Mothers' experiences of breast milk expression during separation from their hospitalized infants: a systematic review of qualitative evidence.

BACKGROUND: Mother-infant separation, which is occurring with an increasing incidence, is a barrier to direct breastfeeding. Owing to the importance of breast milk to hospitalized infants, mothers are actively encouraged to express milk during their infants' neonatal intensive care unit (NICU) stay. However, mothers are often faced with a number of challenges in this process. There is a need to understand such mothers' real-life experiences of breast milk expression to develop supportive strategies to reduce the burden on mothers and increase breastfeeding rates. METHODS: A comprehensive search of 12 databases was conducted for relevant studies published from database construction to December 2022. All qualitative and mixed-method studies published in English and Chinese that reported on mothers' experiences of human milk expression during separation from their hospitalized infants were included. Two reviewers independently conducted screening, data extraction, and quality appraisal, with disagreements resolved by a third reviewer. The process of searching followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The JBI Qualitative Assessment and Review Instrument was used to assess study quality and the credibility of study findings. Meta-aggregation was performed to integrate the results. RESULTS: This systematic review aggregated mothers' experiences of milk expression during separation from their hospitalized infants. Database search yielded 600 records, of which 19 full-text documents were screened. Finally, 13 studies of good quality were included with data from 332 mothers across seven countries. A total of 61 primary findings with illustrations were extracted from the 13 eligible studies, the findings were generalized into 16 categories, and further were concluded as four synthesized findings: purpose and motivation, physical and emotional experiences, barrier factors, and coping styles. CONCLUSION: Mothers were driven by extrinsic motivation in their decision to express breast milk. They experienced physical exhaustion and many negative emotional feelings while expressing. This process was affected by numerous barriers. Social support was essential to the initiation and maintenance of milk expression. Medical staff and families should pay more attention to the mental health of mothers with infants in the NICU. Future research should incorporate strategies to cope with emotional responses and offer practical strategies for managing milk expression. SYSTEMATIC REVIEW REGISTRATION: [ www.crd.york.ac.uk ], identifier [PROSPERO 2022 CRD42022383080].

Initiation of lactation and the provision of human milk to preterm infants in German neonatal intensive care units from the mothers' perspective.

BACKGROUND: If infants with a very low birth weight (VLBW) are to be fed exclusively with human milk, it is essential to focus on lactation initiation. The aim of the study is to learn more about the current state of lactation initiation and human milk provision in neonatal intensive care units in Germany from the mothers' perspective. METHODS: Written surveys were conducted with mothers of VLBW infants to learn more about the timing of initiation of lactation, pumping frequency during the first three days postpartum and feeding of the preterm infant during hospitalisation. RESULTS: The data of 437 mothers (response rate: 44.7%) were included in the analyses. Of these, only 7.8% stated that they had initiated lactation immediately after delivery and 38.2% within 6 h. In terms of pumping frequency, 50.1% pumped 7-9 times a day within the first 3 days postpartum; 60.9% reported that their infant received formula feedings during the hospital stay. CONCLUSION: Overall, deficits were still evident with regard to the initiation of lactation in mothers of VLBW infants in Germany, resulting in a large proportion of VLBW infants receiving formula in the hospital. TRIAL REGISTRATION: German Clinical Trial Register: DRKS00017755 .

Unseen, unheard: a qualitative analysis of women's experiences of exclusively expressing breast milk.

BACKGROUND: Breast milk feeding has numerous benefits for women and infants. Positive maternal experiences with breast milk feeding impacts exclusivity, duration, and maternal mental health. Most research focuses on women feeding directly at the breast. Some women elect to feed exclusively expressed milk to their healthy, term infants rather than feed directly at the breast. Little is known about what constitutes a positive experience among this population. Therefore, the aim of this study was to explore women's experiences of exclusive expression (EE). METHODS: Interviews were conducted via Microsoft Teams to collect qualitative data from a purposive sample of 21 women practicing EE. Interviews were analyzed for themes. RESULTS: Three themes: Unseen and Unheard, Doing it My Way, and Getting into the Groove, and 8 subthemes: Breast is Best, Missed Opportunities for Healthcare Provider Support, Fighting for it, What Works for Us, A Sense of Control, Preparation, Tricks of the Trade, and Making it Manageable were identified. Despite challenges, including a lack of support from healthcare providers and a lack of acknowledgement as breastfeeding mothers, exclusive expression offered participants a method to continue breast milk feeding in a way that they found to be satisfying. CONCLUSION: This study provides insight into experiences of exclusive expression that clinicians can use to improve their support of breast milk feeding during perinatal encounters. Societal pressure to feed from the breast may have negative emotional consequences for women electing to exclusively express. There is a need for more information and support for breast milk expression from healthcare providers along with a reframing of how breast milk feeding is discussed and promoted.

