| 41. |
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| 42. |
- Flacking, Renée, et al.
(författare)
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Pathways to emotional closeness in neonatal units - a cross-national qualitative study.
- 2016
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Research shows evidence for the importance of physical and emotional closeness for the infant, the parent and the infant-parent dyad. Less is known about how, when and why parents experience emotional closeness to their infants in a neonatal unit (NU), which was the aim of this study.METHODS: A qualitative study using a salutogenic approach to focus on positive health and wellbeing was undertaken in three NUs: one in Sweden, England and Finland. An 'emotional closeness' form was devised, which asked parents to describe moments/situations when, how and why they had felt emotionally close to their infant. Data for 23 parents of preterm infants were analyzed using thematic networks analysis.RESULTS: A global theme of 'pathways for emotional closeness' emerged from the data set. This concept related to how emotional, physical, cognitive and social influences led to feelings of emotional closeness between parents and their infants. The five underpinning organising themes relate to the: Embodied recognition through the power of physical closeness; Reassurance of, and contributing to, infant wellness; Understanding the present and the past; Feeling engaged in the day to day and Spending time and bonding as a family.CONCLUSION: These findings generate important insights into why, how and when parents feel emotionally close. This knowledge contributes to an increased awareness of how to support parents of premature infants to form positive and loving relationships with their infants. Health care staff should create a climate where parents' emotions and their emotional journey are individually supported.
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| 43. |
- Flacking, Renée, et al.
(författare)
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Perceptions and experiences of using a nipple shield among parents and staff : an ethnographic study in neonatal units
- 2017
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Preterm infants have an immature sucking behavior and the capacity to be exclusively breastfed may be reduced for a period of weeks or months, depending on gestational age. Nipple shields have been used, not only as a device to help mothers with sore nipples, but also to facilitate the infant's latch on to the breast. However, the benefits of using nipple shields have been debated. The aim of this study was to explore perceptions and experiences of using a nipple shield among parents and staff in neonatal units in Sweden and England.METHODS: An ethnographic study was undertaken where observations and interviews were conducted in four neonatal units in Sweden and England. The data were analyzed using a thematic networks analysis.RESULT: The global theme was developed and named, 'Nipple shield in a liminal time'. This comprised of two organizing themes: 'Relational breastfeeding' and 'Progression'. 'Relational breastfeeding' was underpinned by the basic themes, 'good enough breast', 'something in between' and 'tranquil moment'. 'Progression' was underpinned by the basic themes, 'learning quicker', 'short-term solution' and 'rescue remedy'. Although breastfeeding was seen primarily as a nutritive transaction, the relational aspects of breastfeeding were of crucial importance. These two organizing themes show the tension between acknowledging the relational aspects of breastfeeding and yet facilitating or supporting the progression of breastfeeding in the period from tube feeding or cup feeding to breastfeeding. It is a liminal time as mothers and their infants are "in between" phases and the outcome, in terms of breastfeeding, is yet to be realized.CONCLUSION: This study demonstrates parents' and staffs' perceptions of the nipple shield as a short term solution to help initiation of breastfeeding but also as a barrier between the mother and infant. It is important that the mother and baby's own particular needs are taken into account, in a person-centred way and on an ongoing basis. Furthermore, we need to emphasise the importance of the 'relational' whilst understanding the need for 'progression'. Holding these in balance may be the key to appropriate use of the nipple shield.
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| 44. |
- Flacking, Renée, et al.
(författare)
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Perinatal and socioeconomic determinants of breastfeeding duration in very preterm infants
- 2007
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 96:8, s. 1126-1130
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To describe the impact of prematurity, size at birth, neonatal disorders and the families' socioeconomic status (SES) on breastfeeding duration in mothers of very preterm infants. Methods: Prospective population-based cohort study. Data on breastfeeding, registered in databases in two Swedish counties in 1993-2001, were matched with data from two national registries: the Medical Birth Registry and Statistics Sweden. Mothers of 225 very preterm singleton infants were identified and included. Results: Seventy-nine percent of the mothers breastfed at 2 months, 62% at 4 months, 45% at 6 months, 22% at 9 months and 12% at 12 months. Prematurity, size at birth and neonatal disorders did not show an effect on breastfeeding duration. Being adversely exposed to any of the SES factors (maternal education, unemployment benefit, social welfare and equivalent disposable income in the household) was significantly associated with earlier weaning up to 6 months of infants' postnatal age. Conclusions: This study shows new and noteworthy results concerning breastfeeding duration in mothers of very preterm infants, which was not influenced by degree of prematurity, size at birth or neonatal disorders but was affected by SES. This highlights the need for improved support of socioeconomically disadvantaged mothers, during and after the hospital stay.
