Introduction: Human milk provides critical immunologic, nutritional, and developmental advantages for preterm and medically complex infants. Infants with renal failure requiring dialysis face repeated interruptions to enteral feeding, prolonged hospitalizations, and maternal–infant separation, all of which threaten breastfeeding success. Yet these vulnerable infants may benefit most from human milk. Main Issue: This case report describes Baby R, a late preterm infant with dysplastic kidneys and renal failure requiring dialysis, who faced multiple surgeries and a prolonged nil per os status, meaning no oral or enteral intake. In the face of her infant’s critical illness, the mother maintained hope and a steadfast commitment to breastfeed her child for as long as possible if he survived. The primary lactation challenge was to preserve the maternal milk supply and achieve direct breastfeeding despite repeated setbacks, while honoring the mother’s feeding aspirations. Management and Outcomes: Born at 36 3/7 weeks’ gestation, weighing 3,120 g, Baby R required a Hickman catheter, peritoneal dialysis catheter, gastrostomy tube, and intubation. His 22-year-old mother initiated pumping within hours postpartum using a multiuser breast pump. By day of life (DOL) 7, she had produced 14–16 oz/day; by DOL 14, she had exceeded 30 oz/day. Direct breastfeeding was reintroduced after each clinical interruption, supported by daily visits from IBCLCs, individualized education, and family engagement. At discharge on DOL 61, Baby R was receiving daytime direct breastfeeding and nighttime expressed breast milk during dialysis. Conclusion: This case demonstrates that medically fragile infants can successfully breastfeed with proactive, patient-centered lactation care. Key takeaways include the importance of interdisciplinary collaboration, maternal empowerment, and IBCLC-led proactive strategies.
Objective: Human milk is the optimal source of nutrition for infants in their first 6 months of life; however, many families do not meet this goal. Confidence, the belief in one’s ability to perform a particular task, is key to breastfeeding. The purpose of this clinical practice article is to discuss strategies that nurture breastfeeding confidence and facilitate breastfeeding support. Methods: Women experience breastfeeding confidence as a dynamic interaction between their experiences and expectations, their infants’ breastfeeding behavior, and their support systems. The strategies presented address this interaction and provide insights into nurturing confidence. Results: Asking effective questions that elicit parents’ expectations about breastfeeding, facilitating parental understanding of infant behavior, and developing community partnerships focused on supporting breastfeeding can effectively nurture confidence. Conclusion: Nurturing breastfeeding confidence promotes optimal breastfeeding experiences and can be accomplished with education during pregnancy, supportive hospital environments, and building community breastfeeding partnerships.
Objective: Breastfeeding outcomes are influenced by both maternal factors and relational, community, and structural supports. This scoping review examines the impact of caregiving networks on breastfeeding, utilizing a framework inspired by hives as a conceptual lens, rather than a biological analogy. Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, peer-reviewed research published between 2005 and 2025 was searched in PubMed, Scopus, Google Scholar, and reference lists (last updated on August 20, 2025). Thirty-four studies fulfilled the inclusion criteria. Analytic domains were predetermined and subsequently improved inductively: collaborative caregiving, shared nourishment, efficient communication, and structural resilience. Results: Across various settings, engagement of partners, peer support, donor milk channels, ongoing counseling, and favorable workplace or hospital rules correlated with enhanced initiation, exclusivity, duration, and maternal confidence. Conclusions: Optimal breastfeeding is maintained when support systems, rather than individual mothers alone, are adequately resourced. The hive-inspired paradigm systematically organizes varied findings and may inform clinical treatment, program development, and policy formulation. Subsequent studies should assess context-specific “support bundles.”
Objective: Professional development frameworks, such as clinical ladders, have demonstrated success in nursing and allied health professions by promoting retention, morale, and recognition. However, no nationally recognized clinical ladder currently exists for IBCLCs, creating inconsistencies in advancement and recognition. Methods: This article reviews the theoretical foundation of Patricia Benner’s novice-to-expert model and examines existing nursing clinical ladder structures. Drawing from these models, a four-tier framework tailored to IBCLCs was developed, incorporating years of practice, education, mentorship, quality improvement contributions, and leadership roles. Results: The proposed IBCLC Clinical Ladder includes four levels: associate, competent, advanced, and expert. Each level outlines competencies, educational milestones, mentorship responsibilities, and scholarly expectations. The model aligns with Magnet Recognition Program ® standards and emphasizes both professional growth and improved patient care. Conclusions: Adopting a structured clinical ladder for IBCLCs in hospital setting offers a pathway for professional recognition, retention, and leadership while enhancing the quality of lactation care delivery across diverse healthcare settings.
