Mothers of very preterm infants continue to face challenges related to providing their expressed breast milk in the neonatal intensive care unit (NICU).
Objective:
This qualitative study sought to understand the experience of mothers of hospitalized very preterm infants related to their daily pumping routine during the NICU stay.
Methods:
Fourteen women who were pumping breast milk for their hospitalized infants were interviewed. Sequential, semistructured, audiotaped individual interviews were conducted at 2 different time points: within 2 weeks following delivery when the mothers were pumping only, and 4 to 6 weeks once breastfeeding had been initiated.
Results:
The central themes found were: becoming a “mother–interrupted” and negotiating a paradoxical experience of separation and connection. Unique to these findings were the paradoxical view of the pump as both a wedge and a link to their infants, the intense dislike the mothers had for the tasks required to provide their expressed breast milk, and diversionary tactics used during pumping sessions.
Conclusion:
The complexity of thoughts, actions, and behaviors revealed in the mothers’ narrative accounts provides a guide to direct future breastfeeding interventions and management.
MerewoodABrooksDBauchnerHMacAuleyLMehtaSD. Maternal birthplace and breastfeeding initiation among term and preterm infants: a statewide assessment for Massachusetts. Pediatrics. 2006;118(4):e1048-e1054.
2.
SiskPMLoveladyCADillardRGGruberKJ. Lactation counseling for mothers of very low birth weight infants: effect on maternal anxiety and infant intake of human milk. Pediatrics. 2006;117(1):e67-e75.
3.
SmithMMDurkinMHintonVJBellingerDKuhnL. Initiation of breastfeeding among mothers of very low birth weight infants. Pediatrics. 2003;111(6 Pt 1):1337-1342.
4.
MerewoodAChamberlainLBCookJTPhilippBLMaloneKBauchnerH. The effect of peer counselors on breastfeeding rates in the neonatal intensive care unit: results of a randomized controlled trial. Arch Pediatr Adolesc Med. 2006;160(7):681-685.
5.
CreganMDDe MelloTRKershawDMcDougallKHartmannPE. Initiation of lactation in women after preterm delivery. Acta Obstet Gynecol Scand. 2002;81(9):870-877.
6.
HillPDAldagJC. Milk volume on day 4 and income predictive of lactation adequacy at 6 weeks of mothers of nonnursing preterm infants. J Perinat Neonatal Nurs. 2005;19(3):273-282.
7.
MeierPPEngstromJLHurstNM. A comparison of the efficiency, efficacy, comfort, and convenience of two hospital-grade electric breast pumps for mothers of very low birthweight infants. Breastfeed Med. 2008;3(3):141-150.
8.
Dall’OglioISalvatoriGBonciENantiniBD’AgostinoGDottaA. Breastfeeding promotion in neonatal intensive care unit: impact of a new program toward a BFHI for high-risk infants. Acta Paediatr. 2007;96(11):1626-1631.
9.
FlackingRWallinLEwaldU. Perinatal and socioeconomic determinants of breastfeeding duration in very preterm infants. Acta Paediatr. 2007;96(8):1126-1130.
10.
da SilvaOPKnoppertDCAngeliniMMForretPA. Effect of domperidone on milk production in mothers of premature newborns: a randomized, double-blind, placebo-controlled trial. CMAJ. 2001;164(1):17-21.
11.
WanEWDaveyKPage-SharpMHartmannPESimmerKIlettKF. Dose-effect study of domperidone as a galactagogue in preterm mothers with insufficient milk supply, and its transfer into milk. Br J Clin Pharmacol. 2008;66(2):283-289.
12.
BoucherCABrazalPMGraham-CertosiniCCarnaghan-SherrardKFeeleyN. Mothers’ breastfeeding experiences in the NICU. Neonatal Netw. 2011;30(1):21-28.
13.
CallenJPinelliJ. A review of the literature examining the benefits and challenges, incidence and duration, and barriers to breastfeeding in preterm infants. Adv Neonatal Care. 2005;5(2):72-88; quiz 89-92.
14.
SwansonVNicolHMcInnesRCheyneHMactierHCallanderE. Developing maternal self-efficacy for feeding preterm babies in the neonatal unit. Qual Health Res. 2012;22(10):1369-1382.
15.
KrouseAM. The family management of breastfeeding low birth weight infants. J Hum Lact. 2002;18(2):155-165.
16.
BernaixLWSchmidtCAJamersonPASeiterLSmithJ. The NICU experience of lactation and its relationship to family management style. MCN Am J Matern Child Nurs. 2006;31(2):95-100.
