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Palmér, L. & Ericson, J. (2019). A qualitative study on the breastfeeding experience of mothers of preterm infants in the first 12 months after birth. International Breastfeeding Journal, 14, Article ID 35.
Open this publication in new window or tab >>A qualitative study on the breastfeeding experience of mothers of preterm infants in the first 12 months after birth
2019 (English)In: International Breastfeeding Journal, ISSN 1746-4358, E-ISSN 1746-4358, Vol. 14, article id 35Article in journal (Refereed) Published
Abstract [en]

Background: Being a mother of a preterm infant (< 37 gestational weeks) puts the mother in a vulnerable and fragile situation wherein breastfeeding is an important part of becoming a mother and bonding with the infant. Nevertheless, the breastfeeding experience of mothers during the first year after a preterm birth has not been well studied. To develop professional caring and supporting relationships, it is important to address this knowledge gap. The aim of this study was to describe the breastfeeding experience of mothers of preterm infants from birth up until 12 months after birth.

Methods: The data in this qualitative study are derived from a multicentre randomized controlled trial where 270 mothers of preterm infants provided 496 written comments through questionnaires containing open-ended questions. The questionnaires were sent to the mother three times during the first 12 months after birth. A thematic network analysis based on hermeneutical philosophy was used to analyse and interpret the resulting data to describe the mothers' experiences of breastfeeding.

Results: Three organizing themes, namely, "navigating smoothly," "navigating with a struggle" and "navigating in ambiguity" were revealed in the mothers' narratives regarding their breastfeeding experiences during the first 12 months after birth. These organizing themes were further interpreted as one global theme that was deemed "A journey to finding one's unique way in breastfeeding."

Conclusion: Mothers of preterm infants are in an exposed and vulnerable situation when initiating breastfeeding during the first year. This situation leads to a unique journey wherein each mother navigates through breastfeeding depending on her individual situation. An awareness of the diversity of breastfeeding experiences may contribute to the provision of professional caring and supportive relationships.

Trial registration: www.clinicaltrial.gov NCT01806480 registered 7 March 2013.

Keywords
Breastfeeding, Experiences, First year, Mothers, Preterm infant, Qualitative
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30604 (URN)10.1186/s13006-019-0229-6 (DOI)000478670200001 ()31388343 (PubMedID)
Available from: 2019-08-12 Created: 2019-08-12 Last updated: 2019-08-15Bibliographically approved
Ericson, J. & Palmér, L. (2019). Mothers of preterm infants' experiences of breastfeeding support in the first 12 months after birth: a qualitative study. Birth, 46(1), 129-136
Open this publication in new window or tab >>Mothers of preterm infants' experiences of breastfeeding support in the first 12 months after birth: a qualitative study
2019 (English)In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 46, no 1, p. 129-136Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Breastfeeding support is important for breastfeeding mothers; however, it is less clear how mothers of preterm infants (< 37 gestational weeks) experience breastfeeding support during the first year. Thus, the aim of this study was to describe how mothers of preterm infants in Sweden experience breastfeeding support during the first 12 months after birth.

METHODS: This qualitative study used data from 151 mothers from questionnaires with open-ended questions and telephone interviews. The data were analyzed using an inductive thematic network analysis with a hermeneutical approach.

RESULTS: The results exposed two organizing themes and one global theme. In the organizing theme "genuine support strengthens," the mothers described how they were strengthened by being listened to and met with respect, understanding, and knowledge. The support was individually adapted and included both practical and emotional support. In the organizing theme "inadequate support diminishes," the mothers described how health professionals who were controlling and intrusive diminished them and how the support they needed was not provided or was inappropriate. Thus, the global theme "being thrown into a lottery-dependent on the health professional who provided breastfeeding support" emerged, meaning that the support received was random in terms of knowledge and support style, depending on the individual health professionals who were available.

