Aiming to be a breastfeeding mother in a neonatal intensive care unit and at home: a thematic analysis of peer-support group discussion in social media

Predictors of Direct Breastfeeding in Preterm Infants

Objective: Rates of mother's own milk (MOM) provision in the neonatal intensive care unit (NICU) vary widely, despite acceptance as the gold standard for nutrition in preterm infants. Direct breastfeeding (DBF) supports long-term provision of MOM, but factors that support DBF in preterm infants are unknown. The purpose of this study was to identify factors that predict DBF at oral feeding initiation and at NICU discharge. Methods: This was a retrospective cohort study of preterm infants born at ≤ 32 weeks who were receiving MOM at 32 weeks corrected gestational age (cohort 1) and at discharge to home (cohort 2). The primary outcomes were rates of DBF at oral feeding initiation (cohort 1) and at hospital discharge (cohort 2). We examined bivariate associations between infant characteristics, maternal sociodemographic factors, and hospital practices (e.g., lactation visit timing and frequency) with DBF outcomes and then built logistic regression models to determine the adjusted odds ratio and 95% confidence interval ([adjusted odds ratio [aOR] [95%CI]) for independent predictors of the DBF outcomes. Results: Sixty-four percent of eligible infants initiated DBF, and 51% were DBF at discharge. Sociodemographic, NICU, and lactation support factors were associated with both outcomes. Post hoc analysis showed that similar factors also influenced lactation support provision. Conclusions: Lactation support, NICU and sociodemographic variables influence DBF initiation and DBF at discharge. Interventions that optimize efficient use of available lactation support, address bias, and provide ample opportunity for DBF practice could improve rates.

Breastfeeding, Chestfeeding, and Lactating Parents' Experiences With Online Support Groups: An Integrative Review

INTRODUCTION

The aim of this integrative review is to understand (1) how parents in specific populations engage with online breastfeeding, chestfeeding, or lactation support groups, (2) how these support groups influence extended breastfeeding duration and other outcomes, and (3) whether the use of support groups by these specific populations has changed since the start of the COVID-19 pandemic.

METHODS

Of the articles identified across 4 electronic databases, 10 studies met the inclusion criteria; they were published between 2013 and 2023, written in English, and focused on the use of online peer support groups for breastfeeding, chestfeeding, and lactation support in specific populations. Eight of these studies are qualitative, 1 is a randomized controlled trial, and 1 is mixed methods.

RESULTS

Eight themes were identified: (1) overcoming lack of real world support, (2) normalization, (3) practical support, (4) emotional support and shared experiences, (5) building a bridge to in-person relationships, (6) reciprocity and activism, (7) self-efficacy and outcomes, and (8) issues with online support groups.

DISCUSSION

Specific subpopulations of breastfeeding, chestfeeding, and lactating parents and their partners found comfort in online support groups because they normalized more unique feeding practices and offered a space to provide and receive encouragement. Additionally, this review includes fathers/partners as a previously ignored subpopulation who benefit from education and support with breastfeeding, chestfeeding, and lactation. This subpopulation is also an area for expanded research on the use of online support groups by partners of lactating parents.

Breastfeeding Practice Before Bottle-Feeding: An Initiative to Increase the Rate of Breastfeeding for Preterm Infants at the Time of Neonatal Intensive Care Unit Discharge

Preterm babies who received 72 hours of breastfeeding practice before introducing a bottle had significantly higher rates of breastfeeding at the time of neonatal intensive care unit (NICU) discharge than did babies who were introduced to bottle-feeding with or before breastfeeding during the first 72 hours of oral feeding or babies who were primarily bottle-fed. There were no statistical differences in corrected gestational age (CGA) at birth, first oral feeding, or full oral feeds, in days from first to full oral feeds, or in CGA or days of life at NICU discharge.

Social Media as a Source of Medical Information for Parents of Premature Infants: A Content Analysis of Prematurity-Related Facebook Groups

OBJECTIVE

Parents are increasingly turning to social media for medical recommendations. Our objective was to systematically examine posts on Facebook for parents of infants hospitalized in the neonatal intensive care unit (NICU) to analyze how advice on medical topics was requested and given, and whether this advice was potentially medically inappropriate.

STUDY DESIGN

One hundred Facebook groups were screened for study eligibility. In each group, up to 400 posts on medical topics were evaluated. The first 10 comments of each post were classified based on content and presence of medical advice. Appropriateness of advice was evaluated by a neonatologist.

RESULTS

Of 28 groups meeting study criteria, 10 permitted access for data collection. We identified 729 posts requesting medical advice of which 29% referenced the NICU period. Posts on diagnosis and development (30 and 32% of posts, respectively) were the most common topics, and most likely to receive advice (78 and 76% of posts on these topics, respectively). We identified 238 comments containing potentially inappropriate medical advice and 30 comments recommending going against medical advice.

CONCLUSION

Parents are utilizing Facebook as a source of support and medical information. Parents are most likely to give development-related advice from their own parenting experiences. The high percentage of posts requesting advice about diagnosis and development in the post-NICU stage suggests parents seek increased anticipatory guidance.

KEY POINTS

· Parents of premature infants use Facebook to obtain medical advice.. · Advice was at times potentially medically inappropriate.. · Much advice focused on the post-NICU period..

“Breastfeeding at Night Is Awesome” Mothers’ Intentions of Continuation of Breastfeeding Extreme and Very Preterm Babies upon Discharge from a Kangaroo Mother Care Unit of a Tertiary Hospital in South Africa

Kangaroo mother care (KMC) is effective in increasing mothers’ initiation and maintenance of breastfeeding (BF) for extreme and very preterm (VLBW) infants. Although South Africa has implemented KMC for more than two decades, little is known about mothers’ perspectives on KMC. The purpose of this study was to describe the BF intentions and practices of mothers of VLBW infants at home following discharge and assess the role long stay in KMC has on their decision to BF beyond discharge. This qualitative study was conducted at the KMC unit of a tertiary hospital in Pretoria, South Africa. Focus group interviews were conducted with 38 mothers of VLBW infants who had transitioned from neonatal intensive care (NICU) to KMC. We analysed transcripts following the five steps for qualitative thematic data analysis. Mothers were knowledgeable of the importance and value of BF preterm infants and conceded that breast milk has advantages over formula. Mothers had positive feelings toward BF their preterm infants. The stay in KMC increased the direct BF of their preterm infants, mothers’ BF efficacy, and had a positive influence on mothers’ intentions to continue BF following discharge and to exclusively breastfeed for six months. Their BF intentions, efficacy, and practices were influenced by the skilful BF counselling, training, and support they received from the nursing staff. High intention to BF among these mothers is suggestive of their knowledge and confidence in BF for their VLBW infants. It is important that nursing staff in NICU and KMC appreciate the significant role they play in mothers’ readiness and confidence to breastfeed beyond discharge.

Very-low-birth-weight infant short-term post-discharge outcomes: A retrospective study of specialized compared to standard care

OBJECTIVE

Ongoing health care challenges, low breast milk intake, and the need for rehospitalization are common during the first year of life after hospital discharge for very low birth weight (VLBW) infants. This retrospective cohort study examined breast milk intake, growth, emergency department (ED) visits, and non-surgical rehospitalizations for VLBW infants who received specialized post-discharge follow-up in western Canada, compared to VLBW infants who received standard follow-up in central Canada.

