Approaches to supporting lactation and breastfeeding for very preterm infants in the NICU: a qualitative study in three European regions

Abstract

ObjectivesTo explore differences in approaches to supporting lactation and breastfeeding for very preterm infants in neonatal intensive care units (NICU) in 3 European regions.DesignQualitative cross-sectional study carried out by means of face-to-face semistructured interviews. Verbatim transcripts were coded using a theoretical framework derived from the literature and supplemented by data-driven concepts and codes.Setting4 purposively selected NICUs in each of 3 European regions in 2010 (Ile-de-France in France, Lazio in Italy, and the former Trent region in the UK).ParticipantsNICU staff members (n=22).ResultsPolicies and practices for managing mother's own milk for very preterm babies differed between regions, and were much more complex in Ile-de-France than in the Trent or Lazio regions. Staff approaches to mothers to initiate lactation differed by region, with an emphasis on the nutritional and immunological value of human milk in the Trent region and on the ‘normalising’ effect of breastfeeding on the mother-child relationship in Lazio. French and English staff expressed conflicting opinions about the use of bottles, which was routine in Italy. Italian informants stressed the importance of early maternal milk expression and feeding, but also mentioned discharging infants home before feeding at the breast was established. In Ile-de-France and Trent, successful feeding from the breast was achieved before discharge, although this was seen as a factor that could prolong hospitalisation and discourage continued breastfeeding for some women.ConclusionsTargeted health promotion policies in the NICU are necessary to increase the number of infants receiving their mother's milk and to support mothers with transfer of the infant to the breast. Integrating knowledge about the different approaches to lactation and breastfeeding in European NICUs could improve the relevance of recommendations in multiple cultural settings.

Unit policies and breast milk feeding at discharge of very preterm infants: The EPIPAGE‐2 cohort study

“…Several other care components have to be considered when investigating factors associated with BMF—informed decision, establishment and maintenance of lactation, storage and handling of breast milk, feeding with human milk, non‐nutritive sucking at the breast, transition from tube to the breast, opinions about use of bottles for breastfed infants, unit visiting policies, peer‐to‐peer support, and appropriate follow‐up . However, collecting such complex information, at population level, is a real challenge.…”

“…However, large variations among neonatal intensive care units (NICUs) are observed in many countries . Professional support, including hospital staffing rates, staff attitudes, and design of neonatal units, is also associated with successful BMF . Consequently, unit policies can overcome the low BMF rate associated with individual factors, including social risk factors .…”

Low breastfeeding continuation to 6 months for very preterm infants: A European multiregional cohort study

“…The variation in the proportion of infants who stopped breastfeeding while still in hospital illustrates that neonatal unit policies can impact on continuation. In a previous qualitative study on breastfeeding with neonatal unit staff in several regions participating in the Effective Perinatal Intensive Care in Europe project, UK participants suggested that discharge policies may discourage continued breastfeeding when formula feeding is perceived to facilitate earlier discharge (Bonet et al, ). Other unit policies have been found to affect breastfeeding at discharge in our cohort, including the presence of dedicated personnel for breastfeeding support in the Portuguese regions (Rodrigues et al, ) and the baby‐friendly hospital initiative in the overall sample (Wilson et al, ).…”

“…The reasons for these persistent large disparities are likely linked to unit policies, as discussed above, as well as the support and counselling available to mothers after their discharge from hospital; the importance of these latter factors, which we could not include in our study, was highlighted in the integrative review by Briere et al on breastfeeding duration after NICU discharge (Briere, McGrath, Cong, & Cusson, ). Broader policies promoting breastfeeding in the general population as well as structural measures related to the duration of maternity leave or employment regulations that facilitate combining work with breastfeeding also differ across the countries in our sample, but further research is needed to understand their impact on breastfeeding continuation in this population (Bonet et al, ).…”

Ability to Keep Milk-Ejecting Activity after Premature Birth

“…Bonet и соавт. провели необычное сравнение под-ходов к поддержке и сохранению лактации у матерей после преждевременных родов в ОРИТ в 3 европейских регионах [32]. Были выбраны неонатальные центры во Франции (Иль-де-Франс) и Италии (Трент и Лацио).…”