Breastfeeding the High Risk Infant: Implications for Midwifery Management


  • Kimberly A. Black CNM, MS,

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    • Kimberly Black received a bachelor's degree in nursing from George Mason University and a master of science degree from the nurse-midwifery education program at Georgetown University. She is currently working as a nurse practitioner in the area of Womens' Health and is a clinical instructor in the Georgetown University School of Nursing. She has experience as a Certified Childbirth Educator and as an RN in a Level II neonatal nursery.

  • Mary Ann Hylander CNM, DrPH

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    • Mary Ann Hylander received a master of science degree in nurse-midwifery from Columbia University and a doctorate in Public Health from the Johns Hopkins School of Hygiene and Public Health. She has practiced maternal/newborn nursing with the Indian Health Service in Gallup, New Mexico and Tuba City, Arizona and midwifery in a migrant health program in Belle Glade, Florida with the National Health Service Corps. Currently, she is a Research Fellow at the Infant and Child Health Studies Branch, National Center for Health Statistics. As the mother of a 12-year-old daughter who was born at 26 weeks and breastfed, she has personally experienced the challenges of breastfeeding a high risk infant.

Infant and Child Health Studies Branch, National Center for Health Statistics, 6525 Belcrest Rd. Rm. 790, Hyattsville, MD 20782.


The mother of a high risk infant is confronted with numerous parenting challenges, not the least of which is the decision about how to nourish her vulnerable newborn. Successful breastfeeding depends on overcoming obstacles posed by infant condition, maternal health, and the neonatal intensive care environment. These obstacles include maternal separation from the nursing infant during hospitalization, delayed initiation of the expression of breast milk due to maternal illness and/or surgery, the inability to suckle her infant or feed on demand, and the lack of sufficient maternal follow-up after discharge. This article reviews the benefits of providing breast milk to high risk infants, problems that may be encountered by mothers of high risk infants, and the interventions that may be used by the midwife to facilitate the breastfeeding process.