Birth of a very low birth weight preterm infant and the intention to breastfeed 'naturally'

School of Nursing and Midwifery, Flinders University, Adelaide, SA, Australia.
Women and Birth (Impact Factor: 1.57). 04/2008; 21(1):13-20. DOI: 10.1016/j.wombi.2007.11.001
Source: PubMed


An interpretive phenomenological study involving 17 Australian parents was undertaken to explore parents' experiences of breastfeeding very low birth weight (VLBW) preterm infants from birth to 12 months of age. Data were collected from 45 individual interviews held with both mothers and fathers, which were then transcribed verbatim and analysed using thematic analysis. From this study, the analysis identified the following themes: the intention to breastfeed naturally; breast milk as connection; the maternal role of breast milk producer; breastmilk as the object of attention; breastfeeding and parenting the hospitalised baby and the demise of breastfeeding. The discussion presented here presents the theme of the intention to breastfeed 'naturally'. This study found that all of the participant women decided to breastfeed well before the preterm birth, and despite the birth of a VLBW preterm infant continued to expect the breastfeeding experience to be normal regardless of the difference of the postpartum experience. It is without doubt that for these parents the pro-breastfeeding rhetoric is powerfully influential and thus successful in promoting breastfeeding. Furthermore, all participants expected breastfeeding to be 'natural' and satisfying. There is disparity between parents' expectations of breastfeeding 'naturally' and the commonplace reality of long-term breast expression and uncertain at-breast feeding outcomes. How the parents came to make the decision to breastfeed their unborn child -- including the situations and experiences that have influenced their decision making -- and how the preterm birth and the dominant cultures subsequently affected that decision will be discussed. The findings have implications for midwifery education and maternity care professionals who support parents making feeding decisions early in pregnancy and those striving to breastfeed preterm infants.

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    • "There are numerous studies generalized to premature and low-birthweight infants describing maternal perceptions of breastfeeding. These qualitative analyses describe feelings of disparity between breastfeeding expectations and reality (Sweet, 2008), objectification of breast milk (Sweet, 2006), concerns regarding inadequate milk volume and composition (Callen, Pinelli, Atkinson, & Saigal, 2005; Kavanaugh, Mead, Meier, & Mangurten, 1995), a duty versus reciprocal breastfeeding viewpoint (Flacking, Ewald, Nyqvist, & Starrin, 2006; Flacking, Ewald, & Starrin, 2007), and the act of breastfeeding as providing a claim on the infant and validating maternal identity (Kavanaugh, Meier, Zimmermann, & Mead, 1997). As a result of significant research in this area, evidence-based interventions for providing breastfeeding support in the neonatal intensive care unit have been delineated (Meier & Brown, 1996). "
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    ABSTRACT: To synthesize the published research pertaining to breastfeeding establishment and outcomes among late preterm infants and to describe the state of the science on breastfeeding within this population. Online databases Ovid MEDLINE, CINAHL, PubMed, and reference lists of reviewed articles. Nine data-based research articles examining breastfeeding patterns and outcomes among infants born between 34 0/7 and 36 6/7 weeks gestation or overlapping with this time period by at least 2 weeks. Effect sizes and descriptive statistics pertaining to breastfeeding initiation, duration, exclusivity, and health outcomes among late preterm breastfed infants. Among late preterm mother/infant dyads, breastfeeding initiation appears to be approximately 59% to 70% (U.S.), whereas the odds of breastfeeding beyond 4 weeks or to the recommended 6 months (exclusive breastfeeding) appears to be significantly less than for term infants, and possibly less than infants ≤34 to 35 weeks gestation. Breastfeeding exclusivity is not routinely reported. Rehospitalization, often related to "jaundice" and "poor feeding," is nearly twice as common among late preterm breastfed infants as breastfed term or nonbreastfed late preterm infants. Barriers to optimal breastfeeding in this population are often inferred from research on younger preterm infants, and evidence-based breastfeeding guidelines are lacking. Late preterm infants are at greater risk for breastfeeding-associated rehospitalization and poor breastfeeding establishment compared to their term (and possibly early preterm) counterparts. Contributing factors have yet to be investigated systematically.
    Preview · Article · Jan 2011 · Journal of Obstetric Gynecologic & Neonatal Nursing
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    • "Breastfeeding was one way these women were able to take part as a mother in the hospital nursery environment while most of their babies' needs were being attended to by the midwifery, nursing and medical staff. While expressed breast milk offered a form of connection and closeness for the participants to their newborn premature infant, it also became a burden [27,28,33]. Women received emotional satisfaction from providing breast milk for their infants and expressed great pleasure in being able to perform this motherhood role; however, it was evident that these women felt much moral obligation to persist with their breast expression. "
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    ABSTRACT: Breast milk is considered the optimal nutrition for all newborn infants. While there is high initiation of lactation among mothers of preterm infants in Australia, there is a rapid decline of continued lactation. Furthermore, there is an inverse relationship between infant gestation and duration of lactation. To better understand the breastfeeding experience of parents of very low birth weight (VLBW) preterm infants an interpretive phenomenological study was conducted. This longitudinal study was conducted using an interpretive phenomenological approach. Data were collected from 17 parents through 45 individual interviews with both mothers and fathers, from birth to 12 months of age. This data was then transcribed verbatim and analysed using thematic analysis. The analysis identified six primary themes: the intention to breastfeed naturally; breast milk as connection; the maternal role of breast milk producer; breast milk as the object of attention; breastfeeding and parenting the hospitalised baby and the demise of breastfeeding. This paper reports on the theme of 'breast milk as connection'.Providing expressed breast milk offered one way the mothers could be physiologically and emotionally connected to their preterm infant while they were in the constant care of hospital staff. Indeed, breast milk was considered the only way the new mother could connect her body (or part there of) to her preterm baby in hospital. This sense of connection however, comes at a cost. On the one hand, the breast milk offers a feeling of connection to the baby, but, on the other, this connection comes only after disconnection of the mother and baby and - through breast expression - mother and her milk. This ability of breast milk to connect mother and baby makes the expressed breast milk highly valued, and places unexpected pressure on the mother to produce milk as integral to her sense of motherhood. The findings of this study have implications for healthcare practice. It is evident that the association of breastfeeding success with mothering success only jeopardises some families' self-esteem and sense of parenting ability. These findings suggest it would be beneficial to find alternate ways to connect preterm infants and their parents in the preterm nursery environment, and find more positive ways to support breastfeeding.
    Full-text · Article · Jan 2009 · International Breastfeeding Journal
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    ABSTRACT: To examine the factors involved in mothers' decisions to provide breast milk for their premature infants and to determine if these factors differ between Black and White mothers. Secondary analysis of data from 2 primary studies at 2 time points within 2 days of hospital admission (T1) and just before discharge (T2). Urban level III Neonatal Intensive Care Unit in the eastern United States. Convenience sample of 80 mothers, 34 White and 46 Black, who delivered a singleton infant less than 30 weeks' gestation. Mother-focused and infant-focused factors involved in the decision to breastfeed or formula feed as measured by the Preterm Infant Feeding Survey. Infant-focused scores ranked higher than mother-focused scores at T1. Mother-focused scores ranked higher than infant-focused scores at T2. Between T1 and T2, the increase in mother-focused scores and the decrease in infant-focused scores were significant. There were no significant differences between the Black and White mothers' scores at either time point. Mothers' focus on factors that impact their feeding decisions change over time from their infant to themselves. Additionally, no differences were noted between the Black and White mothers.
    No preview · Article · May 2009 · Journal of Obstetric Gynecologic & Neonatal Nursing
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