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Facilitators and Barriers to Human Milk: The Maternal Perspective


Objectives (Educational Content) :

1. Describe barriers to breastfeeding parents meeting their feeding goals.

2. Identify how health care providers support of breastfeeding can facilitate breastfeeding success.

3. Recognize the importance of physician education to removing barriers to human milk feeding.

4. Communicate the value of engaged fathers and fatherhood.

5. Describe and identify the unique services palliative care can provide to mothers who have a baby diagnosed in utero with a complex or life-threatening condition.

6. Identify the correlation between breastfeeding and infant mortality.

7. Explain maternal metabolic health predictors and breastfeeding.

8. Describe signs, symptoms and risk factors for perinatal trauma.

9. Explain and define what dysphoric milk ejection reflex (D-MER) is and what it is not.

Target Audience:

The target audience for this lecture will be obstetricians, pediatricians, family practice physicians, neonatologists, perinatologists, advanced practice nurses, nurses, lactation consultants, dietitians, WIC peer helpers, social workers and varying other specialties dealing with mothers and babies.

Identified Gap:

Many providers and staff are not aware of how medical disease can impact the provision of maternal breast milk to the neonate. Improving the knowledge gap with our physician providers and APP can assist with improving better communication with our mothers as they strive to provide breast milk for their babies. Fathers also impact mother or their significant others to support them in the NICU setting and supporting maternal milk production. We are seeing an increase in the medically complicated neonate. Our palliative care team assist our families as they navigate through appointments, complicated diagnosis, lack of family support with their children.

Estimated Time to Complete the Educational Activity:

1 hour(s)

Expiration Date for CE/CME Credit:


Method of Participation in the Learning Process:

The learner will view the presentation, successfully complete a post-test and complete an activity evaluation.

Evaluation Methods:

All learners must successfully complete a post-test, as well as an activity evaluation, to claim CE/CME credit.


Statement Planners, faculty, or others who may control educational content are requested to disclose all financial relationships that they have had in the past 24 months with ineligible companies. An ineligible company is any entity whose primary business is producing, marketing, selling, re-selling, or distributing health care products used by or on patients.

Accreditation Statement: As required by the Accreditation Council for Continuing Medical Education (ACCME), each speaker is required to complete a Speaker Disclosure Form which outlines any relationship the speaker has with any commercial company whose products the speaker(s) will be discussing. The prospective audience must be made aware of the affiliation/financial interest by an acknowledgment in the program or syllabus or in the faculty listing.

The intent of this policy is not to prevent a speaker from making a presentation. It is intended only that any potential conflict of interest should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts.

The speaker has returned the disclosure form, indicating that the following relevant financial or other relationship with the following commercial interest.


1. Peer reviewed resources:
Meek, J.Y., Noble, L., & Section on Breastfeeding (2022).  Policy statement: Breastfeeding and the use of human milk.  Pediatrics
150(1), 1-9.  doi:

2. Meek, J.Y.& The Academy of Breastfeeding Medicine. (2019). Educational objectives and skills for the physician with respect to breastfeeding, revised 2018.  Breastfeeding Medicine, 14(1), 5-13. doi: 10.1089/bfm.2018.29113.jym

3. Abass-Dick, J., Brown, H.K., Jackson, K.T., Rempel, L., & Denis, C.L. (2019).  Perinatal breastfeeding interventions including fathers/partners: A systematic review of the literature.  Midwifery, 75, 41-51.  doi:

4. United States Department of Labor.  FLSA Protection to Pump Act. (2022).  Retrieved from: FLSA Protections to Pump at Work | U.S. Department of Labor (

5. Nomsen-Rivers, L.A., Wagner, E.A., Roznowhski, D.M., Riddle, S.W., Ward, L.P., & Thompson, A. (2022).  Breastfeeding Medicine, 17(7), 566-576.  doi: 10.1089/bfm.2021.0292

6. Bengtson, L.& Aubushon-Endsley, N.L. (2023).  Prenatal depression moderates the relationship between maternal trauma exposure and cortisol production and breastfeeding behavior. Women and Health, 63(5), 334-335.  doi:

7. Carter, B.S. (2018).  Pediatric Palliative Care infants and neonates, Children, 5(21), 1-9.  doi:

8. Uvnas-Moberg, K. & Kendall-Tackett, K. (2018).  The mystery of d-mer. Clinical Lactation, 9(1), 23-29.  doi: 10.1891/2158-0782.9.1.23


  • Ann Will MD, FABM, IBCLC
  • Nancy Carst LISW-S, CT, APHSW-C
  • Cesley Hegyi, MPH
  • Alia Macrina Heise, IBCLC
  • Laura Hlavaty, PhD
  • Jarold (Tom) Johnston , DNP, RN, CNM, IBCLC
  • Denise Powers Fabian, LISW-S
  • Jodi Regan, MD, FACOG

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