The experiences of mothers in breastfeeding their very low birth weight infants

Parental support and exclusive breastfeeding at 3 months in West Java, Indonesia: a mixed-methods approach

BACKGROUND

The exclusive breastfeeding (EBF) rate in Indonesia is lower than expected. Among the key factors affecting breastfeeding practices, paternal support has been suggested.

PURPOSE

To explore the role of paternal support in EBF failure among 3-month-old infants.

METHODS

This sequential mixed-methods study, part of an ongoing cohort study in West Java in early 2022, included 225 infants. The parents of 3-month-old infants were interviewed. Paternal support was assessed using a 15-point validated questionnaire for a total score of 15-60 points. Multivariate binary regression was used to determine adjusted odds ratios (aORs). The qualitative exploration was based on in-depth interviews (IDIs) and forum group discussions (FGDs) following the quantitative survey.

RESULTS

Of the 225 infants, 52.2% were no longer EBF. High paternal support (greater than the mean score) of breastfeeding was determined in 52.9% of cases (mean± standard deviation, 38.7±6.7 for the overall population vs. 37.5±6.3 and 40.2±6.8 for infants who were and were not EBF at 3 months of age, respectively). Low paternal support was associated with an increased EBF failure rate (aOR, 2.84; 95% confidence interval [CI], 1.46-5.54). Other variables that remained as predictors in the final model were a low birth rate (aOR, 7.35; 95% CI, 1.73-31.20), negative maternal attitude (aOR, 3.31; 95% CI, 1.63-6.75), lower self-efficacy (aOR, 4.82; 95% CI, 2.43-9.57), and lower maternal education level (aOR, 2.87; 95% CI, 1.03- 8.03). The IDIs and FGD observed the importance of the father's support of the mother and EBF. The qualitative exploration revealed a lack of knowledge about EBF as a parental support barrier.

CONCLUSION

Paternal support is important for EBF. Paternal involvement in EBF planning encouraged themother to continue. Plans that include fathers in breastfeeding education may help increase paternal support.

Breast milk expression as a challenge for mothers of premature infants

The aim of this study was to examine the psychometric properties of the 11-item Breast Milk Expression Experience Scale and determine the level of breast milk expression experience of mothers after preterm delivery in Turkey. 165 mothers who agreed to participate between February 2019 and March 2020 used the Breast Milk Expression Experience Scale (BMEE-S). The general Cronbach alpha coefficient was 0.82 for the BMEE-S. The fit indices calculated by confirmatory factor analysis were χ² (41) = 87.95, p = .00003, χ^2/sd = 2.15, GFI = 0.91, NNFI = 0.93, CFI = 0.95, RMSEA = 0.08 and SRMR = 0.078. The BMEE-S three-factor structure was verified by the confirmatory factor analysis. The BMEE-S was a valid and reliable instrument for mothers of preterm infants. Multiparity and high-risk pregnancy history negatively affected the milk expression experience, whereas spousal support positively affected it.Impact statementWhat is already known on this subject? The risk of infectious diseases, obesity, diabetes, and impaired intellectual development increases in children who do not breast milk (Verduci et al. 2014). International breastfeeding guidelines recommend supporting all mothers to start breastfeeding within one hour of birth, and counselling mothers who are separated from their babies about expressing milk.What the results of this study add? The breast milk expression experience scale is a valid and reliable tool for women who give preterm birth and express milk. The experience of expressing breast milk can affect the amount of milk that passes from mother to baby. Multiparity and high risk pregnancy history of mothers negatively affects the milk expression experience while husband support positively affects the milk expression experience.What the implications are of these findings for clinical practice and/or further research? Our study provides a quantitative examination of the experiences of mothers who are separated from their babies. The BMEE-S should be adapted to different cultures and the experiences of mothers in this process should be determined.

Breastfeeding practices in neonatal wards in Spain. Neo-BFHI international survey

INTRODUCTION

In 2017, a worldwide survey was conducted on compliance with the practices promoted by Neo-BFHI (Baby-friendly Hospital Initiative expansion to neonatal wards).

OBJECTIVE

To present the results of the Spanish wards that participated in the global survey and compare them with those obtained internationally.

MATERIAL AND METHODS

Cross-sectional study through a survey on compliance with the Neo-BFHI ("Three basic principles", "Ten steps adapted to neonatal wards" and "the compliance with the International Code of Marketing of Breast-milk Substitutes" and subsequent relevant World Health Assembly resolutions). Compliance was calculated as the mean in each indicator and a final mean score for each neonatal unit. For the partial and final scores for each country and at the international level, the median was used. All scores ranged between 0 and 100.

