Breastfeeding the Very Preterm Hospitalized Infant

The ability to initiate and sustain lactation during an extended hospitalization is a critical challenge faced by the mothers of very preterm infants (PI). However, the thoughts, attitudes, and behaviors of mothers related to their daily pumping routine and breastfeeding concerns are not fully understood. These are important aspects that may influence breastfeeding outcomes. Moreover, high rates of depressive symptoms have been reported among preterm mothers that may account for the less than optimal success in breast pumping/feeding practices.

Purpose. To understand mothers’ narrated descriptions of breastfeeding their PI in the neonatal intensive care unit (NICU).

Methods. A mixed method design was used with a dominant qualitative approach (open-ended semi-structured interviews and fieldwork) combined with a quantitative component (demographic/clinical information, milk expression patterns, and Edinburgh Postpartum Depression Scale (EPDS) scores.

Findings. Thematic analysis of 23 interviews with 14 subjects revealed that mothers of very PI experienced an interruption in the process of becoming a mother, a paradoxical experience related to aspects of their milk expression routines, and negotiating the NICU environment. EPDS scores did not reveal congruent differences in those mothers scoring high compared to those scoring low.

Conclusions. Understanding the experiences of the mothers in this study allows for a better perspective of breastfeeding the very PI in the context of the NICU. Findings from this study validate the difficult and incremental process of attaining maternal identity and the significant burden placed on these women with regards to the provision of breast milk and breastfeeding during their infant’s hospitalization.