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Table 2 Study characteristics and quality appraisal of included studies

From: Positive breastfeeding experiences and facilitators in mothers of preterm and low birthweight infants: a meta-ethnographic review

Ref no.

Author Year

Aim

Country Type of unit(s)

Study design

Infants’ GA /weight at birth

Sample

Age of infant or timing when the study was conducted

Parent characteristics (age/parity)

Data collection methods

Data analysis methods

QA Grade

[30]

Bjork et al. 2012

To illuminate mothers experiences of breastfeeding a preterm infant in a neonatal ward

Sweden

One 10-bed neonatal unit

Qualitative

27–36 gw

12 mothers who were breastfeeding at discharge

At home, 2–7 months post-discharge.

22–40 yrs., 7 had university education

Written text by mothers asked to write about their experiences of breastfeeding

Thematic analysis

B

[31]

Boucher et al. 2011

To explore the maternal experience of breastfeeding initiation and progression in the NICU

Canada

One level III NICU

Qualitative descriptive

27–34 gw

10 mothers who had begun to breastfeed

At hospital, 2–7 weeks old

24–35 yrs., 7 had a secondary education, half of the mothers were primiparous

Face-to-face interviews

Qualitative content analysis

B

[32]

Breivold et al. 2019

To explore mothers’ experience after coming home from the hospital with a moderately to late preterm infant

Norway

One unspecified neonatal unit

Qualitative explorative

30–35 gw

10 mothers

At home, 2–3 months after discharge

26–40 yrs., 8 Norweigan and 2 from Easetern Europe, 7 primiparous, 2 mothers with twins

Face-to-face interviews

Qualitative content analysis

A/B

[33]

Bujold et al. 2018

To explore whether mothers perceived expressing human milk for their infant in the NICU to be a closeness or separation experience and what factors gave rise to these perceptions

Canada

One level III NICU

Qualitative descriptive

23–32 gw

15 mothers

At hospital, on average 37 days old at first data collection

26–44 yrs., 10 university education 10, primpiparous, 10 Canadian citizens

By the “Happy-app”, mother made voice recording where they described their experiences

Thematic content analysis.

A/B

[34]

Ericson et al. 2017

To explore mothers experiences of the proactive and reactive telephone support

Sweden

Six NICUs

Qualitatively driven mixed-method evaluation

All < 37 gw with a mean GA of 34 gw

274 mothers provided written comments and 26 mothers were interviewed

At home, 8 weeks after discharge and at 6 and 12 months of infant age.

More than half had a university education, about 60% were primiparous, 6% not born in Sweden

Written comments to open-ended questions on questionnaires issued at 8 weeks after discharge and at 6 and 12 months of age.

Telephone interviews at 8 weeks after discharge and at 6 months of age

Thematic network analysis

B

[35]

Ericson and Palmér 2019

To describe how mothers of preterm infants in Sweden experience breastfeeding support during the first 12 months after birth

Sweden

Six NICUs

Hermeneutic approach

<  37 gw with a mean of 34 gw

151 mothers; 125 provided written comments, 12 interviewed, and 14 gave comments and interviewed

At home, 8 weeks after discharge and at 6 and 12 months of infant age.

Mean age was 30, 60% had a university education, 60% primiparous, 15% had twins, 6% not born in Sweden

Written comments to open-ended questions on questionnaires issued at 8 weeks after discharge and at 6 and 12 months of age.

Telephone interviews at 8 weeks after discharge and at 6 months of age

Thematic network analysis

B

[36]

Flacking and Dykes 2013

To explore, in-depth, the impact of place and space on parents’ experiences and practices related to feeding their preterm babies in NICUs in Sweden and England

England and Sweden

2 NICUs in each country

Ethnographic

23–35 gw

52 mothers; 22 Swedish and 30 English

At hospital, observations were made throughout the hospital stay

19–45 years, 30 primiparous, 6 were not born in Sweden/England

Participant observations (210 h) and face-to-face interviews (96 h)

Grounded theory

A/B

[37]

Flacking and Dykes 2017

To explore perceptions and experiences of using a nipple shield among parents and staff in neonatal units in Sweden and England

England and Sweden

2 NICUs in each country

Ethnographic

Median 31 gw

12 mothers

At hospital, observations and interviews were made throughout the hospital stay

8 primiparous, 3 mothers with twins

Participant observations and face-to-face interviews

Thematic network analysis

B

[38]

Holdren et al. 2019

To understand how differences in neonatal care culture in two units in Finland and the US were translated to parents’ infant feeding experiences

Finland and the USA

One level III NICU in each country

Unspecified qualitative

23–32 gw

15 mothers; 8 Finnish and 7 US mothers

In Finland: last week during the hospital stay, in the US: recently admitted to the NICU

20–44 years (mean 30), 6 mothers had twins

Interviews via telephone or face-to-face

Thematic narrative analysis

B/C

[39]

Ikonen et al. 2016

To describe maternal experiences of expressing breast milk for preterm or SGA infants.

