In response to Margery Wilson's post regarding NICU timed feeds etc. In our NICU, in a suburb of NYC, most of our preemies who are on oral feeds ,breastfeeding, are fed at least every 3 h. Many of them if not fully established get supplemented after a BF. We are currently working on inservicing all staff this month to get comfort levels up regarding the alternate feeding methods so as to hopefully avoid bottlefeeds for complements/supplements in many situations. If a baby is stable and getting closer to discharge the mom is encouraged to board overnight and room in as much as possible to facilitate more breastfeeding on a more cued basis. This does happen frequently esp. with our more motivated moms but many times I am the one encouraging the mom to stay. We have one semi-private room with 2 bedbath , rockers, and pump access where moms can stay. We are looking to increase the space as construction for our new unit will begin soon. You are absolutely right about going from this very scheduled, controlled feeding pattern to unexpected frequent feeds overnight if she does not have the chance to transition to the cue based feeding pattern. The key is dealing with the transition more effectively. I must say it is hard for me sometimes to stay in communication with staff, neo and moms as I am the only LC and the NICU is just a part of what I do. I would love ideally for all NICU nurses to be passionate enough about it to support the process even just a little bit more to deal with the transitioning to more breastfeeding prior to DC. We do kangaroo more now since staff was inserviced. There are a lot of variables involved in getting higher rates of BF in the NICU. Our pumping rates are great, our breastfeeding rates need improvement. The key is having mom available a lot. They get cabin fever staying in the hospital all the time. We don't always have facilities for everyone to stay overnight. Am I condoning that? No . I'd want a bed for avery mother wo wanted to stay and we should have it. But I don't run the hospital. Next comes having the amount of staff needed to handle the critical load in NICU and having teaching time. We all know how much time we need teaching and assisting, and supporting the breastfeeding process. Ideally there should be NICU based LCs that just do breastfeeding . I know some of the bigger units have those positions. And you need physcians and nurses who are breasfeeding friendly and committed to the process within the constraints, understandably , in a NICU setting. With all that said I am off to bed before I will be useless in my NICU setting tomorrow am Jane Ciaramella