DESIGN

Data were collected from two neonatal follow-up programs for VLBW babies (n = 150 specialized-care; n = 205 standard-care). Logistic regression was used to examine odds of breast milk intake and generalized estimating equations were used for odds of growth, ED visits and non-surgical rehospitalization by site.

RESULTS

Specialized-care was associated with enhanced breast milk intake duration; the odds of receiving breastmilk at 4 months in the specialized-care cohort was 6 times that in the standard-care cohort. The specialized-care cohort had significantly more ED visits and rehospitalizations. However, for infants with oxygen use beyond 36 weeks compared to those with no oxygen use, the standard-care cohort had over 7 times the odds of rehospitalization where as the specialized-care cohort with no increased odds of rehospitalization.

CONCLUSION

Specialized neonatal nursing follow-up was associated with continued breastmilk intake beyond discharge. Infants in the specialized-care cohort used the ED and were hospitalized more often than the standard-care cohort with the exception of infants with long term oxygen needs.

Mothers of children with down syndrome: A qualitative study of experiences of breastfeeding and breastfeeding support

BACKGROUND

Children with down syndrome (DS) are breastfed to a lesser extent than infants in general, despite research showing that it is possible for these children to breastfeed successfully.

AIM

The aim was to describe how mothers of children with DS experienced breastfeeding and breastfeeding support from healthcare professionals.

METHOD

A qualitative study with an inductive approach. Individual interviews were performed with seven mothers from southern Sweden. The interviews were analysed using qualitative content analysis.

RESULT

The mothers felt that the support varied, as some healthcare professionals were supportive, while others had preconceptions regarding breastfeeding and DS. They also experienced that the guidelines could be an obstacle in the encounter with healthcare professionals thereby affecting the possibility to establish breastfeeding. Information and support were important to the mothers, and when insufficient, they turned to the internet for help.

CONCLUSIONS

Mothers felt that healthcare professionals were bound to ward routines and guidelines, which could be contrary to their own and the family's wishes. They were also sensitive to the attitudes of healthcare professionals, which can affect their own state of mind. Healthcare professionals' preconceptions regarding breastfeeding and DS have not changed, despite research showing that infants with DS can breastfeed successfully. Increased awareness of the possibility to breastfeed an infant with DS is needed to provide better support to mothers.

Breastfeeding initiation, duration, and experiences of mothers of late preterm twins: a mixed-methods study

Background

Twins and late preterm (LPT) infants are at an increased risk of being breastfed to a lesser extent than term singletons. This study aimed to describe the initiation and duration of any and exclusive breastfeeding at the breast for mothers of LPT twins and term twins during the first 4 months and to explore the breastfeeding experiences of mothers of LPT twins.

Methods

A sequential two-sample quantitative–qualitative explanatory mixed-methods design was used. The quantitative data were derived from a longitudinal cohort study in which 22 mothers of LPT twins and 41 mothers of term twins answered questionnaires at one and four months after birth (2015–2017). The qualitative data were obtained from semi-structured interviews with 14 mothers of LPT twins (2020–2021), based on results from the quantitative study and literature. Analysis included descriptive statistics of quantitative data and deductive content analysis of the qualitative data, followed by condensation and synthesis.

Results

All mothers of LPT twins (100%) and most mothers of term twins (96%) initiated breastfeeding. There was no difference in any breastfeeding during the first week at home (98% versus 95%) and at 1 month (88% versus 85%). However, at 4 months, the difference was significant (44% versus 75%). The qualitative data highlighted that mothers of LPT twins experienced breastfeeding as complex and strenuous. Key factors influencing mothers’ experiences and decisions were their infants’ immature breastfeeding behaviors requiring them to express breast milk alongside breastfeeding, the burden of following task-oriented feeding regimes, and the lack of guidance from healthcare professionals. As a result, mothers started to question the worth of their breastfeeding efforts, leading to changes in breastfeeding management with diverse results. Support from fathers and grandparents positively influenced sustained breastfeeding.

Conclusions

Mothers of LPT twins want to breastfeed, but they face many challenges in breastfeeding during the first month, leading to more LPT twins’ mothers than term twins’ mothers ceasing breastfeeding during the following months. To promote and safeguard breastfeeding in this vulnerable group, care must be differentiated from routine term infant services, and healthcare professionals need to receive proper education and training.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-022-00507-3.

Encourage, Assess, Transition (EAT): A Quality Improvement Project Implementing a Direct Breastfeeding Protocol for Preterm Hospitalized Infants

BACKGROUND

The opportunity to establish a direct breastfeeding (DBF) relationship with a preterm infant, if desired by the mother or lactating parent, is a known driver of positive healthcare experiences. Preterm birth is an independent risk factor for early human milk (HM) cessation, and DBF at the first oral meal promotes continued DBF during hospitalization and HM duration beyond discharge. While the Spatz 10-step model for protecting and promoting HM and breastfeeding in vulnerable infants provides best practices, lack of standardized implementation results in missed opportunities to meet parents' DBF goals.

PURPOSE

To standardize clinical practices to increase DBF at the first oral meal, total DBF meals during hospitalization, and use of test weighing to measure milk transfer for preterm infants.

METHODS

Quality improvement methods were used to develop and implement Encourage, Assess, Transition (EAT): a DBF protocol for infants less than 37 weeks gestation at birth, in a level II neonatal intensive care unit.

RESULTS

Thirty-eight (45%) infants from 27.7 to 36.7 weeks of gestation initiated the protocol. The proportion of infants' DBF at first oral meal increased from 22% to 54%; mean DBF meals during hospitalization increased from 13.3 to 20.3; and use of test weighing increased by 166%.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Standardizing DBF practices with the EAT protocol increased DBF during hospitalization-a known driver of patient experience-and HM duration beyond discharge, in hospitalized preterm infants. Researchers should validate the reported benefits of EAT (increased DBF during hospitalization, use of test weighing, and improved patient experience), methods to promote passive dissemination of evidence, and sustain change.Video abstract available at: https://journals.na.lww.com/advancesinneonatalcare/pages/videogallery.aspx?autoPlay=false&videoId=61.

What are LGBTQI+ parental experiences of healthcare support and decision-making regarding infant feeding options? A grounded theory study

OBJECTIVE

To explore LGBTQI+ parental experiences regarding their interactions with healthcare professionals as a resource for feeding options during the prenatal-to-neonatal period.

STUDY DESIGN

This single-center, interview-based qualitative study of LGBTQI+ parents utilized grounded theory to identify and verify emergent themes and subthemes. We developed a conceptual framework to illustrate relationships among themes and subthemes, as well as opportunities for healthcare professionals and families to improve LGBTQI+ parental support.

RESULTS

Thematic saturation was attained after interviewing 21 parents from 12 families. Analyses revealed four main themes representing opportunities for improvement: education, continuity of care, parental engagement and open communication. Personal and interpersonal factors influenced parental experiences and decisions, which shaped ultimate feeding outcomes.

CONCLUSIONS

LGBTQI+ parents revealed challenges of establishing feeding practices that best aligned with their values and goals. Recognizing these factors can help healthcare professionals improve their counseling, engagement and support of LGBTQI+ parents.