Objective: Exclusive breastfeeding (EBF) is critical for optimal growth of infants and for maternal health. Despite global, country, and local initiatives, EBF rates remain low in South Africa, particularly beyond the immediate postpartum period. There is limited research that has explored the psychosocial factors influencing breastfeeding practices among White South African mothers. This study aimed to explore breastfeeding practices and assess the influence of maternal psychosocial factors in the province of Gauteng, South Africa. Methods: An exploratory cross-sectional study was conducted among 106 lactating mothers attending private postnatal clinics in Gauteng, with 55 completing the questionnaires. Data were collected using validated tools, including the Breastfeeding Self-Efficacy Scale, Iowa Infant Feeding Attitude Scale, Edinburgh Postnatal Depression Scale, and State-Trait Anxiety Inventory. Descriptive statistics were used to summarize sociodemographic characteristics, breastfeeding practices, and psychosocial factors. Point-biserial correlation analysis was used to assess relationships between breastfeeding practices and psychosocial measures. Results: Participants were primarily White (89.1%), married (92.6%), and highly educated (72.2% had tertiary qualifications). Out of the households that participated, 73.8% had an income above 20,000 South African rand (U.S.$1,142) per month. Most respondents (94.6%) reported being food-secure. EBF prevalence reached 93.5% by 6 weeks postpartum. High breastfeeding self-efficacy was reported (Breastfeeding Self-Efficacy Scale mean score: 141/172). Most mothers (63.6%) experienced low anxiety, and 21.8% exhibited depressive symptoms. Positive associations were observed between EBF and higher self-efficacy ( r = .40, p < .001), positive attitudes ( r = .29, p = .03), and lower anxiety ( r = .36, p = .01). Conclusions: The findings highlight predominantly optimal breastfeeding practices in this high socioeconomic population, with high self-efficacy and low anxiety contributing to EBF success. Impactful interventions should sustain breastfeeding beyond the early postpartum period by enhancing maternal confidence and addressing early introduction of complementary foods. Further research with a larger sample size is required to ascertain factors that significantly influence breastfeeding.
Objective: With the advancement of technology, virtual reality applications are increasingly being used in the field of healthcare and nursing education. Breastfeeding, which is of critical importance for maternal and child health, is recommended by the World Health Organization as exclusive breastfeeding for the first 6 months of life. However, women may experience various problems during the breastfeeding process, which increases the need for effective educational methods. Methods: This study was conducted to develop a virtual reality-based educational program and implementation protocol for breastfeeding education. During the development process, the breastfeeding education content was created in line with the literature, a scenario was prepared, and it was integrated into the virtual reality environment. Results: As a result, a structured virtual reality program and implementation protocol were developed for use in breastfeeding education. Conclusions: This program is considered to be an innovative and effective tool for breastfeeding education.
Objective: This study aimed to evaluate the rates of early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) at 24 hours and 6 weeks postpartum, alongside their impact on infant weight gain. Factors associated with failure to achieve EIBF and EBF at 6 weeks and weight gain at 6 weeks were also examined. Methods: Data from 2,527 singleton live-born infants of women in a prospective, longitudinal cohort study at an urban secondary care hospital in Nagpur were analyzed. Data were collected at enrollment, delivery, and 6 weeks postpartum. Results: EIBF, EBF at 24 hours, and EBF at 6 weeks postpartum were 31.6%, 87%, and 88.7%, respectively. The mean weight gain in EBF and non-EBF groups was 1,452.0 and 1,266.2 grams, respectively ( p < .001). Infants EBF at both time points had thrice the odds of appropriate weight gain. Conclusion: EBF ensured significant weight gain, even among term low-birth-weight infants.
