Abstract
This study aimed to explore if and how OTs are addressing breastfeeding in the NICU, including the types of interventions used, the roles assumed, and subjective perceptions of barriers to addressing breastfeeding. An online survey was distributed nationwide to OTs currently working in NICUs. Data were collected from 85 eligible participants in 30 states; 84% of respondents indicated they provide breastfeeding interventions primarily in the roles of clinician and educator.
Primary Author and Speaker: Allison Smith
Additional Authors and Speakers: Erin Kastelz, Alexandra Moini, Erica Strutner, Eric Ingersoll
Contributing Authors: Jim Le
Breastfeeding is an occupation encouraged worldwide due to proven benefits for both infants and mothers. Preterm infants are immature, medically fragile, and have difficulty initiating and continuing breastfeeding, but it is often unclear who on the Neonatal Intensive Care Unit (NICU) team is responsible for addressing feeding difficulties due to inconsistent health care practices and role confusion. Occupational therapists (OTs) on the NICU team are trained to provide interventions including oral-motor skills, parent-infant relationships, adaptive equipment, environmental modifications, and parent education, but OTs’ roles and responsibilities in the NICU have historically been misunderstood and confused with other NICU team members. Therefore, it is important for OTs to ensure their unique role is clearly defined and understood in the NICU. Currently, there is no research about what role OTs play in addressing breastfeeding in NICUs. The purpose of this study was to explore the role of OTs in addressing breastfeeding in the NICU by answering the following research questions:
1. Are OTs providing breastfeeding interventions in NICU settings? If so, what interventions are being utilized?
2. What roles do OTs assume to address breastfeeding in NICUs?
3. What are the perceived barriers to breastfeeding identified by OTs who work in the NICU setting?
A descriptive research design was used. The inclusion criteria were any OTs currently working in a NICU in the US. Sampling procedures included convenience and snowball sampling through professional organizations, social media, and personal contacts.
The researchers created and distributed an anonymous, online survey through Qualtrics®. The survey consisted of 28 demographic, Likert-scale, and open-ended questions, taking approximately 10 minutes to complete. To validate the survey, experts were consulted in survey design and NICU OT. Data were then analyzed for frequency of responses using SPSS.
140 individuals provided informed consent with 85 participants from 30 states meeting inclusion criteria. 84% of respondents indicated they were providing breastfeeding interventions. All respondents reported using infant interventions of oral stimulation with breast milk, non-nutritive sucking, kangaroo care, and mother-infant education. Most used adaptive equipment included 89% reported using reclining chairs, 95% my breast friend/boppy, and 94% nipple shields. Caregiver interventions that were most commonly used related to the mother's culture, values, beliefs, and spirituality or assisting with the mechanics of breastfeeding. Participants reported working as “clinician” and “educator” most frequently when addressing breastfeeding. Parent, institutional/facility, and infant factors were indicated as being the most common barriers in addressing breastfeeding in the NICU.
This research identified how OTs are currently addressing breastfeeding in the NICU. Most OTs who work in the NICU are addressing breastfeeding and assume a variety of roles using a range of adaptive equipment, infant interventions, and caregiver interventions to address breastfeeding in the NICU. OTs have the skills to address breastfeeding in the NICU but need further evidence to support OTs specific contribution to supporting breastfeeding in the NICU. Findings in the areas of perceived barriers present opportunities for OTs in the NICU to assume the role of advocate and consider environmental modifications and work schedule changes in order to meet the needs of the breastfeeding mother-infant dyad in the NICU context. This research is significant for OT practice and policy providing evidence to define OT’s role in addressing breastfeeding as an emerging practice area that supports infant and maternal health.
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