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.
