Am J Perinatol 2024; 41(07): 842-852
DOI: 10.1055/a-1787-7576
Original Article

A Randomized Control Trial of Meditation for Mothers Pumping Breastmilk for Preterm Infants

1   Department of Obstetrics and Gynecology, Washington University, Saint Louis, Missouri
Soumya Ramireddy
2   Saint Louis University School of Medicine, Saint Louis, Missouri
Sara Ficenec
3   Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
Carolyn Mank
4   Department of Obstetrics and Gynecology, Saint Louis University School of Medicine, Saint Louis, Missouri
5   Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, Missouri
6   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Missouri-Kansas City, Children's Mercy Kansas City, Kansas City, Missouri
› Author Affiliations
Funding Financial support for this study was obtained through a Departmental Seed Grant through Saint Louis University School of Medicine Department of Obstetrics and Gynecology. Access to the Expectful meditation app, both for study procedure purposes, and as a 3-month subscription as a study incentive awarded to participants following completion of the study was provided by Expectful. The Expectful company had no role in the study design or analysis of data, or in decisions to submit our findings for publication. Expectful did provide data collection by electronic monitoring of the frequency of use of the app during the study period. The authors of this study have no financial involvement that could pose a potential conflict of interest in this study.


Objective Mothers of preterm infants face unique challenges in establishing milk supply. We hypothesized that daily meditation practice while pumping would increase milk volume.

Study Design This was a randomized control trial examining the effect of meditation on the breastmilk supply of women delivering preterm infants. The meditation group engaged in daily use of a mindfulness-focused meditation app in addition to routine lactation support. The primary outcome was mean breastmilk volume on the infant's nineth day of life. Secondary outcomes included use of lactation-promoting behaviors, continuation of breastfeeding, and measures of mental health and breastfeeding self-efficacy by validated questionnaires. In addition to the intention to treat analysis, a per protocol analysis examined the association of frequent meditation with these breastfeeding and mental health outcomes.

Results A total of 60 women were analyzed. Mean milk volume was 647.1 ± 467.8 mL in the meditation group and 514.9 ± 393.5 mL in the routine care group (p = 0.27). Median number of pumping sessions was 7 (interquartile range [IQR] 5–8) in the meditation group, compared to 6 (IQR 4–7) in the routine care group (p = 0.11). Other lactation-promoting behaviors, breastfeeding continuation, and questionnaire scores were similar.

Adjusting for confounders, we found an increase in breastmilk production of 223.2 mL (95% CI 98.8–347.5, p = 0.001) and in pumping episodes by 0.93 (95% CI 0.16–1.70, p = 0.020) associated with frequent meditation. Skin-to-skin contact was increased to 100% (p = 0.006) among women who meditated seven or more times. Adjusted odds of a clinically significant Edinburgh Postnatal Depression Scale score of >9 was 0.057 (95% CI 0.0014–0.711, p = 0.023) with frequent meditation.

Conclusion Breastmilk production was similar in mothers practicing meditation compared to those receiving routine lactation support. For women engaging in frequent mediation, there may be an effect in establishing breastmilk supply and reduction of depression symptoms.

Key Points

  • Breastmilk is not increased for neonatal intensive care unit (NICU) moms asked to engage in meditation.

  • Maternal mental health is not improved among NICU moms asked to meditate.

  • However, higher-frequency meditation is associated with increased milk volume and lower odds of high scores on depression screening.

Publication History

Received: 25 March 2021

Accepted: 18 February 2022

Accepted Manuscript online:
03 March 2022

Article published online:
24 May 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

