Sustaining Breastmilk Expression and Direct Feeding at Breast for Very Low Birth Infants: A Qualitative Exploration of Parental Perspectives

In Ireland, while most women express milk for their preterm very low birthweight (VLBW) infants, only a few are discharged home exclusively receiving mothers' own milk, and even fewer are engaged in direct feeding at breast (DFAB). This is in the context of Ireland having one of the lowest breastfeeding initiation and sustenance rates in the world. This qualitative descriptive study aimed to explore parents' experiences and perspectives on sustaining breastmilk expression and DFAB for VLBW infants. Semi-structured interviews were conducted with nine mothers and three partners, and the data were analysed using Braun and Clarkes' (2022) framework for reflexive thematic analysis. The themes developed were: (1) Sustaining breastmilk expression for preterm infants; (2) Navigating the transition to DFAB; and (3) The emotional Journey of feeding a VLBW infant. Supportive conditions for sustained milk expression included access to equipment, skin-to-skin contact, and both practical and emotional support from partners and healthcare professionals. Key influences on the transition to DFAB encompassed infant-related challenges, health system factors and the role of partner involvement. Scheduled support from lactation consultants, midwives and nurses in both hospital and community settings, who have undertaken specialised training on supporting women to breastfeed a VLBW infant is recommended to facilitate the transition to DFAB. Participants identified strategies that could be integrated into a 'DFAB care pathway' to provide a structured and consistent evidence-based approach to support women, their premature infants and families.