Advanced Clinical Practice Fellowships

Professional development of the lactation consultant role at CHEO and improving accessibility to double electric


The RNAO Human Milk Feeding BPG was one of 5 guidelines implemented at CHEO as an overall hospital goal to be recognized a RNAO Best Practice Spotlight Organization (1). The overall goals of this fellowship were to learn more about the lived experiences of parents expressing human milk in a lactation consultant role and further support access to breast pumps through a loaner pump program, as well as organization of human milk feeding resources. Reasons indicating pumping during a hospital admission included feeding choice and/or prolonged milk expressing due to a medical indication contradicting direct chest-or breastfeeding (for example a diagnosis of prematurity). Having the time to review the literature, reach out to community and regional networks was impactful for personal and professional growth. Attending CPBF, EPIQ and CMNRP webinars, as well as collaborating with experts in lactation after loss (Roger Nielson House-Lesley Sabourin, CMNRP-Catherine Gascon, PAIL-Michelle LaFontaine) have provided insight into families lived experiences of lactation suppression and or donation to Rogers Hixon Ontario Human Milk Bank, part of Sinai Health. Sharing insights and fellowship knowledge gained with colleagues at NICU education days enhanced presentation and public speaking skills, as well as further knowledge translation of human milk feeding importance. Human milk is the unequalled and universally recognized as the optimal feeding choice for every infant (1-5).


CHEO Organization

-Continue support of RNAO Breastfeeding BPG implementation and ongoing connecting regionally for human milk feeding nursing education (1)

-Increased community and organizational awareness of supporting lactation after a loss, loaner pump program CHEO NICU and Ottawa Public Health & Roger Neilson House collaboration (6-7)

-Ongoing multi hospital awareness of process for human milk donation to Rogers Hixon Human Milk Bank, part of Sinai Health (4)

CHEO Families

-Pump at every bedside for family expressing human milk achieved & sustained (8).

-Loaner pump program to support equitable access to a pump to support parents meeting their feeding goals, as well as more critically ill infants receiving nutrition of human milk (1-5)

-Draft human milk policy and lactation support after loss policy.

CHEO Staff

-Increased awareness of Post-Partum Depression in parents through support of Heather MacDougall’s master’s in nursing work.

-Epic human milk feeding updates.

-2 human milk feeding stations as part of NICU education days (Nov 2021 & April 2022).

-Pilot project professional development of the lactation role (completed November 2021).

-Draft human milk policy and lactation support after loss policy for reference and best practice (1, 6-7).

Overall experience

-Professional learning opportunity from webinars focusing on zero separation, family integrated care, proactive lactation care, lactation after loss, supporting and honouring Indigenous families, partnering with families in research, and importance of parent voices in policies

-Importance of family togetherness for optimal physiological, mental, and human milk feeding outcomes, importance of family integrated (10)

-Witnessing growth mindset with colleagues and collaboration with patient experience to uphold parents as the centre of holistic family centered care.

-New appreciation for biomedical engineers!

-CHEO multidisciplinary collaboration is where it is at!

-Our staff have a strong commitment to respect all individuals, challenge innovation and learning, and all the while continue to remain present with families (and staff) wherever they are in their journey that day (9).

-Understanding of organizational processes related to human milk feeding equipment and resources, how to update EPIC for nurses to document breast pump accessibility/use, recognizing social determinants of health that impact accessibility to pumps, and decrease barriers to accessibility, initiating a loaner pump program and collaborating with Ottawa Public Health for community supports post discharge.

-Witnessed and reflected on parents lived experiences of what it means to be pumping often for a long period of time for a critically ill infant at CHEO.

-Benchmarked other Canadian pediatric hospitals with an established lactation consultant program (1).

-Lactation consultant programs significantly improve human milk outcomes (1)

-Increased resources of proactive lactation support improved parent’s milk provision for high-risk population (NICU admissions) (5)

-Researched lactation consultant role with ongoing evaluations and strategic planning to optimize one of the most socioeconomical and upstream health initiatives of supporting human milk feeding for optimal growth and nutrition, with lifelong impacts for both the child and parents (1).

-Motivated to continue learning about how to facilitate organizational change, team building opportunities and connection with community networks related to human milk feeding.

-The RNAO team facilitating the fellowship program was, knowledgeable and supportive.

-Support and recommend all nurses to further their own learning and facilitate quality initiatives to continue supporting our nursing profession and the incredible families we are privileged to partner in care with.



Protecting, promoting, and supporting breastfeeding: the Baby-friendly Hospital Initiative for small, sick, and preterm newborns. Geneva: World Health Organization and the United Nations Children’s Fund (UNICEF), 2020. Licence: CC BY-NC-SA 3.0 IGO.

Hoban R, McLean L, Sullivan S, Currie C. Proactive Lactation Care is Associated With Improved Outcomes in a Referral NICU. J Hum Lact. 2022 Feb;38(1):148-155. doi: 10.1177/0890334421993467. Epub 2021 Feb 13. PMID: 33586505; PMCID: PMC8814956.

Fernández-Medina IM, Jiménez-Lasserrotte MDM, Ruíz-Fernández MD, Granero-Molina J, Fernández-Sola C, Hernández-Padilla JM. Milk Donation Following A Perinatal Loss: A Phenomenological Study. J Midwifery Womens Health. 2022 Feb 15. doi: 10.1111/jmwh.13342. Epub ahead of print. PMID: 35166428.

Porta R, Miralles N, Paltrinieri A, Ibáñez B, Giménez J, Roca T, Vega A. A Breast Milk Pump at the Bedside: A Project to Increase Milk Production in Mothers of Very Low Birth Weight Infants. Breastfeed Med. 2021 Apr;16(4):309-312. doi: 10.1089/bfm.2020.0122. Epub 2020 Dec 22. PMID: 33351698.