  • References

  • 1 Cregan MD, De Mello TR, Kershaw D, McDougall K, Hartmann PE. Initiation of lactation in women after preterm delivery. Acta Obstet Gynecol Scand 2002; 81 (09) 870-877
  • 2 Hill PD, Aldag JC, Chatterton RT, Zinaman M. Primary and secondary mediators' influence on milk output in lactating mothers of preterm and term infants. J Hum Lact 2005; 21 (02) 138-150
  • 3 Chiang KV, Sharma AJ, Nelson JM, Olson CK, Perrine CG. Receipt of breast milk by gestational age—United States, 2017. MMWR Morb Mortal Wkly Rep 2019; 68 (22) 489-493
  • 4 Parker LA, Sullivan S, Krueger C, Mueller M. Association of timing of initiation of breastmilk expression on milk volume and timing of lactogenesis stage II among mothers of very low-birth-weight infants. Breastfeed Med 2015; 10 (02) 84-91
  • 5 Parker LA, Sullivan S, Krueger C, Kelechi T, Mueller M. Effect of early breast milk expression on milk volume and timing of lactogenesis stage II among mothers of very low birth weight infants: a pilot study. J Perinatol 2012; 32 (03) 205-209
  • 6 Meier PP, Patel AL, Bigger HR, Rossman B, Engstrom JL. Supporting breastfeeding in the neonatal intensive care unit: Rush Mother's Milk Club as a case study of evidence-based care. Pediatr Clin North Am 2013; 60 (01) 209-226
  • 7 Dewey KG, Nommsen-Rivers LA, Heinig MJ, Cohen RJ. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics 2003; 112 (3 Pt 1): 607-619
  • 8 Chen DC, Nommsen-Rivers L, Dewey KG, Lönnerdal B. Stress during labor and delivery and early lactation performance. Am J Clin Nutr 1998; 68 (02) 335-344
  • 9 Zhang F, Cheng J, Yan S, Wu H, Bai T. Early feeding behaviors and breastfeeding outcomes after cesarean section. Breastfeed Med 2019; 14 (05) 325-333
  • 10 Obeidat HM, Bond EA, Callister LC. The parental experience of having an infant in the newborn intensive care unit. J Perinat Educ 2009; 18 (03) 23-29
  • 11 Wyatt T, Shreffler KM, Ciciolla L. Neonatal intensive care unit admission and maternal postpartum depression. J Reprod Infant Psychol 2019; 37 (03) 267-276
  • 12 Lefkowitz DS, Baxt C, Evans JR. Prevalence and correlates of posttraumatic stress and postpartum depression in parents of infants in the neonatal intensive care unit (NICU). J Clin Psychol Med Settings 2010; 17 (03) 230-237
  • 13 Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 1977; 84 (02) 191-215
  • 14 Dennis CL. Theoretical underpinnings of breastfeeding confidence: a self-efficacy framework. J Hum Lact 1999; 15 (03) 195-201
  • 15 Vieira ES, Caldeira NT, Eugênio DS, Lucca MMD, Silva IA. Breastfeeding self-efficacy and postpartum depression: a cohort study. Rev Lat Am Enfermagem 2018; 26: e3035
  • 16 Dennis CL, McQueen K. Does maternal postpartum depressive symptomatology influence infant feeding outcomes?. Acta Paediatr (Oslo, Norway: 1992) 2007; 96 (04) 590-594
  • 17 Fotiou C, Siahanidou T, Vlastarakos PV, Tavoulari EF, Chrousos G. The effect of body and mind stress-releasing techniques on the breastfeeding of full-term babies; a critical analysis of published interventional studies. J Matern Fetal Neonatal Med 2018; 31 (01) 98-105
  • 18 Perez-Blasco J, Viguer P, Rodrigo MF. Effects of a mindfulness-based intervention on psychological distress, well-being, and maternal self-efficacy in breast-feeding mothers: results of a pilot study. Arch Women Ment Health 2013; 16 (03) 227-236
  • 19 Keith DR, Weaver BS, Vogel RL. The effect of music-based listening interventions on the volume, fat content, and caloric content of breast milk-produced by mothers of premature and critically ill infants. Adv Neonatal Care 2012; 12 (02) 112-119
  • 20 Kabat-Zinn J. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. Hachette Books; 1994
  • 21 Jain S, Shapiro SL, Swanick S. et al. A randomized controlled trial of mindfulness meditation versus relaxation training: effects on distress, positive states of mind, rumination, and distraction. Ann Behav Med 2007; 33 (01) 11-21
  • 22 Kuyken W, Warren FC, Taylor RS. et al. Efficacy of mindfulness-based cognitive therapy in prevention of depressive relapse: an individual patient data meta-analysis from randomized trials. JAMA Psychiatry 2016; 73 (06) 565-574