Objective: The article will provide the theoretical framework for the convergence of two conceptual care models: one prenatal and the other postpartum. The two models are the Positive Direction Model and the Tri-Core Breastfeeding Model, which are integrated into a unified translational perinatal framework for the creation of the PeriWell Intervention. Methods: This article lays the foundation for the PeriWell Intervention and provides literature to support the convergence of the two conceptual care models. Results: The development of the PeriWell Intervention 12-week session perinatal virtual group to improve emotional regulation and increase breastfeeding self-efficacy. The statistical results are in Part II of the series. Conclusions: The Positive Direction Model and the Tri-Core Breastfeeding Model fused together to create the PeriWell Intervention to cover the perinatal period. The PeriWell Intervention's 12-week session prioritized emotional regulation and empowered self-efficacy.
Objective: Breastfeeding mothers who require prescription medications often face uncertainty regarding the safety of these medications during lactation. This lack of clear information may lead to interruptions in breastfeeding or discontinuation of necessary medications. We report the experiences of two American women navigating medication use while breastfeeding, focusing on the challenges they encounter when gathering information and making informed decisions. Methods: This pilot project involved semistructured interviews with two breastfeeding mothers, recruited through the Facebook group “Breastfeeding for Busy Moms.” Both participants had taken or considered prescription medications while breastfeeding within the past 6 months. Manual coding and thematic analysis were used to identify recurring themes across both cases. Results: Three primary themes emerged from the analysis. First, both women experienced difficulty in accessing reliable and comprehensive information regarding medication safety during breastfeeding. Second, participants expressed feelings of isolation due to conflicting advice from healthcare providers and the lack of collaboration between specialists. Third, both mothers individualized the risks of infant exposure against the benefits of continued breastfeeding. Conclusions: This report highlights the critical need for more comprehensive research on the challenges medication safety during lactation poses for breastfeeding women and their healthcare providers. Larger, more diverse studies are essential to capture the experiences of breastfeeding women from various socioeconomic and educational backgrounds, as well as those with differing health conditions and medication needs. Such research would provide healthcare providers with a framework to reduce inconsistencies and improve medication support for breastfeeding mothers.
Objective: Because of its calming effect, breast milk may help reduce the restlessness of infants undergoing phototherapy. The aim of this study is to determine the effect of breast milk odor on the duration of separation from phototherapy and bilirubin levels in term infants receiving phototherapy. Methods: It is an experimental randomized controlled study. There are two groups in the study. These are the breast milk-scented group ( n = 37) and the control group ( n = 35). Infants born at 37–39+6 weeks of gestation and receiving phototherapy were included in the study. Groups were separated by randomization method. Cotton soaked with breast milk was placed in a container at a distance of about 15 cm from the head of the newborn in the breast milk scent group. The cotton in the container was replaced with a new one every 3 hours. In the control group, the mother and infant were allowed to stay together, which is the routine practice of the clinic. Results: The time to be separated from phototherapy due to feeding was determined to be longer in the group in which breast milk scent was administered ( p = .00), whereas the time to leave phototherapy due to crying and follow-up was longer ( p = .001, p = .015) in the control group. When the effect of the smell of breast milk on the rate of decrease in the hourly bilirubin level was examined, no significant difference was found between the groups ( p = .995). Conclusions: The smell of breast milk caused the infants to prolong the feeding times and decrease the crying and follow-up times. It is recommended that the application of breast milk scent should be made into the routine practice of clinics in infants receiving phototherapy. Trial Registration: NCT05167474 .
Objective: Breastfeeding is the gold standard for infant feeding; however, intrinsic and extrinsic factors play a role in breastfeeding outcomes. While several breastfeeding survey tools have been validated to identify intrinsic factors, few have been developed to predict breastfeeding outcomes related to extrinsic factors, such as those associated with social determinants of health (SDOH). The Navigating External Support Themes (NEST) Breastfeeding Scale is an instrument designed to measure the effect that SDOH have on breastfeeding outcomes. Methods: Participants who were pregnant with the intent to breastfeed, currently breastfeeding, or had completed breastfeeding within 6 months of the study were invited to participate. The content validity, construct validity, and internal consistency were tested on 437 breastfeeding individuals. After correcting for questions with poor internal consistency and reliability, the NEST Breastfeeding Scale resulted in 12 questions. Results: Content validity, construct validity, and internal consistency met thresholds set to confirm the validity and reliability of the tool. Conclusion: Based on the theoretical framework of the socioecological model, the psychometric analysis of the NEST Breastfeeding Scale has determined it to be a valid and reliable instrument. Its use in identifying extrinsic motivators related to breastfeeding could help predict and improve breastfeeding outcomes.
