A qualitative exploration of antenatal milk expression experiences among Hong Kong Chinese women with gestational diabetes: insights from the GAME programme

BACKGROUND: Women with gestational diabetes mellitus (GDM) often face challenges initiating breastfeeding. Antenatal milk expression is a promising intervention to support breastfeeding, but the lived experiences and perceptions of women with GDM, particularly in Asian populations, remain underexplored. AIM: To explore the experiences, challenges, and support needs of Chinese women with GDM who performed antenatal milk expression from 37 weeks gestation. METHODS: A qualitative phenomenological study was conducted. Nineteen women from the Gestational diabetes and Antenatal Milk Expression (GAME) trial in Hong Kong participated in semi-structured interviews at 2-4 months postpartum. Data were analysed using reflexive thematic analysis. FINDINGS: Five key themes were identified: 1) Navigating the burdens and benefits of antenatal milk expression; 2) Cultural and health beliefs influencing practice; 3) The pivotal role of support in building confidence; 4) Physical and psychological preparation for breastfeeding; and 5) Recommendation for program enhancement. Women were highly motivated by the desire to provide colostrum but faced challenges related to time constraints and physical discomfort. Support from partners and, crucially, from midwives and lactation consultants, was fundamental to their persistence. Antenatal milk expression helped women become familiar with their bodies and hand-expression skills, which facilitated earlier milk production and problem-solving postpartum. CONCLUSION: Antenatal milk expression is a valuable but complex practice for women with GDM. Midwifery support that is individualized, culturally sensitive, and focuses on skill-building over volume output is essential. Integrating antenatal milk expression education into standard antenatal care for this population can empower women and improve breastfeeding outcomes.