RESULTS

The response rate in Spain was 90%. The range of the national mean for neonatal wards were from 37 to 99, with no differences in the final score according to the level of care. The global score for Spain (72) is below the international median (77) and this also occurs in 8 of 14 items. The neonatal wards from BFHI designated hospitals, obtained a significantly higher mean global score, and in 9 of 14 items than the non-accredited ones.

CONCLUSIONS

Both international and national results indicate an improvement in breast feeding practices in neonatal units. The benefits of the BFHI accreditation of maternity reach neonatal wards. Spain has several key points below the international score.

The Baby-friendly Hospital Initiative for neonatal wards. A mini review

The Baby-friendly Hospital Initiative for Neonatal Wards (Neo-BFHI) is an expansion of the WHO/UNICEF Ten Steps to Successful Breastfeeding to address the needs of infants and families in all levels of neonatal care. The Neo-BFHI includes Three Guiding Principles as basic tenets, Ten Steps to protect, promote and support breastfeeding closely following the original Baby-friendly Hospital Initiative, and adherence to the International Code of Marketing of Breast-milk Substitutes. In 2020, the WHO/UNICEF published recommendations for breastfeeding small, sick and preterm newborns that aligns with the Neo-BFHI. Conclusion: This mini review provides a brief description of the content in the Neo-BFHI.

Exclusive breastfeeding of full-term infants during the first 6 months after discharge from a neonatal unit in China: A cross-sectional study

OBJECTIVES

To elucidate breastfeeding patterns, the reasons for stopping exclusive breastfeeding, and the sociodemographic characteristics associated with exclusive breastfeeding of full-term infants during the 6 months after discharge from a neonatal unit in China.

METHODS

This cross-sectional study included mothers of full-term infants who were discharged from the 40-bed neonatal unit (level IIA) of a tertiary hospital in Hunan province, China between August 2019 and September 2020. Information on breastfeeding patterns was collected through telephone interviews with the mothers 6 months after their infants had been discharged from the neonatal unit. Binary logistic regression was used to determine the factors associated with exclusive breastfeeding.

RESULTS

This study included 489 mother-infant dyads. At 6 months after discharge, 51.5% of mothers were exclusively breastfeeding, 29.0% of mothers were partially breastfeeding, and 19.4% of mothers were not breastfeeding. The most common reason for stopping breastfeeding was "poor milk supply" (81.2%). Factors associated with exclusive breastfeeding included multiparity, exclusive breastfeeding before the hospitalization, providing breast milk to the hospitalized infant, and a high level of maternal education.

CONCLUSIONS

In the Chinese culture, mothers who experienced multiparity and higher-level education were more likely to breastfeed their infants to 6 months after discharge from the neonatal unit. In addition, infants who were exclusively breastfed before and during hospitalization were also more likely to be exclusively breastfed after discharge. The results will help inform future research aimed at identifying interventions to reduce early breastfeeding cessation.

Webcam use in German neonatological intensive care units: an interview study on parental expectations and experiences

BACKGROUND

To bridge the physical distance between parents and children during a neonatal intensive care unit (NICU) stay, webcams are used in few German NICUs. They allow parents to view their infant even when they cannot be present on the ward. The aim of the study was to explore the factors for and against webcam use that parents with or without webcam use encountered.

METHODS

Guideline-based, semi-structured qualitative interviews were conducted in the period from September 2019 to August 2020. Interview transcripts were analysed using a category-based content analysis. The categories were generated in a combined deductive-inductive procedure.

RESULTS

We interviewed 33 mothers and seven fathers. Parents with webcam experience emphasised positive aspects concerning their webcam use. Factors that increased webcam acceptance included feeling certain about the child's well-being and an increased sense of proximity. Only a few critical voices emerged from parents who had webcam experience, e.g. regarding privacy concerns. Parents who had no experience with webcam use showed ambivalence. On the one hand, they expressed a positive attitude towards the webcam system and acknowledged that webcam use could result in feelings of control. On the other hand, reservations emerged concerning an increase of mental stress or a negative influence on parental visitation behaviour.

CONCLUSION

In addition to the parents' positive experiences with webcam use, results show a need within parents who lacked webcam experience. Despite some criticism, it was evident that webcam use was primarily seen as an opportunity to counteract the negative consequences of separation in the postnatal phase.

TRIAL REGISTRATION

The Neo-CamCare study is registered at the German Clinical Trials Register.