Mothers' Experiences with Antenatal Milk Expression.

BACKGROUND: Antenatal milk expression is a milk expression intervention beginning at either 36 or 37 weeks of gestation for the purpose of potential colostrum collection and storage prior to birth for postnatal infant feeding. Research on antenatal milk expression is limited and originates outside the United States. METHODS: Women who used antenatal milk expression were interviewed about their experiences. A conventional, inductive approach to qualitative content analysis was used to analyze participants' responses. RESULTS: Three women participated in interviews. They reported learning and performing antenatal milk expression for various postpartum needs including avoidance of formula, milk available for potential infant hypoglycemia, and to support human milk feeding during surrogate mother-infant separation. These mothers obtained education and information on antenatal milk expression primarily on their own. CLINICAL IMPLICATIONS: Greater awareness and understanding of antenatal milk expression is needed in the professional community caring for childbearing women. Perinatal nurses need to be aware of all breastfeeding practices including antenatal milk expression. Knowledge of the practice and advocacy for more research on antenatal milk expression will improve lactation support and ensure expectant mothers reach their personal breastfeeding goals.

A qualitative study of expectations and experiences of women using a social media support group when exclusively expressing breastmilk to feed their infant.

BACKGROUND: Global recommendations are that mothers exclusively breastfeed their infants for the first six months of life to achieve optimal growth, development, and health outcomes. When infants are unable to feed at the breast, giving expressed breastmilk is the preferred alternative. Mothers who exclusively express breastmilk are poorly supported in mainstream healthcare, and are increasingly using social media groups for assistance. AIM: To understand the expectations and experiences of women who access social media groups when exclusively expressing breastmilk. METHODS: A qualitative descriptive approach was used. Participants were recruited online using purposive sampling. The data was collected using semi-structured in-depth interviews with ten women. Audio data were transcribed and subjected to a thematic analysis. FINDINGS: The first theme was expecting and experiencing emotional support; sub-themes include: coping with grief through emotional support and shared experiences; providing emotional support in the absence of in-person social support; providing emotional support through being non-judgemental; and the ability to access emotional support and engagement 24/7. The second theme was receiving information to manage exclusive expressing; sub-themes include: expression schedules and the let-down reflex; managing exclusive expression; and resolving lactation and breast-related issues. DISCUSSION: Ajzen's 'Theory of Planned Behaviour' is used to better understand the women's expectations and experiences of belonging to an online peer support group while exclusive expressing. CONCLUSION: The study highlights the importance of both antenatal and postnatal education and support, the need for reliable information, and the impact of the inability to breastfeed on mothers' emotional health.

Informal Milk Sharing for the Hospitalized at-Risk Infant in the Ultra-Orthodox-Haredi Jewish Community in the United States.

The process of human milk donation and sharing for the promotion of infant health is a phenomenon of interest as it directly affects children's health and well-being. Although its prevalence is currently unknown, informal sharing of human milk is occurring across the United States. The U.S. Food and Drug Administration recommends against informal sharing of human milk. However, the Ultra-Orthodox (Haredi) Orthodox Jewish population, who strictly observes Jewish laws and often consults with rabbis before making medical decisions, is known to donate and obtain milk through informal sharing. The objective of this study was to explore the lived experience of informal donation from the perspective of Ultra-Orthodox mothers from the Northeastern region of the United States who engaged in milk sharing to support hospitalized at-risk infants. Women were interviewed by an Orthodox Jewish member of the team, using a semistructured interview guide. Informal milk sharing was regarded as a positive empowering experience. Themes which illuminate the phenomena of milk sharing include faith, mistrust of the medical establishment, a strong reliance on social connectedness, and importance of sacred cultural traditions. Health care providers need to be aware of these specific needs to provide culturally sensitive care for safer milk sharing practices in cloistered and faith-based communities.

A mother-centered evaluation of breast pumps.

