Janet F. Geyer, RN, ARNP, CPNP and Ekhard E. Ziegler, MD
Peer Review Status: Internally Peer Reviewed - 2/24/12

  1. It is the responsibility of the healthcare team to promote breastfeeding as best for infant feeding based on scientific knowledge and research.  All mothers should be offered the right to breastfeed.
  2. The healthcare team recognizes that breastfeeding success or failure is a personally defined experience based on a woman’s individual perceptions.
  3. Information regarding the use of donor milk from the Mother’s Milk Bank of Iowa will be presented to families.
  4. Expressed milk is precious to the mother and the baby and should be treated as a valuable commodity. It should be discarded only for a good reason.
  5. Breastfeeding is contraindicated in a small number of rare conditions or circumstances:
    1. Infant with galactosemia.
    2. Mothers with active untreated TB.
    3. Mother who is HIV or HTLV Type I or II positive.
    4. Mothers receiving antimetabolites or chemotherapeutic agents until they clear the milk.  For additional medications refer to LIP or Lactation Specialist, to clear the milk for feeding.
    5. Mothers receiving diagnostic or therapeutic radioactive materials (for as long as milk is radioactive).
    6. Mothers that test positive for using drugs of abuse during this pregnancy.
    7. Mothers with active herpes simplex lesions on a breast (infant can feed from the other breast if no lesions are present).
  6. Milk may be expressed by hand, manual pump or electric pump. The most effective are the electric breast pumps. Electric breast pumps are located in each NICU room, available at Ronald McDonald House, in the Mother Baby Unit (MBCU) and are available for rent from drugstores and medical supply businesses across Iowa. University of Iowa’s Children’s Hospital has a lending service available. Some insurance companies will pay for the rental of an electric breast pump with a prescription for breast milk.
  7. Instructions given to the mother regarding pumping should be specific and complete, with emphasis on cleanliness. Before expression, hands should be washed with soap and water. Breast cleansing routines are unnecessary and can be damaging to nipple skin.  Mothers should be instructed to empty breasts as completely as possible to include end milk with high caloric content (high fat content).
  8. Containers for storage of expressed milk should be small in size (4 oz. or less). If milk is to be frozen it should be stored in airtight containers (polycarbonate of polypropylene)
  9. The collection container and pumping parts need to be washed in hot soapy water and rinsed in hot water between uses and allowed to air dry in the designated clean area.
  10. Breast milk requires proper identification to assure expressed milk is fed only to the infant whose mother provided the milk.  All patient supplied breast milk will need to be labeled with the following: 1) Patient’s name and hospital number – use Zebra printer labels 2) Date and time pumped – use blank labels for mom to add this information
  11. Expressed milk should be refrigerated within 1 hour. If it was never frozen, it may be kept for up to 5 days.
  12. Mothers should be encouraged to store fresh expressed milk in feeding-size portions that will be consumed in 24 hours due to smaller volumes consumed.
  13. Human milk, to which fortifiers have been added, should be used within 24 hours of fortification.
  14. Thawed milk that has not been warmed for use or fed to the infant should be stored in the refrigerator and used within 24 hours.
  15. All transported human milk should be packed tightly in a cooler with freezer gel pads.  Do not use ice during transport to the hospital.

References: N-CWS-PEDS-13.010 Breastfeeding: Promotion, Support and Protection SOP

  1. Alade, R. L. (1992). Sucking technique and its effects on success of breastfeeding. Birth. 19(4), 185-189.
  2. American Academy of Breastfeeding Medicine. #7 Model Breastfeeding Policy.
  3. American Academy of Pediatrics. Policy Statement, Breastfeeding and the Use of Human Milk. Pediatrics, 115(2) (February 2005), 496-506.
  4. Dix, D. (1991). Why women decide not to breastfeed. Birth:  Issues in Perinatal Care and Education. 18(4), 222-225.
  5. Glass, P. (1994). The Vulnerable Neonate and the Intensive Care Environment. Neonatology, Pathophysiology, and Management of the Newborn (4th ed.). J. B. Lippincott.
  6. Hubbard, Deborah, Lactation Specialist, Children’s and Women’s Services, UIH.C
  7. International Lactation Consultants Association (ILCA). Clinical Guidelines for Establishment of Exclusive Breastfeeding (June, 2005).
  8. Isaccson, Laura J. (2006). Steps to Successfully Breastfeed the Premature Infant. Neonatal Network, 25(2), 77-86.
  9. Mohrbacher, N., Stock, J. (Eds.) (2003). The Breastfeeding Answer Book. LaLeche League International (3rd ed.). Schaumburg, IL, 542-545.
  10. Morris, S. E., Klein, M. D. (1987). Pre-Feeding Skills. Therapy Skill Builders (pub.).
  11. Palmer, M. M., Vandenberg, K. A. (1998). A Closer Look at Neonatal Sucking. Neonatal Network, 17 (2), 77-79.
  12. Riordan, J., Auerbach, K. (Eds.) (2005). Breastfeeding and Human Lactation (3rd ed.). Jones and Bartlett pub., Boston, MA, 449-481.
  13. Zaichkin, J. (2002). Newborn Intensive Care: What Every Parent Needs to Know. NICU Ink, Petaluma, CA.

Research references:

  1. Alade, R. L. (1990). Effect of delivery room routines on the success of first breastfeed. Lancet. 336, 1105-1107.
  2. Arafat, I., Allen, D., Fox, J. (1981). Maternal practice and attitudes towards breastfeeding. JOGNN. 10, 91-95.
  3. Baranowski, T., Bee D. E., Rassin, D. L., et al. (1983). Social support, social influence, ethnicity and the breastfeeding decision. Social Science Medicine. 17, 1599-1611.
  4. Meier, P. & Mangurten, H. (1993). Breastfeeding the preterm infant. In:  Riordan, J. & Auerbach, K.G. (Eds). Breastfeeding and Human Lactation. Boston:  Jones & Bartlett Publishers, Inc.
  5. Ludington-Hoe, S. & others (1994). Kangaroo Care:  Research results and practice implications and guidelines. Neonatal Network, 13, 19-27.
  6. Lawrence, R. (2005). Breastfeeding:  A Guide for the Medical Profession, (6th ed.). St. Louis: Mosby.
  7. Shrago, L. & Bocar, D. (1990). The Infant’s Contribution to Breastfeeding. JOGNN, 19(3), 209-215.
  8. Stine, M. (1990). Breastfeeding the Premature Newborn:  A Protocol Without Bottles. Journal of Human Lactation, 6(4), 167-170.
  9. Byzak, Susan (1990). Factors Associated with the Transition to Oral Feeding in Infants Fed by Nasogastric Tubes. The American Journal of Occupational Therapy, 44 (12), 1070-1078.
  10. Human Milk Bank Association of North America (2005). Best Practice for Expressing, Storage, and Handling Human Milk in Hospitals, Homes, and Child Care Settings.