DRKS-ID

DRKS00017755 . Date of Registration in DRKS: 25-09-2019.

[Breastfeeding practices in neonatal wards in Spain. Neo-BFHI international survey]

INTRODUCTION

In 2017, a worldwide survey was conducted on compliance with the practices promoted by Neo-BFHI (Baby-friendly Hospital Initiative expansion to neonatal wards).

OBJECTIVE

Present the results of the Spanish wards that participated in the global survey and compare them with those obtained internationally.

MATERIAL AND METHODS

Cross-sectional study through a survey on compliance with the Neo-BFHI ("Three basic principles", "Ten steps adapted to neonatal wards" and "the compliance with the International Code of Marketing of Breast-milk Substitutes" and subsequent relevant World Health Assembly resolutions). Compliance was calculated as the mean in each indicator and a final mean score for each neonatal unit. For the partial and final scores for each country and at the international level, the median was used. All score ranged between 0 and 100.

RESULTS

The response rate in Spain was 90%. The range of the national mean for neonatal wards were from 37 to 99, with no differences in the final score according to the level of care. The global score for Spain (72) is below the international median (77) and this also occurs in 8 of 14 items. The neonatal wards from BFHI designated hospitals, obtained a significantly higher mean global score, and in 9 of 14 items than the non-accredited ones.

CONCLUSIONS

Both international and national results indicate an improvement in breastfeeding practices in neonatal units. The benefits of the BFHI accreditation of maternity reach neonatal wards. Spain has several key points below the international score.

Evaluation of an e-Learning Breastfeeding Program for Postpartum Mothers of Moderately High-Risk Newborn Infants Admitted to the Special Care Nursery

Because of a lack of proper breastfeeding education to mothers and the visitation policy in the special care nursery, breastfeeding initiation and maintenance can be very challenging for both the mother and her infant who is admitted to the neonatal special care nursery after birth. Difficulties associated with forming initial bonds may contribute to some mothers changing their mind about their initially chosen feeding method. The aim of this quasi-experimental study was to evaluate the effectiveness of an e-learning breastfeeding program on maternal breastfeeding outcomes. Thirty-four mothers in the comparison group received routine care; 34 in the intervention group received an e-learning breastfeeding program and routine care. The program included 28 modules of different topics downloaded to a personal tablet computer. Each module elaborated on a breastfeeding issue and provided video clips to show practice steps. During the mothers' 3- to 5-day stay in the postpartum unit, they could repeatedly watch selected topics related to their situations at their own pace. After adjusting for each infant's birth weight, mothers in the intervention group had better attachment to their infants, greater perceived nurse support, and a higher exclusive breastfeeding rate than mothers in the comparison group. Using a tablet computer device to disseminate breastfeeding education is a feasible and supplemental method for postpartum mothers whose infants are in the special care nursery. Through the demonstrated situations, mothers are better prepared to understand their high-risk infants and the situations they may encounter during breastfeeding.

Breast milk expression for premature infant in the neonatal intensive care unit: A review of mothers' perceptions

OBJECTIVE

To identify the existing literature on mothers' perception towards the impact of expressing breast milk for their premature infant in the neonatal intensive care unit.

METHOD

Guided by the PRISMA Statement review checklist, a systematic review of the Scopus and Web of Science database has identified 10 related studies. The articles were assessed and analyzed after evaluated using The Joanna Briggs Institute Critical Appraisal tools (JBI). Thematic analysis was obtained after using Nvivo software as a tool for data analysis by author.

RESULT

Further review of these articles resulted in three main themes-maternal changes during expressing breast milk, pumping challenges and impact of motivation factors to initiating lactation.

CONCLUSION

Expressing breast milk should be recognized as an important way to restructure motherhood with a preterm infant in NICU. However, maintaining expressed breast milk during preterm infants' treatment period in NICU may increase stress and difficulties for some mothers. Some recommendations are emphasized in relation to the need for more qualitative studies in this issue, which is to have a specific and standard systematic review method for guide research synthesis in context of climate change adaptation.

A randomized interventional study to promote milk secretion during mother-baby separation based on the health belief model: A consort compliant

BACKGROUND

Breast milk is the most important nutrition for premature babies, but mothers of premature infants have difficulty in initiating and sustaining lactation. Breastfeeding infants who are separated with mothers have decreased morbidity. Nevertheless, such decrease is limited due to insufficient milk supply resulting from mother-baby separation during lac.

OBJECTIVE

To evaluate the effect of intervention methods based on the health belief model on promoting the secretion of milk among mothers who were separated with their babies.

