Barriers to Human Milk Feeding at Discharge of Very-Low-Birth-Weight Infants: Maternal Goal Setting as a Key Social Factor

Abstract

Background: While black mothers initiate human milk (HM) provision at lower rates than non-black mothers in the United States, some neonatal intensive care units (NICUs) report similar initiation rates regardless of race/ ethnicity for mothers of very-low-birth-weight (VLBW) infants. However, racial disparity frequently becomes evident in the proportion of black infants who continue to receive HM feedings at NICU discharge. Since social factors have been associated with differences in HM provision for term infants, we sought to identify differences in social factors associated with HM feeding at discharge based on race/ethnicity. Materials and Methods: A prospective cohort study of racially diverse mothers of VLBW infants measured social factors including maternal education, breastfeeding support, return to work/school, HM feeding goal, previous breastfeeding, or formula experience. Multivariate logistic regression modeling was applied to social factors to predict HM feeding at discharge. Additional regression models were created for racial/ethnic subgroups to identify differences. Results: For all 362 mothers, WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) eligibility and maternal goal near time of discharge of providing any HM negatively and positively predicted HM feeding at discharge, respectively. Perceived breastfeeding support from the infant's maternal grandmother negatively predicted HM feeding at discharge for black mothers. Conclusions: Future interventions to increase duration of HM provision in VLBW infants should focus on the establishment and maintenance of maternal HM feeding goals. Further studies of the familial support system of black mothers are warranted to determine multigenerational impact and potential interventions.

Unit policies and breast milk feeding at discharge of very preterm infants: The EPIPAGE‐2 cohort study

“…13 They may change their pre-delivery wishes for human milk feeding during the course of hospitalisation. 28 In EPIPAGE-2, policies supporting BMF maintenance and available for the study were associated with higher rates of BMF at discharge, although we were not able to explore difficulties of breast pump dependence, maternal stress and fatigue, insufficient social support, and inconsistent advice in NICUs, 12 already described as having a negative impact on maintaining lactation. These policies may help defining strategies at unit level to support BMF.…”

“…Multiple transfers can break this chain and alter BMF at discharge. We have only explored the impact of the first unit of hospitalisation on BMF at discharge, but sensitivity analysis included infants hospitalised in only one unit did not modify the associations reinforcing the role of maternal goal setting and successful establishment of lactation managed in the first unit . Finally, we do not have data about educational interventions having an impact on practices, as this kind of data was too complex to collect at national level.…”

Evidence-Based Methods That Promote Human Milk Feeding of Preterm Infants

“…14 It has been proposed that the profound dislike and inconvenience of long-term HM expression, maternal stress and fatigue, insufficient encouragement and assistance from family and friends, and inconsistent advice in the NICU all play a role in mothers’ discontinuation of HM provision prior to NICU discharge. 25–28 Furthermore, it is likely that some mothers, especially those whose initial pre-birth intent was to formula-feed, revert back to their pre-birth feeding goals, especially as the infant’s condition improves and the mother perceives that “HM has done its job” of protecting from acquired morbidities. 8,14 …”

Oral metoclopramide boosts lactogenesis II in mothers with preterm infants: a randomized placebo-controlled trial.

“…Prenatal or postnatal anxiety increases breastfeeding-cessation risk and limits e cacy of peer support from lactation counsellors (27). Though we did not speci cally study maternal anxiety, it is expected that psychosocial stress associated with preterm delivery in addition to separation and disorganized feeding will adversely affect breastfeeding (28), although mothers of preterm infants are often motivated to express milk (29,30). Maternal anxiety should be actively managed in at-risk mothers, particularly as failed breastfeeding can perpetuate depressive symptoms (31).…”