"It's Hard but Worth It": Facilitators and Barriers to Providing Mother's Own Milk in the NI CU.

Abstract

Background: Mother's own milk (MOM) remains the optimal nutrition for preterm infants, yet disparities persist in its provision. Building on institutional findings identifying human milk feeding disparities among preterm infants in the neonatal intensive care unit (NICU), we identified facilitators and barriers to MOM provision during NICU hospitalization.

Methods: As part of a quality improvement initiative at a California Level IV NICU, an open-ended survey was administered (August-October 2025) in English or Spanish to mothers of preterm infants born at ≤32 weeks' gestational age. Questions included attitudes toward MOM, feeding practices, facilitators, and barriers to MOM provision. Emergent themes were identified through thematic analysis. This project received a Not Human Subjects Research determination.

Results: Thirty surveys were completed (80% English, 20% Spanish). Mean maternal age was 33 years, 73% had private insurance, and 43% were Hispanic or Latina. Facilitators of MOM provision included the following: positive attitudes toward its nutritional and immunologic benefits (n = 24); lactation consultant and team-based support fostering confidence and emotional reassurance (n = 19); and access to pumps and supplies in the NICU (n = 16). Key barriers included the following: maternal stress spanning emotional, physical, and logistical burdens from recovery and visitation (n = 17); pumping challenges encompassing pain, fatigue, and equipment-related frustrations (n = 17); and low milk supply leading to discouragement and cessation (n = 13).

Conclusions: Despite strong motivation, emotional, physical, and structural barriers limited sustained MOM provision. These findings identify actionable opportunities to strengthen NICU lactation support through earlier and more accessible services, reduced logistical barriers, and individualized psychosocial support.