Helping Mothers Make Milk for a Baby Born Too Soon: What Two New Studies Tell Families

A plain-language look at a German study of lactation support in 15 neonatal units (Köberlein-Neu et al., 2026) and a review of herbal milk-boosting products for mothers of premature babies (Cragg et al., 2026)

Making enough milk is often harder than anyone expects when a baby is born very early. A German study of 15 neonatal units found that structured breastfeeding and pumping support helped about 11 more babies per 100 go home fed only on their mother's milk, with no sign of added harm. A review of small trials found hints that some herbal products may raise pumped milk, but the evidence is weak.

Why this matters to families

A tiny baby's gut, lungs and defences are still developing. Milk from the baby's own mother carries nutrients and protective substances, and babies fed human milk have lower rates of a serious intestinal illness called necrotising enterocolitis [1]. Pooled studies also link human milk to less of a long-term lung condition called bronchopulmonary dysplasia [2]. If a mother cannot supply enough, milk donated by other mothers to a milk bank is the next best choice and lowers the risk of the intestinal illness compared with formula [3].

Even so, in studies from several countries only about 30% to 65% of the smallest babies were fed only their mother's milk when they left the NICU [4]. The reasons are understandable. A mother whose baby is in intensive care usually cannot breastfeed directly at first, so she has to use a breast pump, often many times a day, while recovering from the birth and worrying about her baby. Stress itself can make milk harder to produce [5].

How families and hospitals used to cope

For many years the answer was mostly individual effort. A mother might see a lactation consultant if one happened to be available, borrow a pump and be told to keep going. Hospitals tried different ideas, such as pumping programmes, skin-to-skin cuddling and milk banks, and reviews of these found that comprehensive packages seemed to help, although the studies were so different from one another that firm conclusions were hard to draw [6]. Studies of donor milk banks gave mixed answers about whether they helped or hindered mothers' own breastfeeding, and most had been done in just one hospital [7]. Some research found that units with a milk bank had more mothers feeding only their own milk at discharge, but that kind of study cannot show cause and effect [8].

Mothers have also turned to medicines and herbs. A medicine called domperidone helped mothers who were expressing for preterm babies make more milk in a pooled analysis [9], whereas another, metoclopramide, did not [10]. Herbal teas and capsules are popular, but specialists advise caution because the strength of a herbal product can vary and the safety information is limited [11].

The German study: giving every unit the same organised support

Researchers in Germany tested a programme called Neo-MILK, which stands for structured lactation support and the setting up of human donor milk banks in neonatal centres. It ran in 15 German NICUs of the highest level of care between April 2022 and March 2024 [4][12]. Instead of comparing some hospitals with others, the team used a "stepped" design in which every unit began with usual care and switched to the programme at a randomly chosen time. This is a fair way to compare before and after when every hospital wants the new approach [13].

The programme gave mothers counselling both before and after the birth, a sheet of questions to help them prepare, information in several languages, and a phone app to record pumping and send reminders. Staff received training, and hospitals were helped to open their own donor milk bank. In total 1,627 babies weighing under 1,500 grams (about 3 pounds 5 ounces) were included.

Under usual care, 43 out of every 100 of these babies went home fed only on their mother's milk. With the programme, about 11 more babies per 100 did so. Fewer babies went home on formula alone. The programme did not increase serious complications, and the babies' hospital stays were no longer. The results were less clear for the very smallest babies, under 1,000 grams, and for the sickest babies; in these groups the numbers were too small to say whether it worked.

The study also asked whether the programme was practical. Staff found it acceptable, and it reached nearly every eligible baby, but not every part was delivered fully: only about 7 in 10 mothers received the planned counselling before delivery, and milk banks were opened in 4 of every 10 units. The programme cost about 649 euros per baby, and the researchers estimated that the German health system could come out ahead financially, although this depends on how well hospitals carry it out.

The review of herbal products: promising hints, thin proof

A second team gathered every randomised trial of herbal milk-boosting products in mothers of premature babies [14]. They found only ten trials involving 856 mothers, and each tested a different product. Four showed higher pumped milk after about a week: a barley malt and lemon balm mix [15], a milk thistle extract combined with other ingredients [16], anise seed tea [17] and lettuce syrup [18]. The extra milk was roughly 80 to 150 millilitres a day, a few ounces. A leaf capsule from the Moringa plant also looked helpful in a small early trial. Fenugreek, the herb people most often recommend, was tested only in two very small trials and showed no clear benefit.

The reviewers rated the certainty of all this evidence as low or very low, because the trials were small, short and often lacked planning details, and trials with negative results may never have been published. Most mothers reported no side effects, although only a few trials described how they checked.

How much weight to give these findings

The German study is reassuring because it took place in real hospitals of different sizes and cultures, not in one specialist centre, and because every unit eventually received the programme. Its limits are worth knowing. It only included the highest-level units, which may not match smaller hospitals. The programme was a package of several parts, so we cannot say whether the counselling, the app or the milk banks made the biggest difference; in fact, hospitals that opened a milk bank did not show clearly bigger gains. Only about a quarter of mothers answered the follow-up survey, so some of what mothers said may not represent everyone. Among those surveyed, most were willing to donate milk (92%), but fewer were willing to accept donated milk (68%), which shows that families need time and gentle conversation about donor milk [4].

The herbal review has a different limitation: it can describe what small trials found, but it cannot tell us what a given mother should take. Products were different in every trial, some trials were paid for by the companies that make the product, and the trials mostly lasted a week or less, so we do not know what happens to milk supply, or to babies, over the longer term [14].

What this means for your family

If your baby is in the NICU, ask early about lactation support, a pump you can use at the bedside, and written information in your language. Many units now offer these, and the German study suggests that this kind of organised help can make a measurable difference. Expressing milk is not easy, and many mothers do not reach their goals; that is not a personal failing, and any amount of mother's milk still counts. Donor milk can fill the gap while your supply builds.

If you are thinking about herbal teas, capsules or other products, talk with your baby's care team or a pharmacist first. Some herbs can interact with medicines and conditions; for example, fenugreek may thin the blood or lower blood sugar, and some herbal ingredients are limited for breastfeeding mothers. The studies so far cannot tell us which products work best or are safest for mothers of premature babies.

What researchers are working on next

Researchers want to find better support for the mothers of the smallest and sickest babies, who gained least in the German study, including ways to reduce stress and to offer breastfeeding help by video after discharge. They also want larger, better-designed trials of the most promising herbal products, and a trial comparing different doses of domperidone has been planned [19]. Studies that follow babies for longer will show whether more mother's milk in the NICU leads to better health later.

In summary

Organised, well-resourced support in the NICU helped more premature babies go home on their mother's own milk. Herbal products hold some promise but are not yet proven. In the meantime, the most reliable steps are early support, a good pump, donor milk when needed and kindness toward mothers who are doing a very hard job.

References

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  2. Huang J, Zhang L, Tang J, et al. Human milk as a protective factor for bronchopulmonary dysplasia: a systematic review and meta-analysis. Archives of Disease in Childhood - Fetal and Neonatal Edition. 2019;104(2):F128-F136. doi:10.1136/archdischild-2017-314205 ↩
  3. Quigley M, Embleton ND, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database of Systematic Reviews. 2019;7:CD002971. doi:10.1002/14651858.CD002971.pub5 ↩
  4. Köberlein-Neu J, Dymek NG, Zimmer V, et al. Effectiveness of structured lactation support and human donor milk banking in German NICUs: a stepped-wedge cluster-randomized trial. BMC Medicine. 2026;24(1):504. doi:10.1186/s12916-026-05211-1 ↩
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