CONCLUSION: Breastfeeding support to mothers of preterm infants was highly variable, either constructive or destructive depending on who provided support. This finding clearly shows major challenges for health care, which should make breastfeeding support more person-centered, equal, and supportive in accordance with individual needs.

Keywords
breastfeeding support, child health care center, neonatal care, postnatal care, preterm infant
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28260 (URN)10.1111/birt.12383 (DOI)000459794300015 ()30053350 (PubMedID)2-s2.0-85051132067 (Scopus ID)
Available from: 2018-08-07 Created: 2018-08-07 Last updated: 2019-03-14Bibliographically approved
Ericson, J., Eriksson, M., Hoddinott, P., Hellström-Westas, L. & Flacking, R. (2018). Breastfeeding and risk for ceasing in mothers of preterm infants - long-term follow-up. Maternal and Child Nutrition, 14(4), Article ID e12618.
Open this publication in new window or tab >>Breastfeeding and risk for ceasing in mothers of preterm infants - long-term follow-up
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2018 (English)In: Maternal and Child Nutrition, ISSN 1740-8695, E-ISSN 1740-8709, Vol. 14, no 4, article id e12618Article in journal (Refereed) Published
Abstract [en]

Breastfeeding is challenging for mothers of preterm infants. The aim of this paper is to describe risk factors for ceasing breastfeeding and methods of feeding until 12 months postnatal age in mothers who breastfed their preterm infants at discharge from neonatal intensive care units (NICUs). The data come from a randomised controlled trial, which evaluated the effectiveness on exclusive breastfeeding at 8 weeks of proactive telephone support compared with reactive support offered to mothers of preterm infants following discharge from NICU. Six NICUs across Sweden randomised a total of 493 mothers. We used regression and survival analyses to assess the risk factors for ceasing breastfeeding and the long-term outcomes of the intervention. The results showed that 305 (64%) of the infants were breastfed at 6 months and 49 (21%) at 12 months. Partial breastfeeding at discharge, low maternal educational level, and longer length of stay in the NICU increased the risk for ceasing breastfeeding during the first 12 months. Furthermore, the Kaplan-Meier analysis showed that the proportion of mothers who ceased breastfeeding did not differ between the intervention (n = 231) and controls (n = 262) during the first 12 months (log-rank test p = .68). No difference was found between groups on method of feeding. More than 85% of the infants were fed directly at the breast. These findings provide important insights for health professionals who are supporting mothers of preterm infants to breastfeed long term.

Registered in www.clinicaltrials.gov (NCT01806480).

Keywords
RCT, bottle, breast milk, feeding, mother, neonatal
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-27651 (URN)10.1111/mcn.12618 (DOI)000448900800013 ()29733102 (PubMedID)2-s2.0-85046532136 (Scopus ID)
Note

Open Access APC beslut 11/2018

Available from: 2018-05-09 Created: 2018-05-09 Last updated: 2018-11-15Bibliographically approved
Ericson, J. & Palmér, L. (2018). Experiences of breastfeeding support in mothers of preterm infants. In: : . Paper presented at 19th ISRHML (International society for research in human milk and lactation) Conference 6-12 oktober 2018, Kaganawa, Japan.
Open this publication in new window or tab >>Experiences of breastfeeding support in mothers of preterm infants
2018 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Nursing
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29085 (URN)
Conference
19th ISRHML (International society for research in human milk and lactation) Conference 6-12 oktober 2018, Kaganawa, Japan
Available from: 2018-12-13 Created: 2018-12-13 Last updated: 2018-12-13Bibliographically approved
Ericson, J., Eriksson, M., Hellström-Westas, L., Hoddinott, P. & Flacking, R. (2018). Proactive telephone support provided to breastfeeding mothers of preterm infants after discharge: a randomised controlled trial. Acta Paediatrica, 107(5), 791-798
Open this publication in new window or tab >>Proactive telephone support provided to breastfeeding mothers of preterm infants after discharge: a randomised controlled trial
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2018 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 5, p. 791-798Article in journal (Refereed) Published
Abstract [en]

AIM: The aim was to evaluate the effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants after discharge from neonatal intensive care units (NICU).