Experiences, Motivations, and Perceived Impact of Participation in a Facebook-Based Support Group for Caregivers of Children and Youth With Complex Care Needs: Qualitative Descriptive Study

BACKGROUND

Caregivers of children and youth with complex care needs (CCNs) often require considerable support to ensure the well-being of their families. Social media present an opportunity to better support caregivers through computer-mediated communication for social support. Peer-to-peer (P2P) support groups are a way in which caregivers are accessing needed support; however, the experiences of caregivers who use these groups and the perceived impact that participation has on caregivers of children and youth with CCNs are not known.

OBJECTIVE

This study aimed to explore the experiences of caregivers of children and youth with CCNs who use a Facebook-based P2P support group to communicate, understand their motivations to use the group, and investigate its perceived impact on knowledge of programs and services and sense of community belonging among caregivers.

METHODS

A qualitative descriptive design was used to explore the experiences and perceived impact of a Facebook-based (Meta Platforms) P2P support group for caregivers of children and youth with CCNs in New Brunswick, Canada. The group was launched on the web in October 2020, during the COVID-19 pandemic, and resulted in 108 caregivers joining the group. A web-based survey was distributed, and semistructured interviews were conducted in February 2021 with a subsample of members. Thematic analysis was used to identify and report patterns related to caregivers' experiences and perceived impacts of participation.

RESULTS

A subsample of members in the Facebook group completed the web-based survey (39/108, 36.1%) and interviews (14/108, 12.9%). A total of 5 themes emerged from the interviews: safe space, informational support and direction, web-based connection with peers, impact on knowledge of programs and services, and degree of community belonging. Participants reported joining the group to obtain geography-specific information support and connect with peers. Many participants reported an improvement in their knowledge of programs and services and felt connected to the community; however, the short observation period and diversity among the caregiver population were cited as barriers to community belonging.

CONCLUSIONS

Social media present an important opportunity to facilitate the exchange of support between patients and caregivers in an accessible and curated environment. Findings from this study suggest that involvement in web-based, geography-specific P2P support groups can influence perceived knowledge of services and resources and sense of community belonging among caregivers of children and youth with CCNs. Furthermore, this study provides insight into the experiences and motivations of caregivers of children and youth with CCNs who participate in a private social media environment.

Expectations and Experiences of Spanish Primiparous Women Who Decide to Breastfeed Their Infants and Strategies for Change in 2020—A Qualitative Study

To describe the experiences and expectations of Spanish women regarding breastfeeding and the support they receive from healthcare professionals, family, and friends during the breastfeeding journey, A qualitative study using an empirical-phenomenological approach was conducted. Primiparous women that had already given birth were interviewed using a purposive and snowball sampling. In-depth interviews were conducted between 1 January and 30 April 2020. The interviews were transcribed verbatim and analysed using Haase’s adaptation of Colaizzi’s phenomenological method. We recruited 14 women who had recently become mothers. Three major themes describing experiences of infant feeding by maternal lactation were identified—institutional influences, establishing breastfeeding, and cessation of breastfeeding—as well as the following 10 categories: hospital routines, lactation concerns (amount and infant nutrition), antenatal breastfeeding decision, embarrassment to breastfeed, and normalisation of breastfeeding. Prior education and support were identified as key elements in possible breastfeeding support strategies.

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.

An integrative review on mothers' experiences of online breastfeeding peer support: Motivations, attributes and effects

Information on the experiences surrounding online breastfeeding peer support among breastfeeding mothers and its effects on breastfeeding outcomes is growing yet to be synthesized. The aim of this review was to synthesize the evidence of mothers' experiences of online breastfeeding peer support. An integrative review was conducted. Five electronic databases were searched. Two reviewers independently screened the articles for inclusion. The inclusion criteria were (1) involved original data focusing on mothers' experiences of online breastfeeding peer support, (2) participants who were mothers who were breastfeeding or had experiences of breastfeeding and (3) studies focusing on interaction and communication among mothers through online communities. In total, 14 publications met the inclusion criteria. Breastfeeding mothers turned to online groups when they felt isolated, lacked professional support or preferred online support over face-to-face support. Online breastfeeding peer support was characterized as a virtual community, with easy access, availability and a wealth of resources from actual experiences of mothers. It empowered breastfeeding mothers and resulted in changes in breastfeeding outcomes and perceptions. The positive aspects of online breastfeeding peer support have recently garnered more attention. This review provided baseline data and evidence to supplement and improve the current breastfeeding support system for breastfeeding mothers. The evidence on the effectiveness of online breastfeeding peer support for influencing breastfeeding outcomes remains inconclusive. Further empirical studies with rigorous study designs are warranted.

Predictors of early initiation of breastfeeding in Indonesia: A population-based cross-sectional survey

Introduction

Commencing breastfeeding within one hour of birth is defined as early initiation of breastfeeding (EIBF). Both the mother and child benefit from EIBF. This study aims to identify the predictors of EIBF among Indonesian women.

Methods

This paper analyses data from a weighted sample of 6,616 women collected at the Indonesia Demographic and Health Survey (IDHS) 2017.The frequency of EIBF is measured by the proportion of children born in the two years preceding the survey who received breastmilk within one hour of birth. The analysis uses bivariate and multivariate logistic regression for complex sample designs, adjusted for confounders to examine the relationship of EIBF with women’s individual, household and community level characteristics.

Results

Overall, 57% (95% CI: 54.9%-58.2%) of the children born in the two years preceding the survey had EIBF. Statistically significant (p<0.05) predictors of EIBF are women’s non-working status, second or higher order of the birth of the most recent child, average or large size of the most recent child at birth, poor status of the household and non-agricultural work of the woman’s husband; while statistically highly significant (p<0.01) predictors are skin-to-skin contact with the new-born (OR: 2.62; 95% CI: 2.28–3.00), Caesarean deliveries (OR: 0.47; 95% CI: 0.40–0.56), and skilled birth attendants (OR: 1.83; 95% CI: 1.65–2.08). Caesarean deliveries reduce the likelihood of EIBF by half compared to vaginal deliveries. Women’s age, education or rural-urban residence display no statistically significant relationship with EIBF.

Conclusion

Skin-to-skin contact, mode of delivery and type of birth attendance exert the strongest influence on EIBF in Indonesia in 2017. EIBF should be continuously promoted and supported particularly among mothers who do not have early skin-to-skin contact with their new-born, who have Caesarean deliveries and who have no skilled birth attendant.

Compensatory Health Beliefs on Breastfeeding Varying by Breastfeeding Status; A Scale Development

AIMS

To examine whether compensatory health beliefs (CHB) on breastfeeding vary as a function of breastfeeding status among mothers of infants.

METHODS

Participants included 773 women aged 18 and older (M = 32.8) who gave birth in the last two years; 445 were breastfeeding exclusively, 165 were breastfeeding partially, and 163 were not breastfeeding. They responded to a survey posted on social media sites' closed groups that focused on post-natal issues. Design was cross-sectional, with CHB as the outcome variable (14 items) and demographics and feeding status as the explanatory variables.

RESULTS

The internal reliability of the CHB scale was α = 0.87. There was a statistically significant difference in the level of CHB between non-breastfeeding women, breastfeeding women, and women who combined breastfeeding with infant formula, so that non- breastfeeding women had the highest level of CHB. There was no significant difference in CHB by either birth experience or demographic characteristics.

CONCLUSION

This study extended CHB to breastfeeding, documenting the minimization of the disadvantages of not breastfeeding by non-breastfeeding women, attempting to neutralize or reduce the cognitive dissonance between non-nursing and optimal infant care. Possible uses of the scale for counselling were suggested, both in the prenatal and post-natal period, proactively bringing forward and addressing ambivalence towards breastfeeding.

