Breastfeeding satisfaction post hospital discharge and associated factors - a longitudinal cohort study of mothers of preterm infants

Jenny Ericson, Erik Lampa, Renée Flacking, Jenny Ericson, Erik Lampa, Renée Flacking

Abstract

Background: Mothers' satisfaction with breastfeeding is important for breastfeeding duration but rarely investigated in mothers of preterm infants. The aim of this study was to describe breastfeeding satisfaction and associated factors during the first year in mothers of preterm infants (gestational age < 37 weeks).

Methods: This longitudinal cohort study, based on secondary analysis data from a randomized controlled trial, included 493 mothers of 547 preterm infants. Data on breastfeeding duration and satisfaction, parental stress and attachment were collected at 8 weeks post discharge, and at 6 and 12 months after birth. Breastfeeding satisfaction was measured by the Maternal Breastfeeding Evaluation Scale. Descriptive statistics and linear mixed effect models were used when analyzing the data.

Results: During the first 12 months breastfeeding satisfaction increased in the mean summary scores and points in the dimensions "role attainment" and "lifestyle and maternal body image". In the dimension "infant growth and satisfaction", there was an increase in mean points from 6 to 12 months after birth, but not between 8 weeks after discharge and 12 months after birth. The findings also showed that partial and no breastfeeding, higher parental stress, and infant gestational age < 32 weeks were associated with decreased breastfeeding satisfaction. Older maternal age and greater maternal attachment were associated with increased maternal breastfeeding satisfaction. There were no associations between maternal breastfeeding satisfaction and maternal educational level, parity, multiple birth, or maternal birth country other than Sweden, during the first 12 months after birth.

Conclusions: Breastfeeding satisfaction was clearly associated with breastfeeding duration during the first year after birth. Breastfeeding satisfaction may be important to take into account when supporting breastfeeding and when designing interventions to support breastfeeding. Furthermore, these findings highlight the complexity of breastfeeding and emphasize the need for early and good support during neonatal care, so that mothers feel trust in themselves and their infant and in exclusive breastfeeding at discharge and in the first months thereafter.

Trial registration: The randomized controlled trial was registered NCT01806480 with www.clinicaltrials.gov on 2013-03-07.

Keywords: Breastfeeding; Breastfeeding evaluation; Breastfeeding satisfaction; Mothers; Neonatal care; Predictors; Preterm infants.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of participating mothers
Fig. 2
Fig. 2
Proportion of mothers breastfeeding (exclusive, partial and no) at each follow-up (discharge, 8 weeks after discharge, and 6 and 12 months after birth), N = 493

