Mothers' experiences of a telephone based breastfeeding support intervention after discharge from neonatal intensive care units: a mixed-method study

Jenny Ericson, Renée Flacking, Camilla Udo, Jenny Ericson, Renée Flacking, Camilla Udo

Abstract

Background: After discharge from a neonatal intensive care unit (NICU), many mothers of preterm infants (gestational age < 37 weeks) experience a lack of support for breastfeeding. An intervention study was designed to evaluate the effects of proactive (a daily telephone call initiated by a member of a breastfeeding support team) and/or reactive (mothers could call the breastfeeding support team) telephone based breastfeeding support for mothers after discharge from the NICU. The mothers in the intervention group had access to both proactive and reactive support; the mothers in the control group only had access to reactive support. The aim of this study was to explore the mothers' experiences of the proactive and reactive telephone support.

Methods: This study was a qualitatively driven, mixed-method evaluation using three data sources: questionnaires with qualitative open-ended questions, visual analogue scales and telephone interviews. In total, 365 mothers contributed data for this study. The qualitative data were analysed with an inductive thematic network analysis, while the quantitative data were analysed with Student's t-test and the chi-square test.

Results: Proactive support contributed to greater satisfaction and involvement in breastfeeding support. The mothers who received proactive support reported that they felt strengthened, supported and secure, as a result of the continuous care provided by staff who were knowledgeable and experienced (i.e., in breastfeeding and preterm infants), which resulted in the global theme 'Empowered by proactive support'. The mothers who received reactive support experienced contradictory feelings; some felt secure because they had the opportunity to call for support, whereas others found it difficult to decide when and if they should use the service, which resulted in the global theme; 'Duality of reactive support'.

Conclusion: There were positive aspects of both proactive (i.e., greater satisfaction and feelings of empowerment) and reactive support (i.e., the opportunity to call for support); however, the provision of reactive support alone may be inadequate for those with the greatest need for support as they are the least likely to access it.

Trial registration: NCT01806480 on 5 March 2013.

Keywords: Breastfeeding; Mixed method; Neonatal; Preterm infant; Support; Telephone; Thematic network analysis.

Conflict of interest statement

All eligible mothers who agreed to participate in this study signed a written consent form after receiving oral and written information. The mothers were given the opportunity to ask questions about the study and were informed that participation in the study was voluntary and that they could withdraw at any time without any repercussions. The mothers and infants’ confidentiality were ensured at all stages of the research process. The study was approved by the Regional Ethical Review Board, Uppsala (Dnr: 2012/292).Not applicable.The authors declare no competing interest.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Data collection and the number of participants
Fig. 2
Fig. 2
Global and organising themes

