Positive breastfeeding experiences and facilitators in mothers of preterm and low birth weight infants: A meta-ethnographic review

Background Most qualitative research on breastfeeding the preterm or low-birth-weight (LBW) infant has focused on negative insights; there are no comprehensive insights into how, when and why mothers experience positive breastfeeding experiences. We aimed to address this knowledge gap by exploring what characterizes and facilitates a positive breastfeeding experience in mothers of preterm and/or LBW infants. Methods A systematic review using meta-ethnographic methods was conducted. Search strategies involved a comprehensive search strategy on six bibliographic databases, citation tracking and reference checking. The analysis involved a reciprocal level of translation and a line of argument synthesis. Results Searches identified 1774 hits and 17 articles from 14 studies were included, representing the views of 697 mothers. A positive breastfeeding experience was identified as being ‘attuned’. Three themes and eight sub-themes were developed to describe what characterizes attuned breastfeeding. ‘ Trusting the body and what it can do’, concerned how attuned breastfeeding was facilitated through understanding the bodily responses and capacity and feeling comfortable with holding the infant and to breastfeed. ‘ Being emotionally present – in the here and now ’ described the importance of feeling relaxed and reassured. ‘ Experiencing mutual positive responses’, illuminated how attunement was related to feelings of mutuality - when the mother recognises the infant’s cues, responds to these signals and receives a positive response from the infant. The key factors to facilitate attuned breastfeeding were opportunities for prolonged close physical contact with the infant, positive relationships with and support from staff and peers, and being facilitated to breastfeed when the infant showed feeding cues. Conclusions This study provides new insights into what characterizes a positive breastfeeding experience and how staff can facilitate and enable mothers to achieve attuned breastfeeding. Improvements in units’ design, such as for rooming-in and having prolonged skin-to-skin contact, and care provided by knowledgeable, supportive and encouraging staff and peers, are crucial. The mother’s physical and emotional states and the infant's behavioural responses and physiological signals should guide the process towards positive breastfeeding practices

Positive breastfeeding experiences and facilitators in mothers of preterm and low birth weight infants: a meta-ethnographic review

Background: Most qualitative research on breastfeeding the preterm or low-birthweight (LBW) infant has focused on negative insights; there are no comprehensive insights into how, when and why mothers experience positive breastfeeding experiences. We aimed to address this knowledge gap by exploring what characterizes and facilitates a positive breastfeeding experience in mothers of preterm and/or LBW infants.Methods: A systematic review using meta-ethnographic methods was conducted. Search strategies involved a comprehensive search strategy on six bibliographic databases, citation tracking and reference checking. The analysis involved a reciprocal level of translation and a line of argument synthesis.Results: Searches identified 1774 hits and 17 articles from 14 studies were included, representing the views of 697 mothers. A positive breastfeeding experience was identified as being 'attuned'. Three themes and eight sub-themes were developed to describe what characterizes attuned breastfeeding. 'Trusting the body and what it can do', concerned how attuned breastfeeding was facilitated through understanding the bodily responses and capacity and feeling comfortable with holding the infant and to breastfeed. 'Being emotionally present - in the here and now' described the importance of feeling relaxed and reassured. 'Experiencing mutual positive responses', illuminated how attunement was related to feelings of mutuality - when the mother recognises the infant's cues, responds to these signals and receives a positive response from the infant. The key factors to facilitate attuned breastfeeding were opportunities for prolonged close physical contact with the infant, positive relationships with and support from staff and peers, and being facilitated to breastfeed when the infant showed feeding cues.Conclusions: This study provides new insights into what characterizes a positive breastfeeding experience and how staff can facilitate and enable mothers to achieve attuned breastfeeding. Improvements in units' design, such as for rooming-in and having prolonged skin-to-skin contact, and care provided by knowledgeable, supportive and encouraging staff and peers, are crucial. The mother's physical and emotional states and the infant's behavioural responses and physiological signals should guide the process towards positive breastfeeding practices.</p

Symptoms of depression in parents after discharge from NICU associated with family-centred care

AimsThe aim of this study was to examine the potential association of family-centred care as perceived by parents during a NICU stay with parents’ depressive symptoms at discharge and at 4 months corrected for infant age.DesignA longitudinal, multicentre cohort study was conducted from 2018 to 2020 in 23 NICUs across 15 countries.MethodsParents (n = 635 mothers, n = 466, fathers) of infants (n = 739) born before 35 weeks of gestation and admitted to the participating NICUs were enrolled to the study during the first weeks of their infants’ hospitalizations. They responded to Digi-FCC daily text messages inquiring about their perception of family-centred care provided by NICU staff. In addition, they completed a questionnaire assessing their overall perception of family-centred care at discharge. Parents’ depressive symptoms were measured by the Edinburgh Postnatal Depression Scale at discharge and again after discharge when their infants were at 4 months corrected for age.ResultsThe mothers’ and the fathers’ perceptions of family-centred care were associated with their depressive symptoms at discharge and at 4 months corrected age, controlling for gestational age, multiple birth, parent education and relationship status. Parents’ participation in infant care, care-related decisions and emotional support provided to parents by staff explained the variation in the parents’ perceptions of family-centred care. The factors facilitating the implementation of family-centred care included unlimited access to the unit for the parents and for their significant others, as well as amenities for parents.ConclusionsOur study shows that family-centred NICU care associates with parents’ depressive symptoms after a NICU stay.ImpactDepression is common in parents of preterm infants. The provision of family-centred care may protect the mental well-being of parents of preterm infants.</p

Associations between single-family room care and breastfeeding rates in preterm infants

Background: Hospitalization in neonatal intensive care units with a single-family room design enables continuous maternal pres- ence, but less is known regarding the association with milk production and breastfeeding. Research aim: To compare maternal milk production, breastfeeding self-efficacy, the extent to which infants received mother’s milk, and rate of direct breastfeeding in a single-family room to an open bay neonatal intensive care unit. Methods: A longitudinal, prospective observational study comparing 77 infants born at 28– 32° weeks gestational age and their 66 mothers (n = 35 infants of n = 30 mothers in single family room and n = 42 infants of n = 36 mothers in open bay). Comparisons were made on milk volume produced, the extent to which infants were fed mother’s milk, and rate of direct breastfeeding from birth to 4 months’ corrected infant age. Breastfeeding self-efficacy was compared across mothers who directly breastfed at discharge (n = 45). Results:Firstexpression(6hrvs.30hr,p<.001)andfirstattemptatbreastfeeding(48hrvs.109hr,p<.001)occurredsignificantly earlier, infants were fed a greater amount of mother’s milk (p < .04), and significantly more infants having single-family room care were exclusively directly breastfed from discharge until 4 months’ corrected age; OR 6.8 (95% CI [2.4, 19.1]). Volumes of milk produced and breastfeeding self-efficacy did not differ significantly between participants in either units. Conclusion: To increase the extent to which infants are fed mother’s own milk and are exclusively directly breastfed, the design of neonatal intensive care units should facilitate continuous maternal presence and privacy for the mother–infant dyad

Associations between single-family room care and breastfeeding rates in preterm infants

Background Hospitalization in neonatal intensive care units with a single-family room design enables continuous maternal presence, but less is known regarding the association with milk production and breastfeeding. Research aim To compare maternal milk production, breastfeeding self-efficacy, the extent to which infants received mother’s milk, and rate of direct breastfeeding in a single-family room to an open bay neonatal intensive care unit. Methods A longitudinal, prospective observational study comparing 77 infants born at 28– 32° weeks gestational age and their 66 mothers (n = 35 infants of n = 30 mothers in single family room and n = 42 infants of n = 36 mothers in open bay). Comparisons were made on milk volume produced, the extent to which infants were fed mother’s milk, and rate of direct breastfeeding from birth to 4 months’ corrected infant age. Breastfeeding self-efficacy was compared across mothers who directly breastfed at discharge (n = 45). Results First expression (6 hr vs. 30 hr, p < .001) and first attempt at breastfeeding (48 hr vs. 109 hr, p < .001) occurred significantly earlier, infants were fed a greater amount of mother’s milk (p < .04), and significantly more infants having single-family room care were exclusively directly breastfed from discharge until 4 months’ corrected age; OR 6.8 (95% CI [2.4, 19.1]). Volumes of milk produced and breastfeeding self-efficacy did not differ significantly between participants in either units. Conclusion To increase the extent to which infants are fed mother’s own milk and are exclusively directly breastfed, the design of neonatal intensive care units should facilitate continuous maternal presence and privacy for the mother–infant dyad

Parent psychological wellbeing in a single-family room versus an open bay neonatal intensive care unit.

BACKGROUND: Studies of parents' psychological well-being in single-family rooms in neonatal intensive care units have shown conflicting results. AIMS: To compare emotional distress in the form of depression, anxiety, stress and attachment scores among parents of very preterm infants cared for in a single-family rooms unit vs an open bay unit. STUDY DESIGN: Prospective survey design. SUBJECT: Parents (132) of 77 infants born at 28 0/7-32 0/7 weeks of gestation in the two units. OUTCOME MEASURES: Duration of parental presence was recorded. Scores for depression (The Edinburgh Postnatal Depression Scale), anxiety (The State-Trait-Anxiety Inventory, Short Form Y), stress (The Parent Stressor Scale: neonatal intensive care unit questionnaire and The Parenting Stress Index-short form) and attachment (Maternal Postnatal Attachment Scale) measured 14 days after delivery, at discharge, expected term date and four months post-term. RESULTS: Parents were present 21 hours/day in the single-family room unit vs 7 hours/day in the Open bay unit. Ninety-three percent of the fathers in the single-family rooms unit were present more than 12 hours per day during the first week. Mothers in the single-family rooms had a significantly lower depression score -1.9 (95% CI: -3.6, -0.1) points from birth to four months corrected age compared to mothers in the Open bay unit, and 14% vs 52% scored above a cut-off point considered being at high risk for depression (p&lt;0.005). Both mothers and fathers in the single-family rooms reported significantly lower stress levels during hospitalization. There were no differences between the groups for anxiety, stress or attachment scores after discharge. CONCLUSION: The lower depression scores by the mothers and lower parental stress scores during hospitalization for both parents supports that single-family rooms care contribute to parents' psychological wellbeing

