Mothers of preterm infants' experiences of breastfeeding support in the first 12 months after birth: A qualitative study

Challenges and Choices in Breastfeeding Healthy, Sick and Preterm Babies: Review

Although breastfeeding is associated with many health-related benefits for both mothers and children, the WHO recommendation for exclusive breastfeeding is not achieved by the majority in any WHO region. This paper aims to present the current state of research on challenges and choices in breastfeeding healthy, sick and preterm babies. The research was organized as a systematic search in PubMed and the study was performed as a narrative review after applying the PRISMA protocol. Finally, n = 57 studies were included. Both barriers and support factors emerge as a complex interaction of individual, group and societal factors, the precise understanding of which is relevant to increasing breastfeeding rates in the future. Knowledge as well as practical skills proved to be generally helpful, whereas the lack of breastfeeding support for mothers, who are often separated from their premature babies in hospital, was identified as a key risk factor for this subgroup. Appropriate training for healthcare professionals can improve the situation as a result. After discharge, workplace-related barriers are of major concern to allow further breastfeeding when maternity leave ends. Thus, the promotion of breastfeeding must be perceived as a task for society as a whole.

Factors affecting breastfeeding self-efficacy among mothers with preterm infants

BACKGROUND

Although challenges in breastfeeding are more common in mothers of preterm infants, maternal breastfeeding self-efficacy is a modifiable factor that may improve breastfeeding rates.

OBJECTIVE

To evaluate the factors affecting breastfeeding self-efficacy among mothers with preterm babies.

DESIGN

A cross-sectional study.

METHODS

This study was carried out using a double-stage cluster sampling method. In total, 360 mothers of preterm infants under 6 months of age were included. Data were collected using sociodemographic characteristics, Breastfeeding Self-efficacy Scale-Short Form (BSES-SF), multiple scales of perceived social support, and Depression, Anxiety, and Stress questionnaires.

RESULTS

The results showed social support (15.6%), depression (12.2%), anxiety (11%), and stress (12.2%) contributed independently, and together they explained 25% of the variance in BSES-SF. The higher levels of social support (β = 0.283), lower levels of mental health problems (β = -0.340), having breastfeeding experience (β = -0.253), and higher gestational age at birth (β = 0.106) were significantly related to the high level of BSES-SF.

CONCLUSION

These findings can help healthcare providers be aware of effective factors in improving breastfeeding self-efficacy. Increased access to counselors, active support for mothers after preterm labor, and increased support facilities for mothers with preterm delivery may be helpful to improve breastfeeding self-efficacy.

From Expressing Human Milk to Breastfeeding-An Essential Element in the Journey to Motherhood of Mothers of Prematurely Born Infants

BACKGROUND

Lactation and breastfeeding present an extraordinary challenge for mothers of prematurely born infants.

PURPOSE

To explore the significance of and the circumstances that affect lactation for mothers of premature infants.

METHODS

A qualitative exploratory study based on single, in-depth, semistructured interviews with 16 purposefully sampled mothers of premature infants admitted to the neonatal intensive care unit (NICU). Data were analyzed using content analysis. The study was reported according to Standards for Reporting Qualitative Research.

FINDINGS

The overall theme was "From expressing human milk to breastfeeding-an essential element in the journey to motherhood." The theme emerged from 3 categories: the birth preparation time has been interrupted; expressing human milk is essential for lactation; and the motherhood journey encompasses breastfeeding. The analysis also revealed that the categories were impacted by initiating, performing, and maintaining lactation and further influenced by inhibitors and promoters.

IMPLICATIONS FOR PRACTICE

The promoters for performing milk expression and breastfeeding should be stimulated and the inhibitors should be eliminated. The achievement of "zero separation" and mother-infant couplet care in the NICU would be beneficial. In order for mothers to maintain successful lactation, it is essential that they receive supportive around-the-clock access to health professionals with expertise in lactation and breastfeeding until exclusive breastfeeding is well established.

IMPLICATIONS FOR RESEARCH

The study highlights the need to investigate mother-infant as one entity rather than separately as mother and infant.

Parental experiences and breastfeeding outcomes of early support to new parents from family health care centres-a mixed method study

Background

Early parenthood is a sensitive period for parents. Parents may feel uncertain about their new roles and unsure about where to find trusted information and support. The aim of this study was to explore the association between breastfeeding and early home visits and a proactive telephone support intervention and to describe parental experiences.