Affordances supporting mothers’ engagement in information-related activities through Facebook groups

Social networking sites have become indispensable information and communication tools in everyday life. This qualitative study investigated the information-related activities and affordances of a Facebook group for foreign mothers living in Sweden. Four key information activities were identified: posting, monitoring, commenting and searching. These activities show how the group members accessed the information resources embedded within the group in a variety of visible, invisible, active and passive modes. The article concludes with a discussion of how these different modes are facilitated by the affordances of visibility, accessibility, persistence and associations.

Does breastfeeding self-efficacy theory apply to mothers of moderate and late preterm infants? A qualitative exploration

BACKGROUND

Breastmilk feeding reduces morbidities and improves outcomes related to prematurity. However, breastmilk feeding rates in preterm infants are substantially lower than those in term infants. Breastfeeding self-efficacy theory is a social change theory, which is predictive of exclusive breastmilk feeding at 2 months postpartum in mothers of full-term infants. However, this theory has not been well explored in mothers of moderate and late preterm infants.

AIMS AND OBJECTIVES

To explore maternal experiences with feeding moderate (32^0/7 - 33^6/7  weeks' gestational age) and late preterm infants (34^0/7 - 36^6/7  weeks' GA) in neonatal intensive care units and assess applicability of breastfeeding self-efficacy theory.

METHODS

We conducted a qualitative descriptive exploration of maternal experiences with infant feeding in neonatal intensive care units. Using purposive, maximum variation sampling, we selected mothers of preterm infants born at 32^0/7 - 34^6/7  weeks, who experienced high mean differences in their BSE scores between admission and discharge. Fourteen mothers participated in semi-structured telephone interviews. Data were examined using thematic analysis. To explore and describe breastfeeding self-efficacy within the context of neonatal intensive care units, we super-imposed the four sources of information from breastfeeding self-efficacy theory onto the defined themes.

RESULTS

Three main themes emerged: (a) institutional influences, (b) relationship with the pump and (c) establishing breastfeeding, with an emphasis on the importance of direct breastfeeding at discharge. Overlaying the four sources of information from breastfeeding self-efficacy highlighted the presence of three sources of information: verbal persuasion, performance accomplishment and physiologic/affective responses. Vicarious experience was not identified in maternal experiences with infant feeding.

CONCLUSION

Our findings indicate that breastfeeding self-efficacy is an applicable theory for mothers of preterm infants.

RELEVANCE TO CLINICAL PRACTICE

Healthcare providers need to be aware of the influence that institutional culture and policies may have on maternal breastfeeding self-efficacy and breastfeeding outcomes.

Shared information practices on Facebook

Purpose

This study aims to develop an in-depth understanding of the underlying dynamics of an emergent shared information practice within a Facebook group, and the resources the group develops to sustain this practice.

Design/methodology/approach

In-depth semi-structured interviews were carried out with twenty members from the group. The findings are based on comparative analysis combined with narrative analysis and were interpreted using theories of situated learning and Community of Practice.

Findings

The study shows that although members of this multicultural mothers group endorsed different, sometimes opposing parenting practices, the group had to find common ground when sharing information. Managing these challenges was key to maintaining the group as an open information resource for all members. The group produced a shared repertoire of resources to maintain its activities, including norms, rules, shared understandings, and various monitoring activities. The shared online practice developed by the community is conceptualised in this article as an information practice requiring shared, community-specific understandings of what, when, and how information can or should be sought or shared in ways that are valued in this specific community. The findings show that this shared information practice is not static but continually evolves as members negotiate what is, or not, important for the group.

Originality/value

The research provides novel insights into the underlying dynamics of the emergence, management, and sustainability of a shared information practice within a contemporary mothers group on Facebook.

Breastfeeding preterm born infant: Chance and challenge

Background and Objectives

For preterm infants, breastmilk plays an important role in their development, but mothers encounter a number of barriers to breastfeeding. The aim of this study was to investigate breastfeeding prevalence in preterm infants and to examine factors that may face mothers when starting to feed at-breast and their impact on the result.

Methods

Women (N = 79) with preterm infants (N = 84) were interviewed within the follow-up program in Latvia during a six-month period in 2018 using the original study protocol.

Results

61.9% infants were breastfed and 38.1% were not. The median infant birth weight in breastfed group was 1730 g, the median duration of tube feeding 21 days. The median age when started to feed at-breast 33 days. Later only 40.4% infants were still feeding at-breast. A relationship was found between breastfeeding and the mother's confidence during pregnancy that she would breastfeed (P < .05). 98% mothers who began to feed at-breast, during pregnancy were confident that they would breastfeed. 54.2% women who started to breastfeed as success mentioned medical staff training, 29.2% family support.The median birth weight in the non-breastfed group was 1494 g, the median duration of tube feeding 21 days. 50% women who did not begin to breastfeed had not received enough information about breastfeeding; 17.2% during pregnancy were not confident that they would breastfeed. 38.7% women stated infants' inability to suckle as failure, 22.6% thought they had no milk. Mothers under 32 years were more likely not to breastfeed their infant (OR = 0.8, 95% CI 0.33-1.96).

Conclusion

Most mothers began to breastfeed immediately, less than half continued later. Women did not receive enough family support. Young maternal age was associated with decrease in breastfeeding. Mothers with higher education were more likely to breastfeed. Being born extremely preterm and very preterm were associated with the least chance of being breastfed.

A qualitative cross-cultural analysis of NICU care culture and infant feeding in Finland and the U.S

BACKGROUND

The benefits of family-centered care for the health and well-being of preterm infants and their families include increased parent-infant closeness, improved lactation, and positive mental health outcomes; however, it is known that the extent to which family-centered care is adopted varies by unit. This study aimed to understand how differences in neonatal care culture in two units in Finland and the U.S. were translated to parents' infant feeding experiences in the hope of improving relationally focused feeding practices in both locations.

METHODS

This qualitative, cross-sectional study utilized narrative methodologies to understand the lived experiences of 15 families hospitalized in a tertiary neonatal intensive care unit in Finland (n = 8) and the U. S (n = 7).

RESULTS

A global theme of lactation as a means or an end showed that lactation and infant feeding were framed differently in each location. The three supporting themes that explain families' perceptions of their transition to parenthood, support as a family unit, and experience with lactation include: universal early postnatal challenges; culture and space-dependent nursing support; and controlled or empowering breastfeeding experiences.

CONCLUSIONS

Care culture plays a large role in framing all infant caring activities, including lactation and infant feeding. This study found that in the unit in Finland, breastfeeding was one method to achieve closeness with an infant, while in the unit in the U.S., pumping was only an end to promote infant nutritional health. Therefore, breastfeeding coupled with closeness was found to be supportive of a salutogenic, or health-promoting, care approach for the whole family.

Barriers to Providing Mother's Own Milk to Extremely Preterm Infants in the NICU

BACKGROUND

Mothers' own milk (MOM) has more than nutritional benefits for extremely preterm infants (<28 weeks). However, mothers encounter barriers that make it difficult to provide their own milk to their extremely preterm infants.

PURPOSE

The aim of this study was to describe and understand the experiences of mothers of extremely preterm infants regarding barriers to providing their own milk during infant hospital stay in the neonatal intensive care unit (NICU).

