A Simple Change in Process Results in Significant Improvement in the Rate of First Feeding at Breast

To increase the number of neonatal intensive care unit (NICU) newborns discharged on maternal breast milk (MBM). Pumping to establish and maintain a milk supply requires tremendous dedication. Many NICU mothers pump for weeks or even months before their infants are physically and developmentally ready to attempt oral feedings. In 2009 to 2011 at Winnie Palmer Hospital for Women & Babies, 85% of NICU mothers initiated breast pumping and were still supplying MBM for their infants on day 7 of life. However, by the newborns’ discharge, this rate fell to less than 40%. The NICU's Breast is Best Committee implemented a First Feeding at Breast initiative as a nursing measure to improve rates of newborns who received MBM at discharge. As a department, the NICU prioritizes the first oral feeding to be a breast feeding for all NICU infants whose mothers desire to breastfeed. NICU policy states a nipple feeding can be a bottle nipple or a breast feeding. Individual nursing care practice ultimately determines route of initial oral feeding. Mothers who were pumping were asked if they would like for their infants’ first oral feeding to be a breast feeding. If the mother agreed (and most did), then a small sign was attached to the crib indicating the mother's desire to breastfeed for her newborn's first nipple feeding. This visual cue reminded the mother of her ultimate goal and encouraged staff to support her efforts. When this initiative began, the rate of first feeding at breast was zero and the portion of newborns who received MBM at discharge was approximately 40%. Within 6 months of implementation, the rate of first feed at breast was up to 92% and within this cohort, 92% were discharged on MBM. In contrast, during this same period, the rate of MBM at discharge for newborns whose first oral feeding was not a breast feed was 40% before the initiative and 36% after. This nurse-driven initiative essentially costs nothing other than interest and a willingness to alter individual practice routines. The collaboration between the nurse and mother regarding a first oral feeding also highlighted the mother's expanding role in the daily care of her infant. The NICU experience by its very nature robs parents of so many facets of parenting, at least for a time. The First Feeding at Breast initiative returned one big first to the mother.