Method

This study was conducted as a mixed method study with a convergent design using qualitative data from the written comments of parents, and the quantitative data consisted of demographics, breastfeeding, and Likert questions about parents’ satisfaction with the early home visit and telephone support. Historic control (2017–2018) and intervention (2019–2020) data were collected from one family health care centre, and control (2019–2020) data were collected from another family health care centre.

Results

In total, 838 infants, 42 mothers and 38 fathers contributed to the data in the study. The intervention group had a statistically significantly earlier home visit than the control groups. Early home visits and proactive telephone support to parents with newborn infants were not associated with breastfeeding outcomes up to six months after birth, but we could not exclude the possibility that this was a consequence of our observational study design. However, the early home visit was appreciated by the parents where they received both practical and emotional support.

Conclusions

Although the intervention was not associated with breastfeeding, the parents appreciated the service. This shows the importance of continuing to investigate how and which support parents of newborn infants need and the effects of such support, including interventions to provide optimal support to facilitate continued breastfeeding.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04469-6.

Supporting Premature Infants’ Oral Feeding in the NICU—A Qualitative Study of Nurses’ Perspectives

One major task in the neonatal intensive care unit (NICU) involves ensuring adequate nutrition and supporting the provision of human milk. The aim of this study was to explore nurses’ experiences of the oral feeding process in the NICU when the infant is born extremely or very preterm. We used a qualitative inductive approach. Nine nurses from three family-centered NICUs were interviewed face-to-face. The interviews were transcribed verbatim and analyzed using content analysis. Five sub-categories and two generic categories formed the main category: ‘A complex and long-lasting collaboration.’ The nurses wished to contribute to the parents’ understanding of the feeding process and their own role as parents in this process. The nurses’ intention was to guide and support parents to be autonomous in this process. They saw the family as a team in which the preterm infant was the leader whose needs and development directed the feeding and the parents’ actions in this process. Written and verbal communication, seeing all family members as important members of a team and early identification of the most vulnerable families to direct the emotional and practical feeding support accordingly can strengthen the feeding process in the NICU.

Positive breastfeeding experiences and facilitators in mothers of preterm and low birthweight infants: a meta-ethnographic review

Background

Most qualitative research on breastfeeding the preterm or low-birthweight (LBW) infant has focused on negative insights; there are no comprehensive insights into how, when and why mothers experience positive breastfeeding experiences. We aimed to address this knowledge gap by exploring what characterizes and facilitates a positive breastfeeding experience in mothers of preterm and/or LBW infants.

Methods

A systematic review using meta-ethnographic methods was conducted. Search strategies involved a comprehensive search strategy on six bibliographic databases, citation tracking and reference checking. The analysis involved a reciprocal level of translation and a line of argument synthesis.

Results

Searches identified 1774 hits and 17 articles from 14 studies were included, representing the views of 697 mothers. A positive breastfeeding experience was identified as being ‘attuned’. Three themes and eight sub-themes were developed to describe what characterizes attuned breastfeeding. ‘Trusting the body and what it can do’, concerned how attuned breastfeeding was facilitated through understanding the bodily responses and capacity and feeling comfortable with holding the infant and to breastfeed. ‘Being emotionally present – in the here and now’ described the importance of feeling relaxed and reassured. ‘Experiencing mutual positive responses’, illuminated how attunement was related to feelings of mutuality - when the mother recognises the infant’s cues, responds to these signals and receives a positive response from the infant. The key factors to facilitate attuned breastfeeding were opportunities for prolonged close physical contact with the infant, positive relationships with and support from staff and peers, and being facilitated to breastfeed when the infant showed feeding cues.

Conclusions

This study provides new insights into what characterizes a positive breastfeeding experience and how staff can facilitate and enable mothers to achieve attuned breastfeeding. Improvements in units’ design, such as for rooming-in and having prolonged skin-to-skin contact, and care provided by knowledgeable, supportive and encouraging staff and peers, are crucial. The mother’s physical and emotional states and the infant’s behavioural responses and physiological signals should guide the process towards positive breastfeeding practices.

Vulnerable mothers' experience of feeding their preterm infant in neonatal care

Background

Worldwide, preterm birth is a rising threat to maternal and child health. The universal challenges of being the mother of a preterm infant, combined with context-specific challenges such as poverty and poor linguistic and cultural representation, bring about risks for both mother and infant. This includes poor maternal mental health; poor mother–infant bonding and attachment and potential suboptimal developmental outcomes for the infant.

Objective

This article describes how Afrikaans-speaking mothers living in poverty experienced feeding their preterm infants in neonatal care.

