The Role of Work as a Social Determinant of Health in Mother's Own Milk Feeding Decisions for Preterm Infants: A State of the Science Review

Where does the time go? Temporal patterns of pumping behaviors in mothers of very preterm infants vary by sociodemographic and clinical factors

Background

Mothers of very preterm (<32 weeks gestational age [GA]) infants are breast pump dependent and have shorter duration of milk provision than mothers of term infants. The opportunity (i.e., time) cost of pumping and transporting mother's own milk (MOM) from home to the NICU may be a barrier. There is a paucity of data regarding how much time mothers actually spend pumping.

Objective

To investigate the variation in pumping behavior by postpartum week, maternal characteristics, and infant GA.

Methods

Prospectively collected pump log data from mothers enrolled in ReDiMOM (Reducing Disparity in Mother's Own Milk) randomized, controlled trial included pumping date and start time and end time of each pumping session for the first 10 weeks postpartum or until the infant was discharged from the NICU, whichever occurred first. Outcomes included number of daily pumping sessions, number of minutes spent pumping per day, and pumping behaviors during 24-h periods, aggregated to the postpartum week. Medians (interquartile ranges) were used to describe outcomes overall, and by maternal characteristics and infant GA.

Results

Data included 13,994 pump sessions from 75 mothers. Maternal characteristics included 55% Black, 35% Hispanic, and 11% White and 44% <30 years old. The majority (56%) of infants were born at GA 28-31 weeks. Mothers pumped an average of less than 4 times per day, peaking in postpartum week 2. After accounting for mothers who stopped pumping, there was a gradual decrease in daily pumping minutes between postpartum weeks 2 (89 min) and 10 (46 min). Black mothers pumped fewer times daily than non-Black mothers after the first 2 weeks postpartum.

Conclusion

On average mothers pumped less intensively than the minimum recommendation of 8 times and 100 min per day. However, these pumping behaviors represent significant maternal opportunity costs that should be valued by the institution and society at large.

Work as a social determinant of maternal health: A qualitative exploration of college-educated Black women's experiences at work during pregnancy and postpartum

BACKGROUND

Black women are disproportionately impacted by higher rates of maternal mortality in the United States (US). Limited research has focused on adverse maternal health outcomes among college-educated Black women, although research has found these outcomes persistent among this population.

OBJECTIVES

This study aimed to fill a critical gap in current research by elucidating the nuanced experiences of college-educated Black women in the workplace during pregnancy and postpartum. By exploring this under-researched area, our study contributes to the academic discourse on Black maternal health disparities within the scope of occupational health. It offers practical insights for enhancing workplace gender equity, informing healthcare practices, and shaping policies that support equitable maternal health outcomes among Black women.

DESIGN

This qualitative study conducted semi-structured interviews with 17 Black mothers between March 2019 and September 2019.

METHODS

Seventeen in-depth interviews were conducted with college-educated Black women in the US from March 2019 to September 2019. Participants were asked several questions about work stress, discrimination, and other workplace experiences during pregnancy and postpartum.

RESULTS

Our analysis identified three themes, including Strong Black Woman/Superwoman, work stress (sub-themes: consciousness of work stress, mental and physical responses to stress, and work-family conflict), and perceived work-related discrimination.

CONCLUSION

For college-educated Black women experiencing pregnancy and postpartum, it is crucial to understand the structural and social determinants of optimal occupational health. It is critical that workplaces enact occupational health equity with attention to racial, gender, and disability-centered considerations to address the unique challenges experienced by Black women.