Preterm infants’ mothers’ lactation experiences
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Author, Objective Methods Findings to support theme Coping Findings to support theme Coping
Year, with the birth of preterm infant with barriers and concerns
Location
Bernaix Describe parents’ D: Descriptive qualitative Expressing and offering beneficial Expressing and maintaining milk et al., perceptions of S: n=9 breast milk was important for supply was difficult for mothers.
2006, providing breast T: Parents of preterm mothers, while breastfeeding was Separation and insufficiency of time
USA milk to their infants (range 24-32 gw), perceived desirable. Providing were concerns for mothers. The
premature infant NICU III breast milk supported the sense of insufficiency of milk supply caused
hospitalized in the mothering. feelings of frustration and lack of
NICU confidence.
Björk et Describe mothers’ D: Descriptive qualitative The message of beneficial breast The lack of privacy and separation al., 2012, experiences of S: n=12 milk motivated mothers to express. were concerns for the mothers. Test-
Sweden breastfeeding a weighing both stressed and addicted
preterm infant the mothers. Problems with
Preterm infants’ mothers’ lactation experiences
during T: Mothers of preterm breastfeeding caused difficult
hospitalization infants (range 27-36 gw), feelings.
neonatal ward
Boucher Describe mothers’ D: Descriptive qualitative Beneficial breast milk motivated Mothers realized that their et al., experiences of S: n=10 mothers to express. Breastfeeding breastfeeding experience would be
2011, breastfeeding T: Mothers of preterm was an opportunity to bond with an different. Mothers were concerned
Canada initiation and infants (range 27-34 gw), infant. Mothers looked forward for about their adequate milk supply.
progression in the NICU III pleasurable breastfeeding during Scheduled feeding was a barrier.
NICU expressing. Breastfeeding needed to be learned.
Callen et Determine barriers D: Descriptive qualitative No findings Low milk volume and infants’ al., 2005, to the successful S: n=64 compromised physical status were
Canada breastfeeding in the T: Mothers of preterm barriers to breastfeeding. Nipple and
hospital and after infants (range 24-35 gw), breast problems and poor
discharge NICU III breastfeeding technique were also
prevalent.
Preterm infants’ mothers’ lactation experiences
Flacking Describe mothers’ D: Grounded theory Breastfeeding became a complex NICU environment was interfering. et al., emotional S: n=25 process for mothers. Breastfeeding Mothers had feelings of frustration
2006, experiences of the T: Mothers of preterm helped mothers to bond with their and guilt regarding breastfeeding
Sweden breastfeeding infants (range 24-31 gw), infant and gave hope for mothers. problems.
process seven NICUs Breastfeeding was a way to
decrease the difficult feelings of
emotional and physical separation.
Flacking Describe mothers’ D: Grounded theory Breastfeeding was a social norm Breastfeeding was non-reciprocal et al., experiences of S: n=25 and a sign of good mother. and goal-oriented task for mothers.
2007, breastfeeding after T: Mothers of preterm Breastfeeding was a way to Breastfeeding was pleasurable and
Sweden the discharge infants (range 24-31 gw), decrease mothers’ feelings of guilt. reciprocal when mothers had an
seven NICUs ability to read infant’s cues, and
when the needs of mother and infant
were in balance.
Flacking Explore the impact D: Ethnography No findings Breastfeeding was easier in a single
& of place and space S: n=52 room, while concentrating was
Preterm infants’ mothers’ lactation experiences
Dykes, on mothers’ feeding T: Parents of preterm difficult in noisy, crowded nursery.
2013, experiences and infants (range 23-35 gw), Cue-based breastfeeding was easier
Sweden practices four NICUs when a mother lived with her infant. and UK Without privacy breastfeeding felt
unnatural. Cultural differences were
noted in comfortableness in
breastfeeding publicly.
Hurst et Determine mothers’ D: Descriptive quantitative No findings Mothers were concerned about al., 2004, perceptions of using S: n=31 knowing infants’ milk intake during
USA test-weighing during T : Mothers of preterm breastfeeding and about adequate
the first month infants (31-36 gw), NICU milk intake. Mothers felt that test-
postdischarge weighing was or would have been
helpful for them.
