Table 2 Characteristics of the 13 included qualitative studies

Brodsgaard et al. (2022) [29]

Denmark

To explore the circumstances that affect lactation for mothers of premature infants and their significance

Qualitative exploratory approach

Purposive sampling

Semi-structured, individual interview

Content analysis

16

Mothers of premature infants admitted to a university hospital NICU in the Capital region of Denmark

Three themes:

1. The birth preparation period has been interrupted.

2. Expressing human milk is essential for breastfeeding.

3. The motherhood journey encompasses breastfeeding.

Fernández Medina et al. (2019) [30]

Spain

To describe and understand the experiences of mothers of extremely preterm infants regarding barriers to providing their own milk during infant hospital stay in the NICU

Qualitative, interpretative design using Gadamer’s hermeneutic approach

Convenience sampling

Semi-structured interviews

A modified form of the stages developed by Fleming et al.

15

Mothers of extremely preterm infants who were admitted to a level III NICU in the southeast of Spain

Two themes:

1. Unexpected and unusual lactation.

2. Providing mother’s own milk to a tiny infant in an unknown technological environment.

Yang et al. (2019) [18]

China

To understand Chinese mothers’ experiences of expressing breast milk for their preterm hospitalized infants and to identify the support they needed to establish and maintain an adequate milk supply

Husserl’s descriptive phenomenological approach

Purposive sampling

Semi-structured, individual interviews

Thematic analysis

11

Mothers separated from their preterm infants admitted to three level III Beijing NICUs in 2017

Four themes:

1. Providing breast milk is a way to identify as a mother.

2. Perceptions and intentions.

3. Milk expression makes mothers exhausted.

4. Health professional support for breastfeeding is urgently needed.

Bujold et al. (2018) [31]

Canada

To document maternal experiences expressing human milk for their infant in the NICU as a closeness or separation experience, and to discover what factors gave rise to these perceptions

Qualitative descriptive approach

Convenience sampling

Audio recorded their thoughts and feelings with a smartphone application

Thematic analysis

15

Mothers who were expressing while their infant was hospitalized in a level 3 urban Canadian NICU

Three themes:

1. Finding ways to cope with milk expression helps mothers feel close.

2. Being overwhelmed by the challenges and feeling separated.

3. Location and environment.

Parker et al. (2018) [32]

USA

To examine the perceived barriers and facilitators of providing milk for very preterm infants during the hospitalization among Hispanic and non-Hispanic black mothers

Grounded theory approach

Purposive sampling

Semi-structured interviews

Systematic, iterative approach to data analysis

23

Mothers that initiated milk production for their very preterm infants in the NICU—12 English and Spanish-speaking Hispanic mothers and 11 non-Hispanic black mothers

Four themes pertaining to general experiences:

1. Breastfeeding intent impacts mothers’ success in providing milk throughout the hospitalization.

2. Pumping milk for a hospitalized infant is repetitive and exhausting, and does not elicit the same emotional connection as breastfeeding.

3. Hospital providers are an important source of support, when sufficient time is spent to address ongoing issues.

4. Providing milk creates a unique sense of purpose when mothers otherwise feel a lack of control.

Four themes pertaining to the experiences of Hispanic and non-Hispanic black mothers:

1. Breastfeeding as a cultural norm influences mothers’ intent to initiate and continue breastfeeding.

2. Hospital staff are viewed as more supportive when interactions and treatment are perceived as racially/ethnically unbiased.

3. Hospital staff are viewed as more supportive when communication occurs in the primary language.

4. Mother-infant separation creates logistical challenges that negatively impact ongoing milk production.

Bower et al. (2017) [17]

USA

To describe mothers’ experiences expressing milk for their VLBW infants in a level 3 NICU

Phenomenological

approach

Purposive sampling

Individual interviews and

telephone interviews

Colizzi’s seven-step phenomenological analysis

17

Mothers of VLBW at a local level 3 NICU in the southeastern United States

Three themes:

1. I was heartbroken.

2. Pumping is a full-time thing.

3. I literally sacrificed nights.

Froh et al. (2017) [33]

USA

To describe the breastfeeding experience of mothers of infants with congenital diaphragmatic hernia (CDH) cared for in the NICU

Qualitative descriptive approach

Purposive sampling

Phased interviews

Content analysis

11

Mothers with an CDH infant were recruited from a large level 3 NICU in an urban, northeastern pediatric hospital

Six themes:

1. Hopeful for breastfeeding.

2. Latching on … to the pump.

3. We’ve already worked so hard.

4. Getting the hang of it—it’s getting easier.

5. A good safety net.

6. Finding a way that works for us.

Rossman et al. (2017) [34]

USA

To describe the human milk provision experiences, goals, and outcomes for teen mothers of LBW infants hospitalized in the NICU

A multi method study using a qualitative research design, survey, and infant medical

records

Purposive sampling

In-depth, semi-structured

individual interviews

Content analysis

15

Teen mothers (12 black, 3 Hispanic) of LBW infants hospitalized in a tertiary NICU

Two themes:

1. Wanting to do the right thing.

2. Everything’s fine.

Ikonen et al. (2016) [35]

Finland

To describe mothers’ experiences with expressing breast milk for preterm or small for gestational age (SGA) infants

Qualitative descriptive

approach

Convenience sampling

Internet-based questionnaire with open-ended questions

Inductive content analysis

130

Mothers who required to express milk for their preterm or SGA infants admitted to a NICU

Four themes:

1. Managing the situation.

2. Looking forward to easier breastfeeding.

3. Managing daily life.

4. Managing feelings.

Rossman et al. (2013) [36]

USA

To describe the meaning of milk for mothers who are providing milk for their VLBW infants hospitalized in the neonatal intensive care unit

Qualitative descriptive approach

Convenience sampling

Semi-structured interviews

Content analysis

23

Mothers of VLBW infants hospitalized in the level 3 NICU at a large Midwestern urban medical center

Two themes:

1. The healing properties of milk related to the infant.

2. The healing properties of milk related to the mother.

Hurst et al. (2013) [37]

USA

To understand the experience of mothers of hospitalized very preterm infants related to their daily pumping milk routine during the NICU stay

Medical ethnographic approach

Purposive sampling

Semi-structured interviews

Thematic analysis

14

Mothers expressing their milk using hospital-grade mechanical pumps exclusively to provide their breast milk for their infants in the level 2 NICU in southeastern Texas

Three themes:

1. Becoming a “mother–interrupted.”

2. A paradoxical experience.

3. Negotiating.

Sisk et al. (2010) [38]

USA

To identify patterns of factors that supported or hindered initiation of breast milk expression and maintenance of breast milk production after the birth of a VLBW infant in a sample of US women with varied prenatal infant feeding intentions

Qualitative approach

Purposive sampling

Semi-structured, individual interviews

Content analysis

32

Mothers who initiated breast milk expression after delivery of their LBW infants at the Sara Lee Center for Women’s Health NICU, Forsyth Medical Center.

Two themes:

1. Barriers and supports for initiation of breast milk expression.

2. Barriers and supports for maintenance of breast milk production.

Sweet. (2008) [39]

Australia

To understand the breastfeeding experience of parents of VLBW preterm infants

Interpretive phenomenological approach

Purposive sampling

Semi-structured, individual interviews

Thematic analysis

10

Mothers who intended to breastfeed their preterm VLBW infants in the NICU

Five themes:

1. Breastfeeding is initially not a priority.

2. Being a “good” parent.

3. Breastfeeding as a marker of “good” motherhood.

4. “So much is taken out of your hands.”

5. “You have to do it”—expressing is not a choice.