METHODS

In this prospective, randomized controlled clinical trial, we enrolled 260 separation mothers between September 26, 2016 and March 7, 2017, in a 3rd-grade women and children hospital of Chengdu. The mothers all had cesarean delivery and were randomized into 2 groups: the intervention group (educated by investigators based on the health belief) and the control group (routinely educated by obstetric nurses). Data on the onset of lactation and the milk volume during 3 days postpartum were collected. The breast swelling rate within 3 days postpartum and the exclusive breastfeeding rate at 42 days postpartum were compared. The psychologic scores of separation maternal in both groups were assessed with State-Trait Anxiety Inventory at the 3rd day postpartum.

RESULTS

Compared with the control group, the intervention group had significantly earlier lactation time (P < .01), significantly larger milk volume (P < .01) during 24, 24 to 48, and 48 to 72 hours, and significantly lower psychologic scores (P < .01) at the 3rd-day postpartum.The onset of lactation among mothers who initiated milk expression within 1 hour after childbirth were earlier than those who initiated milk expression between 1 and 6 hours (P < .01); the milk volume within 24-hour postpartum did not differ significantly between the 2 groups (P > .05). However, the milk volume of the early-expression group (<1 hour) was significantly higher than that of the late-expression group (1-6 hours) during 24 to 48 and 48 to72 hours (P < .05).The breast swelling rate of separation mothers within 3 days postpartum in the intervention group was lower than that in the control group (P < .05). The exclusive breastfeeding rate of mothers in the intervention group was significantly higher than that in the control group (59% vs 35%; P < .01) at 42 days postpartum.

CONCLUSION

Nursing intervention based on the health belief model can stimulate milk secretion in mothers who were separated with their babies.

"I Had One Job and That Was To Make Milk"

BACKGROUND

For very-low-birth-weight (VLBW) infants, breastfeeding may no longer be an immediate option. Mothers often turn to mechanically expressing their milk with a breast pump to provide their infants human milk. Research aim: This study aimed to describe mothers' experiences expressing milk for their VLBW infants in a level 3 neonatal intensive care unit.

METHODS

Qualitative, phenomenological methods were used to better understand the milk expression experiences of 17 mothers of VLBW infants. In-depth interviews were audio-recorded and transcribed verbatim. Transcripts were analyzed using Colaizzi's seven-step protocol, and themes were identified to illustrate the lived experience of the mothers.

RESULTS

Five global themes emerged from interviews with mothers. However, this article focuses on one global theme, "I had one job and that was to make milk," and the supporting subthemes: (1) "I was heartbroken," (2) "Pumping is a full-time thing," and (3) "I literally sacrificed nights."

CONCLUSION

This study provides insight into the complex experience that mothers in the southeastern United States undergo when expressing milk for their VLBW infants.

Effectiveness of a nurse educational oral feeding programme on feeding outcomes in neonates: protocol for an interrupted time series design

INTRODUCTION

Oral feeding is a complex physiological process. Several scales have been developed to assess the ability of the neonate to begin suck feedings and assist caregivers in determining feeding advancement. However, feeding premature neonates remains an ongoing challenge and depends above all on caregivers' feeding expertise. We will evaluate the effect of a nurse training programme on the achievement of full oral feeding with premature neonates.

METHODS AND ANALYSIS

The study design will be an interrupted time series design with 3 phases: (1) A 6-month baseline period; (2) a 22-month intervention period and (3) a 6-month postintervention period. The intervention will consist of an educational programme, for nurses and assistant nurses, on feeding patterns in neonates. The training modules will be composed of a 2-day conference, 2 interactive multidisciplinary workshops, and routine practice nurse coaching. A total of 120 nurses and 12 assistant nurses, who work at the neonatal unit during the study period, will participate in the study. All premature neonates of <34 weeks postmenstrual age (PMA) will be included. The primary outcome will be the age of tube withdrawal PMA and chronological age are taken into account. The secondary outcomes will be the transition time, length of hospital stay, competent suckle feeding without cardiorespiratory compromise, rate of neonates presenting with feeding issues or feeding rejection signs, and current neonatal pathologies or deaths during hospital stay. A segmented regression analysis will be performed to assess the impact of the programme.

ETHICS AND DISSEMINATION

Approval for the study was obtained from the Hospital Ethics Committee, and the Institutional Review Board, as well as the French Data Protection Agency. The findings from the study will be disseminated through peer-reviewed journals, national and international conference presentations and public events.

