Improving Mothers’ Own Milk Provision at NICU Discharge: Optimizing Achievement of Secretory Activation and Coming to Volume as Key Strategies

2 modules


Course Length
60 mins

Medela Global Education



Embedded in this approach is evidence that the mammary gland undergoes essential programming during the first two weeks postpartum, which can be measured with biomarkers, and is essential to long-term mothers’ own milk (MOM) provision. Clinical strategies that target the early postpartum period will be highlighted, including species-specific mammary gland stimulation, monitoring of MOM biomarkers of secretory activation and assessment of coming to volume. Additionally, the distinction between impaired secretory differentiation and delayed/impaired secretory activation in this population will be discussed, with application to NICU mothers who have multiple inflammation-based morbidities that increase the risk for lactation problems.



Paula Meier PhD, RN

Paula Meier, PhD, RN, is a Professor of Paediatrics and Nursing at Rush University Medical Center in Chicago. Dr. Meier has worked as a practitioner, researcher, and educator in the area of human milk, lactation and breastfeeding for premature infants and their mothers since 1975.

Dr. Meier's lifetime research focus has been on the improvement of initiation and maintenance of lactation in breast pump-dependent mothers of NICU infants, and in the development and testing of clinical techniques to optimize the impact of human milk on health and cost outcomes in NICU infants. Most recently, she is the recipient of the 2022 Macy-Gyorgy Award from ISRHML, a biennial award that recognizes outstanding lifetime research contributions to human milk, lactation and breastfeeding.


Upon completion of this program, the participant will be able to:

  • Cite evidence about differences in outcomes for MOM-fed versus pasteurized donor human milk (PDHM)-fed premature infants, underscoring the importance of prioritization of MOM availability.
  • Define terminology, including: achievement of secretory activation; achievement of coming to volume; biomarkers (MOM biomarkers and pumped MOM volume), secretory differentiation, and maternal inflammation-based morbidities.
  • Compare the effectiveness and efficiency of MOM removal via electric breast pump versus hand-expression only techniques during this critical window.
  • Delineate best clinical practices to optimize achievement of secretory activation and coming to volume, including the use of point-of-care MOM biomarkers of secretory activation (sodium, lactose, citrate, total protein and sodium: potassium ratio).


By completing/passing this course, you will attain the certificate Certificate CPD Improving Mothers’ Own Milk Provision at NICU Discharge

Learning Credits

Improving mothers’ own milk provision at NICU discharge
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CPD Course Evaluation
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Added 12 days ago, by Carol
I love the way Dr. Paula Mier explains things in such an understandable way! Great course!
Added 12 days ago, by Judith
Added 22 days ago, by Daniela
Added about 2 months ago, by Anonymous
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Added 2 months ago, by Mijin
Thank you
Added 3 months ago, by Anonymous
Good information for those working with NICU babies
Added 3 months ago, by Anonymous
Added 4 months ago, by Kim
Excellent!!! I always learn something new from Dr Meier even after 23 years of being an LC.
Added 4 months ago, by Amy
Excellent education.

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