Hurst et Describe how D: Ethnography Expressing was a paradoxical Pumping was exhausting and al., 2013, mothers of very S: n=14 experience, while mothers felt that demanding, and mothers had to
USA preterm infants they are connected and separated negotiate to cope with it. Pumping
Preterm infants’ mothers’ lactation experiences
navigate the use of T: Mothers of very from their infants. Breast pump was was time-consuming and frustrating,
the breast pumps in preterm infants (range 24- experienced as a wedge and a link and mothers used distractions to
the context of the 30 gw), NICU II and III to their infant. Breastfeeding was manage with pumping. Mothers had
NICU seen as eligible and as a natural part controversial experiences of
of maternal role. pumping at the infant’s bedside.
Jones et Discover mothers D: Descriptive quantitative Expressing gave the feeling of Concerns in expressing were al., 2009, perceptions of the S: n=91 contribution for the mothers. engorgement, insufficient milk
UK information leaflet T : Mothers of preterm Persevering with expressing was supply, and need to persevere with
and advice about infants, (range 24-36 gw), worthy because of the benefits. expressing. Concerns in
milk expression and three NICUs breastfeeding were poor milk supply,
breastfeeding need to persevere, and problems with
problems breastfeeding technique.
Krouse, Identify, describe, D: Descriptive qualitative Facilitating families were Low milk volume was a concern.
2002, and provide a S: n=13 committed to lactation and Mothers found feeding schedules
USA theoretical analysis T: Mothers and a breastfeeding because of benefits of both helpful and concerning.
of the family significant family breast milk. Obstructing families Expressing was time-consuming.
Preterm infants’ mothers’ lactation experiences
management of members of preterm found expressing as frustrating. Obstructing families used cessation
breastfeeding LBW infants (M=29-33 gw) Breastfeeding was a way to bond as a way to cope with problems.
infants with their infant.
Lee et Describe mothers’ D: Descriptive qualitative Mothers tried to compensate the Expressing was exhausting, and al., 2009, breastfeeding S: n=31 preterm birth by their beneficial concerns of sufficient milk supply
Taiwan experiences T: Mothers of preterm breast milk. Expressing was a way were prevalent.
infants (range 23-33 gw), to maintain connectedness.
NICU
Myers & Describe barriers the D: Descriptive quantitative Mothers felt that their breast milk Mothers were neutral in concern
Rubarth, mothers encounter in S: n=15 was beneficial, and felt that about adequate milk supply.
2013, the NICU T : Mothers of preterm expressing was something only Separation, lack of pumping
USA infants (range 24-37 gw), mother can do for her infant. machines, and lack of time were
NICU Mothers were satisfied with their barriers for the mothers.
breastfeeding experience. Mothers
were not concerned about
expressing.
Preterm infants’ mothers’ lactation experiences
Nyqvist Obtain suggestions D: Descriptive qualitative Breastfeeding was seen as a norm Separation was a major concern for
& from mothers S: n=13 and integral part of motherhood, the mothers. Learning the infants’
Kylberg, regarding of the T: Mothers of preterm but also as a small part of cues was confidence-building.
2008, Baby-Friendly infants (range 26-31 gw), motherhood. Expressing was a Mothers had controversial
Sweden Hospital Initiative NICU necessary evil but also a source of experiences of test-weighing.
joy and fulfillment. Breastfeeding
was joyful.
Pridham Describe mothers’ D: Case study Mother had a strong commitment to Mother had assumed that they are et al., experiences of S: n=3 breastfeeding. unable to achieve their breastfeeding
2004, feeding issues T: Mothers of preterm goals. Expressing was exhausting,
USA through the infant’s infants (26, 27, and 32 gw) and led to cessation. Mother
first post-term year vanished the importance of
breastfeeding while ceasing.
Rossman Describe mothers’ D: Descriptive qualitative Mothers believed the message of Insufficiency of milk caused et al., experiences of S: n=21 beneficial breast milk. Providing frustration. Expressing was
received lactation breast milk was something only frustrating.
