It can happen in an instant – a mother experiences a medical emergency during delivery that requires intensive care. 

Meanwhile, her newborn infant is sent to the neonatal intensive care unit. 

This early separation can greatly disrupt the establishment of adequate milk supply for those who want to breastfeed. 

Recent research from the University of Michigan reveals that simple awareness on the part of the care team can help protect the breastfeeding relationship for patients in the ICU.

The work was spearheaded by Kayla Kolbe, M.D., clinical assistant professor of Pulmonary and Critical Care Medicine, who notes a dearth of research around lactation in critical care, as unprecedented numbers of pregnant people were admitted to the ICU during the COVID pandemic. 

“Part of the background of this project was to look at charts and describe what actions we were taking to support lactating patients, as well as to identify potential barriers,” she said.

She and her research team reviewed medical charts for adult pregnant and postpartum patients within six months of delivery who were admitted to the ICU at U-M Health over a period of six years from January 2018 to January 2024.

They found that 85% of postpartum-initiated lactation in the ICU, aligning with the national average for initiation of lactation in the general population.

Just over 63% of patients had clearly documented pre-delivery lactation plans in their charts, with an association between having a specific plan to lactate and the initiation of lactation after delivery. 

For the 47 patients who lactated in the study who received mechanical ventilation, 17% didn't undergo milk expression while intubated.

Limited documentation and delays during mechanical ventilation seem to be barriers to lactation in the ICU.

"What I've learned through talking to nurses and going around on the units and asking and interviewing people is we don’t consistently talk about lactation on rounds. Our ICU teams are so thoughtful, and I think more awareness could really make a difference. We think supporting patients’ lactation goals can be empowering, offering them a way to connect with their separated infant. We think that when much is going wrong, this is something that can go right," said Kolbe.

“We have found that many people simply don’t know where to start. There is no defined process by which lactation is initiated in the ICU, so we have been working on ways to make this clearer.”

To that end, the team is developing an algorithm and guideline that walks people through the process of lactation, starting with communicating with the patient and documenting their wishes, then consulting lactation consultants, and practical steps that explain how to help a patient continue their lactation journey even beyond hospital discharge.

Additional authors: Virginia Sheffield, Katerina Castillo, Kriya S. Patel, Jessica A. Blank, Melissa H. Ross, Thomas S. Valley and Rommel Sagana

Paper cited: “Lactation Practices in Critically Ill Patients,” CHEST Critical Care. DOI: 10.1016/j.chstcc.2024.100123

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