Sep 21 2015

Evaluating the Breastfeeding Peer Counselor Practice

In 2005, the level III neonatal intensive care unit (NICU) at Rush University Medical Center (RUMC) began employing breastfeeding peer counselors (BPCs) as direct lactation care providers for new NICU families. The BPCs were parents of infants previously cared for in the RUMC, who had completed a 5-day BPC training program and a 3-month intensive NICU orientation course.  Three separate, but related prospective studies conducted by Dr. Beverly Rossman and colleagues have evaluated the NICU mothers' and health care providers' perceptions of the BPC practice. Mothers of very low birthweight (VLBW; <1500 grams) infants also provide perspectives on the meaning of providing milk and the value of peer support.

Peer Counselor and MomOverall, the mothers perceived the BPCs to be competent, knowledgeable and especially resourceful in helping them find solutions to their specific lactation questions and problems.  Similarly, the healthcare providers felt that the BPCs were well-integrated into the fabric of the NICU and practiced within a complementary role that allowed them to work as an indispensable member of the NICU team. More specifically, mothers of VLBW infants who had received lactation care from the BPC team indicated that the shared experience of having an infant in the NICU (rather than any demographic similarities) was at the heart of the BPC-new mother relationship. Being able to “share with someone who actually dealt with it” was important for mothers, as it helped them to feel less alone and alleviated some of their anxiety about having a VLBW infant in the NICU. Mothers also reported that

… the information they received about the benefits of their milk for their infants as well as the compassionate and caring manner of the BPCs served as a powerful motivator to initiate lactation, even if the mother had not planned to do so.

 Mothers related their dedication to providing milk to the BPC's ability to provide specialized information and support, which helped them confront challenges whenever a problem arose. They also felt that the BPCs made a significant difference in their NICU experience by validating and normalizing their experiences.

In a separate study,

… mothers of VLBW infants rated providing milk as the most important thing they could do for their infant while still hospitalized in the NICU.

BPC weighing baby

Mothers had faith in the healing properties of their milk and equated providing milk with “giving life” to their infants, mitigating the effects of complications, and keeping their infants healthy and stable. Witnessing and understanding the specific impact of their milk on their infant’s health strengthened this faith and increased their motivation to continue providing milk.


Mothers also rated peer support by the BPCs as the most facilitative and supportive aspect of developing the maternal role in the NICU.

Mothers welcomed the thoughtful care they received from the BPCs because they often found it difficult to relate to family members and friends who didn’t understand the stress they were experiencing. Peer support and role modeling by the BPCs helped mothers cope with their infant’s hospitalization, starting with giving them hope, to engaging mothers in coming to know and learning to care for their infants as part of the process of developing maternal identity.  

BPC with Mom & twinsHealthcare providers (neonatologists, nurses, dieticians, and nurse-IBCLCs) who worked with the BPCs in the NICU emphasized the team approach to lactation care through collaboration and consultation with the BPCs. Most of the healthcare providers remarked that they did not have either the expertise or the time to provide comprehensive, evidence-based lactation education, counseling, and support to breast pump-dependent or breastfeeding NICU mothers and respected the BPCs' knowledge and expertise.

The healthcare providers reported that having BPCs in the NICU made their jobs easier, the BPCs were part of the culture of the NICU, and they would not want to practice in a NICU that prioritized human milk feedings without BPCs.

In summary, these three studies suggest that the BPC-NICU model of lactation care, as described and evaluated in this research, is highly effective in meeting the lactation needs of new NICU mothers and the lactation support needs of NICU healthcare providers. Furthermore, the data indicate that the NICU-based BPC can serve as a unique support and role model for new NICU mothers in helping them establish a healthy mother-infant relationship and promoting the development of their maternal role. 

To read more: 

Meier PP, Engstrom JL, Rossman B. (2013). Breastfeeding peer counselors as direct lactation care providers in the neonatal intensive care unit. Journal of Human Lactation 29: 313-322.  PMID: 23563112.

Rossman B, Engstrom JL, & Meier PP. (2012). Healthcare providers' perceptions of breastfeeding peer counselors in the neonatal intensive care unit. Research in Nursing and Health 35: 460-474. PMCID: 3442151.

Rossman B, Engstrom JL, Meier PP, Vonderheid S, Norr KF, Hill PD. (2011). “They’ve walked in my shoes”: Mothers of very low birthweight infants and their experiences with breastfeeding peer counselors in the neonatal intensive care unit. Journal of Human Lactation 27: 14-24. PMID: 2117342.

Rossman B, Greene MM, Meier PP. (2015). The role of peer support in the development of maternal identity for "NICU moms". JOGNN.  DOI: 10.1111/1552-6909.12527.

Rossman B, Kratovil AL, Greene MM., Engstrom J L., & Meier PP. (2013). “I have faith in my milk”: The meaning of milk for mothers of very low birth weight infants hospitalized in the neonatal intensive care unit. Journal of Human Lactation 29: 359-365.  PMID: 23599267.

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