Parents with babies in the NICU have unique lactation-related needs. On top of navigating a stressful environment, many NICU parents are forced to make impossible choices about being present during this time due to a lack of access to sufficient leave to cover both NICU stay and time at home. This can make it difficult for parents to manage their lactation needs and establish breastfeeding.
One in ten babies in the U.S. is born preterm. Expanding the Family and Medical Leave Act (FMLA) to provide a right to additional job-protected NICU leave would extend a life raft to the hundreds of thousands of families whose babies spend time in the NICU each year. It would also help NICU parents take the time they need to manage lactation-related needs and establish breastfeeding, without worrying about risking their jobs.
Below is a Q&A with Naomi Bromberg Bar-Yam, PhD, a maternal and child health advocate, educator, and researcher who herself experienced having two children in the NICU after birth. In addition to serving on the board of Massachusetts Breastfeeding Coalition, she is past president of the Human Milk Banking Association of North America (HMBANA) and is the founding director emerita of Mothers’ Milk Bank Northeast, which provides safe donor milk to hospitals and families throughout the northeastern U.S.
What’s something people often don’t realize about NICU parents and their needs?
For people who haven’t lived it, it is difficult to understand how all-consuming it can be to have a baby in the NICU. Every part of you wants to hold, feed, and care for that child at home — but instead, you spend long hours in a scary, unfamiliar medical environment, watching your baby fight to survive. That sense of helplessness, fear, and grief is constant and exhausting.
What unique challenges do NICU parents face when it comes to lactation?
Two factors make lactation especially hard in the NICU: stress and separation. First, stress matters physiologically. High stress raises adrenaline, which interferes with oxytocin, the hormone that triggers milk let-down (the process that causes breast milk to release and flow through milk ducts.) In the NICU a parent is under nearly constant stress, watching their tiny, vulnerable baby undergo treatments and procedures. That stress can blunt the let-down response and reduce milk supply, even when someone is trying hard to pump regularly.
“Breastfeeding and pumping require time, rest, extra calories, and emotional bandwidth. When parents don’t have to rush back to work, they can spend more time at the bedside, breastfeed when possible, establish consistent pumping schedules, and attend follow-up medical appointments.”
Second, physical separation makes a big difference. A baby’s presence at the breast or nearby is a powerful trigger for milk production. Many NICU infants are separated from their parents for medical reasons, or parents must leave to care for other children or to resume work. Over time, pumping alone can simply be less effective and less comforting than nursing at the breast, and the logistics of long separations can undermine supply.
How can our systems better support NICU parents and their lactation-related needs?
Hospitals work hard to make NICUs more parent-friendly, but access to leave and practical supports that reduce separation and stress are also critical to protect lactation. Breastfeeding and pumping require time, rest, extra calories, and emotional bandwidth. When parents don’t have to rush back to work, they can spend more time at the bedside, breastfeed when possible, establish consistent pumping schedules, and attend follow-up medical appointments. That reduces stress, improves milk supply, supports maternal recovery, and helps families establish feeding routines that benefit both infant health and long-term parent–child bonding.
NICU parents are often juggling taking care of other children, jobs, and household responsibilities while trying to be at the hospital. Practical help from friends and neighbors, meals, grocery runs, childcare, can make a huge difference. But employers and policymakers can also help by providing extra leave for families with babies in the NICU. This enables parents to be present for their infants without losing pay or risking their jobs. That investment pays off in loyalty, reduced turnover, and better outcomes for families. Expanded NICU leave under the FMLA would allow parents to focus their energy where it’s needed most, on their baby and on recovering from birth.