Parent-Centered, Trauma-Informed NICU Lactation Care
Breastfeeding Literacy Project Module 7.7
Parents in crisis often don’t know what questions to ask—or that there’s a clock ticking in relation to their milk production.
We assume parents will speak up if they need help. But NICU parents can feel very overwhelmed. They don’t know the right questions because they are just learning about everything that is happening with their baby. They don’t know that when it comes to milk production, the first few days actually matter more than the first few weeks.
Our job is to bring the information to them clearly, kindly, and repeatedly, rather than waiting for them to ask.
When we do this, we are also heading off the confusion that can arise when parents turn to the internet and AI for answers to their lactation questions. We can also help them to remember that they shouldn’t compare themselves or their babies to any other babies around them because a preterm baby has different needs.
Normalize That “Ideal” May Not Be Possible
Normalize that “ideal” milk expression may not be possible. Adapt and adjust the plan as needed.
Some parents will not be able to “pump eight times a day in the first 24 hours”. They may be in the ICU themselves. They may be recovering from an unexpected surgical birth. They may be dissociating from birth trauma or the shock of giving birth early.
If we treat the “ideal” pumping schedule as a mandate, we add to their suffering. Instead, we say: “Here’s the goal. Here’s why it matters. And here’s how we’re going to adapt it for what your body needs right now.”
Flexibility is not failure. We don’t focus on what didn’t happen in the hours and days before - we only move forward from the present.
Strengths-Based Language
“Our job is to adjust the plan so your body and your baby get what they need.”
“You’re not pumping enough” may feel like blame. “Let’s look at what’s getting in the way and adjust” is partnership.
The words we use shape how parents experience their care.
“You’re not pumping enough” lands very differently than “Let’s look at what’s getting in the way and think about what we could adjust.”
We want parents to feel like we’re on their team—that our job is to solve problems with them, not to evaluate their performance. This is especially important for parents whose milk production is lower despite doing everything “right.” They need to hear clearly that this is not a willpower test.
When Skin to Skin Is Delayed
When holding or skin to skin is delayed, use SENSE-style alternatives:
- Voice recordings for playback at bedside
- Photos of parents near the isolette
- Scent cloths left with baby
Connection matters even when skin-to-skin isn’t possible yet.
Sometimes, for a variety of reasons, skin to skin does not happen right away. But connection still matters for the shared microbiome of baby and mother, for baby’s development and for the mother’s sense of caring for her own baby.
The SENSE program gives us a framework: parents can record their voice for playback, bring photos, leave a cloth with their scent. These aren’t substitutes for skin-to-skin, but they are still valuable. They keep the parent present even when they can’t be at the bedside. And the mom can take blankets that have been on the baby with her when she leaves so that she can smell them while pumping and take videos or pictures of her baby to look at while expressing milk away from baby’s bedside.
About The Breastfeeding Literacy Project
Breastfeeding Literacy is a free, evidence-based curriculum for anyone who supports breastfeeding families.
Built on the First 100 Hours framework, this curriculum covers the physiology of lactation, clinical assessment and intervention, ethics and industry influence, and support for special populations including late preterm infants and NICU families.
It’s designed for lactation professionals, nurses, midwives, doulas, medical students, peer counselors — and parents who want to understand how breastfeeding actually works.
Why free? Because access to accurate lactation education shouldn’t depend on what you can pay. No paywall. No sponsors. No industry influence.
About Christine Staricka
Christine Staricka is an IBCLC with 25 years of experience, an international speaker, and founder of Evolve Lactation Media. She is the author of Evolving the Modern Breastfeeding Experience: Holistic Lactation Care in the First 100 Hours.