Expressed breast milk for premature infants in neonatal intensive care unit : exploring the experiences of mothers and nurses

Abstract

Background: Premature infants in the Neonatal Intensive Care Unit require specialized medical support including receiving good nutrition after birth. Therefore, breast milk is an ideal source of nutrition that has be chosen to optimize the growth and development of premature infants. The process of preparation expressed breast milk from mothers to premature infants in the Neonatal Intensive Care Unit could be challenging. In order to facilitate mothers to express breast milk and promoting exclusive breastfeeding practice, mutual agreement between mothers and nurses in Neonatal Intensive Care Unit is essential. Objectives: This study aimed to explore mothers experience in handling expressed milk and to understand the nurses’ practice in supporting EBM mothers in the Neonatal Intensive Care Unit. This study also to identify the current guidelines including policies and procedures related to breastfeeding management specifically on expressed breast milk. Methods: A qualitative research design using purposive sampling with multiple method was conducted involving 19 in-depth interviews with mothers those their premature infants hospitalized in neonatal intensive care unit, 4 focus groups discussion among 16 nurses working in Neonatal Intensive Care Unit and analysis of 20 documents related to breastfeeding and breast milk management. Data were digitally recorded, transcribed, and analyzed using NVivo. Thematic analysis and content analysis were adopted concurrently in analysis the rich data from participants. Results: This study identify four major conceptual ideas derived from participant’s experience in handling expressed breast milk: (1) received good support and motivation; (2) challenges and obstacles faced during expressing breast milk; (3) efforts to continue expressing breast milk; and (4) mothers’ needs. On the other hand, six themes were captured in the focus groups: (1) prioritized main topics for health education, (2) follow checklist and guideline, (3) engaged in education session, (4) encountering the difficulties, (5)nurse’s needs, and (6) valuing mothers’ feedback. Documents on breastfeeding management were tabulated under two topics: (1) management of expressed breast milk in the NICU; and (2) breastfeeding practice in the NICU. Conclusions: Hospital management, nurses’ commitment, and maternal awareness on the importance of breast feeding play an important role in ensuring that premature infants receive optimal nutrition. However, some factors influence these three components. By implementing standard guidelines in the management of expressed breast milk in the NICU gave staff an advantage in managing expressed breast milk and providing support to mothers.

Keywords: Expressed breast milk, mother, nurses, premature infant, NICU