Mothers' experiences of breast milk expression during separation from their hospitalized infants: a systematic review of qualitative evidence.

BACKGROUND: Mother-infant separation, which is occurring with an increasing incidence, is a barrier to direct breastfeeding. Owing to the importance of breast milk to hospitalized infants, mothers are actively encouraged to express milk during their infants' neonatal intensive care unit (NICU) stay. However, mothers are often faced with a number of challenges in this process. There is a need to understand such mothers' real-life experiences of breast milk expression to develop supportive strategies to reduce the burden on mothers and increase breastfeeding rates. METHODS: A comprehensive search of 12 databases was conducted for relevant studies published from database construction to December 2022. All qualitative and mixed-method studies published in English and Chinese that reported on mothers' experiences of human milk expression during separation from their hospitalized infants were included. Two reviewers independently conducted screening, data extraction, and quality appraisal, with disagreements resolved by a third reviewer. The process of searching followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The JBI Qualitative Assessment and Review Instrument was used to assess study quality and the credibility of study findings. Meta-aggregation was performed to integrate the results. RESULTS: This systematic review aggregated mothers' experiences of milk expression during separation from their hospitalized infants. Database search yielded 600 records, of which 19 full-text documents were screened. Finally, 13 studies of good quality were included with data from 332 mothers across seven countries. A total of 61 primary findings with illustrations were extracted from the 13 eligible studies, the findings were generalized into 16 categories, and further were concluded as four synthesized findings: purpose and motivation, physical and emotional experiences, barrier factors, and coping styles. CONCLUSION: Mothers were driven by extrinsic motivation in their decision to express breast milk. They experienced physical exhaustion and many negative emotional feelings while expressing. This process was affected by numerous barriers. Social support was essential to the initiation and maintenance of milk expression. Medical staff and families should pay more attention to the mental health of mothers with infants in the NICU. Future research should incorporate strategies to cope with emotional responses and offer practical strategies for managing milk expression. SYSTEMATIC REVIEW REGISTRATION: [ www.crd.york.ac.uk ], identifier [PROSPERO 2022 CRD42022383080].

The prevalence of trimester-specific dietary supplements and associated factors during pregnancy: An observational study.

Objectives: This study aimed to assess the prevalence of trimester-specific dietary supplements (DS)s use and their possible correlates during pregnancy. Method: Pregnant women were convenience sampled and recruited from a comprehensive obstetric care center in Shanghai, China. Data relating to the use of DS during pregnancy, social support and other social-demographic and obstetric data were collected. Trimester-specific DS use and factors related DS were explored. Results: Of the 2803 women participating in this study, 94.8%, 96.2%, 93.8%, and 94.4% reported the use of at least one DS during pregnancy (all trimesters) and in the first, second, and third trimesters of pregnancy, respectively. Significant differences were noted in the use of DS containing folic acid, calcium, iron, vitamins, and docosahexaenoic acid (DHA), during the three trimesters of pregnancy. A higher proportion of DS use was negatively associated with certain categories of pregnant woman, including unemployed/housewife, low education level, obese, and low social support. A positive association was identified with gestational age. Conclusion for practice: Considering the high prevalence of DS use during pregnancy, future studies are needed to evaluate the accuracy and suitability of DS usage during pregnancy.

Review of clinical practice guidelines for postpartum hemorrhage according to AGREE II.

BACKGROUND: Clinical practice guidelines for postpartum hemorrhage (PPH) are available worldwide, but no review has assessed the quality of these guidelines. Poor-quality guidelines for PPH may lead clinicians to follow incorrect approaches. OBJECTIVES: High-quality guidelines for PPH are important in guiding the clinical diagnosis and treatment of PPH and decreasing maternal mortality. The aim of this study was to assess the quality of clinical guidelines for PPH. METHODS: We collected studies from different countries through a literature search including PubMed (MEDLINE), Web of Science, the Cochrane library, websites of health institutions from multiple countries, and search sites, according to the criterion of clinical guidelines for treatment of PPH published between inception and October 2022. Four independent reviewers assessed the eligible guidelines by using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Agreement among reviewers of the guidelines was measured with the intra-class correlation coefficient (ICC). The number of recommendations, strength of recommendations, and level of evidence were determined. RESULTS: Seven sets of PPH guidelines published from 2007 to 2022 were identified. An overall high agreement among reviewers in each domain was observed (ICC 0.74 to 0.95). The median scores and ranges for each AGREE II domain were as follows: (i) scope and purpose (median = 86.51%, range: 61.11%-94.44%); (ii) stakeholder involvement (median = 73.02%, range: 52.78%-90.28%); (iii) rigor of development (median = 76.49%, range: 66.15%-97.92%); (iv) clarity and presentation (median = 88.49%, range: 68.06%-100.00%); (v) applicability (median = 73.36%, range: 53.13%-93.75%); and (vi) editorial independence (median = 84.52%, range: 60.42%-95.83%). Three sets of PPH guidelines scored high in all domains and were classified as recommended for clinical practice. The other guidelines were classified as recommended with modifications. CONCLUSION: The methodological and reporting quality of the guidelines for PPH included in this review was generally good, but the strength of the recommendations and the quality of the evidence varied, thus potentially leading to confusion among clinicians applying the guidelines. An urgent need exists for rigorous studies to close important evidence gaps to support the development of guidelines for PPH.

Breastfeeding-oriented education for parturients separated from their hospitalized infants: a qualitative study of nurses' perspectives in Shanghai, China.

BACKGROUND: The benefits of breastfeeding for both mother and baby are well recognized. However, the separation of the mother-newborn dyad leads to a lower breastfeeding rate. These parturients who are separated from their hospitalized infants are sometimes unaware of the importance of breastfeeding, while nurses do know how important health education on breastfeeding is and how it can be improved. This descriptive qualitative study aimed to explore the experiences of nurses regarding health education on breastfeeding and summarize the potential ways to improve it. METHODS: A descriptive phenomenological qualitative approach was utilized in this study, and in-depth, semi-structured interviews were conducted with nurses at a tertiary A-grade obstetrics-and gynecology-specialized hospital in Shanghai, China. The purposive and snowball sampling method was used and Colaizzi's seven-step phenomenological analysis was employed. The Consolidated criteria for Reporting Qualitative research (COREQ) was followed to report findings. RESULTS: Fifteen nurses participated in the study and shared their suggestions based on their experiences. Four overarching themes emerged from the data: (1) extending the education duration, (2) enriching the educational content, (3) expanding the education subjects, and (4) perfecting the educational process. Each theme included several subthemes. CONCLUSION: Health education on breastfeeding should focus on the time, content, subjects, and process as a whole. The nurses' statements provided a reference for nursing or hospital supervisors to take measures to improve education and increase the breastfeeding rate of hospitalized neonates. Further research from the perspectives of parturients and their family members is needed, to find out what the key points are that all of them attach importance to.