Associations between single-family room care and breastfeeding rates in preterm infants

Background: Hospitalization in neonatal intensive care units with a single-family room design enables continuous maternal pres- ence, but less is known regarding the association with milk production and breastfeeding. Research aim: To compare maternal milk production, breastfeeding self-efficacy, the extent to which infants received mother’s milk, and rate of direct breastfeeding in a single-family room to an open bay neonatal intensive care unit. Methods: A longitudinal, prospective observational study comparing 77 infants born at 28– 32° weeks gestational age and their 66 mothers (n = 35 infants of n = 30 mothers in single family room and n = 42 infants of n = 36 mothers in open bay). Comparisons were made on milk volume produced, the extent to which infants were fed mother’s milk, and rate of direct breastfeeding from birth to 4 months’ corrected infant age. Breastfeeding self-efficacy was compared across mothers who directly breastfed at discharge (n = 45). Results:Firstexpression(6hrvs.30hr,p<.001)andfirstattemptatbreastfeeding(48hrvs.109hr,p<.001)occurredsignificantly earlier, infants were fed a greater amount of mother’s milk (p < .04), and significantly more infants having single-family room care were exclusively directly breastfed from discharge until 4 months’ corrected age; OR 6.8 (95% CI [2.4, 19.1]). Volumes of milk produced and breastfeeding self-efficacy did not differ significantly between participants in either units. Conclusion: To increase the extent to which infants are fed mother’s own milk and are exclusively directly breastfed, the design of neonatal intensive care units should facilitate continuous maternal presence and privacy for the mother–infant dyad

Parent psychological wellbeing in a single-family room versus an open bay neonatal intensive care unit

Background Studies of parents’ psychological well-being in single-family rooms in neonatal intensive care units have shown conflicting results. Aims To compare emotional distress in the form of depression, anxiety, stress and attachment scores among parents of very preterm infants cared for in a single-family rooms unit vs an open bay unit. Study design Prospective survey design. Subject Parents (132) of 77 infants born at 28 0/7–32 0/7 weeks of gestation in the two units. Outcome measures Duration of parental presence was recorded. Scores for depression (The Edinburgh Postnatal Depression Scale), anxiety (The State–Trait–Anxiety Inventory, Short Form Y), stress (The Parent Stressor Scale: neonatal intensive care unit questionnaire and The Parenting Stress Index—short form) and attachment (Maternal Postnatal Attachment Scale) measured 14 days after delivery, at discharge, expected term date and four months post-term. Results Parents were present 21 hours/day in the single-family room unit vs 7 hours/day in the Open bay unit. Ninety-three percent of the fathers in the single-family rooms unit were present more than 12 hours per day during the first week. Mothers in the single-family rooms had a significantly lower depression score -1.9 (95% CI: -3.6, -0.1) points from birth to four months corrected age compared to mothers in the Open bay unit, and 14% vs 52% scored above a cut-off point considered being at high risk for depression (p<0.005). Both mothers and fathers in the single-family rooms reported significantly lower stress levels during hospitalization. There were no differences between the groups for anxiety, stress or attachment scores after discharge. Conclusion The lower depression scores by the mothers and lower parental stress scores during hospitalization for both parents supports that single-family rooms care contribute to parents’ psychological wellbeing

Ten Years of Neonatal Intensive Care Adaption to the Infants&rsquo; Needs: Implementation of a Family-Centered Care Model with Single-Family Rooms in Norway

Ten years ago, the Neonatal intensive care unit in Drammen, Norway, implemented Single-Family Rooms (SFR), replacing the traditional open bay (OB) unit. Welcoming parents to stay together with their infant 24 h per day, seven days per week, was both challenging and inspiring. The aim of this paper is to describe the implementation of SFR and how they have contributed to a cultural change among the interprofessional staff. Parents want to participate in infant care, but to do so, they need information and supervision from nurses, as well as emotional support. Although SFR protect infants and provide private accommodation for parents, nurses may feel isolated and lack peer support. Our paper describes how we managed to systematically reorganize the nurse&rsquo;s workflow by using a Plan-Do-Study-Act (PDSA) cycle approach. Significant milestones are identified, and the implementation processes are displayed. The continuous parental presence has changed the way we perceive the family as a care recipient and how we involve the parents in daily care. We provide visions for the future with further developments of care adapted to infants&rsquo; needs by providing neonatal intensive care with parents as equal partners