Clinical Studies
Breastfeedilzg Support Services in the Neonutd Intensive-Care Unit

https://doi.org/10.1111/j.1552-6909.1993.tb01814.xGet rights and content

Abstract

Objective: To describe a model for providing breastfeeding support in the neonatal intensive-care unit (NICU).

Abstract

Design: Naturalistic, participant observation.

Abstract

Setting: Suburban Level III NICU.

Abstract

Patients: One hundred thirty-two mother-infant pairs over 1 year. Infants were hospitalized In the NICU, and mothers had initiated lactation efforts.

Abstract

Interventions: Investigators provided breastfeeding interventions for the mother-infant pairs, based on identified problems, the research literature, or both.

Abstract

Main Outcome Measures: Percentage of mothers who were breastfeeding at the time of discharge from the NICU.

Abstract

Results: Interventions were classified into jive categories: expression and collection of mothers' milk, gavage feeding of expressed mothers' milk, in-hospital breastfeeding sessions, postdischarge breastfeeding management, and additional consultation.

Abstract

Conclusions: This model was effective In preventing breastfeeding failure for this population. The model can provide the basis for NICU breastfeeding standards of care, protocols, and chart records, or for reimbursement purposes. The model also provides a framework for studying a specific category or breastfeeding intervention.

Section snippets

Sample

The sample consisted of 132 mother-infant pairs who received breastfeeding support services in a suburban Level III NICU during a 12-month period. Mothers expressed the desire to breastfeed and initiated lactation efforts when their infants were admitted to the NICU. Because heterogeneity of maternal and infant characteristics was desired, the researchers made no attempt to restrict inclusion criteria for such factors as maternal complications, infant diagnoses, or previous breastfeeding

Design

he study incorporated a participant-observation approach in which the investigators provided research- based breastfeeding interventions and then documented the interventions used and subsequent breastfeeding outcomes. The researchers selected this naturalistic design because the investigators and nursery staff believed that randomly assigning mothers to receive or not to receive interventions would be unethical. Additionally, the investigators thought that conducting a two-group randomized

Measures

The investigators developed two data collection forms to record the interventions. Members of the research team completed the first form, the Breastfeeding Intervention Record, for each mother-infant pair. This form included background information, such as demographic data, birth and NICU history, previous breastfeeding experience, and source of referral for breastfeeding services. The form also had space for the investigator to record the specific breastfeeding interventions provided to the

Procedures

The investigators assumed that all mothers were breastfeeding candidates until the mothers specified an intent to bottle-feed. This approach minimized the possibility that a breastfeeding mother might be overlooked or might fail to receive interventions needed to initiate lactation early after the birth. A member of the research team spoke with the mother directly, ei ther in the NICU, in the mother’s postpartum room, or by phone at the referring hospital.

Members of the research team provided

Defining and Quantifying Breastfeeding Support.

A five-category phasic model of breastfeeding support emerged from the data: expression and collection of mothers’ milk; gavage feeding of expressed mothers’ milk (EMM); in-hospital breastfeeding sessions; postdischarge breastfeeding management; and consultation, with the family, nursery personnel, or both, that was not combined with a specific intervention.

Expression and collection of mothers’ milk.

This category included a series of interventions that were provided early after the birth and reflected the establish-ment of a milk supply

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    Copyright © 1993 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.