Universität zu Köln

Schwab, Isabella ORCID: 0000-0003-0476-2814 (2024). Providing breast milk for a very low birth weight infant - organisational and individual challenges from the mothers' perspective. PhD thesis, Universität zu Köln.

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Abstract

Background: Exclusive breastfeeding positively impacts maternal and child health and is recommended by the World Health Organization for at least the first six months of life. For sick and preterm infants, especially those with a very low birth weight (VLBW, <1.500g), this nutrition is crucial due to their early developmental stage. However, mothers of VLBW infants face structural, socio-cultural, and individual challenges. Since the infants can often not be fully breastfed, mothers have to express breast milk, which requires continuity. Furthermore, individual challenges in terms of the prematurely ended pregnancy and the hospitalisation of the infant in a neonatal intensive care unit (NICU) can negatively affect lactation. To date, there is a lack of information on organisational determinants of lactation support in NICUs in Germany, as well as on the individual, psychosocial challenges behind the mothers' perceptions of providing breast milk. Objectives: This cumulative dissertation aims at investigating organisational and individual barriers and opportunities for the provision of breast milk from the VLBW mothers’ perspective. First, the status quo of lactation support in NICUs in Germany is illustrated. Second, the mothers’ perceptions whether providing breast milk is perceived as a stressor or coping resource is elaborated by applying the theory of maternal role attainment. Methods: Two data sources are used within the research papers underlying this dissertation. All three research papers triangulate quantitative and qualitative data. The first data source comprises a quantitative cross-sectional survey with mothers of VLBW infants (n=533), which includes validated scales, self-developed items, and an option for written comments. Furthermore, interviews with mothers of VLBW infants (n=12) are utilised. Descriptive and multivariate analysis, as well as content analysis of the written comments and qualitative interviews were performed. Results: On the organisational level, considerable deficits in lactation support, covering the initiation of lactation, skin-to-skin contact, and continuous support are shown. By applying the theory of maternal role attainment, complex interdependencies emerge concerning the individual level of psychosocial challenges. Following the interruption of the process of developing the maternal role after premature birth, mothers describe the provision of breast milk for their infants as a continuation of their caregiving role, while perceiving it as both stressful and a coping resource. Therefore, to what extent it is recognised as stressful or as a coping resource is particularly dependent on achieving sufficient milk supply. Conclusion: The results indicate that a multifaceted approach, which includes structural, socio-cultural and individual levels, is necessary to optimally support mothers in the provision of breast milk and thus improve the nutrition of preterm infants. This dissertation contributes to the state of knowledge of lactation support in NICUs in Germany, thereby enabling the development of targeted interventions for improvement. Furthermore, it identifies the vulnerability of mothers after premature birth, who experience a complex emotional response to the provision of breast milk. This knowledge enables healthcare providers to gain a deeper understanding of maternal needs and thus to support them during lactation. Additionally, this dissertation indicates the potential for further research on maternal role challenges after premature birth to expand upon these findings.

Item Type:	Thesis (PhD thesis)
Creators:	Creators Email ORCID ORCID Put Code Schwab, Isabella isabella.schwab@uk-koeln.de orcid.org/0000-0003-0476-2814 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-741316
Date:	2024
Language:	English
Faculty:	Faculty of Medicine
Divisions:	Faculty of Medicine > Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft
Subjects:	Social sciences Medical sciences Medicine
Uncontrolled Keywords:	Keywords Language breast milk English psychosocial challenges English very low birth weight English
Date of oral exam:	2 October 2024
Referee:	Name Academic Title Hellmich, Martin Prof. Dr. Kribs, Angela PD Dr.
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/74131