METHODS

This study followed a qualitative, interpretative design using Gadamer's hermeneutic approach and included 15 in-depth semistructured interviews. The data were analyzed using a modified form of the steps described by Fleming.

RESULTS

Fifteen mothers of extremely preterm infants participated in the study. The following themes were extracted from the data analysis: (1) "unexpected and unusual lactation," including the subthemes "the extremely preterm birth and the decision to provide MOM," "the battle to produce milk," and "my job was to make milk"; and (2) "providing MOM to a tiny infant in an unknown technological environment," with the subthemes "the limitations of providing MOM in the NICU" and "the difficulties of having an extremely preterm infant."

IMPLICATIONS FOR PRACTICE

To provide MOM to an extremely preterm infant, there is a need for informational and practical counseling by neonatal nurses educated in breastfeeding according to mothers' requirements and emotional needs.

IMPLICATIONS FOR RESEARCH

Future research may analyze the parents' and neonatal nurses' experience about facilitators to improve MOM provision and the influence of women's sociodemographic characteristics in providing MOM to the extremely preterm infants.

"Am I doing this wrong?" Breastfeeding mothers' use of an online forum

As mothers seek out information around breastfeeding, many are turning to online message boards, listservs, or social media for advice. Babycenter.com, a parenting website with widespread use, hosts a Breastfeeding Support and Help community forum with over 140,000 users and more than one million conversation threads. The purpose of this study is to examine this online support forum to understand the information seeking and sharing practices of its users. We extracted a total of 258 original posts and 1,445 corresponding comments from Babycenter.com's breastfeeding forum posted over a 10-day period. Using content analysis, we coded the posts into 15 categories reflective of the types of information users were seeking. We then randomly selected 45 conversation threads across the most popular categories to further understand how users were sharing information. The most popular breastfeeding topics for which users sought out information included feeding challenges, supply issues, feeding schedule and duration, pumping, physical health, excretion issues, storing milk, nipple issues, and general breastfeeding questions. Participants elicited information from others using interviewing questions and built consensus around issues by agreeing with previous posts. They shared their knowledge and personal breastfeeding experiences and also provided encouragement to continue breastfeeding and overcome challenges. Online support forums are actively being used by breastfeeding mothers seeking information from others with similar experiences. This presents an important resource for breastfeeding mothers and may, therefore, be an important component of future breastfeeding interventions.

It Takes an E-Village: Supporting African American Mothers in Sustaining Breastfeeding Through Facebook Communities

BACKGROUND

Lack of breastfeeding support is a common barrier reported by African American mothers, whose breastfeeding rates remain significantly below the national average. Despite mothers' reported use of social network sites to access support on topics relating to child rearing, few studies have examined their use to exchange breastfeeding support.

RESEARCH AIMS

To describe (1) the experiences of African American mothers who participate in breastfeeding support groups on Facebook and (2) the breastfeeding beliefs, practices, and outcomes for this population of mothers.

METHODS

This was a prospective, cross-sectional qualitative study with an online focus group design. The study was guided by Black Feminist Thought and an integrated model of behavior prediction. Four online focus groups (N = 22) were conducted using video conferencing during September 2017 with African American mothers who were participating in breastfeeding support groups on Facebook.

RESULTS

Thematic analysis was used to develop four themes and two subthemes, including creating a community for Black mothers, online interactions and levels of engagement, advantages of participating in online support groups, critiques of online support groups, empowerment of self and others, and shifts in breastfeeding perceptions and decisions. Among participants in this study, positive imagery of African American breastfeeding mothers and ongoing support from women with shared experiences improved confidence with public breastfeeding and prolonged goals for breastfeeding duration.

CONCLUSION

Receiving peer support within Facebook communities may positively influence breastfeeding norms and confidence in breastfeeding, help mothers to overcome breastfeeding challenges, and ultimately extend intended breastfeeding duration.

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.

Effect of vacuum-release teat versus standard teat use on feeding milestones and breastfeeding outcomes in very preterm infants: A randomized controlled trial

Background

Breast milk is important to infant health, yet shorter breastfeeding duration is reported for preterm infants. Both breast and bottle feeds are given in the neonatal unit, with full oral feeding often the last milestone to be achieved prior to discharge home. Unlike standard bottle teats, a vacuum release teat requires the application of negative intra-oral pressure to release milk, and so may facilitate breastfeeding in preterm infants. The objective of this study was to determine the effect of vacuum release teat use on timing of achievement of the first full oral feed and on first completion of 24 h full oral feeds. Feeding method at discharge home, 2 weeks, 6 weeks and 12 weeks corrected gestational age were also examined.

Methods

A randomized controlled trial was completed with mothers of preterm infants born 24–33 weeks gestation in the neonatal unit of a tertiary women’s hospital. Infants were randomized to one of two parallel groups using a vacuum release teat or standard teat for oral feeds when the mother was not available to breastfeed. Test weights were completed for all oral feeds. It was not possible to blind participants, care givers and outcome assessors to group assignment due to the nature of the study.

Results

The groups did not differ with regard to timing of achievement of first full oral feed or 24 h of full oral feeds. Significantly more infants in the vacuum release teat group were exclusively fed breast milk at discharge from hospital and breastfed at 3 months corrected gestational age.

Conclusions

Use of a vacuum release teat when the mother is not available to breastfeed may promote preterm breastfeeding skills, resulting in higher rates of exclusivity and longer breastfeeding duration.

Trial registration

The trial is registered with the Australian New Zealand Clinical Trials Registry ACTRN12615000245594.

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.

A Typology of Breastfeeding Mothers of Preterm Infants: A Qualitative Analysis

BACKGROUND

Breastfeeding is an important element of motherhood with a preterm infant, but the role of maternal emotions in relation to breastfeeding is vague.

PURPOSE

To describe maternal emotions regarding and insights into breastfeeding during the first year after a preterm birth.

METHODS

In total, 80 mothers of preterm infants (<35 gestational weeks) participated in this secondary analysis of a larger study. The data were collected with an open question at discharge and 3, 6, and 12 months after the expected birth date and analyzed using thematic analysis.

FINDINGS

A typology of breastfeeding mothers of preterm infants was created. The group of survivors wished to be breastfeeding mothers, but after some unexpected difficulties, they had to give up their dream. The disappointment alleviated with time, but some of the mothers still harbored self-accusations after a year. The highfliers were mothers who succeeded in breastfeeding because of their own persistence. They described breastfeeding as enjoyable for both the mother and the infant. The pragmatist mothers breastfed because it was the general norm and a practical way to feed the infant; breastfeeding caused neither passion nor discomfort. The group of bottle-feeding-oriented mothers expressed that breastfeeding did not interest them at any point.

IMPLICATIONS FOR PRACTICE

Being aware of the typology could help nurses and midwives carefully observe mothers' individual counselling needs. Mothers' wishes and decisions regarding breastfeeding need to be respected and supported without any judgment.

IMPLICATIONS FOR RESEARCH

The possibilities to tailor breastfeeding interventions based on the typology should be investigated.

Facebook support for breastfeeding mothers: A comparison to offline support and associations with breastfeeding outcomes

OBJECTIVES

For breastfeeding mothers, online support groups through Facebook may be a more convenient and preferred source for accessing breastfeeding information and support, but few studies exist that examine the use of Facebook groups specifically for breastfeeding support. This study explores the sources of support among users of Facebook breastfeeding support groups and a possible mechanism by which support received on Facebook may translate to behavioral outcomes among breastfeeding mothers.