Finland

Internet-based

Descriptive

23–38 gw, mean of 31 gw

130 mothers

At home, 0–20 years (mean 4 years) of age

21–50 years (mean 34 years) 73% college or university degree, 23% twins or triplets, 58% previous breastfeeding experience

Open-ended questions in a web-survey

Qualitative inductive content analysis

B/C

[40]

Niela-Vilen et al. 2015

To describe the perceptions of breastfeeding mothers of preterm infants based on the postings in peer-support group discussions in social media.

Finland

One level III NICU

Unspecified qualitative

Preterm infants

30 mothers of which 22 posted comments

At hospital and at home; 1st week post partum and then continuously during the first year

20–46 years (mean 29 years), 21 mothers were primiparous

Mothers posted comments on a secure FB page where only mothers who were recruited in a RCT could join. They accessed the FB group the 1st week postpartum and could continue to access the group at least until the infant turned 1 year

Inductive thematic analysis

C

[41]

Niela-Vilen et al. 2019

To describe maternal emotions regarding and insights into breastfeeding during the first year after a preterm birth.

Finland

One level III NICU

Unspecified qualitative

25–35 gw

80 mothers

At infants’ discharge (hospital), and at 3, 6 and 12 months corrected age

21–46 years (median 31 years), 73% had a polytechnic/ university education, 70% primiparous, 11 mothers had twins

Answers on open-ended questions at discharge, 3 and 6 months. Telephone interviews or short questionnairs at 12 months.

Inductive thematic analysis

B/C

[42]

Palmér and Ericson 2019

To describe mothers’ experiences of breastfeeding their preterm infants from birth until 12 months after birth

Sweden

Six NICUs

Unspecified qualitative

<  37 gw, median 34 gw

270 mothers

At home, 8 weeks after discharge and at 6 and 12 months of infant age.

Mothers had a mean age of 30 years, 51% had a university education, 59% primiparous and 32 mothers had twins

496 written comments to open-ended questions on questionnaires issued at 8 weeks after discharge and at 6 and 12 months of age.

Thematic network analysis

A

[43]

Parker et al. 2018

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

USA

Two level III NICUs

Unspecified qualitative

24–37 gw median of 30 gw

23 mothers

At hospital and at home, when the infants were 2–18 months old

21–40 years, 12 Hipanic and 11 non-Hipsanic mothers, 2 mothers with twins

Interviews

Grounded theory approach

B

[44]

Radtke Demirci et al. 2015

To describe the process of breastfeeding establishment among late preterm mother-infant dyads.

USA

One level III NICU

Constructivistic grounded theory

<  37 gw

10 mothers

At hospital 1–2 days after birth and then at home at 1, 2, and 6–8 weeks post partum

21–41 years, 7 had a college education, 5 primiparous, 2 mothers of twins,

Interviews with some mothers also contributing with e-mail or audioe diaries and video recordings with simulated recall interviewing

Grounded theory approach

B

[45]

Rossman et al. 2011

To describe the experiences of mothers with VLBW infants who received lactation care from certified Breastfeeding Peer Carers with special preparation for NICU care.

USA

One level III NICU

Qualitative descriptive

24–31 gw and VLBW 511–1460 g

21 mothers

At hospital 12–80 days after birth during NICU stay

18–41 years, 17 had some college education, 10 primiparous

Interviews

Content analysis

A

[46]

Rossman et al. 2013

To describe the meaning of milk for mothers who were providing milk for their very low birth weight infants, hospitalised in the NICU

USA

One level III NICU

Qualitative descriptive

23–33 gw and VLBW 600–1445 g

23 mothers

4–8 weeks of age

19–37 years, 5 had graduated from college education, 18 primiparous

Interviews and participant observations

Conventional (inductive) content analysis

A/B

  1. Abbreviations: GA gestational age, gw gestational weeks, NICU Neonatal Intensive Care Unit, VLBW very low birth weight, SGA small for gestational age