By Paula P. Meier, PhD, RN and Leslie A. Parker, APRN PhD FAAN FAANP
The first 2-4 weeks postpartum are characterized by high rates of suboptimal lactation outcomes in mothers of both healthy and at-risk infants hospitalized in the neonatal intensive care unit (NICU). A primary maternal concern driving these outcomes is perceived or real insufficient mothers’ own milk (MOM) volume, often leading to unplanned cessation of exclusive or any MOM provision via breastfeeding or pumping. Few research-based interventions have targeted this short, but biologically complex time frame, with most recommendations calling for “additional support” by professionals, peers and family members. However, “additional support” has not translated into specific strategies to prevent, identify, mitigate and evaluate concerns about insufficient MOM volume during the early lactation phases of secretory activation (SA) and the upregulation of autocrine and paracrine mechanisms. Both of these time-dependent processes are essential for continued MOM synthesis and secretion.
Our own research over the last decade has focused on understanding the biology of early lactation in breast pump-dependent mothers of preterm infants hospitalized in the NICU.1 This focus was largely informed by Hoban’s classic 2018 study revealing that achievement of coming to volume (CTV; daily MOM volume ≥ 500 mLs by postpartum day 14) was the primary predictor (odds ratio = 9.70) of receipt of MOM at NICU discharge in very low birthweight infants (<1500 g).2 These findings strongly suggested a critical window during the first 14 days postpartum that was key to long-term lactation outcomes. Thus, our research focused on developing and testing objective measures of breast pumping behaviors (daily sessions, daily minutes, inter-pump intervals) and pumped MOM volume, as alternatives to error-prone maternal self-report via pumping logs. We also leveraged innovative point-of-care (POC) technology to objectively measure achievement of secretory activation (SA) and the maintenance of paracellular pathway closure in the mammary gland following achievement of SA through to CTV.
In June 2024, we hosted an invited workgroup of our trainees and colleagues, which was made possible by the receipt of an unrestricted educational grant to the University of Florida from Medela. This 14-person group included researchers from public health, nursing, neonatal medicine, economics, and nutrition science with expertise in both healthy and at-risk populations. We shared data and methodologies, conceptualized objective nomenclature and established a collective vision for “next step” dissemination of scholarly papers and applications for research funding. We partnered senior mentors (Drs. Meier, Parker, Hoban and Johnson) with trainees and junior scholars for papers and research collaborations. Soon, we realized that a special issue on this topic—rather than individual studies published in miscellaneous journals—would have the biggest impact on practice and research. We reached out to Dr. Arthur Eidelman, who invited us to prepare this special issue, and we are grateful for his guidance and wisdom.
The 8 papers in this issue include a novel framework for the study and practice of early, unplanned lactation cessation that incorporates biological, behavioral and economic factors. An integrative review summarizes evidence for the use of POC technologies that hold promise for addressing perceived and real insufficient MOM volume in term dyads. The 5 original research papers enrolled both healthy and NICU dyads and used one or more of the POC technologies described in the integrative review. The multiple findings and strategies outlined in the papers were consolidated into a commentary by Dr. Anne Eglash, with clinical implications for breastfeeding medicine practitioners. Our issue is Open Access, meaning that all of the papers are available for download without cost. We are very proud of our work and our team, and hope that you find this content helpful in your practice and research endeavors.
👉 Explore the full issue here: Read the July 2025 Special Issue of Breastfeeding Medicine
Disclaimer
The journal information provided is for educational purposes only and does not imply any affiliation with or endorsement by the Academy of Breastfeeding Medicine or the journal Breastfeeding Medicine.