METHODS

From July-September 2017 a survey was distributed online to African American mothers (N = 277) who participate in breastfeeding support groups on Facebook. The survey assessed network support from Facebook and other sources of breastfeeding support, perceived breastfeeding norms, breastfeeding self-efficacy and breastfeeding attitudes. Correlations and linear regression analysis were used to examine the relationship between covariates and outcome variables.

RESULTS

The average intended breastfeeding duration among participants in this study was 19 months. Participants reported the highest amount of breastfeeding support received from their Facebook support group, in comparison to other sources of support, and Facebook support was significantly correlated with intended breastfeeding duration (p < 0.05). Self-efficacy and breastfeeding attitudes remained significant predictors of intended breastfeeding duration within the final regression model.

CONCLUSIONS

Breastfeeding support received within Facebook groups may compensate for inadequate support received within mothers' networks. More research is needed to understand the mechanism through which Facebook support may contribute to prolonged breastfeeding durations.

Protecting, promoting, and supporting breastfeeding on Instagram

Breastfeeding has many established benefits for mothers, children, and society at large; however, the vast majority of infants globally do not meet international breastfeeding recommendations. There are many complex reasons for suboptimal breastfeeding rates, including social and societal factors. Alongside increasing social media use worldwide, there is an expanding research focus on how social media use affects health behaviours, decisions and perceptions. The objective of this study was to systematically determine if and how breastfeeding is promoted and supported on the popular social media platform Instagram, which currently has over 700 million active users worldwide. To assess how Instagram is used to depict and portray breastfeeding, and how users share perspectives and information about this topic, we analysed 4,089 images and 8,331 corresponding comments posted with popular breastfeeding-related hashtags (#breastfeeding, #breastmilk, #breastisbest, and #normalizebreastfeeding). We found that Instagram is being mobilized by users to publicly display and share diverse breastfeeding-related content and to create supportive networks that allow new mothers to share experiences, build confidence, and address challenges related to breastfeeding. Discussions were overwhelmingly positive and often highly personal, with virtually no antagonistic content. Very little educational content was found, contrasted by frequent depiction and discussion of commercial products. Thus, Instagram is currently used by breastfeeding mothers to create supportive networks and could potentially offer new avenues and opportunities to "normalize," protect, promote, and support breastfeeding more broadly across its large and diverse global online community.

Breastfeeding and risk for ceasing in mothers of preterm infants-Long-term follow-up

Breastfeeding is challenging for mothers of preterm infants. The aim of this paper is to describe risk factors for ceasing breastfeeding and methods of feeding until 12 months postnatal age in mothers who breastfed their preterm infants at discharge from neonatal intensive care units (NICUs). The data come from a randomised controlled trial, which evaluated the effectiveness on exclusive breastfeeding at 8 weeks of proactive telephone support compared with reactive support offered to mothers of preterm infants following discharge from NICU. Six NICUs across Sweden randomised a total of 493 mothers. We used regression and survival analyses to assess the risk factors for ceasing breastfeeding and the long‐term outcomes of the intervention. The results showed that 305 (64%) of the infants were breastfed at 6 months and 49 (21%) at 12 months. Partial breastfeeding at discharge, low maternal educational level, and longer length of stay in the NICU increased the risk for ceasing breastfeeding during the first 12 months. Furthermore, the Kaplan–Meier analysis showed that the proportion of mothers who ceased breastfeeding did not differ between the intervention (n = 231) and controls (n = 262) during the first 12 months (log‐rank test p = .68). No difference was found between groups on method of feeding. More than 85% of the infants were fed directly at the breast. These findings provide important insights for health professionals who are supporting mothers of preterm infants to breastfeed long term. Registered in http://www.clinicaltrials.gov (NCT01806480).

Proactive telephone support provided to breastfeeding mothers of preterm infants after discharge: a randomised controlled trial

Aim

The aim was to evaluate the effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants after discharge from neonatal intensive care units (NICU).

Methods

Between March 2013 and December 2015, a randomised controlled trial was conducted at six NICUs across Sweden. At each NICU, a breastfeeding support team recruited, randomised and delivered the support to participating mothers. The intervention group received a daily proactive telephone call up to 14 days after discharge from the support team. The control group could initiate telephone contact themselves. Primary outcome was exclusive breastfeeding eight weeks after discharge. Secondary outcomes were maternal satisfaction with breastfeeding, attachment, quality of life and parental stress.

Results

In total, 493 mothers were randomised, 231 to intervention group and 262 to control group. There were no differences between the groups for exclusive breastfeeding, odds ratio 0.96, 95% CI 0.66–1.38, nor for maternal satisfaction with breastfeeding, attachment or quality of life. The intervention group reported significantly less parental stress than the controls, t = 2.44, 95% CI 0.03–0.23, effect size d = 0.26.

Conclusion

In this trial, proactive telephone support was not associated with increased exclusive breastfeeding prevalence eight weeks following discharge. However, intervention group mothers showed significantly lower parental stress.

Expressing Human Milk in the NICU: Coping Mechanisms and Challenges Shape the Complex Experience of Closeness and Separation

BACKGROUND

Human milk has multiple benefits for human health; however, rates of infants receiving human milk at discharge in Canadian neonatal intensive care units (NICUs) are far below recommendations of the Baby Friendly Hospital Initiative supported by the Canadian Pediatric Association. Mothers of infants requiring NICU care usually need to express their milk, especially mothers of premature infants, since for some time their infant is unable to feed directly at the breast. Expressing human milk for an extended period can be challenging for mothers.

PURPOSE

To document maternal experiences expressing human milk for their infant in the NICU as a closeness or separation experience, and to discover what factors gave rise to these perceptions.

METHODS

In this descriptive qualitative cross-sectional study, 15 mothers whose infants were hospitalized in a level III NICU and who were expressing human milk audio recorded their thoughts and feelings with a smartphone application for 48 hours while they were expressing milk. A thematic content analysis was used to analyze data.

FINDINGS

Expressing human milk for their hospitalized infant was a difficult experience for all mothers, and most described both closeness and separation feelings while expressing milk. Their feelings fluctuated depending on their coping mechanisms, perceived challenges, as well as their location and environment. Mothers were all pursuing their goal of continued milk expression with various levels of motivation.

IMPLICATIONS FOR PRACTICE

NICUs should adopt a family-centered approach to care whereby mothers' care needs related to milk expression are addressed. Nurses can ask open-ended questions to explore how mothers are coping, and they can assist mothers to find effective coping strategies to minimize the challenges related to milk expression to promote mother-infant closeness.

IMPLICATIONS FOR RESEARCH

The impact of environment and location on mothers with hospitalized infants should be explored, as unit designs could be altered to foster closeness.

Mothers' experiences of a telephone based breastfeeding support intervention after discharge from neonatal intensive care units: a mixed-method study

Background

After discharge from a neonatal intensive care unit (NICU), many mothers of preterm infants (gestational age < 37 weeks) experience a lack of support for breastfeeding. An intervention study was designed to evaluate the effects of proactive (a daily telephone call initiated by a member of a breastfeeding support team) and/or reactive (mothers could call the breastfeeding support team) telephone based breastfeeding support for mothers after discharge from the NICU. The mothers in the intervention group had access to both proactive and reactive support; the mothers in the control group only had access to reactive support. The aim of this study was to explore the mothers’ experiences of the proactive and reactive telephone support.