17.
SweetL. Expressed breast milk as ‘connection’ and its influence on the construction of ‘motherhood’ for mothers of preterm infants: a qualitative study. Int Breastfeed J. 2008;3:30.
18.
KavanaughKMeierPZimmermannBMeadL. The rewards outweigh the efforts: breastfeeding outcomes for mothers of preterm infants. J Hum Lact. 1997;13(1):15-21.
19.
WelbornJM. The experience of expressing and donating breast milk following a perinatal loss. J Hum Lact. 2012;28(4):506-510.
20.
SweetL. Breastfeeding a preterm infant and the objectification of breastmilk. Breastfeed Rev. 2006;14(1):5-13.
21.
FlackingREwaldUNyqvistKHStarrinB. Trustful bonds: a key to “becoming a mother” and to reciprocal breastfeeding. Stories of mothers of very preterm infants at a neonatal unit. Soc Sci Med. 2006;62(1):70-80.
22.
FlackingREwaldUStarrinB. “I wanted to do a good job”: experiences of ‘becoming a mother’ and breastfeeding in mothers of very preterm infants after discharge from a neonatal unit. Soc Sci Med. 2007;64(12):2405-2416.
23.
LeeTYLeeTTKuoSC. The experiences of mothers in breastfeeding their very low birth weight infants. J Adv Nurs. 2009;65(12):2523-2531.
24.
HurstNM. Breastfeeding the Very Preterm Hospitalized Infant: An Ethnographic Study [dissertation]. Houston, TX: School of Nursing, University of Texas Health Science Center; 2007.
SpradleyJP. The Ethnographic Interview. Belmont, CA: Wadsworth Group/Thompson Learning; 1979.
27.
GreenJThorogoodN. Qualitative Methods for Health Research. London: SAGE Publications; 2004.
28.
EngebretsonJ. Clinically applied medical ethnography: relevance to cultural competence in patient care. Nurs Clin North Am. 2011;46(2):145-154, v.
29.
KleinmannA. Patients and Healers in the Context of Culture: An Exploration of the Borderland between Anthropology, Medicine, and Psychiatry. Berkeley, CA: University of California Press; 1981.
30.
SavageJ. One voice, different tunes: issues raised by dual analysis of a segment of qualitative data. J Adv Nurs. 2000;31(6): 1493-1500.
LindbergCNashSLindbergC. On the Edge: Nursing in the Age of Complexity. CreateSpace Independent Publishing Platform; 2008.
33.
KelsoJASEngstromDA. The Complementary Nature. Cambridge, MA: MIT Press; 2006.
34.
BaumNWeidbergZOsherYKoheletD. No longer pregnant, not yet a mother: giving birth prematurely to a very-low-birth-weight baby. Qual Health Res. 2011;22(5):595-606.
35.
BlackBPHolditch-DavisDMilesMS. Life course theory as a framework to examine becoming a mother of a medically fragile preterm infant. Res Nurs Health. 2009;32(1):38-49.
36.
TilokskulchaiFPhatthanasiriwethinSVichitsukonKSerisathienY. Attachment behaviors in mothers of premature infants: a descriptive study in Thai mothers. J Perinat Neonatal Nurs. 2002;16(3):69-83.
37.
BialoskurskiMCoxCLHayesJA. The nature of attachment in a neonatal intensive care unit. J Perinat Neonatal Nurs. 1999;13(1):66-77.
38.
FeldmanRWellerALeckmanJFKuintJEidelmanAI. The nature of the mother’s tie to her infant: maternal bonding under conditions of proximity, separation, and potential loss. J Child Psychol Psychiatry. 1999;40(6):929-939.
39.
WigertHJohanssonRBergMHellstromAL. Mothers’ experiences of having their newborn child in a neonatal intensive care unit. Scand J Caring Sci. 2006;20(1):35-41.
40.
SpicerK. What every nurse needs to know about breast pumping: instructing and supporting mothers of premature infants in the NICU. Neonatal Netw. 2001;20(4):35-41.
41.
DowlingDABlatzMAGrahamG. Mothers’ experiences expressing breast milk for their preterm infants: does NICU design make a difference?Adv Neonatal Care. 2012;12(6):377-384.
42.
EngstromJLMeierPPJegierBMotykowskiJEZulegerJL. Comparison of milk output from the right and left breasts during simultaneous pumping in mothers of very low birthweight infants. Breastfeed Med. 2007;2(2):83-91.
