Approximately 14% of infants born in the United States are admitted to neonatal intensive care units (NICU). The evidence for the use of human milk in the NICU is convincing. NICU mothers are at greater risk of delayed onset of lactation and insufficient milk when compared with healthy breastfeeding couplets. Unfortunately many infants leave the NICU not receiving sufficient or any breastmilk. A mother’s success depends upon the obstetric and NICU environment, and the knowledge and attitudes of those who care for her and her infant(s). Obstetrician-gynecologists have a significant role in the decision to breastfeed and the success of the provision of human milk and breastfeeding in the NICU.