Qualitative analysis of barriers to breastfeeding in very-low-birthweight infants in the hospital and postdischarge.
PURPOSE: To determine barriers to the successful establishment and maintenance of breastfeeding in very-low-birthweight (VLBW) infants, both in the hospital and after discharge, and changes in barriers over time. SUBJECTS: Sixty-four mothers of infants <1500 g birth weight who planned to breastfeed and were in the supplementary structured breastfeeding counseling intervention group. DESIGN: This qualitative, longitudinal study is a secondary analysis of a previously reported randomized controlled trial of a breastfeeding support intervention that examined infants weighing <1500 g at birth. METHODS: A qualitative technique, content analysis, was used to review, analyze, interpret, and categorize data for the current study. Data were extracted from the research records of the research lactation consultant that addressed all aspects of mothers' reported breastfeeding experiences. The principal investigator identified the main issues of the conversations, entered these into a summary chart, and then assigned appropriate categories. All categories are a reflection of maternal perception. Categorical data were analyzed descriptively using the crosstabs function. MAIN OUTCOME MEASURES: Barriers to the successful establishment and maintenance of breastfeeding during discharge from the neonatal intensive care unit (NICU), at discharge home, and at 1, 3, 6, and 12 months corrected age, or until weaning from breastfeeding. Changes in breastfeeding barriers across the 6 time periods were also determined. PRINCIPAL RESULTS: At NICU discharge, low milk volume was the greatest breastfeeding barrier. During the period from discharge home and at 1 month and 3 months, the infants' compromised physical status was the largest barrier to breastfeeding. Data from the 6- and 12-month time periods indicated that the provision of complementary feeding was the greatest barrier to breastfeeding; it was most prevalent in the period following NICU discharge and before discharge home. Across all time periods, nipple and breast problems were most prevalent at NICU discharge, whereas poor technique was a barrier at 1 month. Mothers' compromised emotional status was greatest at discharge from the NICU and diminished thereafter. CONCLUSIONS: Results from this study indicate the need to address time-period-specific barriers encountered during the breastfeeding experience of mothers of VLBW infants.