511 ‘Journey of acceptance’: A qualitative study exploring pasteurised donor human milk usage and its impact on maternal emotional wellbeing

Abstract

<h3>Background</h3> Human milk is the ideal food for all babies, especially vulnerable infants who are sick and premature. When mothers are unable to provide their babies with adequate breast milk, donor human milk is recommended to improve the infants’ health outcomes. Singapore’s first donor human milk (DHM) bank was established in August 2017 to provide pasteurised human donor milk to eligible babies, who are primarily premature infants below 35 weeks’ gestational age. To date, more than 1963 babies have received DHM. However, there is currently limited knowledge about maternal experiences of DHM usage in Singapore. <h3>Objectives</h3> This study aimed to explore Singaporean mothers’ perception of DHM, examine the impact of DHM usage on maternal emotional wellbeing, and help inform clinicians to better support mothers of preterm infants in their breastfeeding journey. <h3>Methods</h3> Ethics approval was obtained from the National Healthcare Group Domain Specific Review Board (NHG DSRB). Convenience sampling was done to recruit mothers of premature babies hospitalised in the level II or level III Neonatal Intensive Care Unit, who had received donor human milk. In-depth semi structured Interviews were audio-recorded and transcribed verbatim. Transcripts were analysed using Braun and Clarke’s six-step process of thematic analysis. <h3>Results</h3> Seventeen mothers participated in this study. Many participants described their experience with DHM as a ‘journey of acceptance’. Three supporting themes which illustrate this ‘journey’ include: (1) ‘Resistance to receiving somebody else’s milk,’ (2) ‘Recognising baby’s needs and maternal limitations,’ and (3) ‘Embracing the benefits of donor milk’. Though not all mothers experienced the above in a chronological progression, many described a process of overcoming initial hesitation to eventual acceptance of feeding their child with another person’s milk. Majority of mothers were initially unwilling to give DHM to their baby, citing concerns over the safety and quality of donor milk, as well as an innate responsibility to feed their own child. Feelings of sadness, disappointment, helplessness, guilt and self-blame set in when many realised that they were unable to meet their baby’s demand for milk. For some Muslim mothers, such negative emotions were further aggravated as they considered their baby’s health needs against implications of receiving DHM due to their Islamic faith. Nevertheless, all participants appreciated the benefits of donor human milk, often crediting their baby’s growth and development to the combined effect of their own breast milk and DHM. Mothers who readily accepted DHM for their infants tended to be more open-minded and had greater self-awareness of their own limitations and their infant’s needs. <h3>Conclusions</h3> The experiences of these mothers reflect the spectrum of complex emotions faced when accepting an alternative source of human milk for their prematurely born infants. Healthcare practitioners should acknowledge such emotions in a culturally sensitive manner when sharing information or seeking parental consent to utilise donor milk for premature and sick babies.