Much breastfeeding emphasis and education in the United States focuses on healthy infants and their mothers rather than newborns admitted to the neonatal intensive care unit (NICU).

Given the benefits of human milk—decreasing infections and improving developmental outcomes, for example—NICU infants need it just as much, if not more, argues Diane Spatz, a perinatal nursing and nutrition professor in the School of Nursing and lactation program director at the Children’s Hospital of Philadelphia. They’re also less likely to breastfeed immediately due to separation from mom because of admission to the NICU.

With an aim toward increasing breastfeeding among newborns in the NICU, Spatz created a 10-step model especially for these families, which starts by helping them make an informed decision about breastfeeding, then guides them through the transition to doing so, if that is the mother’s goal.

“This model really gives staff, mother, and family a roadmap of how to navigate a NICU stay,” Spatz says. “Anyone can look at these 10 steps and put them into practice. It also helps the mom know where she [stands]. It’s step by step, sequential.”

Spatz says hospitals should invest the most time on the first five steps, which are:

1.) Aiding parents in making an informed decision about breastfeeding.

2.) Helping mom establish and maintain a supply. This starts with pumping using a hospital-grade pump within one hour of birth.

3.) Educating her to properly store and handle milk.

4.) Starting oral care, which entails coating the infant’s mouth with human milk to decrease infection.

5.) Facilitating skin-to-skin care between mom and baby.

“If you don’t do step one, then you can’t do step two,” Spatz explains. “If you don’t do step two, you can’t do step three.” And so on.

Once those first five steps are solidly in place, Spatz says the other steps will follow. They are:

6.) Allowing the baby to practice feeding at the breast (called non-nutritive suckling).

7.) Helping the mother transition to direct breastfeeding.

8.) Weighing the baby before and after feeding to determine how effectively the baby gets milk.  

9.) Preparing for hospital discharge.

10.) Providing follow-up instructions.

Positive results from sites already using the model have started to emerge. At one hospital in India where Spatz worked during her sabbatical, the human-milk rate—babies receiving milk, either by mom pumping or direct breastfeeding—increased from 15 to 75 percent. And through the Florida Perinatal Quality Collaborative, NICUs across that state have been trained on and are implementing Spatz’s model.

“When you just talk about the milk [itself],” Spatz says, “families really get the fact that the milk is a medical intervention.”