Social Representations of Bedside Milk Expression Among Mothers of Preterm Newborns in Neonatal Intensive Care Units.

Abstract

AIM To understand the social representations of bedside milk expression (BME) among mothers of preterm newborns in neonatal intensive care units (NICUs). DESIGN Qualitative descriptive study. METHODS The study was conducted from July to August 2024 in two NICUs of a referral maternity hospital in Fortaleza, Brazil. Nineteen mothers of hospitalised premature newborns participated. Semi-structured interviews were conducted and subjected to thematic content analysis. RESULTS Mothers perceived BME as a meaningful act of protection and bonding, though some were unfamiliar with the practice. Emotional ambivalence was common, shaped by prior breastfeeding experiences and the context of prematurity. Discomfort related to privacy and shared spaces was noted. Support from healthcare professionals was essential to promote understanding and adherence. CONCLUSION Social representations of BME are shaped by emotional, social and institutional experiences. Anchored in prior breastfeeding experiences and cultural meanings of maternal care, the practice is objectified through both gestures of affection and tangible barriers. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Healthcare professionals, particularly nurses, should receive training to support mothers in BME. Structural improvements, privacy and emotional support are essential for fostering maternal autonomy and confidence. IMPACT This study highlights the barriers to BME, emphasising the role of healthcare support and the need for better infrastructure, privacy and training to enhance maternal confidence and breastfeeding. REPORTING METHOD The study followed the Consolidated Criteria for Reporting Qualitative Research checklist. PATIENT OR PUBLIC CONTRIBUTION None. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: This paper highlights the pivotal role of healthcare professional support in overcoming barriers to BME and promoting breastfeeding practices. WHAT ALREADY IS KNOWN?: Fresh breast milk is considered the gold standard for reducing complications and improving survival in preterm infants. BME is recommended as an effective strategy to ensure the availability of fresh breast milk. Mothers' social representations of this practice remain underexplored within the neonatal intensive care context. WHAT THIS PAPER ADDS?: Explores mothers' social representations of BME in NICUs, addressing a significant gap in qualitative research. Reveals how emotional, social and institutional factors shape mothers' perceptions, motivations and challenges related to BME. Highlights the need for targeted professional support, improved infrastructure and privacy to enhance maternal autonomy and adherence to milk expression practices. IMPLICATIONS FOR PRACTICE Healthcare professionals, particularly nurses, should receive specialised training to provide technical guidance and emotional support, enhancing mothers' confidence and autonomy in BME. Improving infrastructure and ensuring privacy in NICUs are crucial to creating supportive environments that facilitate milk expression and strengthen maternal-infant bonding. Institutional policies should integrate maternal-centred strategies to support breastfeeding continuity and promote humanised neonatal care.