Exploring breastfeeding experiences of mothers with preterm infants: a systematic review and meta-synthesis

Breastfeeding is strongly recommended for preterm infants because of its nutritional, immunological, developmental, and psychological benefits. However, mothers of preterm infants frequently encounter various barriers that complicate breastfeeding experiences. Although qualitative studies have explored these experiences across diverse contexts, evidence remains fragmented. This study aimed to systematically synthesize qualitative evidence regarding the breastfeeding experiences of mothers of preterm infants, and to identify the barriers, facilitators, emotional meanings, and support needs associated with breastfeeding in this population. A systematic review and metasynthesis of qualitative studies was conducted in accordance with PRISMA and ENTREQ guidelines. Electronic databases, including PubMed/MEDLINE, Scopus, Web of Science, CINAHL, Embase, PsycINFO, and ProQuest, were searched from January 2006 to April, 2026. Eligibility criteria were defined using the SPIDER framework. Peer-reviewed English-language qualitative studies exploring breastfeeding experiences among mothers of preterm infants (< 37 week gestation) were included. Two reviewers independently performed study selection, quality appraisal using the Critical Appraisal Skills Programme (CASP) checklist, and data extraction. Findings were synthesized using the thematic synthesis approach of Thomas and Harden. Confidence in the synthesized findings was assessed using GRADE-CERQual. Finally, 47 qualitative studies were included in the metasynthesis. Five overarching themes emerged: (1) the fractured transition to motherhood, characterized by disrupted maternal identity, guilt, and emotional distress; (2) the pump as both lifeline and burden, reflecting the exhausting yet necessary role of milk expression; (3) navigating the neonatal intensive care unit as a paradoxical space, highlighting inconsistent professional support, surveillance, and limited maternal autonomy; (4) the struggle for reciprocity in breastfeeding, describing challenges related to infant immaturity, feeding cues, and the transition from tube to breast; and (5) the journey home: from surveillance to self-governance, illustrating the gradual reconstruction of maternal confidence and autonomy after discharge. Breastfeeding was experienced not only as a nutritional practice but also as a relational and identity-forming process shaped by emotional, institutional, technological, and social influences. Breastfeeding a preterm infant is a complex and emotionally demanding process extending beyond milk provision. Consistent, compassionate, and family-centered breastfeeding support across hospital and community settings is essential to strengthen maternal confidence, reduce emotional burden, and improve breastfeeding outcomes for preterm infants and their families.