Method

The study implemented a cross-sectional, qualitative design. Mothers of preterm infants (chronological ages between 3 and 6 months) were selected through a purposive sampling method and participated in individual semi-structured interviews. Nine interviews were thematically analysed. The participants were a vulnerable group, about whom little research literature was available.

Results

Feeding was perceived as a progressive task that worked towards the goal of discharge from the hospital. It was stressful because of various factors, but insufficient breastmilk supply was a significant contributor. The hospital setting was perceived as something that added to the participants’ anxiety surrounding feeding, but at the same time, it had the potential to decrease their anxiety. When the mother–infant dyad was able to breastfeed successfully, it made the participants feel like mothers at last after an extended period of anticipation.

Conclusion

Feeding their preterm infant was a prominent experience for the mothers, especially whilst in neonatal care. Increased feeding support is required from the healthcare team providing neonatal care in order to optimally use the neonatal period.

Guilt, shame, and postpartum infant feeding outcomes: A systematic review

Negative maternal affect (e.g., depression and anxiety) has been associated with shorter breastfeeding duration and poorer breastfeeding intention, initiation, and exclusivity. Other affective states, including guilt and shame, have been linked with formula feeding practice, though existing literature has yet to be synthesised. A narrative synthesis of quantitative data and a framework synthesis of qualitative and quantitative data were conducted to explore guilt and/or shame in relation to infant feeding outcomes. Searches were conducted on the DISCOVER database between December 2017 and March 2018. The search strategy was rerun in February 2020, together yielding 467 studies. The study selection process identified 20 articles, published between 1997 and 2017. Quantitative results demonstrated formula feeders experienced guilt more commonly than breastfeeding mothers. Formula feeders experienced external guilt most commonly associated with healthcare professionals, whereas breastfeeding mothers experienced guilt most commonly associated with peers and family. No quantitative literature examined shame in relation to infant feeding outcomes, warranting future research. The framework synthesis generated four distinct themes which explored guilt and/or shame in relation to infant feeding outcomes: 'underprepared and ineffectively supported', 'morality and perceived judgement' (breastfeeding), 'frustration with infant feeding care' and 'failures, fears and forbidden practice' (formula feeding). Both guilt and shame were associated with self-perception as a bad mother and poorer maternal mental health. Guilt and shame experiences were qualitatively different in terms of sources and outcomes, dependent on infant feeding method. Suggestions for tailored care to minimise guilt and shame, while supporting breastfeeding, are provided.

Cessation of breastfeeding in mothers of preterm infants-A mixed method study

INTRODUCTION

Many women cease breastfeeding earlier than desired. This study examined the cessation of breastfeeding among mothers of preterm infants. Thus, the aim was to describe the cessation of breastfeeding in mothers of preterm infants up to 12 months after birth.

METHOD

This mixed methods study used a convergent design with both qualitative data, consisting of written comments, and quantitative data, on breastfeeding status and breastfeeding satisfaction. The data were collected from questionnaires sent to the mothers at three points during the first year after birth. In total, 270 mothers of preterm infants who breastfed at the time of discharge from the neonatal unit provided data for the study. The quantitative and qualitative data were analysed separately with statistical tests and hermeneutical analysis, respectively and then together according to the convergent mixed methods design.

RESULTS

Four themes of the meanings of the cessation of breastfeeding were identified in the qualitative analysis: "Desire to regain the mother's and the infant's well-being", "The mothers interpretation that the infants actively ceased breastfeeding", "The mother's body and/or the infants' signals showing the way" and "The mother's own will and perceived external obstacles". Mothers who did not breastfeed as long as they wanted were more likely to report less satisfaction with breastfeeding, a shorter breastfeeding period, and less activity when ceasing breastfeeding. In comparison, mothers who breastfed as long as they wanted were more satisfied with breastfeeding, breastfed for a longer period of time and were more active in decision making in breastfeeding cessation.

CONCLUSION

Maternal passivity or activity influenced the cessation of breastfeeding in mothers of preterm infants who breastfed at the time of discharge from the neonatal unit. Passive behaviour related to breastfeeding may result in early cessation of breastfeeding, and low breastfeeding satisfaction while active behaviour may increase breastfeeding length and satisfaction.

Explaining breastfeeding experiences and assessing factors affecting breastfeeding self-efficacy in mothers of premature infants: a mixed method study protocol

BACKGROUND

Breastfeeding has a great effect on health promotion and disease prevention in premature infants. However, various factors affect the success of breastfeeding process in mothers. The present study aims to: a) explain breastfeeding experiences; b) assess the factors affecting breastfeeding self-efficacy; and c) present a guideline for promoting breastfeeding in mothers of premature infants.

