of the Garbose Family Special Delivery Unit, the world’s first birthing unit within a pediatric hospital dedicated to healthy mothers carrying babies with serious and life-threatening birth defects. The goal is to provide a thorough, individualized plan for the provision of human milk as well as direct breastfeeding if that is the mothers goal prior to delivery. 

Another mother, Kenya, explained her son motivated her to keep pumping while he was in the N/IICU:

“My second day when I didn’t get any milk, I looked at pictures of my son and I pumped. I imagined him being there. I imagined myself holding him, and even though that entire day I didn’t get any milk, I pumped consistently every two hours, and since then I’ve had a beautiful flow of milk.”

Although it was not the original intent of the authors to study the link between breastfeeding and motherhood, some mothers, like Sandra, said breastfeeding her baby made her feel more connected:

“I feel like pumping for the last two months has been worth it. I feel like I’m finally able to soothe her. I feel like a mom more than anything.”

Elizabeth B. Froh, PhD, RN, Janet A. Deatrick, PhD, RN, FAAN, Martha A.Q. Curly, PhD, RN, FAAN, Diane Spatz, PhD, RN, FAAN. “Mothers of Infants with Congenital Diaphragmatic Hernia Describe “Breastfeeding” in the Neonatal Intensive Care Unit: “As Long as it’s My Milk, I’m Happy,” Journal of Human Lactation. Published online June 2017. 

Contact: The Children’s Hospital of Philadelphia,