A qualitative cross-cultural analysis of NICU care culture and infant feeding in Finland and the U.S.

Abstract

Background: The benefits of family-centered care for the health and well-being of preterm infants and their families include increased parent-infant closeness, improved lactation, and positive mental health outcomes; however, it is known that the extent to which family-centered care is adopted varies by unit. This study aimed to understand how differences in neonatal care culture in two units in Finland and the U.S. were translated to parents' infant feeding experiences in the hope of improving relationally focused feeding practices in both locations. Methods: This qualitative, cross-sectional study utilized narrative methodologies to understand the lived experiences of 15 families hospitalized in a tertiary neonatal intensive care unit in Finland (n = 8) and the U. S (n = 7). Results: A global theme of lactation as a means or an end showed that lactation and infant feeding were framed differently in each location. The three supporting themes that explain families' perceptions of their transition to parenthood, support as a family unit, and experience with lactation include: universal early postnatal challenges; culture and space-dependent nursing support; and controlled or empowering breastfeeding experiences. Conclusions: Care culture plays a large role in framing all infant caring activities, including lactation and infant feeding. This study found that in the unit in Finland, breastfeeding was one method to achieve closeness with an infant, while in the unit in the U.S., pumping was only an end to promote infant nutritional health. Therefore, breastfeeding coupled with closeness was found to be supportive of a salutogenic, or health-promoting, care approach for the whole family.

Positive breastfeeding experiences and facilitators in mothers of preterm and low birthweight infants: a meta-ethnographic review

“…One of the studies was reported in three papers [ 34 , 35 , 42 ] and one study in two papers [ 36 , 37 ], thus overall, the 17 articles comprised 14 studies. The 14 studies were conducted in the US ( n = 4) [ 43 – 46 ], Finland ( n = 3) [ 39 – 41 ], Sweden ( n = 2) [ 30 , 34 , 35 , 42 ], Canada ( n = 2) [ 31 , 33 ], Norway ( n = 1) [ 32 ], Sweden and England ( n = 1) [ 36 , 37 ], and Finland and US ( n = 1) [ 38 ]. Overall, these studies represent the views of 697 mothers.…”

“…Feeling attuned was an experience that could occur briefly, or for a longer period, at any time from birth, regardless of breast milk intake, frequency and/or duration achieved. Mothers described attuned breastfeeding in terms of an emotional embodied connection [ 31 , 38 , 42 ], an experienced mutual interaction [ 36 , 42 ], a “ symbiosis ” [ 41 ], or as a “ private moment of intimacy ” between them [ 41 ]. Attuned breastfeeding occurred when the mother trusted her body and what it could do, when the mother could be in the here and now and when she experienced mutual positive responses with her infant.…”

“… Mean age was 30, 60% had a university education, 60% primiparous, 15% had twins, 6% not born in Sweden Written comments to open-ended questions on questionnaires issued at 8 weeks after discharge and at 6 and 12 months of age. Telephone interviews at 8 weeks after discharge and at 6 months of age Thematic network analysis B [ 36 ] Flacking and Dykes 2013 To explore, in-depth, the impact of place and space on parents’ experiences and practices related to feeding their preterm babies in NICUs in Sweden and England England and Sweden 2 NICUs in each country Ethnographic 23–35 gw 52 mothers; 22 Swedish and 30 English At hospital, observations were made throughout the hospital stay 19–45 years, 30 primiparous, 6 were not born in Sweden/England Participant observations (210 h) and face-to-face interviews (96 h) Grounded theory A/B [ 37 ] Flacking and Dykes 2017 To explore perceptions and experiences of using a nipple shield among parents and staff in neonatal units in Sweden and England England and Sweden 2 NICUs in each country Ethnographic Median 31 gw 12 mothers At hospital, observations and interviews were made throughout the hospital stay 8 primiparous, 3 mothers with twins Participant observations and face-to-face interviews Thematic network analysis B [ 38 ] Holdren et al 2019 To understand how differences in neonatal care culture in two units in Finland and the US were translated to parents’ infant feeding experiences Finland and the USA One level III NICU in each country Unspecified qualitative 23–32 gw 15 mothers; 8 Finnish and 7 US mothers In Finland: last week during the hospital stay, in the US: recently admitted to the NICU 20–44 years (mean 30), 6 mothers had twins Interviews via telephone or face-to-face Thematic narrative analysis B/C [ 39 ] Ikonen et al 2016 To describe maternal experiences of expressing breast milk for preterm or SGA infants. Finland Internet-based Descriptive 23–38 gw, mean of 31 gw 130 mothers At home, 0–20 years (mean 4 years) of age 21–50 years (me...…”

Impact of Covid-19 in pregnancy on mother’s psychological status and infant’s neurobehavioral development: a longitudinal cohort study in China

“…Our study found that even after the end of quarantine, nearly a half of mothers continued to separate with their babies due to the fear of uncertain infection, along with a low proportion of breastfeeding in early months. Except for early cessation of breastfeeding, early mother–baby separation is also linked to negative effects on infant brain development, parent psychological well-being, and the parent–infant relationship [ 14 , 33 , 34 ]. Such adversity and stress during the prenatal and early childhood periods are associated with later impairments in learning, behavior, and both physical and mental well-being [ 35 – 37 ].…”

Parental Experiences in Neonatal Intensive Care Unit at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia: A Phenomenological Study

“…Although parental experience in the NICU was explored in different countries (2,5,(32)(33)(34), there are variations in, accessibility of health facilities, parent-HCPs and parental involvement in the care due to socio-cultural differences, nurses' working culture and the hospital setting (35)(36)(37)(38). And also, it is not well explored in Ethiopia.…”