METHODS: Between March 2013 and December 2015, a randomised controlled trial was conducted at six NICUs across Sweden. At each NICU, a breastfeeding support team recruited, randomised and delivered the support to participating mothers. The intervention group received a daily proactive telephone call up to 14 days after discharge from the support team. The control group could initiate telephone contact themselves. Primary outcome was exclusive breastfeeding eight weeks after discharge. Secondary outcomes were maternal satisfaction with breastfeeding, attachment, quality of life and parental stress.

RESULTS: In total, 493 mothers were randomised, 231 to intervention group and 262 to control group. There were no differences between the groups for exclusive breastfeeding, odds ratio 0.96, 95% CI 0.66-1.38, nor for maternal satisfaction with breastfeeding, attachment or quality of life. The intervention group reported significantly less parental stress than the controls, t=2.44, 95% CI 0.03-0.23, effect size d=0.26.

CONCLUSION: In this trial, proactive telephone support was not associated with increased exclusive breastfeeding prevalence eight weeks following discharge. However, intervention group mothers showed significantly lower parental stress. This article is protected by copyright. All rights reserved.

Keywords
Breast milk, discharge, neonatal, person-centred, preterm births
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-27209 (URN)10.1111/apa.14257 (DOI)000430115100012 ()29405368 (PubMedID)2-s2.0-85045438738 (Scopus ID)
Note

Open Access APC beslut 3/2018

Available from: 2018-02-14 Created: 2018-02-14 Last updated: 2018-12-13Bibliographically approved
Ericson, J., Flacking, R. & Udo, C. (2017). Mothers' experiences of a telephone-based breastfeeding support intervention after discharge from neonatal intensive care units - a mixed-method study. International Breastfeeding Journal, 12(1), Article ID 50.
Open this publication in new window or tab >>Mothers' experiences of a telephone-based breastfeeding support intervention after discharge from neonatal intensive care units - a mixed-method study
2017 (English)In: International Breastfeeding Journal, ISSN 1746-4358, E-ISSN 1746-4358, Vol. 12, no 1, article id 50Article in journal (Refereed) Published
Abstract [en]

Background: After discharge from a neonatal intensive care unit (NICU), many mothers of preterm infants (gestational age<37 weeks) experience a lack of support for breastfeeding. An intervention study was designed to evaluate the effects of proactive (a daily telephone call initiated by a member of a breastfeeding support team) and/or reactive (mothers could call the breastfeeding support team) telephone based breastfeeding support for mothers after discharge from the NICU. The mothers in the intervention group had access to both proactive and reactive support; the mothers in the control group only had access to reactive support. The aim of this study was to explore the mothers' experiences of the proactive and reactive telephone support.

Methods: This study was a qualitatively driven, mixed-method evaluation using three data sources: questionnaires with qualitative open-ended questions, visual analogue scales and telephone interviews. In total, 365 mothers contributed data for this study. The qualitative data were analysed with an inductive thematic network analysis, while the quantitative data were analysed with Student's t-test and the chi-square test.

Results: Proactive support contributed to greater satisfaction and involvement in breastfeeding support. The mothers who received proactive support reported that they felt strengthened, supported and secure, as a result of the continuous care provided by staff who were knowledgeable and experienced (i.e., in breastfeeding and preterm infants), which resulted in the global theme 'Empowered by proactive support'. The mothers who received reactive support experienced contradictory feelings; some felt secure because they had the opportunity to call for support, whereas others found it difficult to decide when and if they should use the service, which resulted in the global theme; 'Duality of reactive support'.

Conclusion: There were positive aspects of both proactive (i.e., greater satisfaction and feelings of empowerment) and reactive support (i.e., the opportunity to call for support); however, the provision of reactive support alone may be inadequate for those with the greatest need for support as they are the least likely to access it.

