Impact Of Structured Antenatal Counselling On Early Maternal Milk Expression And Breastfeeding In Neonates <37 Weeks’ Gestation: A Quality-Improvement Initiative

Abstract

Background Timely initiation of maternal milk expression and breastfeeding is life-saving for preterm neonates, yet global adherence remains sub-optimal, especially in low- and middle-income settings. Antenatal counselling is a potentially low-cost strategy to prime mothers for early lactation behaviours.

Methods  We conducted a prospective quality-improvement (QI) study in a tertiary NICU (October 2024–January 2025). Mothers delivering neonates <37 weeks were stratified into group A (<34 weeks) and group B (34–36 ⁶⁄₇ weeks). Baseline practices were recorded over four weeks, followed by three Plan–Do–Study–Act (PDSA) cycles: (1) structured antenatal counselling checklist, (2) post-natal bedside lactation support, (3) reinforcement via nursing reminders/visual aids. Primary outcomes were (i) initiation of milk expression ≤6 h and (ii) use of mother’s own milk (MOM) as first feed. Secondary outcome was direct breastfeeding ≤1 h in stable late-preterm infants. Run charts and χ² tests assessed change over time.

Results One-hundred-twenty mother–infant dyads (group A = 62; group B = 58) were enrolled. Post-intervention, early milk expression improved from 28 % to 73 % in group A and from 45 % to 85 % in group B (p < 0.001). Provision of MOM as first feed rose from 35 % to 82 % (p < 0.001). Among stable late preterms, direct breastfeeding ≤1 h increased from 38 % to 78 % (p < 0.001). Special-cause variation was demonstrated after PDSA 2, with sustained gains through week 16.

Conclusion A structured, multidisciplinary counselling programme markedly enhanced early lactation practices in preterm dyads. The model is feasible, low-cost and scalable for similar resource-limited settings.