TRIAL REGISTRATION NUMBER

NCT02404272 (https://clinicaltrials.gov).

"It's Somebody Else's Milk": Unraveling the Tension in Mothers of Preterm Infants Who Provide Consent for Pasteurized Donor Human Milk

BACKGROUND

Pasteurized donor human milk (DHM), rather than preterm infant formula, is recommended for premature infants when mother's milk is not available.

OBJECTIVE

This study explored the maternal decision-making process in providing consent for DHM feedings.

METHODS

In-depth semistructured interviews were conducted with 20 mothers of premature (mean gestational age = 27 weeks, birth weight = 942 grams) infants hospitalized in the neonatal intensive care unit (NICU) in this qualitative, descriptive study. Conventional content analysis was used to analyze the data.

RESULTS

Although only 1 mother had any previous knowledge of DHM, all mothers provided consent for DHM because they "wanted what is best for my baby." Mothers trusted that DHM was better than formula when their infant's feeding requirements exceeded their own milk supply. However, most mothers described a tension between wanting their infants to receive only "their" milk and DHM being "somebody else's milk." This desire to be the only provider of human milk was more common than concerns about the quality and safety of DHM. The mothers' tension was mediated by trusting the NICU clinicians' recommendations, having adequate time to make an informed decision, observing the positive outcomes of DHM, and feeling empowered that they made the best decision for their infant.

CONCLUSION

The experiences of these mothers reflect the importance of approaching mothers for consent only when DHM is needed, respecting mothers' beliefs and values about DHM, and providing help in mediating any tension with regard to their infants receiving "somebody else's milk."

A Test of Kangaroo Care on Preterm Infant Breastfeeding

OBJECTIVE

To test the effects of kangaroo care (KC) on breastfeeding outcomes in preterm infants compared with two control groups and to explore whether maternal-infant characteristics and the mother's choice to use KC were related to breastfeeding measures.

DESIGN

Secondary analysis of a multisite, stratified, randomized three-arm trial. The treatment groups used KC, auditory-tactile-visual-vestibular (ATVV) intervention, or received preterm infant care information.

SETTING

Neonatal intensive care units from 4 hospitals in the United States from 2006 to 2011.

PARTICIPANTS

Racially diverse mothers (N = 231) and their preterm infants born weighing less than 1,750 g.

METHODS

Mothers and their infants were enrolled once the infants were no longer critically ill, weighed at least 1,000 g, and could be safely held outside the incubator by parents. Participants were instructed by study nurses; those allocated to the KC or ATVV groups were asked to engage in these interactions with their infants for a minimum of 3 times a week in the hospital and at home until their infants reached age 2 months adjusted for prematurity.

RESULTS

Feeding at the breast during hospitalization, the duration of postdischarge breastfeeding, and breastfeeding exclusivity after hospital discharge did not differ statistically among the treatment groups. Regardless of group assignment, married, older, and more educated women were more likely to feed at the breast during hospitalization. Mothers who practiced KC, regardless of randomly allocated group, were more likely to provide their milk than those who did not practice KC. Breastfeeding duration was greatest among more educated women.

CONCLUSION

As implemented in this study, assignment to the KC group did not appear to influence the measured breastfeeding outcomes.

Preterm Infants' Mothers' Experiences With Milk Expression and Breastfeeding: An Integrative Review

BACKGROUND

Preterm infants' mothers face several challenges when providing critical breast milk for their infants; therefore, sensitive and evidence-based counseling and support are needed. However, a general view of the experiences preterm infants' mothers can face during their infants' hospitalization and after discharge is lacking.

PURPOSE

The aim of this integrative review was to explore practical and emotional experiences of preterm infants' mothers with respect to breast milk expression and breastfeeding, from the birth of the preterm infant, during the neonatal intensive care unit (NICU) stay, and postdischarge until the cessation of breastfeeding.

METHODS/SEARCH STRATEGY

A systematic literature search from MEDLINE, CINAHL, PsycInfo, and Cochrane databases were performed. The search resulted in 20 qualitative and 3 quantitative studies. The data were analyzed by thematic analysis.

FINDINGS

Coping was the central theme in mothers' experiences. The benefits of breast milk served both as a supportive factor and an obstructive factor for the mothers, and breastfeeding was used to rebuild connection and motherhood. Simultaneously, the mothers needed to cope with new demands, interfering NICU environment, demanding expressing, and difficulties with breastfeeding.

