Experiences of breastfeeding among mothers of preterm infants during their infant’s hospital stay: a qualitative systematic review and meta-aggregation

Objective: The objective of this review was to explore the breastfeeding experiences and the management of mother’s own milk among mothers of preterm infants during their infant’s hospitalization. Introduction: Mothers of preterm infants often face distinct breastfeeding challenges that differ considerably from those experienced by mothers of term infants. The qualitative synthesis of evidence regarding the breastfeeding experiences of mothers with preterm infants in hospital settings is a valuable area of research that remains underexplored. Eligibility criteria: This systematic review included qualitative studies, as well as the qualitative components of mixed methods studies, that involved mothers of preterm infants, regardless of maternal age or social background. The review specifically focused on studies that explored maternal experiences with breastfeeding and mother’s own milk management during the hospitalization of their preterm infants. Methods: This review was conducted following JBI methodology for qualitative research, with the aim of examining relevant evidence from both published and unpublished studies up to July 2024. The initial search was conducted using PubMed, followed by an extensive search across PubMed, CINAHL (EBSCOhost), Embase (EBSCOhost), and Scopus. Unpublished studies and gray literature were searched through the Mahidol Library Catalogs and the Open Access Theses and Dissertations database. Retrieved records from academic databases, unpublished studies, gray literature, and reference lists of the retrieved records were screened. Studies published in English or Thai were eligible for inclusion. Two reviewers independently screened studies for eligibility and conducted critical appraisals. Data were then extracted and synthesized using meta-aggregation independently by 2 reviewers. All reviewers reached a consensus on the categories and finalized the synthesized findings. Results: This review included 53 studies conducted across 20 countries spanning 6 continents, involving approximately 1212 mothers. A total of 225 findings were identified and organized into 11 categories based on thematic similarities, resulting in 4 synthesized findings: i) Mothers are central to the breastfeeding process, playing a key role in making decisions regarding the provision of breast milk for their preterm infants; ii) Mothers of preterm infants often encounter unique personal challenges in providing breast milk to their infants; iii) External systems serve as both facilitators and barriers to breastfeeding and mother’s own milk management; and iv) Comprehensive support systems enhance breastfeeding practices and outcomes. Conclusions: This review provides a systematic synthesis of the experiences of breastfeeding and mother’s own milk management among mothers of preterm infants in hospital settings. It highlights that these mothers face significant breastfeeding difficulties due to their infant’s health-related concerns, emphasizing the need for comprehensive support to overcome these barriers. The limitations of this review include variability in the quality of the included studies and the potential for language bias. Recommendations for future research include further exploration of the breastfeeding experiences of mothers of preterm infants across diverse contexts, including home and community environments. Additionally, comprehensive breastfeeding support strategies, informed by the synthesized findings, should be investigated to enhance breastfeeding practices and outcomes for these mothers. Review registration: PROSPERO CRD42024501454