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Expressing Human Milk in the NICU: Coping Mechanisms and Challenges Shape the Complex Experience of Closeness and Separation

Bujold, Maude, MSc(A), RN; Feeley, Nancy, PhD, RN; Axelin, Anna, PhD, RN; Cinquino, Claudia, BScN, RN, IBCLC

Section Editor(s): Dowling, Donna PhD, RN; ; Thibeau, Shelley PhD, RNC-NIC;

doi: 10.1097/ANC.0000000000000455
Original Research

Background: Human milk has multiple benefits for human health; however, rates of infants receiving human milk at discharge in Canadian neonatal intensive care units (NICUs) are far below recommendations of the Baby Friendly Hospital Initiative supported by the Canadian Pediatric Association. Mothers of infants requiring NICU care usually need to express their milk, especially mothers of premature infants, since for some time their infant is unable to feed directly at the breast. Expressing human milk for an extended period can be challenging for mothers.

Purpose: To document maternal experiences expressing human milk for their infant in the NICU as a closeness or separation experience, and to discover what factors gave rise to these perceptions.

Methods: In this descriptive qualitative cross-sectional study, 15 mothers whose infants were hospitalized in a level III NICU and who were expressing human milk audio recorded their thoughts and feelings with a smartphone application for 48 hours while they were expressing milk. A thematic content analysis was used to analyze data.

Findings: Expressing human milk for their hospitalized infant was a difficult experience for all mothers, and most described both closeness and separation feelings while expressing milk. Their feelings fluctuated depending on their coping mechanisms, perceived challenges, as well as their location and environment. Mothers were all pursuing their goal of continued milk expression with various levels of motivation.

Implications for Practice: NICUs should adopt a family-centered approach to care whereby mothers' care needs related to milk expression are addressed. Nurses can ask open-ended questions to explore how mothers are coping, and they can assist mothers to find effective coping strategies to minimize the challenges related to milk expression to promote mother–infant closeness.

Implications for Research: The impact of environment and location on mothers with hospitalized infants should be explored, as unit designs could be altered to foster closeness.

Ingram School of Nursing, McGill University, Montreal, Quebec, Canada (Ms Bujold and Dr Feeley); Jewish General Hospital, Montreal, Quebec, Canada (Dr Feeley and Ms Cinquino); and Department of Nursing Science, University of Turku, Finland (Dr Axelin).

Correspondence: Nancy Feeley, PhD, RN, Centre for Nursing Research, Jewish General Hospital, 3755 Côte-Sainte-Catherine Rd, H-301.1, Montreal, QC H3T 1E2, Canada (

Institution where study occurred: Jewish General Hospital, Montreal, Quebec, Canada.

The authors declare no conflicts of interest.

© 2018 by The National Association of Neonatal Nurses