IMPLICATIONS FOR PRACTICE

Expressing and breastfeeding are important for the mothers to contribute to their infants' care and to rebuild the interrupted connection. Evidence-based and sensitive informational and practical counseling are vital for the mothers. Intensive emotional support is important during encountered problems and during cessation.

IMPLICATIONS FOR RESEARCH

Future research is needed about mothers' experiences using supplementation methods, test-weighing, exploring experiences of mothers of late-preterm infants, and the validity of the concept of coping with this phenomenon.

The Association of Low Social Support with Breast Milk Expression in Low-Income Mother-Preterm Infant Dyads

BACKGROUND

Premature infants benefit from receiving expressed breast milk (BM), but expressing breast milk is difficult for new mothers. Little is known about mothers' social support and BM expression during the premature infant's hospital stay.

OBJECTIVE

We examined whether low maternal social support was associated with breast milk expression initiation and low breast milk expression among low-income mothers of premature infants.

METHODS

Maternal intake interview data and daily infant data on proportion of nutrition from BM during hospitalization were analyzed from a larger randomized trial testing a developmental intervention on 181 mother-premature infant dyads with at least 2 of 10 social-environmental risks. Multivariable modified Poisson regression was used to examine the relationship between social support (Personal Resources Questionnaire 2000; dichotomized as low for lowest quartile), initiation (any breast milk expressed vs none), and low breast milk expression (if BM was < 30% of infant total milk/formula intake during hospitalization).

RESULTS

Breast milk expression was initiated by 70.2% of mothers, and 32.3% of those mothers had low breast milk expression. In adjusted multivariable analyses, social support did not relate to the initiation of breast milk expression but was significantly associated with low breast milk expression among mothers who initiated (adjusted relative risk = 1.57; 95% confidence interval, 1.00-2.47).

CONCLUSION

Low social support was not associated with initiation but was associated with low breast milk expression during hospitalization. Interventions to enhance social support for mothers of premature infants, especially those reporting low social support from family and friends, may increase in-hospital expression and long-term breastfeeding.

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

BACKGROUND

Feeding breastmilk to premature infants decreases morbidity but is often limited owing to an insufficient milk supply and delayed attainment of lactogenesis stage II. Early initiation of milk expression following delivery has been shown to increase milk production in mothers of very low-birth-weight (VLBW) infants. Although recommendations for milk expression in this population include initiation within 6 hours following delivery, little evidence exists to support these guidelines. This study compared milk volume and timing of lactogenesis stage II in mothers of VLBW infants who initiated milk expression within 6 hours following delivery versus those who initiated expression after 6 hours.

SUBJECTS AND METHODS

Forty mothers of VLBW infants were grouped according to when they initiated milk expression following delivery. Group I began milk expression within 6 hours, and Group II began expression after 6 hours. Milk volume was measured daily for the first 7 days and on Days 21 and 42. Timing of lactogenesis stage II was determined through mothers' perceptions of sudden breast fullness.

RESULTS

Group I produced more breastmilk during the initial expression session and on Days 6, 7, and 42. No difference in timing of lactogenesis stage II was observed. When mothers who began milk expression prior to 1 hour following delivery were removed from analysis, benefits of milk expression within 6 hours were no longer apparent.

CONCLUSIONS

Initiation of milk expression within 6 hours following delivery may not improve lactation success in mothers of VLBW infants unless initiated within the first hour.

Validity and reliability of breastfeeding advice and coping with breastfeeding instruments

PURPOSE

To pilot two instruments: Breastfeeding Advice and Coping with Breastfeeding in NICU settings.

DESIGN

Psychometric testing of the Breastfeeding Advice and Coping with Breastfeeding instruments.

SAMPLE

Mothers (N = 47) with singleton or twin preterm (≤36 + 6 gestation weeks) infant(s) (N = 55) at discharge collected from seven NICUs in Finland.

MAIN OUTCOME VARIABLES

The validity and reliability of two instruments: Breastfeeding Advice measuring the quality of breastfeeding counseling and Coping with Breastfeeding measuring the mothers' experienced ability to cope with breastfeeding issues.

RESULTS

Infants' mean gestation age was 32.5 weeks at birth. The items of the instruments were supported by previous studies, demonstrating content validity. There was a significant correlation (r = .72, p < .001) between Breastfeeding Advice and Coping with Breastfeeding, indicating constructor validity. Evidence for predictive validity was not found. Good reliability for internal consistency of the Breastfeeding Advice (Cronbach's α = .86) and Coping with Breastfeeding (Cronbach's α = .85) was found.

