Does breastfeeding self-efficacy theory apply to mothers of moderate and late preterm infants? A qualitative exploration.

Abstract

Breastmilk feeding reduces morbidities and improves outcomes related to prematurity. However, breastmilk feeding rates in preterm infants are substantially lower than those in term infants. Breastfeeding self-efficacy theory is a social change theory, which is predictive of exclusive breastmilk feeding at 2months postpartum in mothers of full-term infants. However, this theory has not been well explored in mothers of moderate and late preterm infants. To explore maternal experiences with feeding moderate (320/7 - 336/7 weeks' gestational age) and late preterm infants (340/7 - 366/7 weeks' GA) in neonatal intensive care units and assess applicability of breastfeeding self-efficacy theory. We conducted a qualitative descriptive exploration of maternal experiences with infant feeding in neonatal intensive care units. Using purposive, maximum variation sampling, we selected mothers of preterm infants born at 320/7 - 346/7 weeks, who experienced high mean differences in their BSE scores between admission and discharge. Fourteen mothers participated in semi-structured telephone interviews. Data were examined using thematic analysis. To explore and describe breastfeeding self-efficacy within the context of neonatal intensive care units, we super-imposed the four sources of information from breastfeeding self-efficacy theory onto the defined themes. Three main themes emerged: (a) institutional influences, (b) relationship with the pump and (c) establishing breastfeeding, with an emphasis on the importance of direct breastfeeding at discharge. Overlaying the four sources of information from breastfeeding self-efficacy highlighted the presence of three sources of information: verbal persuasion, performance accomplishment and physiologic/affective responses. Vicarious experience was not identified in maternal experiences with infant feeding. Our findings indicate that breastfeeding self-efficacy is an applicable theory for mothers of preterm infants. Healthcare providers need to be aware of the influence that institutional culture and policies may have on maternal breastfeeding self-efficacy and breastfeeding outcomes.