References

    1. Kair LR, Flaherman VJ, Newby KA, Colaizy TT. The experience of breastfeeding the late preterm infant: a qualitative study. Breastfeed Med. 2015;10(2):102–106. doi: 10.1089/bfm.2014.0121.
    1. Flacking R, Thomson G, Axelin A. Pathways to emotional closeness in neonatal units - a cross-national qualitative study. BMC Pregnancy Childbirth. 2016;16:170. doi: 10.1186/s12884-016-0955-3.
    1. Dosani A, Hemraj J, Premji SS, Currie G, Reilly SM, Lodha AK, et al. Breastfeeding the late preterm infant: experiences of mothers and perceptions of public health nurses. Int Breastfeed J. 2016;12:23. doi: 10.1186/s13006-017-0114-0.
    1. Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475–490. doi: 10.1016/S0140-6736(15)01024-7.
    1. Lau C. Development of suck and swallow mechanisms in infants. Ann Nutr Metab. 2015;66(Suppl 5):7–14. doi: 10.1159/000381361.
    1. Niela-Vilen H, Axelin A, Melender HL, Salantera S. Aiming to be a breastfeeding mother in a neonatal intensive care unit and at home: a thematic analysis of peer-support group discussion in social media. Matern Child Nutr. 2015;11(4):712–726. doi: 10.1111/mcn.12108.
    1. Larsson C, Wagstrom U, Normann E, Thernstrom Blomqvist Y. Parents experiences of discharge readiness from a Swedish neonatal intensive care unit. Nurs Open. 2017;4(2):90–95. doi: 10.1002/nop2.71.
    1. Maastrup R, Hansen BM, Kronborg H, Bojesen SN, Hallum K, Frandsen A, et al. Breastfeeding progression in preterm infants is influenced by factors in infants, mothers and clinical practice: the results of a national cohort study with high breastfeeding initiation rates. PLoS One. 2014;9(9):e108208. doi: 10.1371/journal.pone.0108208.
    1. McFadden A, Gavine A, Renfrew MJ, Wade A, Buchanan P, Taylor JL, et al. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev. 2017;2:Cd001141.
    1. Schmied V, Beake S, Sheehan A, McCourt C, Dykes F. Women's perceptions and experiences of breastfeeding support: a metasynthesis. Birth. 2011;38(1):49–60. doi: 10.1111/j.1523-536X.2010.00446.x.
    1. McCormack B, McCance TV. Development of a framework for person-centred nursing. J Adv Nurs. 2006;56(5):472–479. doi: 10.1111/j.1365-2648.2006.04042.x.
    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;13:73. doi: 10.1186/1471-2431-13-73.
    1. Ericson J, Eriksson M, Hellström-Westas L, Hoddinott P, Flacking R. The effectiveness of a proactive telephone support provided to breastfeeding mothers of preterm infants: a randomised controlled trial. Submitted. 2017;
    1. Sandelowski M. Using qualitative methods in intervention studies. Res Nurs Health. 1996;19(4):359–364. doi: 10.1002/(SICI)1098-240X(199608)19:4<359::AID-NUR9>;2-H.
    1. Fetters MD, Curry LA, Creswell JW. Achieving integration in mixed methods designs-principles and practices. Health Serv Res. 2013;48(6 Pt 2):2134–2156. doi: 10.1111/1475-6773.12117.
    1. Hesse-Biber S. Emerging methodologies and methods practices in the field of mixed methods research. Qual Inq. 2010;16(6):415–418. doi: 10.1177/1077800410364607.
    1. Kvale S: Planning an interview study. In: Doing interviews. 1 edn. Thousand Oaks, Calif: Sage Publications 2007. p. 33-50.
    1. Attride-Stirling J. Thematic networks: an analytic tool for qualitative research. Qual Res. 2001;1(3):385–405. doi: 10.1177/146879410100100307.
    1. Melnyk BM, Feinstein NF, Alpert-Gillis L, Fairbanks E, Crean HF, Sinkin RA, et al. Reducing premature infants’ length of stay and improving parents’ mental health outcomes with the creating opportunities for parent empowerment (COPE) neonatal intensive care unit program: a randomized, controlled trial. Pediatrics. 2006;118(5):e1414–e1427. doi: 10.1542/peds.2005-2580.
    1. Chaput KH, Adair CE, Nettel-Aguirre A, Musto R, Tough SC. The experience of nursing women with breastfeeding support: a qualitative inquiry. CMAJ Open. 2015;3(3):E305–E309. doi: 10.9778/cmajo.20140113.
    1. Osman H, Chaaya M, El Zein L, Naassan G, Wick L. What do first-time mothers worry about? A study of usage patterns and content of calls made to a postpartum support telephone hotline. BMC Public Health. 2010;10:611. doi: 10.1186/1471-2458-10-611.
    1. Hoddinott P, Craig L, Maclennan G, Boyers D, Vale L. Process evaluation for the FEeding support team (FEST) randomised controlled feasibility trial of proactive and reactive telephone support for breastfeeding women living in disadvantaged areas. BMJ Open. 2012;2(2):e001039. doi: 10.1136/bmjopen-2012-001039.
    1. Bryman A. Quantity and quality in social research. New York: Taylor and Francis; 2003. Combining quantitative and qualitative reasarch; pp. 126–155.

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