Methods

This study was a qualitatively driven, mixed-method evaluation using three data sources: questionnaires with qualitative open-ended questions, visual analogue scales and telephone interviews. In total, 365 mothers contributed data for this study. The qualitative data were analysed with an inductive thematic network analysis, while the quantitative data were analysed with Student’s t-test and the chi-square test.

Results

Proactive support contributed to greater satisfaction and involvement in breastfeeding support. The mothers who received proactive support reported that they felt strengthened, supported and secure, as a result of the continuous care provided by staff who were knowledgeable and experienced (i.e., in breastfeeding and preterm infants), which resulted in the global theme ‘Empowered by proactive support’. The mothers who received reactive support experienced contradictory feelings; some felt secure because they had the opportunity to call for support, whereas others found it difficult to decide when and if they should use the service, which resulted in the global theme; ‘Duality of reactive support’.

Conclusion

There were positive aspects of both proactive (i.e., greater satisfaction and feelings of empowerment) and reactive support (i.e., the opportunity to call for support); however, the provision of reactive support alone may be inadequate for those with the greatest need for support as they are the least likely to access it.

Trial registration

NCT01806480 on 5 March 2013.

Feeding Imprinting: The Extreme Test Case of Premature Infants Born With Very Low Birth Weight

Feeding imprinting, considered a survival-enabling process, is not well understood. Infants born very preterm, who first feed passively, are an effective model for studying feeding imprinting. Retrospective analysis of neonatal intensive care unit (NICU) records of 255 infants (M_{gestational age}  = 29.98 ± 1.64) enabled exploring the notion that direct breastfeeding (DBF) during NICU stay leads to consumption of more mother's milk and earlier NICU discharge. Results showed that DBF before the first bottle feeding is related to shorter transition into oral feeding, a younger age of full oral feeding accomplishment and earlier discharge. Furthermore, the number of DBF meals before first bottle feeding predicts more maternal milk consumption and improved NICU outcomes. Improved performance in response to initial exposure to DBF at the age of budding feeding abilities supports a feeding imprinting hypothesis.

Hospital routines promote parent-infant closeness and cause separation in the birthing unit in the first 2 hours after birth: A pilot study

BACKGROUND

Despite the evidence of multiple benefits of early skin-to-skin contact, it does not always happen and infants are separated from their parents because of different hospital practices. The aim of this study was to explore parent-infant closeness and separation, and which factors promote closeness or result in separation in the birthing unit in the first 2 hours after birth from the point of view of staff members.

METHODS

This qualitative descriptive pilot study was conducted in one university hospital in Finland in December 2014. Midwives and auxiliary nurses working in the birthing unit were eligible for the study. The data were collected with a new application downloaded on a smartphone. The participants were asked to record all the closeness and separation events they observed between the infants and parents using the application.

RESULTS

The application was used during 20 work shifts by 14 midwives or auxiliary nurses. The participants described more closeness than separation events. Our findings indicated that the staff of the birthing unit aimed for mother-infant closeness, and father-infant closeness was a secondary goal. Closeness was mostly skin-to-skin contact and justified as a normal routine care practice. Infants were separated from their parents for routine measurements and because of infants' compromised health.

CONCLUSION

Routines and normal care practices both promoted parent-infant closeness and caused separation. Parent-infant closeness and separation were controlled by staff members of the birthing unit.

Social networks in nursing work processes: an integrative literature review

OBJECTIVE

To identify and analyze the available evidence in the literature on the use of social networks in nursing work processes.

METHOD

An integrative review of the literature conducted in PubMed, CINAHL, EMBASE and LILACS databases in January 2016, using the descriptors social media, social networking, nursing, enfermagem, redes sociais, mídias sociais, and the keyword nursing practice, without year restriction.

RESULTS

The sample consisted of 27 international articles which were published between 2011 and 2016. The social networks used were Facebook (66.5%), Twitter (30%) and WhatsApp (3.5%). In 70.5% of the studies, social networks were used for research purposes, in 18.5% they were used as a tool aimed to assist students in academic activities, and in 11% for executing interventions via the internet.

CONCLUSION

Nurses have used social networks in their work processes such as Facebook, Twitter and WhatsApp to research, teach and watch. The articles show several benefits in using such tools in the nursing profession; however, ethical considerations regarding the use of social networks deserve further discussion.

OBJETIVO

Identificar e analisar as evidências disponíveis na literatura sobre a utilização de redes sociais nos processos de trabalho em enfermagem.

MÉTODO

Revisão integrativa da literatura realizada em janeiro de 2016, nas bases de dados PubMed, CINAHL, EMBASE e LILACS, com os descritores social media, social networking, nursing, enfermagem, redes sociais, mídias sociais e a palavra-chave nursing practice, sem restrição de ano.

RESULTADOS

A amostra foi composta por 27 artigos, os quais foram publicados entre 2011 e 2016, todos internacionais. As redes sociais utilizadas foram o Facebook (66,5%), o Twitter (30%) e o WhatsApp (3,5%). Em 70,5% dos estudos as redes sociais foram utilizadas para fins de pesquisa, em 18,5% como ferramenta para auxiliar estudantes nas atividades acadêmicas, e em 11% para a realização de intervenções via internet.

CONCLUSÃO

Em seus processos de trabalho, os enfermeiros têm utilizado as redes sociais Facebook, Twitter e WhatsApp para pesquisar, ensinar e assistir. Os artigos evidenciam diversos benefícios sobre o uso de tais ferramentas na profissão de enfermagem, entretanto, as considerações éticas a respeito da utilização das redes sociais merecem maior discussão.

Breastfeeding education and support for women with twins or higher order multiples

BACKGROUND

There are rising rates of multiple births worldwide with associated higher rates of complications and more hospital care, often due to prematurity. While there is strong evidence about the risks of not breastfeeding, rates of breastfeeding in women who have given birth to more than one infant are lower than with singleton births. Breastfeeding more than one infant can be more challenging because of difficulties associated with the birth or prematurity. The extra demands on the mother of frequent suckling, coordinating the needs of more than one infant or admission to the neonatal intensive care unit can lead to delayed initiation or early cessation. Additional options such as breast milk expression, the use of donor milk or different methods of supplementary feeding may be considered. Support and education about breastfeeding has been found to improve the duration of any breastfeeding for healthy term infants and their mothers, however evidence is lacking about interventions that are effective to support women with twins or higher order multiples.

OBJECTIVES

To assess effectiveness of breastfeeding education and support for women with twins or higher order multiples.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2016), ClinicalTrials.gov (30 June 2016), the WHO International Clinical Trials Registry Platform (ICTRP) (1 July 2016), the excluded studies list from the equivalent Cochrane review of singletons, and reference lists of retrieved studies.

SELECTION CRITERIA

Randomised or quasi-randomised trials comparing extra education or support for women with twins or higher order multiples were included.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We planned to assess the quality of evidence using the GRADE approach, but were unable to analyse any data.

