Differences between neonatal units with high and low rates of breast milk feeding for very preterm babies at discharge: a qualitative study of staff experiences
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Breast milk has significant benefits for preterm babies, but ‘very preterm’ babies are unable to feed directly from the breast at birth. Their mothers have to initiate and sustain lactation through expressing milk for tube feeding until their babies are developmentally ready to feed orally. There are wide disparities between neonatal units in England in rates of breast milk feeding at discharge. This study explored health professionals’ experiences of barriers and facilitators to their role in supporting breast milk feeding and breastfeeding for very preterm babies.
Methods
12 health professionals were interviewed, from four neonatal units in England with high or low rates of breast milk feeding at discharge. Interviews were analysed using comparative thematic analysis.
Results
Five themes were developed: ‘The role of the infant feeding specialist’, ‘Achieving a whole team approach to breast milk feeding’, ‘Supporting initiation of breastfeeding’ ‘Supporting long-term expressing’, ‘Supporting the transition to breastfeeding’. There were notable differences between neonatal units in the time allocated to specialist feeding support, the team’s sense of collective responsibility for supporting feeding, leadership, the use of external standards as levers for change, and training for the multi-disciplinary team. The feeding challenges faced by mothers of very preterm babies could be made worse where there was no joined-up working between neonatal and postnatal staff; inadequate facilities for mothers to stay with their babies; and when opportunities were missed to give information about the importance of early initiation of expressing and to support mothers’ confidence during the transition to direct breastfeeding.
Conclusions
Effective support can be influenced by having a supernumerary post dedicated to infant feeding; strong leadership that champions breast milk feeding and breastfeeding within Family Integrated Care; maintaining accountability by using existing quality improvement tools and accredited standards for neonatal units; and training for the whole multi-disciplinary team that encourages and enables every member of staff to take an appropriate share of responsibility for consistently informing and assisting mothers with expressing and breastfeeding. Joined-up working between staff on antenatal and postnatal wards and neonatal units is important to enable integrated feeding support for the mother-baby dyad.
Methods
12 health professionals were interviewed, from four neonatal units in England with high or low rates of breast milk feeding at discharge. Interviews were analysed using comparative thematic analysis.
Results
Five themes were developed: ‘The role of the infant feeding specialist’, ‘Achieving a whole team approach to breast milk feeding’, ‘Supporting initiation of breastfeeding’ ‘Supporting long-term expressing’, ‘Supporting the transition to breastfeeding’. There were notable differences between neonatal units in the time allocated to specialist feeding support, the team’s sense of collective responsibility for supporting feeding, leadership, the use of external standards as levers for change, and training for the multi-disciplinary team. The feeding challenges faced by mothers of very preterm babies could be made worse where there was no joined-up working between neonatal and postnatal staff; inadequate facilities for mothers to stay with their babies; and when opportunities were missed to give information about the importance of early initiation of expressing and to support mothers’ confidence during the transition to direct breastfeeding.
Conclusions
Effective support can be influenced by having a supernumerary post dedicated to infant feeding; strong leadership that champions breast milk feeding and breastfeeding within Family Integrated Care; maintaining accountability by using existing quality improvement tools and accredited standards for neonatal units; and training for the whole multi-disciplinary team that encourages and enables every member of staff to take an appropriate share of responsibility for consistently informing and assisting mothers with expressing and breastfeeding. Joined-up working between staff on antenatal and postnatal wards and neonatal units is important to enable integrated feeding support for the mother-baby dyad.
Date Issued
2024-12-26
Date Acceptance
2024-12-04
Citation
BMC Pregnancy and Childbirth, 2024, 24
ISSN
1471-2393
Publisher
BMC
Start Page
863
Journal / Book Title
BMC Pregnancy and Childbirth
Volume
24
Copyright Statement
© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/39725883
10.1186/s12884-024-07039-0
Subjects
Barriers
Breastfeeding
Expressing
Facilitators
Family integrated care
Neonatal unit
Qualitative
Staff experiences
Very preterm
Humans
Breast Feeding
Qualitative Research
Infant, Newborn
Female
England
Patient Discharge
Intensive Care Units, Neonatal
Infant, Premature
Attitude of Health Personnel
Infant, Extremely Premature
Health Personnel
Mothers
Patient Care Team
Humans
Patient Discharge
Attitude of Health Personnel
Mothers
Breast Feeding
Qualitative Research
Infant, Newborn
Infant, Premature
Health Personnel
Intensive Care Units, Neonatal
Patient Care Team
England
Female
Infant, Extremely Premature
1110 Nursing
1114 Paediatrics and Reproductive Medicine
1117 Public Health and Health Services
Obstetrics & Reproductive Medicine
Publication Status
Published
Coverage Spatial
England
Article Number
863
Date Publish Online
2024-12-26