Preterm infants’ mothers’ lactation experiences
2011, care from certified T: Mothers of preterm they can do for their infants. Breast
USA BPCs infants (range 24-31 gw), milk was also a way to compensate
NICU III the harm of preterm birth for the
infant.
Rossman Describe the D: Descriptive qualitative Mothers had a strong faith in their Mothers had to re-evaluate their et al., meaning of milk for S: n=23 beneficial breast milk. Breast milk breastfeeding goals after the birth of
2013, mothers of preterm T: Mothers of preterm was a way to compensate the harm preterm infant. Expressing was
USA infants hospitalized infants (range 23-33 gw), of preterm birth for the infant. The frustrating and interfering.
in the NICU NICU III benefits of breast milk caused also
an obligation to maintain
expressing. Offering breast milk
meant connection for the mothers.
Sisk et Identify patterns of D: Descriptive qualitative Anticipation of breastfeeding Separation was a concern for the al., 2010, factors that hindered S: n=32 supported the mothers to continue mothers and caused problems with
USA or supported with expressing. milk supply, transportation, and
initiation and
Preterm infants’ mothers’ lactation experiences
maintenance of T: Mothers of preterm scheduling. Balancing work and
breast milk infants (range 23-35 gw), expressing was difficult.
production NICU
Swanson Explore mothers’ D: Descriptive qualitative Providing breast milk rebuilt the Mothers had to adjust their et al., experiences of infant S: n=19 interrupted connection and breastfeeding goals to the situation.
2012, feeding behaviors in T: Mothers of preterm increased maternal confidence. Expressing and breastfeeding
Scotland the NICU infants (range 23-36 gw), Expressing was both as source of required perseverance. Mothers
NICU III positive and negative emotions. needed to learn new skills. Adequate
Mothers had a strong want to milk supply increased mothers’
breastfeed. confidence, while inadequate milk
supply was discouraging.
Sweet, Describe parents’ D: Pheno- Breast milk was highly valued by Expressing led to objectification of
2006, experiences of menology mothers, which made expressing an breast milk, and breast milk became
Australia breastfeeding S: n=17 obligation. Persevering with measurable thing. Sufficient milk
expressing was connected to being supply was a concern for the
a good mother. mothers. Bottle feeding was
Preterm infants’ mothers’ lactation experiences
T: Parents of preterm undesirable and against mothers’
infants (range 24-30 gw), breastfeeding goals.
NICU II and III
Sweet, Explore parents’ D: Phenomenology The benefits of breast milk Breastfeeding was different
2008, meanings, S: n=17 motivated the mothers to continue experience than the mothers had
Australia perceptions, T: Parents of preterm expressing. Breastfeeding was seen assumed.
experiences and care infants (range 24-30 gw), as natural and important for
practices of NICU II and III bonding.
breastfeeding
Sweet, Explore parents’ D: Phenomenology Providing breast milk enabled the Expressing was not the first priority
2009, breastfeeding S: n=17 mothers to connect with their for the mothers after the birth of
Australia experiences T: Parents of preterm infants. Breast milk was highly preterm infant. The sufficiency of
infants (range 24-30 gw), valued. Breastfeeding was a marker breast milk was a concerns.
NICU II and III of good motherhood. Expressing
was necessary to achieve
breastfeeding.
Preterm infants’ mothers’ lactation experiences
Swift & Describe parents’ D: Phenomenology Expressing meant that the mothers Difficulties in preterm infants’
Scholten, experiences of S: n=9 did something for their infants. feeding progression were frustrating,
2009, feeding difficulties T: Parents of preterm and decreased mothers’ feeling of
Australia at 36 weeks infants (> 29 gw), competence. Expressing was time-
gestation age Neonatal unit, consuming, inconvenient, and
exhausting. Scheduled feeding was
experienced as stressful.
Abbreviations: D, Design; S, Sample; T, Target; gw, gestation weeks; NICU, neonatal intensive care unit