“I had no idea”: Women’s expectations and experiences of breastfeeding a late preterm or early term infant.

Abstract

Background/aim: Globally, there has been an increase in planned late preterm and early term births. These infants have poorer breastfeeding outcomes than full term infants. There is a lack of evidence around the impact of providing information for pregnant women about potential breastfeeding challenges when considering the optimal timing of early planned birth. This study explored what information is provided to pregnant women about potential breastfeeding challenges when early planned birth is being considered. We also explored obstetric doctors’ knowledge about breastfeeding challenges for infants born before 38 weeks’ gestation. Population/setting: This study was conducted at the Grampians Health Ballarat Maternity Services from November 2021 to July 2022. Methods: This was a qualitative, exploratory, descriptive study. Semi-structured interviews were conducted with 10 women who birthed a late preterm or early term infant (LP/ETI) through early planned birth, and with 6 obstetric consultants or registrars. Thematic analysis identified patterns of meaning in the data. Results/findings: We identified an absence of information provided to women about the potential challenges of breastfeeding a LP/ETI when early birth is planned. This contributed to women feeling unprepared and disappointed in the reality versus their expectations of breastfeeding. This may negatively impact breastfeeding duration for these infants. For women receiving high-risk maternity care, minimal contact with midwives reduced opportunities to receive breastfeeding information. Conclusion: Both women and doctors identified midwives as the health professionals with breastfeeding expertise. Strategies to support breastfeeding for these infants should include the provision of targeted antenatal information by midwives to better prepare women for potential breastfeeding challenges. As psychological distress is a significant risk factor for early breastfeeding cessation, antenatal care should incorporate psychosocial support to prepare women for the potential mental health impacts of breastfeeding challenges. Translational impact/implications for future practice: The objective was to inform clinical practices that could better prepare women for the challenges of breastfeeding a LP/ETI. This may include improved midwifery and obstetric collaborative care models, targeted breastfeeding education provided by midwives and standardised consumer information. This study has already led to the development of written consumer information and implementation of education for Grampians Health Services midwives and obstetric doctors specific to this issue.