NICU Nurses and the Responsibility of Human Milk

Evi Dewhurst / February 2016


Neonatal intensive care nurses are increasingly called upon to participate in the management of human milk in their unit. They even actively educate mothers on best practices to pump breast milk for their infants. Why is that, you ask? One reason is this: Research by Hallowell and colleagues demonstrated that only 50% of NICUs had lactation consultants working in the NICU on any shift.1 Occasionally clinical lactation support is limited, which can leave a mother without easy access to information or resources. The job then falls to someone else to help mothers along with their breastfeeding or pumping goals. NICU nurses are the logical solution to this, especially because they understand the importance of human milk to their neonatal patients’ health outcomes. They are also in the ideal situation to have (ideally) consistent interactions with parents which will build trust.

Many NICUs in recent years have adopted a family-centered care focus. The need for emotional, educational and clinical support for families of NICU patients has become increasingly apparent, and neonatal professionals have risen to the challenge. Included in this focus is involving parents with simple infant care tasks in order to encourage bonding, parental confidence and infant care education. Aligned with this is the support and knowledge nurses can share about the lactation process and human milk collection, storage and delivery. When human milk management is included in family-centered care, it can make a big difference to a mother’s goal to provide breast milk.

In recognition of the value of human milk in the NICU and neonatal nursing impact on its provision, the National Association of Neonatal Nurses wrote the following suggested guidelines in their April 2015 position statement #3065, The Use of Human Milk and Breastfeeding in the Neonatal Intensive Care Unit:

  1. Prenatal Lactation Intervention

This is especially important if a mother is identified as at-risk for preterm birth. While prenatal lactation intervention occurs prior to an infant’s birth, it can be an opportunity when OB clinicians and NICU clinicians are working together to fully prepare a mother for eventualities. Early education can not only empower a mother who is confronting a possible preterm birth, but also engage her very early in the process of care for her infant.

  1. Assessment and Maintenance of Human Milk Supply

It is recommended that nurses assess milk supply daily during the first two weeks to ensure that maternal milk supply reaches maximum potential. In fact, mothers are encouraged to pump within one hour of delivery, as evidence suggests it will boost milk supply later.

  1. Oral Care with Human Milk

This care helps to mimic what would occur if the infant were feeding at the breast. Human milk microbial properties also provide a front-line defense.

  1. Human Milk Management, Prioritization, and Optimizing of Human Milk Feedings

Introducing colostrum in the beginning stages benefits the infant in many ways. After colostrum, fresh human milk can be received. NICUs are encouraged to develop a human milk management center in order to optimize, ensure the safety of, and minimize waste of, human milk.

  1. Transitioning the Vulnerable Infant to At-Breast Feedings

Oral care and skin-to-skin contact is recommended in order to facilitate direct at-breast feedings. Skin-to-skin contact helps mothers feel more connected with their infant and can encourage breastfeeding outcomes. It has even demonstrated an improvement to milk supply.

In conclusion to these guidelines, NANN affirms, “Neonatal nurses have a responsibility to facilitate, through support and evidence-based information, the provision of human milk and breastfeeding. It is essential to ensure that infants receive human milk through hospital discharge and that mothers have the opportunity to reach their personal breastfeeding goals.”

While a neonatal nurse’s first consideration is the infant patient, efforts to include and educate family can positively impact infant health outcomes. As the relationship between family and clinical caregiver grows, so too will a family’s confidence that is needed to have a successful breastfeeding journey, handle care tasks and the idea that they can get through this challenging time.

Looking for more information on this topic?
Read “The NICU Nurse and Family Impact.”


1. Hallowell, S., Spatz, D., Rogowski, J., & Lake, E. (2014). Characteristics of the NICU work environment associated with breastfeeding support. Retrieved from