Abstract
Background
Breast milk has significant benefits for preterm babies, but ‘very preterm’ babies born before 32 weeks are less likely to receive their mother’s milk than babies born at later gestation, as mothers have to initiate and sustain lactation through expressing their milk for tube feeding until their babies can 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
There were notable differences between neonatal units. Five themes were developed: (1)‘The role of the infant feeding specialist’ with subthemes ‘Time allocated to infant feeding support’, ‘Supportive relationships and proactive, personalised support’, and ‘Shared responsibility for feeding support’; (2)‘Achieving a whole team approach to breast milk feeding’ with subthemes ‘Leadership and the feeding culture’, ‘Using external standards as levers’, and ‘Training for the multi-disciplinary team’; (3)‘Supporting initiation of breastfeeding’ with subthemes ‘Attitudes to early initiation’ and ‘Joined up working with postnatal ward’; (4)‘Supporting long-term expressing’ with subthemes ‘Positive feedback’, ‘Troubleshooting challenges’ and ‘Provision of breastpumps and facilities’; (5)‘Supporting the transition to breastfeeding’ with subthemes ‘Attitudes to breastfeeding’, ‘Overcoming separation of mothers and babies’, ‘Breastfeeding as the only oral feeding’, ‘Maintaining confidence without measuring volume’, and ‘Reassurance about weight gain’.
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.