The hospitalization of premature, small and/or sick newborns poses multiple challenges to breastfeeding, including:
- The environment at the Neonatal Intensive Care Unit (NICU): It is often noisy, excessively bright, intimidating and lacking in privacy. The multiple connections to devices necessary for the babies’ vital support make it difficult to hold them. Some facilities have a shortage of equipment and are understaffed; others have restrictive policies that hinder the engagement of parents in the care of their children. Inadequate knowledge, lack of skills, resistance to change and intense workload are staff-related barriers to breastfeeding at the ICU.
- Maternal conditions: Mothers often experience severe clinical conditions after preterm delivery and often feel the loss of their role as primary caregiver for their baby, who requires the care of strangers and relies on technological devices to survive. Maternal stress can delay lactogenesis II (the onset of milk production), which, together with difficulty in breastfeeding, can affect milk volume.
- Neonatal conditions: Small mouth relative to the mother's nipple, lack of oral motor skills and uncoordinated sucking-swallowing-breathing may preclude early breastfeeding and discourage the mother.
- Economic barriers can create difficulties in obtaining the mother's own milk supply (cost of pumps and accessories for milk extraction and storage, travel, and lodging and additional food costs parents have to pay to stay close to their child).
- The care of other children at home causes additional stress in families.
The facility’s written policy for successful breastfeeding in premature, small and/or sick people should contemplate how to deal with all these issues.
Unrestricted maternal and paternal admission to neonatal inpatient areas makes it easier to overcome these barriers in favor of breastfeeding