MAIN RESULTS

We found 10 trials (23 reports) of education and support for breastfeeding that included women with twins or higher order multiples. The quality of evidence was mixed, and the risk of bias was mostly high or unclear. It is difficult to blind women or staff to group allocation for this intervention, so in all studies there was high risk of performance and high or unclear risk of detection bias. Trials recruited 5787 women (this included 512 women interviewed as part of a cluster randomised trial); of these, data were available from two studies for 42 women with twins or higher order multiples. None of the interventions were specifically designed for women with more than one infant, and the outcomes for multiples were not reported separately for each infant. Due to the scarcity of evidence and the format in which data were reported, a narrative description of the data is presented, no analyses are presented in this review, and we were unable to GRADE the evidence.The two trials with data for women with multiple births compared home nurse visits versus usual care (15 women), and telephone peer counselling versus usual care (27 women). The number of women who initiated breastfeeding was reported (all 15 women in one study, 25 out of 27 women in one study). Stopping any breastfeeding before four to six weeks postpartum, stopping exclusive breastfeeding before four to six weeks postpartum, stopping any breastfeeding before six months postpartum andstopping exclusive breastfeeding before six months postpartum were not explicitly reported, and there were insufficient data to draw any meaningful conclusions from survival data. Stopping breast milk expression before four to six weeks postpartum, andstopping breast milk expression before six months postpartum were not reported. Measures ofmaternal satisfaction were reported in one study of 15 women, but there were insufficient data to draw any conclusions; no other secondary outcomes were reported for women with multiple births in either study. No adverse events were reported.

AUTHORS' CONCLUSIONS

We found no evidence from randomised controlled trials about the effectiveness of breastfeeding education and support for women with twins or higher order multiples, or the most effective way to provide education and support . There was no evidence about the best way to deliver the intervention, the timing of care, or the best person to deliver the care. There is a need for well-designed, adequately powered studies of interventions designed for women with twins or higher order multiples to find out what types of education and support are effective in helping these mothers to breastfeed their babies.

Impact of Parent-Targeted eHealth on Parent and Infant Health Outcomes: A Scoping Review

Improved communication, education, and parental involvement in infant care have been demonstrated to enhance parental well-being and neonatal health outcomes. eHealth has the potential to increase parental presence in the neonatal intensive care unit (NICU). There has been no synthesized review on the direct impact of eHealth use on parental and neonatal health outcomes. The aim of this scoping review is to explore eHealth utilization by families of high-risk newborn infants in the NICU and/or postdischarge on health outcomes. PubMed, CINAHL, and EMBASE were searched from 1980 to October 2015 using key terms for "neonatal," "parents," "eHealth," and "patient education." Criteria of peer-reviewed empirical studies published in English, targeting parents of NICU infants regardless of diagnosis, and eHealth utilization during NICU stay or postdischarge yielded 2218 studies. Extracted data were synthesized using thematic content analysis. Ten studies met inclusion, and 5 themes emerged: usability and feasibility, parental perceived benefits, infant's hospital length of stay, knowledge uptake, and predictors of variations in use. eHealth utilization was found to be desired by parents and promotes positive change in parental experience in the NICU. Actual and perceived benefits of eHealth for parents included ease of use, higher confidence in infant care, satisfaction, and knowledge uptake.

Changes in the prevalence of breast feeding in preterm infants discharged from neonatal units: a register study over 10 years

OBJECTIVE

There are indications that the prevalence of exclusively breastfed preterm infants is decreasing in Sweden. The objective was to investigate trends in exclusive breast feeding at discharge from Swedish neonatal units and associated factors in preterm infants.

DESIGN, SETTING AND PARTICIPANTS

This is a register study with data from the Swedish Neonatal Quality Register. Data from 29 445 preterm infants (gestational age (GA) <37 weeks) who were born during the period 2004-2013 were retrieved. Data included maternal, perinatal and neonatal characteristics. Data were analysed for the whole population as well as for 3 GA groups.

RESULTS

From 2004 to 2013, the prevalence of exclusive breast feeding decreased, in extremely preterm (GA 22-27 weeks) from 55% to 16%, in very preterm (GA 28-31 weeks) from 41% to 34% and in moderately preterm infants (GA 32-36 weeks) from 64% to 49%. The decline was statistically significant (p<0.001) in all 3 GA groups. This decline remained significant when adjustments were made for factors negatively associated with exclusive breast feeding and which became more prevalent during the study period, that is, small for GA (all groups) and maternal mental illness (very preterm and moderately preterm infants).

CONCLUSIONS

In the past 10 years, Sweden has experienced a lower rate of exclusive breast feeding in preterm infants, especially in extremely preterm infants. The factors analysed in this study explain only a small proportion of this decline. The decline in exclusive breast feeding at discharge from neonatal units raises concern and present challenges to the units to support and promote breast feeding.

Infant Feeding Beliefs and Day-to-Day Feeding Practices of NICU Nurses

The purpose is to examine the infant feeding beliefs and day-to-day feeding practices of NICU nurses with the goal of identifying ways to improve breastfeeding promotion.

DESIGN AND METHODS

An ethnographic approach incorporated 14 months of participant observation and interviewing. General informants consisted of 114 purposively selected NICU nurses from a northeastern, level-IV NICU, pediatric hospital. From this group, 18 nurses served as key informants. There was an average of 13 interactions with each key informant and 3.5 with each general informant. Audio taped interviews and observational field notes were gathered for descriptions of beliefs and practices. Data were coded and analyzed for patterns and themes with the aid of NUD*IST.

RESULTS

1. The nurses identified health benefits of breastfeeding, but spoke in greater detail and with more emotion about day-to-day challenges of breastfeeding in the NICU. 2. Formula feeding evoked less emotion and most nurses viewed it as safe and convenient. 3. Despite infant feeding challenges in the NICU, nurses who had breastfeeding continuing education and/or some positive experiences with breastfeeding: identified evidence based breastfeeding benefits for mothers and babies; emphasized the health-based differences between breast milk and formula; and were more committed to working through difficulties with breastfeeding.

CONCLUSIONS

Breastfeeding promotion interventions should include every NICU nurse and incorporate both evidence-based and affective components to overcome day-to-day feeding practice challenges.

PRACTICE IMPLICATIONS

Breastfeeding promotion interventions must address conflicting and emotionally evocative infant feeding beliefs of NICU nurses. Effective interventions must be integrated within the realities of bedside feeding practices.

Aiming to be a breastfeeding mother in a neonatal intensive care unit and at home: a thematic analysis of peer-support group discussion in social media

Preterm infants are usually breastfed less than full-term infants, and successful breastfeeding requires a supportive environment and special efforts from their mothers. A breastfeeding peer-support group, utilising social media, was developed for these mothers in order to support them in this challenge. Mothers were able to discuss breastfeeding and share experiences. The purpose of this study was to describe the perceptions of breastfeeding mothers of preterm infants based on the postings in peer-support group discussions in social media. The actively participating mothers (n = 22) had given birth <35 gestational weeks. They were recruited from one university hospital in Finland. The social media postings (n = 305) were analysed using thematic analysis. A description of the process of breastfeeding a preterm infant from the point of view of a mother was created. The process consisted of three main themes: the breastfeeding paradox in hospital, the 'reality check' of breastfeeding at home and the breastfeeding experience as part of being a mother. The mothers encountered paradoxical elements in the support received in hospital; discharge was promoted at the expense of breastfeeding and pumping breast milk was emphasised over breastfeeding. After the infant's discharge, the over-optimistic expectations of mothers often met with reality - mothers did not have the knowledge or skills to manage breastfeeding at home. Successful breastfeeding was an empowering experience for the mothers, whereas unsuccessful breastfeeding induced feelings of disappointment. Therefore, the mothers of preterm infants need evidence-based breastfeeding counselling and systematic support in a neonatal intensive care unit (NICU) and at home.