The birth of the GEMs group: implementation of breastfeeding peer support in a children's hospital

The need to support and promote breastfeeding is unquestionable. The World Breastfeeding Week 2013 theme, "Breastfeeding Support: Close to Mothers," focuses on "breastfeeding peer counseling." Mother support groups are traditionally community-based and little is published about peer-to-peer support for mothers who have critically ill newborns. This study describes the development of a support group established in a children's hospital. The Group of Empowered Mothers focuses on a unique population of mothers (those with critically ill hospitalized infants) and involves 3 basic tenets: healthcare provider support; mother-to-mother support; and Certified Breastfeeding Consultant Support.

Taiwanese parents' perceptions of their very low-birth-weight infant with developmental disabilities

This study explores the perceptions and experiences of Taiwanese parents in coping with the unfolding evidence of a disability, their response to the official diagnosis, and their views about their child's developmental disability. This descriptive qualitative study is a partial analysis of data from a larger study including 19 Taiwanese parents of very low-birth-weight infants with developmental disability at 6 and 12 months of corrected age. Four themes were generated: uncertainty and worry about developmental progress, search for meaning and supernatural will, desire for normality and attitude toward services, and finding a balance point in family life and relationships. The parents of very low-birth-weight infants face uncertainty about developmental and other potential problems in the infant's early age. Adequate information related to infant development needs to be integrated into follow-up clinic and early intervention services. Early intervention programs should not only focus on the needs of these infants but also provide support and care to the whole family. Understanding parental beliefs and values toward developmental disabilities can help neonatal and pediatric professionals to provide optimal early intervention to these families.

Providing mother's own milk in the context of the NICU: a paradoxical experience

BACKGROUND

Mothers of very preterm infants continue to face challenges related to providing their expressed breast milk in the neonatal intensive care unit (NICU).

OBJECTIVE

This qualitative study sought to understand the experience of mothers of hospitalized very preterm infants related to their daily pumping routine during the NICU stay.

METHODS

Fourteen women who were pumping breast milk for their hospitalized infants were interviewed. Sequential, semistructured, audiotaped individual interviews were conducted at 2 different time points: within 2 weeks following delivery when the mothers were pumping only, and 4 to 6 weeks once breastfeeding had been initiated.

RESULTS

The central themes found were: becoming a "mother-interrupted" and negotiating a paradoxical experience of separation and connection. Unique to these findings were the paradoxical view of the pump as both a wedge and a link to their infants, the intense dislike the mothers had for the tasks required to provide their expressed breast milk, and diversionary tactics used during pumping sessions.

CONCLUSION

The complexity of thoughts, actions, and behaviors revealed in the mothers' narrative accounts provides a guide to direct future breastfeeding interventions and management.

"I have faith in my milk": the meaning of milk for mothers of very low birth weight infants hospitalized in the neonatal intensive care unit

BACKGROUND

Mothers who deliver a premature infant often choose to provide milk because it is the "one thing that only the mother can do" to optimize her infant's outcome, helps mothers feel a connection with their infants, and helps relieve the guilt associated with the preterm birth.

OBJECTIVE

The purpose of this study was to describe the meaning of milk for mothers who are providing milk for their very low birth weight (VLBW; < 1500 g) infants hospitalized in the neonatal intensive care unit (NICU).

METHODS

Using a qualitative descriptive design, in-depth semistructured interviews were conducted with 23 mothers of VLBW infants hospitalized in a level III NICU. Mothers were asked to share their perceptions about what providing milk meant to them.

RESULTS

Mothers had faith in the healing properties of their milk and equated providing milk with "giving life" to their infants, mitigating the effects of complications, keeping their infants healthy and stable, and helping themselves address the feelings of failure and guilt associated with the premature birth. Mothers' faith in their milk to achieve these outcomes was a maternal motivator to continue pumping, even for mothers who had not intended to provide milk or who experienced the paradox of disliking pumping but wanting to provide their milk.

CONCLUSION

The experiences of these mothers reflect the importance of acknowledging mothers' faith in the healing properties of their milk as a motivating factor for sustaining lactation while coping with the stress and anxiety inherent during the infant's NICU hospitalization.

Psychometric testing of the modified breastfeeding self-efficacy scale (short form) among mothers of ill or preterm infants

OBJECTIVE

To psychometrically assess the modified Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) among mothers of ill or preterm infants.

DESIGN

Methodological study.

SETTING

Three neonatal intensive care units (NICUs) located in two hospitals in a central Canadian city.

PARTICIPANTS

One hundred forty-four (144) breastfeeding mothers of ill or preterm infants.

