prematurity - mom and baby in NICU

Source: United States Breastfeeding Committee

By Naomi Bromberg Bar-Yam, PhD

Massachusetts Breastfeeding Coalition’s three pillars—advocate, educate, collaborate—apply to our work everywhere, every day. As Prematurity Awareness Month draws to a close, it is worthwhile to think about how to apply our mission to this unique segment of our community.

Preterm birth is any baby born at less than 37 weeks gestation (of what should be a 39-40 week pregnancy). Of those, about 85% are late preterm (32-<37 weeks), 10% are very preterm (28-32 weeks) and 5% are extremely preterm (<28 weeks). Mortality and long-term morbidity increase as babies are born earlier.

Globally about 10% of babies are born preterm. Here is a summary of the March of Dimes 2022 Report Card, including the following highlights and concerns:

  • The US preterm birth rate, which has risen slowly and steadily since 2014, increased by a whopping 4% in 2021, to 10.5% of births.
  • Some of the increase is due to the ongoing COVID 19 pandemic. COVID itself increases risks for mothers and babies and affects hospital staffing and resources. Fears of transmission impact care throughout the country.
  • Disparities persist in preterm birth and in maternal and infant mortality.
  • The preterm birth rate in Massachusetts is 9%–below the national average, but there is room for improvement.

Why does prematurity matter?

Fetal development is a wondrous and delicate process, meant to last nine months. Premature birth affects all of a baby’s vital systems: respiratory (lungs at 34 weeks are half the size as at term); cardiovascular; gastrointestinal; immunologic; brain and central nervous system; hearing; vision.

When babies are born early, their life support—placenta and umbilical cord—are cut and they must breathe, eat, keep warm on their own. Their vital systems are not yet ready to take on these functions. For preterm babies, growth and development out of utero take precious energy, calories, brain activity. It is a testament to the premature human body and spirit, the caring and devotion of parents, and the knowledge and dedication of NICU providers and medical researchers that preterm babies, some little more than half gestated, survive and thrive every day.

Breastfeeding challenges in preterm birth

The nutrients, immune, and growth factors in human milk are crucial for premature babies. Mother’s own milk is best suited for her baby, and donor milk is the second option. However, breastfeeding a preterm hospitalized baby presents unique challenges:

  • For very preterm babies, mothers’ bodies are often not yet primed to produce milk.
  • Very preterm babies cannot feed directly at the breast; mothers must pump exclusively.
  • Despite best efforts, the NICU is stressful, which we know can compromise milk supply.
  • Long hospital stays require mother-baby separation, which also affects milk supply.
  • Mothers need, and do not always have, high-quality breast pumps both in hospital and at home to maintain milk supply.
  • Very preterm and sick babies may be transferred to regional level 4 NICUs, far from home, making visits and even transporting milk very difficult.

Massachusetts Breastfeeding Coalition members devote their lives and careers to maternal and child advocacy, education, and collaboration in their hospitals, practices, and communities. What can the Coalition as a group do?


Massachusetts Breastfeeding Coalition’s respected presence across the Commonwealth offers opportunities to support and promote ongoing legislative and policy efforts, and to start new ones. These include:

  • training and coverage for doula care in hospital, at home, after loss;
  • universal access to quality breast pumps at home when medically necessary;
  • paid parental leave to include time considerations for preterm birth;
  • safe, private, clean spaces to pump in the workplace, including bereaved parents pumping for donation;
  • easy access to linguistically and culturally appropriate skilled lactation support as needed; and
  • access to donor milk when baby is most vulnerable and mother’s supply is insufficient.


There is need for community and medical education about the impacts of prematurity and the role of human milk in improving outcomes.

Prematurity does not end when the baby is discharged from the NICU. Medical and lay webinars and programs should provide education about long-term (sometimes lifelong) effects of prematurity and the crucial role of breastfeeding and human milk in long-term outcomes.


Care for preterm and all babies crosses disciplines and organizations. Numerous organizations and coalitions across the Commonwealth are addressing maternal child issues including doula care, maternal mental health, disparities, direct care, nutrition, and more. To succeed, we must all have seats at one another’s tables.

Together we are powerful and can change the landscape of care in Massachusetts and beyond.

Naomi Bromberg Bar-Yam, PhD, has been working in maternal and child health for 35 years as an educator, researcher, advocate, and writer.  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 US. Learn more about her on her LactSpeak profile.  


Blog editor: Ann Marie Lindquist

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