382 - It’s Hard but Worth It: Facilitators and Barriers to Providing Mother’s Own Milk in the NICU

Publication Number: 3369.382

Igbagbosanmi O. Oredein, Stanford University School of Medicine, Menlo Park, CA, United States; Audrey J. Buckland, Stanford University School of Medicine, Palo Alto, CA, United States; Sonia Bonifacio, Stanford University School of Medicine, Palo Alto, CA, United States; Melissa Scala, Stanford University School of Medicine, San Francisco, CA, United States

Background: Mother's own milk (MOM) remains the optimal nutrition for preterm infants, yet disparities persist in its provision and sustainability, particularly among families facing socioeconomic barriers. While quantitative studies identify structural predictors, few have explored the lived experiences of mothers of preterm infants in the neonatal intensive care unit (NICU). Building on prior institutional work identifying disparities in human milk nutrition patterns, this project examined parental perceptions, supports, and challenges influencing MOM provision during prolonged NICU hospitalization.

Objective: To understand barriers and facilitators to MOM provision among families of preterm infants.

Design/Methods: As part of a quality improvement initiative at a Level IV NICU, we administered an open-ended survey in English and Spanish with mothers of preterm infants born ≤32 weeks gestational age (GA) from August 5 to October 16, 2025. Mothers who were severely ill post-delivery were excluded. Surveys included questions about attitudes towards MOM provision, feeding practices, facilitators and barriers to MOM provision. Thematic analysis was completed by dual independent coders with consensus review to identify emergent themes.

Results: Three major facilitators of MOM provision emerged: (1) positive maternal attitudes toward their milk's nutritional and immunologic benefits (n=24); (2) lactation consultant and team-based support fostering confidence and emotional reassurance (n=19); and (3) access to pumps and supplies in the NICU enabling sustained pumping (n=16). Conversely, key barriers included maternal stress (n=17) spanning emotional strain, physical fatigue, and logistical burdens from recovery and hospital visitation. As one mother noted, "The stress of fearing for my baby's life and worrying about her care often kept me from leaving her bedside, even to pump or eat." Pumping challenges (n=17) encompassed pain, fatigue, difficulty maintaining frequent pumping schedules and equipment-related frustrations, while low or fluctuating milk supply (n=13) led to discouragement and self-blame with several mothers describing eventual cessation despite persistent effort.

Conclusion(s): Despite strong motivation and recognition of MOM's value, mothers face overlapping emotional, physical, and structural barriers that limit sustained provision. Understanding these challenges in the lactation trajectory highlights opportunities for earlier, sustained, and emotionally responsive lactation support interventions to improve equitable human milk outcomes in the NICU.

Table 1
Participant Demographics

Figure 1
Maternal Perceptions of Barriers to Mother's Own Milk Provision in the NICU