Breastfeeding initiation, duration, and experiences of mothers of late preterm twins: a mixed-methods study

Abstract

Background Twins and late preterm (LPT) infants are at an increased risk of being breastfed to a lesser extent than term singletons. This study aimed to describe the initiation and duration of any and exclusive breastfeeding at the breast for mothers of LPT twins and term twins during the first 4 months and to explore the breastfeeding experiences of mothers of LPT twins. Methods A sequential two-sample quantitative–qualitative explanatory mixed-methods design was used. The quantitative data were derived from a longitudinal cohort study in which 22 mothers of LPT twins and 41 mothers of term twins answered questionnaires at one and four months after birth (2015–2017). The qualitative data were obtained from semi-structured interviews with 14 mothers of LPT twins (2020–2021), based on results from the quantitative study and literature. Analysis included descriptive statistics of quantitative data and deductive content analysis of the qualitative data, followed by condensation and synthesis. Results All mothers of LPT twins (100%) and most mothers of term twins (96%) initiated breastfeeding. There was no difference in any breastfeeding during the first week at home (98% versus 95%) and at 1 month (88% versus 85%). However, at 4 months, the difference was significant (44% versus 75%). The qualitative data highlighted that mothers of LPT twins experienced breastfeeding as complex and strenuous. Key factors influencing mothers’ experiences and decisions were their infants’ immature breastfeeding behaviors requiring them to express breast milk alongside breastfeeding, the burden of following task-oriented feeding regimes, and the lack of guidance from healthcare professionals. As a result, mothers started to question the worth of their breastfeeding efforts, leading to changes in breastfeeding management with diverse results. Support from fathers and grandparents positively influenced sustained breastfeeding. Conclusions Mothers of LPT twins want to breastfeed, but they face many challenges in breastfeeding during the first month, leading to more LPT twins’ mothers than term twins’ mothers ceasing breastfeeding during the following months. To promote and safeguard breastfeeding in this vulnerable group, care must be differentiated from routine term infant services, and healthcare professionals need to receive proper education and training.

Prospective longitudinal comparative study showed that breastfeeding outcomes were comparable in preterm twins and singleton infants

“…The BSES‐SF questionnaire and or more expanded information before commencing breastfeeding and or pumping at term and at 4 months, would have been beneficial. Jónsdóttir and colleagues found no differences between late preterm twins and term singletons until 1 month after discharge, but a significant difference by 4 months of postnatal age 30 . In our study, at 4 months of corrected age all of the infants had started solid food, and many were weaned.…”

“…Jónsdóttir and colleagues found no differences between late preterm twins and term singletons until 1 month after discharge, but a significant difference by 4 months of postnatal age. 30 In our study, at 4 months of corrected age all of the infants had started solid food, and many were weaned. There may be differences in breastfeeding patterns between discharge and 4 months of corrected age that were missing in this study.…”

Breaking Barriers: Insights into Complex Breastfeeding Scenarios in a Rural Medical College—A Case Series

“…Challenges included prematurity, twin gestation, and maternal inexperience. After counseling on multiple gestation feeding techniques, 11 breastfeeds began via nasogastric tube, gradually upgraded at the NICU. After establishing direct breastfeeding, both the babies were monitored at the high dependency unit in the NICU annex.…”

Initial Description of Breast Care for Fluency of Breast Milk Production in Primiparous Postpartum Mothers (Early Study of Electronic Bra Development)

“…Hal ini berkaitan dengan perawatan payudara dengan melakukan pemijatan pada payudara dan kompres hangat yang harus ibu nifas lakukan rutin setiap hari. Perawatan payudara memiliki hubungan yang signifikan dengan lamanya menyusui terhadap kelancaran produksi ASI pada ibu nifas dengan nilai p = 0,002 [16] [17].…”