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Maternal stress and breastfeeding outcomes in the NICU couplet care experience: a prospective cohort study



Couplet care is an innovative approach to provide postpartum care in the neonatal intensive care unit (NICU) with little known about its impact on infant feeding outcomes and maternal stress.

Study design

We compared breastfeeding outcomes and maternal NICU-related stress among mother-infant dyads based on exposure to couplet care in a prospective cohort study.


Among 19 couplet-care exposed (CCE) dyads and 19 traditional postpartum care dyads, CCE mothers had lower self-reported stress related to parent-infant relationship as compared to traditional care (P < 0.001). CCE infants received relatively more feeds at the breast (P < 0.001), more breastmilk feeds (P = 0.002), and fewer feeds by staff (P < 0.001). Adjusted for gestational age, marital status, and infant length of stay, couplet care was associated with being in a higher tertile of percent breastmilk feeds (aOR 7.29, 95% CI 1.45–36.65).


NICU couplet care was associated with improved parental stress and breastfeeding outcomes during hospitalization.

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The authors thank Henna Shaikh for her assistance with background research.


This study was supported by Yale School of Medicine internal funding.

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Authors and Affiliations



KND drafted the initial manuscript, assisted with and approved the study’s methodology, and carried out analyses. CN assisted with study design and subject enrollment, collected data, and contributed to data interpretation and drafting the initial manuscript. CH collected data and provided assistance with project management. VS assisted with and approved the study’s methodology, reviewed data analyses, and interpreted results. SNT conceptualized and supervised all aspects of the study. CN, VS, and SNT critically reviewed and revised the manuscript. All authors approved the final manuscript.

Corresponding author

Correspondence to Sarah N. Taylor.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

This study was reviewed and approved by the Yale University Institutional Review Board and was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all participants.

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Doughty, K.N., Nichols, C., Henry, C. et al. Maternal stress and breastfeeding outcomes in the NICU couplet care experience: a prospective cohort study. J Perinatol (2024).

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