Keywords
Breastfeeding, Mixed method, Neonatal, Preterm infant, Support, Telephone, Thematic network analysis
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26808 (URN)10.1186/s13006-017-0142-9 (DOI)29270208 (PubMedID)
Available from: 2017-12-15 Created: 2017-12-15 Last updated: 2018-12-13Bibliographically approved
Ericson, J., Flacking, R., Hellström-Westas, L. & Eriksson, M. (2016). Changes in the prevalence of breast feeding in preterm infants discharged from neonatal units: a register study over 10 years. BMJ Open, 6, Article ID e012900.
Open this publication in new window or tab >>Changes in the prevalence of breast feeding in preterm infants discharged from neonatal units: a register study over 10 years
2016 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, article id e012900Article in journal (Refereed) Published
Abstract [en]

Objective: There are indications that the prevalence of exclusively breastfed preterm infants is decreasing in Sweden. The objective was to investigate trends in exclusive breast feeding at discharge from Swedish neonatal units and associated factors in preterm infants.

Design, setting and participants: This is a register study with data from the Swedish Neonatal Quality Register. Data from 29 445 preterm infants (gestational age (GA) <37 weeks) who were born during the period 2004–2013 were retrieved. Data included maternal, perinatal and neonatal characteristics. Data were analysed for the whole population as well as for 3 GA groups.

Results: From 2004 to 2013, the prevalence of exclusive breast feeding decreased, in extremely preterm (GA 22–27 weeks) from 55% to 16%, in very preterm (GA 28–31 weeks) from 41% to 34% and in moderately preterm infants (GA 32–36 weeks) from 64% to 49%. The decline was statistically significant (p<0.001) in all 3 GA groups. This decline remained significant when adjustments were made for factors negatively associated with exclusive breast feeding and which became more prevalent during the study period, that is, small for GA (all groups) and maternal mental illness (very preterm and moderately preterm infants).

Conclusions: In the past 10 years, Sweden has experienced a lower rate of exclusive breast feeding in preterm infants, especially in extremely preterm infants. The factors analysed in this study explain only a small proportion of this decline. The decline in exclusive breast feeding at discharge from neonatal units raises concern and present challenges to the units to support and promote breast feeding.

Keywords
neonatology, paediatrics
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-23595 (URN)10.1136/bmjopen-2016-012900 (DOI)000391303600043 ()27965252 (PubMedID)
Available from: 2016-12-16 Created: 2016-12-16 Last updated: 2018-12-13Bibliographically approved
Ericson, J. & Flacking, R. (2013). Estimated breastfeeding to support breastfeeding in the neonatal intensive care unit. Journal of Obstetric, Gynecologic and Neonatal Nursing, 42(1), 29-37
Open this publication in new window or tab >>Estimated breastfeeding to support breastfeeding in the neonatal intensive care unit
2013 (English)In: Journal of Obstetric, Gynecologic and Neonatal Nursing, ISSN 0884-2175, E-ISSN 1552-6909, Vol. 42, no 1, p. 29-37Article in journal (Refereed) Published
Abstract [en]

Objective. To evaluate the effects of estimated breastfeeding on infant outcomes in comparison to test weighing and to describe staff members experiences of estimated breastfeeding as a method for supporting the transition from tube feeding to breastfeeding.

Design. A mixed method evaluation. Setting Neonatal Intensive Care Unit (NICU) in Sweden. Participants The study included 365 preterm (25th36th gestational weeks) infants and 45 nurses or nurse assistants. Methods A retrospective comparative medical record study was used to assess infant outcomes during a period of test weighing (196 infants) and again after the implementation of estimated breastfeeding (169 infants). A qualitative survey was conducted to explore the staff experiences of estimated breastfeeding.

