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Blog Archive

Maintaining Lactation

May 2015

We had the privilege to attend the 2nd Baby Friendly Hospital Initiative for Neonatal Wards, Neo-BFHI conference in Uppsala, Sweden May 19 and 20, 2015. There were speakers, poster presentations and participants from 37 countries (Argentina, Australia, Belgium, Bhutan, Brazil, Canada, Chile, Colombia, Croatia, Denmark, Estonia, Finland, France, Iceland, Israel, Italy, Japan, Kuwait, Lebanon, Luxembourg, Malaysia, Netherlands, New Zealand, Norway, Palestine, Philippines, Poland, Qatar, Russia, Spain, Sri Lanka, Sudan, Sweden, Switzerland, Ukraine, UK, and USA).  And all came together to talk about how important BFHI is, including in the neonatal intensive care units.

Some topics presented by speakers included: The Influence of milk composition on gastric emptying in term and preterm infants; Human milk & breastfeeding in vulnerable infants; Kangaroo Mother Care verses traditional care: and Breast milk expression at the preterm infant’s bedside. A pilot study, just to name a few. One of my favorites was a presentation by Kerstin Hedberg Nyqvist, RN, MNSc, PhD, entitled, Preterm infants’ early capacity for nutritive sucking at the breast; evidence verses hindering practices.

Dr. Nyqvist discussed how some NICUs apply guidelines which are based on incorrect ideas about the infants’ ability for nutritive sucking at the breast and the need of testing or suck training before allowing breastfeeding. She presented scientific evidence from a study of infants (gestational age 26 – 35weeks) where the decision to initiate breastfeeding was based only on absence of cardio-respiratory instability during handling and was irrespective of postnatal age or weight. The study feeding guidelines included “unrestricted skin-to-skin contact and frequency and duration of bf sessions, early termination of scheduled feeding: introduction of a prescribed total daily milk volume, and supplementation occurring as required (semi-demand feeding) by tube, or cup feeding (from 29 w). Mother’ unrestricted presence 24/7 was supported. The conclusion of the study being: give mothers’ opportunities for unrestricted presence and breastfeeding and adequate support, and they can reach exclusive breastfeeding when the infant is still at a low postmenstrual age.”

Diane Spatz, PhD, RN-BC, FAAN, presented her 10 steps to promote and protect the use of human milk and breastfeeding in vulnerable infants which can be found here.

There was also some discussion about the timing of the first expression for mothers of very low birth weight (VLBW) infants. A study done in 2011, Effect of early breast milk expression on milk volume and timing of lactogenesis stage II among mothers of very low birth weight infants: a pilot study by Parker et al. endeavored to examine this issue. The authors of this study concluded that initiation of milk expression within an hour of the birth increases milk volume and decreases the time to lactogenesis stage II in mothers of VLBW infants. The original article can be found here.

Step 5 is so important for all mothers and it is clearly essential for mothers of VLBW premature and sick infants’ worldwide.


  1. 10 steps to promote and protect the use of human milk and breastfeeding in vulnerable infants
  2. Effect of early breast milk expression on milk volume and timing of lactogenesis stage II among mothers of very low birth weight infants: a pilot study  

Until next time, enjoy your reading and keep up the great work you are all doing supporting both staff and families by striving and maintaining BFHI practices.

Carole and Lenore
Carole Dobrich, RN, IBCLC, ANLC & Lenore Goldfarb, PhD, CCC, IBCLC, ALC
Directors Step2 Education
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