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Aims and Objectives: To describe preterm infants' mothers' expressing practices and exclusive use of mother's breast milk in neonatal intensive care settings, as well as to explore whether mothers' and infants' characteristics are predictors of the mother's inadequate expressing practices and nonexclusive use of mothers' breast milk., Background: Use of their own mother's milk decreases preterm infants' mortality and morbidity, but expression is exhausting for the mothers. Mothers' and infants' characteristics are associated with milk output and exclusive breastfeeding at discharge, as well as later in infancy., Design: Cross-sectional study., Methods: The data were collected through questionnaires in two neonatal units. Multiple logistic regression was used to determine whether mothers' and infants' characteristics are predictors of late expression initiation (>6 hr from birth), inadequate expression frequency (≤6 times per a day) and nonexclusive use of own mother's milk., Results: The sample consisted of 129 mothers. One-third of the mothers had adequate expression practices. Half of the infants exclusively received their mother's own breast milk. Previous neonatal intensive care unit experience, poor psychological well-being, an infant's male gender, caesarean section and high gestational birth age were significant predictors of late expression initiation. None of the studied variables were significant predictors of inadequate expression frequency. Furthermore, lack of previous expression experience, financial woes and high gestational age were predictors of nonexclusive use of own mother's milk., Conclusions: Expression practices, as well as use of own mother's milk, were suboptimal. High gestational age was associated with both late expression initiation and nonexclusive breast milk use. The mothers maintained expression regardless of their well-being., Relevance to Clinical Practice: Counselling and support are needed to avoid suboptimal expression practices. Special attention should be paid to mothers with moderately preterm infants, caesarean delivery, poor psychological well-being and financial woes., (© 2017 John Wiley & Sons Ltd.)

Purpose: To describe mothers' experiences with expressing breast milk for preterm or SGA infants., Study Design and Methods: This is a descriptive qualitative study involving 130 mothers of preterm or SGA infants admitted to a neonatal intensive care unit. Data were collected in collaboration with two Finnish peer support associations. An Internet-based questionnaire with open-ended questions was administered to respondents. Responses were analyzed with inductive content analysis., Results: Mothers had to try to manage daily life and breast pumping. The combination of preterm birth and separation from the hospitalized infants served simultaneously as motivating factors and obstacles. Mothers tried to look beyond the unnatural and difficult process of milk expression, looking forward to eventual breastfeeding. Concerns about time and scheduling, equipment, environment, and sufficient milk supply were prevalent, as well as feelings of unfamiliarity, difficulty, frustration, and loneliness., Clinical Implications: Expressing breast milk should be considered as a helpful factor for preterm or SGA infants' mothers. Separation between mother and infant should be avoided. Mothers need adequate equipment and a private space for expressing milk, in addition to assistance with their daily routines. For mothers to successfully manage expression, they also require an environment that fosters a sense of caring, normality, and hope, as well as frequent care for their emotional needs.

Background: Preterm infants' mothers face several challenges when providing critical breast milk for their infants; therefore, sensitive and evidence-based counseling and support are needed. However, a general view of the experiences preterm infants' mothers can face during their infants' hospitalization and after discharge is lacking., Purpose: The aim of this integrative review was to explore practical and emotional experiences of preterm infants' mothers with respect to breast milk expression and breastfeeding, from the birth of the preterm infant, during the neonatal intensive care unit (NICU) stay, and postdischarge until the cessation of breastfeeding., Methods/search Strategy: A systematic literature search from MEDLINE, CINAHL, PsycInfo, and Cochrane databases were performed. The search resulted in 20 qualitative and 3 quantitative studies. The data were analyzed by thematic analysis., Findings: Coping was the central theme in mothers' experiences. The benefits of breast milk served both as a supportive factor and an obstructive factor for the mothers, and breastfeeding was used to rebuild connection and motherhood. Simultaneously, the mothers needed to cope with new demands, interfering NICU environment, demanding expressing, and difficulties with breastfeeding., Implications for Practice: Expressing and breastfeeding are important for the mothers to contribute to their infants' care and to rebuild the interrupted connection. Evidence-based and sensitive informational and practical counseling are vital for the mothers. Intensive emotional support is important during encountered problems and during cessation., Implications for Research: Future research is needed about mothers' experiences using supplementation methods, test-weighing, exploring experiences of mothers of late-preterm infants, and the validity of the concept of coping with this phenomenon.

Purpose: To pilot two instruments: Breastfeeding Advice and Coping with Breastfeeding in NICU settings., Design: Psychometric testing of the Breastfeeding Advice and Coping with Breastfeeding instruments., Sample: Mothers (N = 47) with singleton or twin preterm (≤36 + 6 gestation weeks) infant(s) (N = 55) at discharge collected from seven NICUs in Finland., Main Outcome Variables: The validity and reliability of two instruments: Breastfeeding Advice measuring the quality of breastfeeding counseling and Coping with Breastfeeding measuring the mothers' experienced ability to cope with breastfeeding issues., Results: Infants' mean gestation age was 32.5 weeks at birth. The items of the instruments were supported by previous studies, demonstrating content validity. There was a significant correlation (r = .72, p < .001) between Breastfeeding Advice and Coping with Breastfeeding, indicating constructor validity. Evidence for predictive validity was not found. Good reliability for internal consistency of the Breastfeeding Advice (Cronbach's α = .86) and Coping with Breastfeeding (Cronbach's α = .85) was found.