Results. No differences were found between groups regarding duration of tube feeding, length of hospital stay, gestational age, weight at discharge, and rate of any breastfeeding. Infants in the estimated breastfeeding group had a higher risk of not being exclusively breast milk fed than infants in the test-weighing group (OR = 2.76, CI [1.5, 5.1]). Staff perceived estimated breastfeeding as a more facilitative and less stressful method for mothers than test weighing. Some staff had difficulty following guidelines while simultaneously providing person-centered care.

Conclusions. Estimated breastfeeding is a nonintrusive and feasible method for assessing and supporting the transition from tube feeding to breastfeeding among preterm infants in a NICU. However, the increased risk for not being exclusively breastfed is of concern. Additional research is needed to assess whether this method is appropriate and feasible in varying contexts and cultures. JOGNN, 42, 29-37; 2013. DOI: 10.1111/j.1552-6909.2012.01423.x

Keywords
breastfeeding; medical record; neonatal intensive care units; preterm birth; tube feeding; qualitative research
National Category
Nursing
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-11904 (URN)10.1111/j.1552-6909.2012.01423.x (DOI)000313728100009 ()
Available from: 2013-02-26 Created: 2013-02-26 Last updated: 2018-12-13Bibliographically approved
Ericson, J., Eriksson, M., Hellstrom-Westas, L., Hagberg, L., Hoddinott, P. & Flacking, R. (2013). The effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants: study protocol for a randomized controlled trial. BMC Pediatrics, 13, Article ID 73.
Open this publication in new window or tab >>The effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants: study protocol for a randomized controlled trial
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2013 (English)In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 13, article id 73Article in journal (Refereed) Published
Abstract [en]

Background: Although breast milk has numerous benefits for infants' development, with greater effects in those born preterm (at < 37 gestational weeks), mothers of preterm infants have shorter breastfeeding duration than mothers of term infants. One of the explanations proposed is the difficulties in the transition from a Neonatal Intensive Care Unit (NICU) to the home environment. A person-centred proactive telephone support intervention after discharge from NICU is expected to promote mothers' sense of trust in their own capacity and thereby facilitate breastfeeding.

Methods/design: A multicentre randomized controlled trial has been designed to evaluate the effectiveness and cost-effectiveness of person-centred proactive telephone support on breastfeeding outcomes for mothers of preterm infants. Participating mothers will be randomized to either an intervention group or control group. In the intervention group person-centred proactive telephone support will be provided, in which the support team phones the mother daily for up to 14 days after hospital discharge. In the control group, mothers are offered a person-centred reactive support where mothers can phone the breastfeeding support team up to day 14 after hospital discharge. The intervention group will also be offered the same reactive telephone support as the control group. A stratified block randomization will be used; group allocation will be by high or low socioeconomic status and by NICU. Recruitment will be performed continuously until 1116 mothers (I: 558 C: 558) have been included. Primary outcome: proportion of mothers exclusively breastfeeding at eight weeks after discharge.

Secondary outcomes: proportion of breastfeeding (exclusive, partial, none and method of feeding), mothers satisfaction with breastfeeding, attachment, stress and quality of life in mothers/partners at eight weeks after hospital discharge and at six months postnatal age. Data will be collected by researchers blind to group allocation for the primary outcome. A qualitative evaluation of experiences of receiving/providing the intervention will also be undertaken with mothers and staff.

Discussion: This paper presents the rationale, study design and protocol for a RCT providing person-centred proactive telephone support to mothers of preterm infants. Furthermore, with a health economic evaluation, the cost-effectiveness of the intervention will be assessed. Trial registration: NCT01806480

Keywords
Breastfeeding, Mothers, Neonatal care, Preterm infant, Support, Telephone
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-12674 (URN)10.1186/1471-2431-13-73 (DOI)000318953500001 ()
Note

Open Access

Available from: 2013-07-01 Created: 2013-07-01 Last updated: 2018-12-13Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3460-7500

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