Receiving screened donor human milk for their infant supports parental wellbeing: a mixed-methods study

Abstract

Background Access to donor human milk (DHM) has primarily been based on the health and development outcomes of premature infants but there has been little examination of the broader impact of an infant receiving it upon parental mental health. Breastfeeding and mental health are closely tied with women who experience breastfeeding difficulties or are unable to meet their own breastfeeding goals often experiencing feelings of guilt, sadness and anger, alongside an increased risk of postnatal depression. The aim of the current study was to explore how experience of receiving DHM for their baby affected the wellbeing of parents. Methods UK parents of infants aged 0 – 12 months who had received screened DHM from a milk bank (typically on the neonatal unit or in some cases in the community) completed an online questionnaire exploring their experiences. The questionnaire included Likert scale items examining perceived impact upon infant health, own wellbeing and family functioning alongside open-ended questions exploring perceptions of how receiving DHM affected wellbeing. Results Almost all of the 107 participants (women = 102) agreed that receiving DHM had a positive impact upon infant health and development, their own mental and physical health, and their family’s wellbeing. Parents felt relieved that their infant was receiving DHM for health reasons but also due to the experience of being listened to, supported and having their infant feeding decisions facilitated. Receiving DHM helped mothers to process some of their emotions at not being able to breastfeed, in part because knowing their baby was being fed gave them the space to focus on recovery and bonding with their baby. Some parents did experience challenges, feeling guilty at receiving DHM, insecure that another woman was able to feed their baby when they could not, or negative reactions from family. Although the impact of receiving DHM upon breastfeeding was not measured, some women who were working to build their own milk supply noted that it helped motivate them to continue. Conclusions DHM may play an important role not only in protecting infant health and development but in supporting the mental health and wellbeing of mothers for whom their infant receiving human milk is important.

Understanding the current and future usage of donor human milk in hospitals: an online survey of UK neonatal units

“…Randomised control trials in India ( 5), along with observational findings from the USA (6,8,9), India (21) and Europe (7,22), published since this systematic review have confirmed that when used in the context of optimal lactation support, DHM can be additionally supportive of lactation. This consistent finding could be explained in part by the psychological stressor of trying to avoid formula use and with the widely known risks of increased NEC and other complications of prematurity, which may impact negatively on the physiological ability of mothers to establish lactation (7,23,24). Secondary lactogenesis depends on an increase in prolactin and oxytocin, mediated by the hypothalamic-pituitary axis.…”

“…A limited qualitative study from the US with 35 participants highlighted that women felt DHM offered a bridge to breastfeeding, allowing time to overcome short term hurdles, while the introduction of infant formula compounded their feelings of personal failure (26). In a recent sample of 105 parents whose infants have received DHM within the last year, responses suggest increased parental wellbeing (7), though further studies are needed to understand how widely these perceptions may be in the general population.…”

“…When UK DHM use was last examined, a report by the British Association of Perinatal Medicine (BAPM) on the provision of human milk banking (HMB) services in the UK in 2016 recommended that more research would be needed before national recommendations on the planning and funding of nationally equitable human HMB services could be made (4). Since then, new avenues of research have established that, when used in the context of optimal lactation support, DHM can be supportive of the establishment of maternal lactation, improved parental wellbeing, maternal psychological health and infant outcomes (5,6,7,8,9). DHM availability may also have positive impacts on infant and maternal health beyond the preterm population (7,10,11,12).…”

“…Since then, new avenues of research have established that, when used in the context of optimal lactation support, DHM can be supportive of the establishment of maternal lactation, improved parental wellbeing, maternal psychological health and infant outcomes (5,6,7,8,9). DHM availability may also have positive impacts on infant and maternal health beyond the preterm population (7,10,11,12).…”

Breastfeeding sick children in hospital: Exploring the experiences of mothers in UK paediatric wards

“…While trauma has been identified among parents whose children experience life‐threatening illness (Foster et al, 2017; Mortensen et al, 2015; Muscara et al, 2015; Woolf et al, 2016), the effects of trauma on breastfeeding in paediatrics are unstudied. The identified challenges of expressing milk may justify the extension of donor human milk provision in the paediatric setting to augment a mother's efforts to keep her child exclusively breastmilk fed, which has been shown to promote parental mental health (Brown & Shenker, 2022).…”