  • 23 Katterman SN, Kleinman BM, Hood MM, Nackers LM, Corsica JA. Mindfulness meditation as an intervention for binge eating, emotional eating, and weight loss: a systematic review. Eat Behav 2014; 15 (02) 197-204
  • 24 Tang YY, Hölzel BK, Posner MI. The neuroscience of mindfulness meditation. Nat Rev Neurosci 2015; 16 (04) 213-225
  • 25 Lindsay EK, Creswell JD. Mechanisms of mindfulness training: monitor and acceptance theory (MAT). Clin Psychol Rev 2017; 51: 48-59
  • 26 Hölzel BK, Lazar SW, Gard T, Schuman-Olivier Z, Vago DR, Ott U. How does mindfulness meditation work? proposing mechanisms of action from a conceptual and neural perspective. Perspect Psychol Sci 2011; 6 (06) 537-559
  • 27 Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987; 150: 782-786
  • 28 Gaudry E, Vagg P, Spielberger CD. Validation of the state-trait distinction in anxiety research. Multivariate Behav Res 1975; 10 (03) 331-341
  • 29 Miles MS, Funk SG, Carlson J. Parental Stressor Scale: neonatal intensive care unit. Nurs Res 1993; 42 (03) 148-152
  • 30 Wheeler BJ, Dennis CL. Psychometric testing of the modified breastfeeding self-efficacy scale (short form) among mothers of ill or preterm infants. J Obstet Gynecol Neonatal Nurs 2013; 42 (01) 70-80
  • 31 Zuppa AA, Tornesello A, Papacci P. et al. Relationship between maternal parity, basal prolactin levels and neonatal breast milk intake. Biol Neonate 1988; 53 (03) 144-147
  • 32 Feher SD, Berger LR, Johnson JD, Wilde JB. Increasing breast milk production for premature infants with a relaxation/imagery audiotape. Pediatrics 1989; 83 (01) 57-60
  • 33 Neville MC, Keller R, Seacat J. et al. Studies in human lactation: milk volumes in lactating women during the onset of lactation and full lactation. Am J Clin Nutr 1988; 48 (06) 1375-1386
  • 34 Segal Z, Williams JMG, Teasdale J. Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse. 1st ed. The Guilford Press;; 2001
  • 35 Piet J, Hougaard E. The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis. Clin Psychol Rev 2011; 31 (06) 1032-1040
  • 36 Chiesa A, Serretti A. Mindfulness based cognitive therapy for psychiatric disorders: a systematic review and meta-analysis. Psychiatry Res 2011; 187 (03) 441-453
  • 37 Lever Taylor B, Cavanagh K, Strauss C. The effectiveness of mindfulness-based interventions in the perinatal period: a systematic review and meta-analysis. PLoS One 2016; 11 (05) e0155720
  • 38 Hall HG, Beattie J, Lau R, East C, Anne Biro M. Mindfulness and perinatal mental health: a systematic review. Women Birth 2016; 29 (01) 62-71
  • 39 Dimidjian S, Goodman SH, Felder JN, Gallop R, Brown AP, Beck A. Staying well during pregnancy and the postpartum: a pilot randomized trial of mindfulness-based cognitive therapy for the prevention of depressive relapse/recurrence. J Consult Clin Psychol 2016; 84 (02) 134-145
  • 40 Howland LC, Jallo N, Connelly CD, Pickler RH. Feasibility of a relaxation guided imagery intervention to reduce maternal stress in the NICU. J Obstet Gynecol Neonatal Nurs 2017; 46 (04) 532-543
  • 41 Karbandi S, Hosseini SM, Hosseini SA, Sadeghi F, Hesari M, Masoudi R. Evaluating the effectiveness of using a progressive muscle relaxation technique on the self-efficacy of breastfeeding in mothers with preterm infants. J Nurs Res 2017; 25 (04) 283-288
  • 42 Woolhouse H, Mercuri K, Judd F, Brown SJ. Antenatal mindfulness intervention to reduce depression, anxiety and stress: a pilot randomised controlled trial of the MindBabyBody program in an Australian tertiary maternity hospital. BMC Pregnancy Childbirth 2014; 14: 369
  • 43 Beddoe AE, Paul Yang CP, Kennedy HP, Weiss SJ, Lee KA. The effects of mindfulness-based yoga during pregnancy on maternal psychological and physical distress. J Obstet Gynecol Neonatal Nurs 2009; 38 (03) 310-319
  • 44 Dunn C, Hanieh E, Roberts R, Powrie R. Mindful pregnancy and childbirth: effects of a mindfulness-based intervention on women's psychological distress and well-being in the perinatal period. Arch Women Ment Health 2012; 15 (02) 139-143