Existing literature outlines mothers' negative experiences with breast pumps, yet a gap exists of which breast pump characteristics are important to mothers. Identifying which breast pump characteristics are important to breast pumping mothers, and any variation between mothers who do or do not work outside of the home, will help identify user needs. A survey collected information on mothers' experiences with breast pumps and impressions of their characteristics. Latent Class Analysis (LCA) was used to determine whether there were possible groupings of impressions of these characteristics. The LCA identified a two-class model with mothers' age as a significant covariate. Portability, ease of use, low-weight, fast milk extraction, comfortability, low-noise, and discreet were all found to be important to one group of mothers, while only portability, ease of use, fast milk extraction, and comfortability were found to be important to another group of mothers. Mothers' work status was not a significant covariate but did predict class membership when considered as a grouping variable in conjunction with age. Breast pumping mothers' needs were found to differ based on their work status and age together, and collecting and considering these different needs is vital to creating redesigns that improve mothers' breast pumping experience.

Breastfeeding experiences and perspectives on support among Chinese mothers separated from their hospitalized preterm infants: a qualitative study.

Background: Chinese mothers of preterm infants often face obstacles to breastfeeding and commonly experience prolonged maternal-infant separation when their high-risk infants are hospitalized in a Neonatal Intensive Care Unit (NICU). This separation hinders mother-infant attachment and the establishment of breastfeeding. Currently, little is known about Chinese mothers' experiences breastfeeding their preterm infants, or their support needs. The aim of this study was to develop an understanding of mothers' experiences breastfeeding a hospitalized preterm infant and the support needed to establish a milk supply during the period separation from their infants. Methods: A qualitative descriptive study was conducted in Beijing in 2017. A total of 11 Chinese mothers were individually interviewed while separated from their infants. The interviews were audio-recorded and transcribed verbatim. A thematic analysis involving a seven-step protocol identified key themes. Results: Mothers of preterm infants reported physically and mentally challenging breastfeeding experiences during the period they were separated from their babies. They viewed expressing breast milk as integral to their maternal role, even though some found expressing breastmilk exhausting. With little professional support available, the mothers depended upon nonprofessionals to establish breastfeeding. Conclusions: The study identified the difficulties mothers experienced establishing a milk supply while separated from their preterm infants, and the importance of access to health professional support.

A Descriptive Study of the Attitudes, Perceptions, and Experiences of Human Milk Donation.

BACKGROUND: The use of pasteurized human donor milk has increased in recent years due to health benefits and rising number of infants who need pasteurized human donor milk. Little is known about milk donors' experiences or what contributes to their motivation to donate. PURPOSE: Using existing evidence and the theory of planned behavior as a guide, our purpose was to describe the personal and social aspects of mothers' milk donation to a milk bank in the Midwest United States. METHODS: A convenience sample of 50 current human milk donors enrolled in this cross-sectional descriptive study. The investigator-designed online survey consisted of open and closed questions based upon existing evidence and theory of planned behavior for assessing reasons for donation, beliefs about benefits and barriers, social support for donation, donation history, and current experiences. We used the Iowa Infant Feeding Attitude Survey to characterize general breastfeeding attitudes. Data analysis consisted of content analysis for narrative data and descriptive statistics for continuous and dichotomous variables. FINDINGS/RESULTS: Six themes represented experiences of discovering donation, reasons and motivations for donating, benefits and barriers to donation, confidence in donating, and support for donation. Practical and altruistic motivations for donation were prevalent. Confidence for donation was instilled by adequate milk supply, growth of the infant, and the milk bank process and professionalism. Support from others was universal. IMPLICATIONS FOR PRACTICE: Findings can inform education regarding human milk donation. Human milk banks may benefit from identified donation barriers to improve support for donors. IMPLICATIONS FOR RESEARCH: Findings are being used for instrument development for research regarding women's intentions and donor behavior.

Predictors of Mother's Own Milk Feeding at Discharge in Preterm Infants.