Objective: This study aims to reveal the impact of face-to-face breastfeeding counseling training on attitudes toward infant feeding and perceptions of breast milk. Method: The sample of this quasi-experimental study consisted of third-year midwifery students who took the Breastfeeding Counseling course ( n = 49) and those who did not take this course. Personal Information Sheet, Breast Milk Perceptions Scale for Adults (BMPSA), and the Iowa Infant Feeding Attitude Scale (IIFAS) were used to collect data. Results: After the training, the experimental group had a mean IIFAS total scale score of 73.42 ± 8.53, whereas the control group had a mean score of 60.59 ± 14.79. Additionally, the mean BMPSA total scale scores were 140.08 ± 13.03 and 125.70 ± 18.55 for the experimental and control groups, respectively. Conclusion: This study found that breastfeeding counseling training positively influenced participants’ attitudes toward infant feeding and their perceptions of breast milk.
Objective: Nurses’ knowledge and skills in providing evidence-based breastfeeding care can improve breastfeeding rates, lower mortality and morbidity among infants, enhance mother–infant bonding, improve maternal–child health, and relieve the economic burden on families. Incorporating breastfeeding education into the nursing curriculum is vital to preparing the next generation of nurses to provide evidence-based breastfeeding care to mothers from all backgrounds. This article presents the recommended evidence-based instructional approaches that can be adapted in the nursing curriculum to prepare nursing students to provide evidence-based breastfeeding care to mothers. Methods: A scoping review of literature was undertaken without placing any restrictions on geographic location or year of publication of the articles. Altogether, 24 peer-reviewed articles that specifically presented a range of evidence-based instructional approaches to improve breastfeeding knowledge and skills of nursing students were shortlisted. Results: The evidence-based instructional methods that are reported to improve the knowledge and skills of nursing students on breastfeeding include integration of breastfeeding across baccalaureate nursing curriculum, coaching and clinical training opportunities for nursing students, combining in-person didactic with skills laboratory and perinatal clinical rotation, in-built breastfeeding education program in nursing courses, evidence-based breastfeeding education toolkit/intervention, breastfeeding workshop led by lactation professionals, use of technological component in breastfeeding education, experiential learning opportunities, and multifaceted educational approach. Conclusions: By employing a range of evidence-based instructional modalities, nursing programs can better equip nursing students with the knowledge and skills needed to advocate for and support breastfeeding practices of mothers.
Objective: The aim of this study is to investigate the relationship between breastfeeding mothers’ perception of insufficient milk production and the amount of milk infants consume, as well as the use of galactagogues in the first 6 months postpartum. Methods: A descriptive, correlational study included 417 breastfeeding mothers in their first month postpartum. The Descriptive Characteristics Form, Perception of Insufficient Milk Questionnaire, and the Urine output, Breast condition, Defecation frequency, Weight, and Satisfaction (IMDAT) Scoring System for Milk Intake were used as data collection tools. Results: Mothers’ perceptions of milk adequacy were moderately high, although the amount of milk their infants consumed was insufficient. A moderate positive correlation was found between mothers’ perceptions and infants' milk consumption ( p < .05). Among the participants, 83.9% made efforts to increase their milk production, and 65.7% used galactagogues. Conclusion: As the perception of inadequacy of milk increases, the perception that the baby is receiving inadequate milk also increases.
In early 1980, I identified and named an as-of-then unknown anatomical nipple anomaly: adhered nipples (Marmet & Shell, 1986, 1989; Marmet et al., 1993). However, this nipple anomaly continues to be incorrectly identified as an inverted nipple. Medical practitioners, including lactation consultants, then and now, did not and do not understand that adhered and inverted nipples are two different anatomical variations. The history of how I identified this class of nipple variation is a personal one, born of desperation and deeply intertwined with my discovery and copyrighting of the Manual Expression of Breastmilk: Marmet Technique (Marmet, 2025a,b).