METHODS

This mixed-methods study with a sequential explanatory design consisted of three phases. The first phase is qualitative study to explore the breastfeeding experiences in mothers of premature infants. In this phase, the subjects will be selected through purposive sampling; moreover, in-depth individual interviewing will be used for data collection. Finally, the conventional content analysis approach will be employed for data analysis. The second phase is quantitative and will be used a cross-sectional approach to assess the association of the social determinants of health with breastfeeding self-efficacy in mothers of premature infants. In this phase, the multistage cluster sampling method will be used to select 360 subjects who will be visited healthcare centers in Tabriz, Iran. The third phase focused on developing strategies to increase the ability of mothers to breastfeed their premature infants, using the qualitative and quantitative results of previous phases, a review of the related literature, and the nominal group technique will be performed among experts.

DISCUSSION

The present research is the first study that investigated the experiences of breastfeeding and factors influencing breastfeeding self-efficacy in mothers of premature infants. For the purposes of the study, the mixed methods approach will be used which aimed to develop strategies for the improvement of healthcare services in this regard. It is worth noting that there is no strategic guideline in Iran's healthcare system for the improvement of breastfeeding, especially regarding mothers of premature infants. Therefore, it is hoped that the strategy proposed in the current study can lead to improvements in this regard.

ETHICAL CODE

IR.TBZMED.REC.1398.100.

A qualitative study on the breastfeeding experience of mothers of preterm infants in the first 12 months after birth

Background

Being a mother of a preterm infant (< 37 gestational weeks) puts the mother in a vulnerable and fragile situation wherein breastfeeding is an important part of becoming a mother and bonding with the infant. Nevertheless, the breastfeeding experience of mothers during the first year after a preterm birth has not been well studied. To develop professional caring and supporting relationships, it is important to address this knowledge gap. The aim of this study was to describe the breastfeeding experience of mothers of preterm infants from birth up until 12 months after birth.

Methods

The data in this qualitative study are derived from a multicentre randomized controlled trial where 270 mothers of preterm infants provided 496 written comments through questionnaires containing open-ended questions. The questionnaires were sent to the mother three times during the first 12 months after birth. A thematic network analysis based on hermeneutical philosophy was used to analyse and interpret the resulting data to describe the mothers’ experiences of breastfeeding.

Results

Three organizing themes, namely, “navigating smoothly,” “navigating with a struggle” and “navigating in ambiguity” were revealed in the mothers’ narratives regarding their breastfeeding experiences during the first 12 months after birth. These organizing themes were further interpreted as one global theme that was deemed “A journey to finding one’s unique way in breastfeeding.”

Conclusion

Mothers of preterm infants are in an exposed and vulnerable situation when initiating breastfeeding during the first year. This situation leads to a unique journey wherein each mother navigates through breastfeeding depending on her individual situation. An awareness of the diversity of breastfeeding experiences may contribute to the provision of professional caring and supportive relationships.

Trial registration

www.clinicaltrial.gov NCT01806480 registered 7 March 2013.

Mothers of preterm infants' experiences of breastfeeding support in the first 12 months after birth: A qualitative study

BACKGROUND

Breastfeeding support is important for breastfeeding mothers; however, it is less clear how mothers of preterm infants (< 37 gestational weeks) experience breastfeeding support during the first year. Thus, the aim of this study was to describe how mothers of preterm infants in Sweden experience breastfeeding support during the first 12 months after birth.

METHODS

This qualitative study used data from 151 mothers from questionnaires with open-ended questions and telephone interviews. The data were analyzed using an inductive thematic network analysis with a hermeneutical approach.

RESULTS

The results exposed two organizing themes and one global theme. In the organizing theme "genuine support strengthens," the mothers described how they were strengthened by being listened to and met with respect, understanding, and knowledge. The support was individually adapted and included both practical and emotional support. In the organizing theme "inadequate support diminishes," the mothers described how health professionals who were controlling and intrusive diminished them and how the support they needed was not provided or was inappropriate. Thus, the global theme "being thrown into a lottery-dependent on the health professional who provided breastfeeding support" emerged, meaning that the support received was random in terms of knowledge and support style, depending on the individual health professionals who were available.

CONCLUSION

Breastfeeding support to mothers of preterm infants was highly variable, either constructive or destructive depending on who provided support. This finding clearly shows major challenges for health care, which should make breastfeeding support more person-centered, equal, and supportive in accordance with individual needs.