Expert Commentary (Nursing)
Strategies to Help Mothers of Neonatal Intensive Care Unit Infants Cope with Milk Expression

Myriam Laniel¹, Vhea Paderanga¹, Aliza Patterson¹, Manahel Sarai¹, Zamila Uddin¹
Published online: April 22, 2022

¹Ingram School of Nursing, McGill University
Corresponding Author: Myriam Laniel, email myriam.laniel@mail.mcgill.ca
DOI: 10.26443/mjm.v20i1.777

Implications for practice and research

Fluctuations between feelings of closeness to and separation from an infant play an important role in milk expression for mothers whose infants are in the NICU. Positive coping strategies must be promoted by neonatal nurses, such as encouraging support-seeking or expressing milk during or right after skin-to-skin contact. (2)

Context

Although human milk consumption has many health benefits for newborns, mothers of preterm infants can face many challenges with expressing milk for an extended period of time while their infant is in the NICU. (2) Bujold et al. sought to document these challenges, explore how mothers cope with them, and determine if expressing milk can lead to feelings of closeness or separation from their infant.

Methods

Bujold et al. conducted a descriptive, qualitative cross-sectional study to explore the personal experiences of mothers expressing milk in a NICU setting. Fifteen mothers were provided with a smartphone equipped with an application allowing them to document their experience. Each time they expressed milk over a 48-hour period, mothers were asked to indicate whether the episode led to a feeling of closeness or separation, as well as audio-record their thoughts and feelings. Data was analyzed using a thematic content analysis. (2)

Findings

Feelings of closeness and separation experienced by mothers during milk expression were influenced by challenges, coping strategies, location and environment. (2) Mothers who coped with the difficulties associated with milk expression by using various strategies reported a more positive bond with their infant compared to mothers who were overwhelmed. (2) Mothers more frequently reported feeling separated from their infant when they expressed milk at home compared to when at their infant’s bedside or in a NICU milk expression room. (2)

Commentary

Consumption of human milk helps reduce neonatal mortality. (3) It may also help address mothers’ mental health as postpartum depression may be linked to the absence or early cessation of breastfeeding. (4) Bujold et al. suggest that promoting positive strategies to cope with milk expression may help foster maternal feelings of closeness with their infant and therefore increase breastfeeding rate in the NICU. (2) For example, skin-to-skin contact reinforces feelings of closeness, physiologically reduces stress and increases milk supply. (5) Similarly, music therapy was shown to reduce cortisol levels and significantly increase the amount of milk expressed. (6) Other effective distractions, such as reading a book, should be considered on an individual basis to positively change the mother’s mindset while pumping. The addition of peer counsellors in lactation programs was shown to increase the rate of exclusive human milk consumption in the NICU and even at discharge. (7) Offering positive reinforcement, encouraging mothers to seek support from significant others, and establishing a peer-to-peer mentoring program would help address the challenges faced by mothers expressing milk while their infant is in the NICU. Several other strategies (Figure 1) can be encouraged by neonatal nurses in an effort to reinforce feelings of closeness, help mothers cope with milk expression and increase human milk consumption in the NICU. The successful implementation of these initiatives by nurses would benefit from a standardized guideline, as proposed in Figure 1.

References

1. Pound CM, Unger SL. The baby-friendly initiative: protecting, promoting and supporting breastfeeding. Canadian Paediatric Society [Internet]. 2012 Jun [cited 2020 Oct 5]; 17(6): 317-21. Available from https://www.cps.ca/en/documents/position/baby-friendly-initiative-breastfeeding
2. Bujold M, Feeley N, Axelin A, Cinquino C, Dowling D, Thibeau S. Expressing human milk in the nicu. Adv Neonatal Care [Internet]. 2018 Feb [cited 2020 Oct 5]; 18(1):38-48. Available from: https://journals-lww-com.proxy3.library.mcgill.ca/advancesinneonatalcare/Fulltext/2018/02000/Expressing_Human_Milk_in_the_NICU__Coping.7.aspx
3. Hoban R, McLean L, Sullivan S, Currie C. Proactive lactation care is associated with improved outcomes in a referral NICU. Journal of Human Lactation [Internet]. 2021 February [cited 2021 April 29]. Available from: https://doi-org.proxy3.library.mcgill.ca/10.1177/0890334421993467
4. Hollen R, Smith AG, Smith-Gagen J. Breastmilk pumping for the mental health of the NICU mother. Clinical Lacatation [Internet]. 2019 May [cited 2021 Apr 11]; 10(2):60-7. Available from: https://connect-springerpub-com.proxy3.library.mcgill.ca/content/sgrcl/10/2/60?implicit-login=true
5. Mansoori M, Salmani N. Effect of breast milk expression during Kangaroo Mother Care on milk volume in mothers with premature infants admitted to neonatal intensive care unit. Journal of Evidenced-based Care [Internet]. 2020 Spring [cited 2021 April 29]; 10(1):44-50. Available from: https://ebcj.mums.ac.ir/article_15453.html
6. Ak J, Lakshmanagowda PB, Goturu J. Impact of music therapy on breast milk secretion in mothers of premature newborns. Journal of Clinical and Diagnostic Research. [Internet]. 2015 April [cited 2021 April 29];9(4):4-6. Available from: https://www-ncbi-nlm-nih-gov.proxy3.library.mcgill.ca/pmc/articles/PMC4437063/pdf/jcdr-9-CC04.pdf
7. Oza-Frank R, Bhatia A, Smith C. Impact of peer counselors on breastfeeding outcomes in a nondelivery NICU setting. Advances in Neonatal Care (Lippincott Wiliams & Wilkins) [Internet]. 2014 Aug [cited 2021 Apr 11]; 14(4):E1-8. Available from: https://journals-lww-com.proxy3.library.mcgill.ca/advancesinneonatalcare/Fulltext/2014/08000/Impact_of_Peer_Counselors_on_Breastfeeding.14.aspx

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