BACKGROUND: The dose-response benefits of human milk for preterm infants are well documented. Understanding factors that influence duration of mother's own milk (MOM) receipt may have important clinical implications. PURPOSE: To identify variables that significantly affect whether or not preterm infants receive their own mother's milk at discharge. METHODS: Maternal-infant dyads were eligible for inclusion if the infant was born between August 1, 2010, and July 31, 2015, was born at 32 weeks' gestation or less, or was 1800 g or less (institutional donor milk receipt criteria). Bivariate and multivariable regression analyses were performed. RESULTS: Of 428 observations, 258 (60.3%) received MOM at discharge and 170 (39.7%) did not. Maternal characteristics that were protective for MOM receipt at discharge were non-Hispanic race, married, partner support, more educated, and private insurance. Protective infant characteristics were higher gestational age at birth, higher percentage of MOM feedings, fewer ventilator days, and more days of direct lactation. In multivariable logistic regression, the odds of receiving MOM at discharge significantly (odds ratio = 1.93; 95% confidence interval, 1.72-2.16; P < .001) increased with the increasing proportion of MOM. Regression analysis showed that gestational age and increased maternal age increased the likelihood of MOM receipt at discharge. IMPLICATIONS FOR PRACTICE: Clinicians will understand the significant effects even small increases in milk volume have on duration of MOM receipt at discharge, informing them of the importance of strategies to encourage and improve milk expression. IMPLICATIONS FOR RESEARCH: Future research studying critical time periods when mothers are most likely to reduce milk expression may have significant clinical importance.

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.

After the Loss of an Infant: Suppression of Breast Milk Supply.

Following an infant death, if breast milk production is not weaned, this could lead to issues for the mother. Lactation suppression can be done safely with proper education and support. Caregivers should be educated on how to provide support to the lactating woman during this difficult situation. An abrupt wean can lead to engorgement and milk trapping. This can be uncomfortable and possibly lead to mastitis with infection. The mother who has been providing breast milk needs special attention. Providing her with the knowledge of what to expect and the use of comfort measures will make the discontinuation of her milk production a smoother and more comfortable process.The emotional support of the grieving process begins in the NICU. Encourage follow-up for the bereaved family by offering them resources. Give the parents the option to donate breast milk. In some situations, donation promotes healing and closure.

Clinician's Guide to Supporting Women With Breast Milk Pumping.

The benefits of breastfeeding and breast milk are well established. Women may intend to exclusively breastfeed their infants, but they often need to provide expressed breast milk upon returning to employment or other activities. Without specialized lactation services, women may turn to health care providers, social media, and Web-based information for support and education. Nurses can support breastfeeding women and help them make informed decisions by providing factual, practical information about breast pumps, expression and storage of breast milk, options for testing breast milk, and available resources.

Female employees' perception of breastfeeding-friendly support in a public university in Spain.

OBJECTIVE: To explore women's experience with continuing breastfeeding when they returned to work. DESIGN AND SAMPLE: A cross-sectional study was conducted. Participants were female employees at the University of Seville who gave birth in the last 10 years while working at University. MEASURES: A questionnaire in Spanish was used to collect information on sociodemographic variables, employment characteristics, continued breastfeeding behavior after returning to work and the dimensions of the validated scale the Workplace Breastfeeding Support Scale (WBSS). RESULTS: A total of 197 women responded, consisting of 53.8% faculty and 46.2% administrative staff. Almost all the women had breastfed their children (92.9%). The proportion of women who continued to breastfeed after they returned to work was 51.3%. The main reason given for interrupting lactation was the challenge of reconciling family and work (53.1%). Faculty members took more breaks for breastfeeding (p = 0.002) and were able to arrange their breaks more easily (p < 0.001). Since it was easier for them to find a quiet place to pump breast milk (p = 0.025), they were more likely to continue breastfeeding after returning to work than were administrative staff (59.8% vs. 41.1%, p < 0.009). CONCLUSION: A designated lactation space and amenities should be provided in order to extend the duration of breastfeeding.

Breastfeeding Without Nursing: "If Only I'd Known More about Exclusively Pumping before Giving Birth".

