Feasibility and Measurement of Bedside Milk Expression in the NICU: A Mixed Methods Study.

Background: Supporting preterm infants with mother's own milk (MOM) can improve health outcomes and decrease mortality. Lactation in the neonatal intensive care unit (NICU) is a disconnected process that often requires mothers to initiate lactation with a breast pump. One solution to improve the mothers' experience is to bring mothers and infants together by expressing milk at the infant's bedside.

Purpose: This study evaluated the feasibility (eg. enrollment, retention, adherence) and maternal experience of daily bedside milk expression for the first month of NICU admission for mothers of infants born at ≤32 weeks.

Methods: A convergent mixed methods approach evaluated the feasibility of bedside milk expression in the NICU. English- and Spanish-speaking mothers were asked to express milk at the bedside and complete a daily survey for one month. After 30 days, the mothers participated in a qualitative interview to understand their experiences.

Results: Out of 32 mothers approached, 28 consented. Most mothers were Black/African American (n = 9) or Hispanic/White (n = 17). The study met the a priori criteria for enrollment and retention but not the criteria for adherence. Barriers were similar between mothers and did not influence adherence to bedside milk expression. The qualitative analysis found that coping moderated the barriers and facilitators to expressing milk at the bedside. The guiding framework was modified to demonstrate the influence of coping on lactation behaviors.

Implications for practice: Interventions to improve maternal coping may improve adherence to bedside milk expression.