METHODS

Mothers completed the BSES-SF modified for mothers of ill or preterm infants, the Hill and Humenick (H&H) Lactation Scale, and demographic questions.

RESULTS

The Cronbach's alpha coefficient for internal consistency for the BSES-SF revised for mothers of ill or preterm infants was 0.88. Construct validity was assessed using comparison of contrasted groups (mothers who continued to breastfeed and those who discontinued) and correlation with the construct of maternal perceptions of insufficient milk supply. Support for predictive validity was demonstrated through significant mean differences between mothers who were breastfeeding (M = 83.44, SD = 8.23) and those who discontinued breastfeeding and breast pumping (M = 75.51, SD = 10.08) at 6-weeks post-infant hospital discharge.

CONCLUSION

Demographic response patterns suggest that the modified BSES-SF is a unique tool to identify breastfeeding mothers of ill or preterm infants at risk of prematurely discontinuing. This study provides evidence that the modified BSES-SF may be a valid and reliable measure of breastfeeding self-efficacy among a sample of mothers of ill or preterm infants.

The effectiveness of early intervention on paternal stress for fathers of premature infants admitted to a neonatal intensive care unit

AIM

This article is a report of a study to evaluate the effectiveness of an intervention on fathering ability, perceived nurse's support and paternal stress after a preterm infant's admission to a neonatal intensive care unit.

BACKGROUND

The birth of a premature infant who is admitted to a neonatal intensive care unit is a stressful experience. Due to the maternal postpartum practice in Taiwan, the father is the main visitor of the infant during the first few weeks, but interventions have rarely focused on the father.

DESIGN

A historical comparison study.

METHODS

Between August 2009-July 2010, 35 fathers in the comparison group received routine care; 34 fathers in the intervention group received a booklet designed for the fathers during their visits to the neonatal intensive care unit and nurses' guidance based on the contents of the booklet. Fathering ability, perceived nurse's support and paternal stress were measured.

FINDINGS

The intervention group had a significantly higher fathering ability and perceived nurse support than the comparison group. In the intervention group, the increased fathering ability reduced paternal stress. After adjusting for severity of illness, an significant moderating effect of perceived nurse support on the relationship between fathering ability and paternal stress was found, accounting for 59·5% of variance.

CONCLUSION

Designing a supportive intervention which provides informational, emotional, instrumental, and esteem support for the father can effectively empower his fathering ability and reduce his stress. The intervention should be initiated from the early admission of the premature infant to the neonatal intensive care unit.

Predictors of breastfeeding and breastmilk feeding among very low birth weight infants

OBJECTIVE

This study investigated associations between maternal and infant factors and breastfeeding practices in infants born <30 weeks gestation in the neonatal intensive care unit (NICU).

STUDY DESIGN

This study was a retrospective cohort. Mother and infant characteristics were investigated for associations with breastfeeding outcomes using multivariate logistic regression.

RESULTS

Seventy-eight percent of infants initiated breastmilk feedings, 48% of those continued to have breastmilk at discharge, and 52% were breastfed in the hospital. The average duration of breastmilk feedings was 43 days. Mothers who were married and had a multiple-infant birth were more likely to initiate breastmilk feeds, African American mothers and younger mothers had less success with maintaining breastmilk feeds until hospital discharge, and African American mothers and mothers of lower socioeconomic status were less likely to participate in direct breastfeeding in the NICU.

CONCLUSIONS

Infant factors, such as birth weight and gestational age, were not associated with breastfeeding behaviors. Mothers can succeed with breastfeeding the premature infant. By understanding what maternal groups are at risk for breastfeeding failure, targeted interventions in the NICU can be implemented.

Breast milk expression and maintenance in mothers of very low birth weight infants: supports and barriers

The study objective was to identify patterns of factors that supported or hindered initiation of breast milk expression and maintenance of breast milk production after the birth of a very low birth weight (VLBW) infant in a sample of US women with varied prenatal infant feeding intentions. In-depth interviews were conducted 1 to 6 months after delivery in 32 women who initiated breast milk expression after encouragement from hospital staff. Pregnancy complications, anxiety regarding their infant's health, and lack of privacy interfered with initiation of milk expression. After hospital discharge, using manual or small electric breast pumps, travel to the neonatal intensive care unit, return to work, and difficulty with time management interfered with maintenance of breast milk production. Family support, positive attitudes toward pumping, and anticipation of breastfeeding supported maintenance of breast milk production. From these data emerge points of intervention where additional support could improve mothers' experiences and increase duration of breast milk feeding.