BACKGROUND: Human milk is understood to be the optimal nutrition for infants, yet many women struggle to nurse. Although exclusively pumping human milk can provide a solution, women may be unaware of this possibility and, thus, experience unnecessary frustration. RESEARCH AIM: This study aimed to (a) determine the proportion of respondents who had heard of exclusive pumping prenatally; (b) describe sources that respondents turned to and/or received breastfeeding-related information from prenatally; (c) explore the ways in which respondents learned prenatally about exclusive pumping; (d) describe how useful respondents found various information sources when learning about exclusive pumping; and (e) describe the differences between respondents who first heard the term exclusive pumping prenatally versus postpartum. METHODS: A cross-sectional, self-report, mixed-methods survey was administered online to a convenience sample of current and/or past exclusive pumpers ( N = 1,215). Descriptive statistics were produced (Research aims 1-4), and chi-square tests (Research aims 1, 2, and 5) and a Mann-Whitney U test (Research aim 5) were conducted, to identify trends and compare respondents. RESULTS: Seventy-one percent ( n = 864) of respondents had not heard of exclusive pumping until after giving birth. Respondents reported that very few prenatal breastfeeding information sources mentioned or explained exclusive pumping. Women who had heard about exclusive pumping prior to giving birth ( n = 291, 24%) reported feeling more knowledgeable about how to exclusively pump and less frustrated, insecure, depressed, rejected, embarrassed, envious, burdened, guilty, and disappointed while exclusively pumping. CONCLUSION: For postpartum knowledge and affective outcomes to improve, prenatal infant feeding information and education must include information about exclusive pumping.

"I Felt Like I Was a Part of Trying to Keep My Baby Alive": Perspectives of Hispanic and Non-Hispanic Black Mothers in Providing Milk for Their Very Preterm Infants.

Background: Compared with non-Hispanic white, Hispanic and non-Hispanic black mothers of very preterm infants are less likely to provide mother's milk at the point of hospital discharge; the perspectives of these mothers are poorly understood. Objectives: To examine the perceived barriers and facilitators of providing milk for very preterm infants during the hospitalization among Hispanic and non-Hispanic black mothers. Materials and Methods: We conducted 23 in-depth, semistructured interviews of English and Spanish-speaking Hispanic and non-Hispanic black mothers that initiated milk production for their very preterm infants, ≤1,750 g at birth. Following thematic saturation, results were validated through expert triangulation and member checking. Results: Twelve mothers were Hispanic, where three were English speaking and nine were Spanish speaking. Eleven mothers were non-Hispanic black and English speaking. We found themes pertaining to general experiences: (1) Breastfeeding intent impacts mothers' success in providing milk throughout the hospitalization; (2) Pumping milk for a hospitalized infant is repetitive, exhausting, and does not elicit the same emotional connection as breastfeeding; (3) Hospital providers are an important source of support, when sufficient time is spent to address ongoing issues; (4) Providing milk creates a unique sense of purpose when mothers otherwise feel a lack of control; and we found themes pertaining to the experiences of Hispanic and non-Hispanic black mothers: (1) Breastfeeding as a cultural norm influences mothers' intent to initiate and continue breastfeeding; (2) Hospital staff are viewed as more supportive when interactions and treatment are perceived as racially/ethnically unbiased and (3) when communication occurs in the primary language; and (4) Mother-infant separation creates logistical challenges that negatively impact ongoing milk production. Conclusions: While providing milk for a hospitalized very preterm infant is exhausting, and logistically challenging, Hispanic and non-Hispanic black mothers are inspired to do so because of their intent to breastfeed, support from hospital providers, and feelings of purpose.

Facilitating Early Breast Milk Expression in Mothers of Very Low Birth Weight Infants.

BACKGROUND: Although early initiation of human milk (HM) expression after birth is known to increase lactation success in mothers of very low birthweight (VLBW) infants, initiation is frequently delayed, potentially decreasing both short- and long-term HM production. Obstetrical (OB) nurses are typically the healthcare provider responsible for facilitating the initial HM expression session. As delays in initiation are common, it is likely that nurses experience obstacles to facilitation of an early initiation of HM expression. The purpose of this study was to determine barriers OB nurses perceive in facilitating early initiation of HM expression in mothers of VLBW infants. STUDY DESIGN AND METHODS: An online survey was administered to nurses from three tertiary care OB units in Florida to determine perceived barriers to early initiation of HM expression in mothers of VLBW infants. RESULTS: Eighty-three nurses completed the survey. The following barriers were identified: (1) lack of time and personnel to assist mothers with HM expression, (2) nurse's perception of the mother's acuity level, and (3) nurse's perception of maternal pain and stress. Discrepancies between nursing judgment, action, and knowledge of unit policies were evident. CLINICAL IMPLICATIONS: Obstetric nurses encounter barriers when facilitating early HM expression in mothers giving birth to VLBW infants. It is possible these barriers could be removed through improvements in education, use of innovative staffing strategies, and maintenance of evidence-based policies.