Objective: Late preterm infants (LPIs) have increased medical complications, lower breastfeeding rates, and confusing infant behaviors. Lactation professionals need current information and resources about LPIs to enhance LPIs' outcomes and their parents' confidence and care. Methods: Forty-three staff from South Dakota Special Supplemental Nutrition Program for Women, Infants and Children (WIC) completed HUG Your Baby's 2-hour online LPI course and accessed HUG's parent education video and handout. Pre-and postcourse knowledge, "clinical teaching" and "clinical confidence," and course evaluations were analyzed using comparative statistics. Results: Statistically significant improvement occurred in knowledge scores (mean improvement: 22.68 percentage points, 95% confidence interval: [17.59, 27.77]) and across all items evaluating current and future practice (p < .05) and confidence (p < .05). Conclusions: Completion of an LPI online course with access to family-friendly parent education enhanced WIC professionals' knowledge of LPIs and their plan and confidence to teach LPI parents. This program could enhance outpatient providers' abilities to help LPI families meet their parenting and breastfeeding goals.
Objective: To guide U.S.-based lactation organizations in developing ethical financial frameworks that reinforce breastfeeding advocacy principles and ensure long-term organizational sustainability. These organizations are vital to advancing maternal-child health, but their survival depends on stable funding. Methods: This article analyzes the common funding challenges faced by U.S. lactation organizations and examines the ethical considerations surrounding diversified financial strategies, including gifts, legacy donations, and strategic investments. A central focus is the risk these strategies pose to stakeholder trust and institutional integrity when misaligned with the International Code of Marketing of Breast-Milk Substitutes (the Code). Results: Sustainable financial strategies-when guided by clear, ethically grounded policies- can accelerate mission fulfillment, innovation, and broader community impact. However, without these policies, strategies like mission-aligned partnerships can create conflicts of interest or the appearance of endorsing products that undermine breastfeeding, thereby risking public trust. The absence of policy creates significant vulnerability. Conclusions: Developing a transparent, mission-aligned financial framework is essential. By preemptively addressing ethical considerations, U.S. lactation organizations can successfully navigate uncertain funding climates, enhance their financial resilience, and safeguard their public credibility and commitment to the core principles of breastfeeding advocacy.
Objective: Breastfeeding has many benefits for mothers and babies; however, women who have been incarcerated are less likely to breastfeed their babies. For incarcerated mothers, breastfeeding and the use of breast milk hold a particular significance in saving the lives of their young children. To promote, protect, and support the breastfeeding practices of incarcerated women, it is essential to examine the range of barriers they experience. This review discusses the breastfeeding barriers experienced by incarcerated women and presents the recommended strategies to support breastfeeding in prison. Methods: A scoping review of peer-reviewed literature published between 2012 and 2024 was undertaken without placing any restrictions on the geographic region. Altogether, 18 sources were shortlisted that specifically offered recommendations or strategies to address several of the common breastfeeding barriers encountered by incarcerated women in correctional settings. Results: Barriers experienced by incarcerated women include mother-infant separation, nonsupportive practices and policies, maternal health issues, stressful environments, and lack of access to breastfeeding education. Development and enforcement of supportive institutional breastfeeding policies, comprehensive breastfeeding education for mothers and service providers, and trauma-informed support and a safe environment are recommended to promote, protect, and support breastfeeding among incarcerated mothers in correctional settings. Conclusion: Addressing barriers to breastfeeding among incarcerated women requires a multifaceted approach, including policy changes, education, access to resources, and supportive interventions within correctional facilities. Collaboration among stakeholders is essential to ensure the well-being of both mothers and infants in carceral settings.
Objective: This article describes the role of self-compassion in breastfeeding support. Background: New parents respond to breastfeeding challenges in very different ways. Self-compassion is a parental trait that is associated with diminished distress in difficult circumstances as well as a lower risk of postpartum depression/anxiety. Self-compassion has three components: self-kindness, mindfulness, and perceiving common humanity. Outcomes: This article provides an overview of the literature on self-compassion, describes what self-compassionate responses could look like for new parents experiencing breastfeeding challenges, and introduces some empirically supported resources for individuals who wish to strengthen their self-compassion.