References

    1. Ericson J, Flacking R, Hellstrom-Westas L, Eriksson M. Changes in the prevalence of breast feeding in preterm infants discharged from neonatal units: a register study over 10 years. BMJ Open. 2016;6(12):e012900. doi: 10.1136/bmjopen-2016-012900.
    1. Hackman NM, Alligood-Percoco N, Martin A, Zhu J, Kjerulff KH. Reduced breastfeeding rates in firstborn late preterm and early term infants. Breastfeed Med. 2016;11(3):119–125. doi: 10.1089/bfm.2015.0122.
    1. Taylor SN. Solely human milk diets for preterm infants. Semin Perinatol. 2019;43(7):151158. doi: 10.1053/j.semperi.2019.06.006.
    1. Niela-Vilen H, Melender HL, Axelin A, Loyttyniemi E, Salantera S. Predictors of breastfeeding initiation and frequency for preterm infants in the NICU. J Obstet Gynecol Neonatal Nurs. 2016;45(3):346–358. doi: 10.1016/j.jogn.2016.01.006.
    1. Palmer L, Ericson J. A qualitative study on the breastfeeding experience of mothers of preterm infants in the first 12 months after birth. Int Breastfeed J. 2019;14(1):35. doi: 10.1186/s13006-019-0229-6.
    1. Gianni ML, Bezze EN, Sannino P, Baro M, Roggero P, Muscolo S, Plevani L, Mosca F. Maternal views on facilitators of and barriers to breastfeeding preterm infants. BMC Pediatr. 2018;18(1):283. doi: 10.1186/s12887-018-1260-2.
    1. Mitha A, Piedvache A, Khoshnood B, Fresson J, Glorieux I, Roué JM, Blondel B, Durox M, Burguet A, Ancel PY, Kaminski M, Pierrat V. The impact of neonatal unit policies on breast milk feeding at discharge of moderate preterm infants: The EPIPAGE-2 cohort study. Matern Child Nutr. 2019;15(4):e12875. 10.1111/mcn.12875. Epub 2019 Aug 13. PMID: 31310706; PMCID: PMC6859988.
    1. Niela-Vilen H, Axelin A, Salantera S, Melender HL. A typology of breastfeeding mothers of preterm infants: a qualitative analysis. Adv Neonatal Care. 2019;19(1):42–50. doi: 10.1097/ANC.0000000000000542.
    1. Flacking R, Ewald U, Starrin B. "I wanted to do a good job": experiences of 'becoming a mother' and breastfeeding in mothers of very preterm infants after discharge from a neonatal unit. Soc Sci Med. 2007;64(12):2405–2416. doi: 10.1016/j.socscimed.2007.03.008.
    1. Bonnet C, Blondel B, Piedvache A, Wilson E, Bonamy AE, Gortner L, Rodrigues C, van Heijst A, Draper ES, Cuttini M, Zeitlin J. EPICE Research Group. Low breastfeeding continuation to 6 months for very preterm infants: A European multiregional cohort study. Matern Child Nutr. 2019;15(1):e12657. 10.1111/mcn.12657. Epub 2018 Aug 23. PMID: 30136374; PMCID: PMC7199087.
    1. Ericson J, Flacking R, Udo C. Mothers' experiences of a telephone based breastfeeding support intervention after discharge from neonatal intensive care units: a mixed-method study. Int Breastfeed J. 2017;12(1):50. doi: 10.1186/s13006-017-0142-9.
    1. Ericson J, Eriksson M, Hoddinott P, Hellström-Westas L, Flacking R. Breastfeeding and risk for ceasing in mothers of preterm infants-Long-term follow-up. Matern Child Nutr. 2018;14(4):e12618. 10.1111/mcn.12618. Epub 2018 May 7. PMID: 29733102; PMCID: PMC6175451.
    1. Ericson J, Eriksson M, Hellström-Westas L, Hoddinott P, Flacking R. Proactive telephone support provided to breastfeeding mothers of preterm infants after discharge: a randomised controlled trial. Acta Paediatr. 2018;107(5):791–798. doi: 10.1111/apa.14257.
    1. The Swedish Health and Wellfare Agency. Breastfeeding statistics. 2021. [] Accessed 25 Jan 2021.
    1. The Swedish Law. The Swedish Social Insurance Law, parental benefits. 2021. [] Accessed 21 Jan 2021.
    1. The World Health Organization. Global strategy on infant and young child feeding. 2021 [] Accessed 7 Jan 2021.
    1. Ericson J, Eriksson M, Hellstrom-Westas L, Hagberg L, Hoddinott P, Flacking R. The effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants: study protocol for a randomized controlled trial. BMC Pediatr. 2013;13(1):73. doi: 10.1186/1471-2431-13-73.
    1. Leff EW, Jefferis SC, Gagne MP. The development of the maternal breastfeeding evaluation scale. J Hum Lact. 1994;10(2):105–111. doi: 10.1177/089033449401000217.
    1. Condon J, Corkindale CJ. The assessment of parent-to-infant attachment: development of a self-report questionnaire instrument. Feb 1998. J Reprod Infant Psychol. 1998;16(1):57–76. doi: 10.1080/02646839808404558.
    1. Ostberg M, Hagekull B, Wettergren S. A measure of parental stress in mothers with small children: dimensionality, stability and validity. Scand J Psychol. 1997;38(3):199–208. doi: 10.1111/1467-9450.00028.
    1. Riordan JM, Woodley G, Heaton K. Testing validity and reliability of an instrument which measures maternal evaluation of breastfeeding. J Hum Lact. 1994;10(4):231–235. doi: 10.1177/089033449401000416.
    1. Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, Erikson P, ISPOR Task Force for Translation and Cultural Adaptation Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR task force for translation and cultural adaptation. Value Health. 2005;8(2):94–104. doi: 10.1111/j.1524-4733.2005.04054.x.
    1. Abidin RR. Parenting stress index: professional manual. 3. Odessa: FL Psychological Assessment Resources, Inc.; 1995.
    1. The World Health Organization. Breastfeeding. 2021. [] Accessed 25 Jan 2021.
    1. Rossman B, Engstrom JL, Meier PP, Vonderheid SC, Norr KF, Hill PD. "They've walked in my shoes": mothers of very low birth weight infants and their experiences with breastfeeding peer counselors in the neonatal intensive care unit. J Hum Lact. 2011;27(1):14–24. doi: 10.1177/0890334410390046.
    1. Maastrup R, Hansen BM, Kronborg H, Bojesen SN, Hallum K, Frandsen A, et al. Factors associated with exclusive breastfeeding of preterm infants. Results from a prospective national cohort study. PloS One. 2014;9(2):e89077. doi: 10.1371/journal.pone.0089077.
    1. Grundt H, Tandberg BS, Flacking R, Drageset J, Moen A. Associations between single-family room care and breastfeeding rates in preterm infants. J Hum Lact. 2020;890334420962709.
    1. Casey L, Fucile S, Dow KE. Determinants of successful direct breastfeeding at hospital discharge in high-risk premature infants. Breastfeed Med. 2018;13(5):346–351. doi: 10.1089/bfm.2017.0209.
    1. Omarsdottir S, Adling A, Bonamy AK, Legnevall L, Tessma MK, Vanpee M. Predictors of sustained maternal milk feeds in extremely preterm infants. J Perinatol. 2015;35(5):367–372. doi: 10.1038/jp.2014.212.
    1. Myrskylä M, Margolis R. Happiness: before and after the kids. Demography. 2014;51(5):1843–1866. doi: 10.1007/s13524-014-0321-x.
    1. The Swedish Public Health Agency. 2021. [] Accessed 25 Jan 2021.
    1. Leff EW, Gagne MP, Jefferis SC. Maternal perceptions of successful breastfeeding. J Hum Lact. 1994;10(2):99–104. doi: 10.1177/089033449401000216.
    1. Raiskila S, Axelin A, Toome L, Caballero S, Tandberg BS, Montirosso R, Normann E, Hallberg B, Westrup B, Ewald U, Lehtonen L. Parents' presence and parent–infant closeness in 11 neonatal intensive care units in six European countries vary between and within the countries. Acta Paediatr. 2017;106(6):878–888. doi: 10.1111/apa.13798.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe