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Preterm Infants' Mothers' Experiences With Milk Expression and Breastfeeding

An Integrative Review

Ikonen, Riikka MNSc, RN; Paavilainen, Eija PhD; Kaunonen, Marja PhD

Section Editor(s): Ikuta, Linda; Zukowsky, Ksenia

doi: 10.1097/ANC.0000000000000232
Clinical Issues in Neonatal Care

Background: Preterm infants' mothers face several challenges when providing critical breast milk for their infants; therefore, sensitive and evidence-based counseling and support are needed. However, a general view of the experiences preterm infants' mothers can face during their infants' hospitalization and after discharge is lacking.

Purpose: The aim of this integrative review was to explore practical and emotional experiences of preterm infants' mothers with respect to breast milk expression and breastfeeding, from the birth of the preterm infant, during the neonatal intensive care unit (NICU) stay, and postdischarge until the cessation of breastfeeding.

Methods/Search Strategy: A systematic literature search from MEDLINE, CINAHL, PsycInfo, and Cochrane databases were performed. The search resulted in 20 qualitative and 3 quantitative studies. The data were analyzed by thematic analysis.

Findings: Coping was the central theme in mothers' experiences. The benefits of breast milk served both as a supportive factor and an obstructive factor for the mothers, and breastfeeding was used to rebuild connection and motherhood. Simultaneously, the mothers needed to cope with new demands, interfering NICU environment, demanding expressing, and difficulties with breastfeeding.

Implications for Practice: Expressing and breastfeeding are important for the mothers to contribute to their infants' care and to rebuild the interrupted connection. Evidence-based and sensitive informational and practical counseling are vital for the mothers. Intensive emotional support is important during encountered problems and during cessation.

Implications for Research: Future research is needed about mothers' experiences using supplementation methods, test-weighing, exploring experiences of mothers of late-preterm infants, and the validity of the concept of coping with this phenomenon.

School of Health Sciences, University of Tampere, Tampere, Finland (Ms Ikonen and Drs Paavilainen and Kaunonen); Etelä-Pohjanmaa Hospital District, Seinäjoki, Finland (Dr Paavilainen); and Pirkanmaa Hospital District, General Administration, Tampere, Finland (Dr Kaunonen).

Correspondence: Riikka Ikonen, MNSc, RN, School of Health Sciences, University of Tampere, Arvo Bldg, FI-33014, University of Tampere, Finland (

The work was conducted at University of Tampere, Tampere, Finland.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

There is no conflict of interest.

© 2015 by The National Association of Neonatal Nurses