Children's Hospital of Philadelphia
Parents of infants in the neonatal intensive care unit (NICU) face unique barriers to long-term breastfeeding and lactation. The physical and emotional demands of having a critically ill or premature newborn combined with the stress, sleep deprivation, and separation inherent to the NICU environment make it difficult for many mothers to sustain breastfeeding and lactation, even when they want to. At the same time, NICU mothers are at elevated risk for post-traumatic stress disorder (PTSD) and poor health-related quality of life, which can further undermine lactation success and overall maternal wellbeing. PeliCaN Multi-Site Breastfeeding tests whether a trained postpartum doula, working directly in the NICU can improve breastfeeding and lactation outcomes and support maternal mental health through 6 months postpartum. Participants are enrolled during their infant's NICU hospitalization to receive either doula support or standard care, depending on the study site condition at the time of enrollment (control vs. intervention). Mothers in the intervention group will receive lactation education and support, and emotional and informational support from a NICU-informed doula for up to 6 months. Mothers in the usual care group receive standard NICU clinical care, including access to NICU lactation consultants, without study doula support. All participants complete surveys at enrollment and at 6 months postpartum covering infant feeding practices, maternal mental health, and demographic characteristics. The study asks two primary questions: (1) Does NICU-informed postpartum doula support improve breastfeeding and lactation rates at 6 months? (2) Does doula support improve health-related quality of life and reduce post-traumatic stress disorder symptoms at 6 months? A subset of intervention participants, NICU staff, and lactation consultants will also participate in qualitative interviews and brief implementation surveys to assess how well the doula program works in practice across participating sites.
Background and Significance: Breastfeeding and the provision of breastmilk have well-documented health benefits for both infants and mothers, yet rates of long-term breastfeeding continuation remain disproportionately low among families whose newborns require NICU hospitalization. Premature and critically ill infants depend heavily on human milk for immune protection and neurodevelopmental support, yet the NICU environment itself creates formidable barriers to lactation: physical separation from the infant, disrupted skin-to-skin contact, the psychological burden of traumatic birth, clinical…
Inclusion Criteria: * Delivery \<34 weeks of gestation and intention to breastfeed or provide their own breastmilk to their infant * Postpartum parents less than or equal to 2 weeks postpartum * ≥ 18 years of age * English or Spanish as the preferred language * No restrictions to visiting their infant(s) in the NICU due to a significant social service issue (e.g. incarceration) * Not planning adoption * The clinical team anticipates that their infant, or at least one of their infants if multiples, will remain in the NICU for a minimum of two additional weeks (to avoid anticipated infant palli…
Intervention participants will receive support from a trained NICU-informed postpartum doula for up to 6 months across four domains: 1. Lactation Consultant Coordination: Doulas will review and reinforce NICU lactation consultant recommendations and facilitate continuity of lactation support through discharge. 2. Pumping Assistance: Doulas will provide hands-on guidance on pump settings, flange fitting, and hand expression; support adherence to pumping schedules; assist with milk tracking, storage, and transport; and provide each participant with a fitted pumping bra. 3. Emotional Support: Doulas will provide reassurance and emotional support throughout the NICU stay, promote bonding practices including skin-to-skin contact, and facilitate mental health referrals when needed. 4. Nutritional Support: Doulas will provide lactation nutrition education and connect participants with community resources including food banks and WIC.