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| 45. |
- Flacking, Renée, 1964-, et al.
(författare)
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Positive breastfeeding experiences and facilitators in mothers of preterm and low birthweight infants : a meta-ethnographic review
- 2021
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Ingår i: International Breastfeeding Journal. - : BioMed Central (BMC). - 1746-4358. ; 16:1
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Forskningsöversikt (refereegranskat)abstract
- BackgroundMost qualitative research on breastfeeding the preterm or low-birthweight (LBW) infant has focused on negative insights; there are no comprehensive insights into how, when and why mothers experience positive breastfeeding experiences. We aimed to address this knowledge gap by exploring what characterizes and facilitates a positive breastfeeding experience in mothers of preterm and/or LBW infants.MethodsA systematic review using meta-ethnographic methods was conducted. Search strategies involved a comprehensive search strategy on six bibliographic databases, citation tracking and reference checking. The analysis involved a reciprocal level of translation and a line of argument synthesis.ResultsSearches identified 1774 hits and 17 articles from 14 studies were included, representing the views of 697 mothers. A positive breastfeeding experience was identified as being 'attuned'. Three themes and eight sub-themes were developed to describe what characterizes attuned breastfeeding. 'Trusting the body and what it can do', concerned how attuned breastfeeding was facilitated through understanding the bodily responses and capacity and feeling comfortable with holding the infant and to breastfeed. 'Being emotionally present - in the here and now' described the importance of feeling relaxed and reassured. 'Experiencing mutual positive responses', illuminated how attunement was related to feelings of mutuality - when the mother recognises the infant's cues, responds to these signals and receives a positive response from the infant. The key factors to facilitate attuned breastfeeding were opportunities for prolonged close physical contact with the infant, positive relationships with and support from staff and peers, and being facilitated to breastfeed when the infant showed feeding cues.ConclusionsThis study provides new insights into what characterizes a positive breastfeeding experience and how staff can facilitate and enable mothers to achieve attuned breastfeeding. Improvements in units' design, such as for rooming-in and having prolonged skin-to-skin contact, and care provided by knowledgeable, supportive and encouraging staff and peers, are crucial. The mother's physical and emotional states and the infant's behavioural responses and physiological signals should guide the process towards positive breastfeeding practices.
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| 46. |
- Flacking, Renée, et al.
(författare)
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Positive Effect of Kangaroo Mother Care on Long-Term Breastfeeding in Very Preterm Infants
- 2011
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Ingår i: Journal of Obstetric, Gynecologic and Neonatal Nursing. - Philadelphia : Elsevier BV. - 0884-2175 .- 1552-6909. ; 40:2, s. 190-197
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate the use of Kangaroo Mother Care (KMC) and its association with breastfeeding at 1 to 6 months of corrected age in mothers of very preterm (VPT) and preterm (PT) infants. Design Prospective longitudinal study. Setting Neonatal Intensive Care Units in four counties in Sweden. Participants The study included 103 VPT (< 32 gestational weeks) and 197 PT (32-36 gestational weeks) singleton infants and their mothers. Methods Data on KMC, measured in duration of skin-to-skin contact/day during all days admitted to a neonatal unit, were collected using self-reports from the parents. Data on breastfeeding were obtained by telephone interviews. Results VPT dyads that breastfed at 1, 2, 5, and 6 months had spent more time in KMC per day than those not breastfeeding at these times. A trend toward significance was noted at 3 and 4 months. In the PT dyads no statistically significant differences were found in the amount of KMC per day between those dyads that breastfed and those that did not. Conclusions This study shows the importance of KMC during hospital stay for breastfeeding duration in VPT dyads. Hence, KMC has empowering effects on the process of breastfeeding, especially in those dyads with the smallest and most vulnerable infants.
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| 47. |
- Flacking, Renée, et al.
(författare)
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The influence of fathers' socioeconomic status and paternity leave on breastfeeding duration : a population-based cohort study
- 2010
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 38:4, s. 337-343
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The propensity to breastfeed is a matter of public concern because of the favourable effects for infants. However, very few studies have described the influence of paternal variables upon duration of breastfeeding. The aim of this study was to describe the effects of fathers' socioeconomic status and their use of paternity leave on breastfeeding duration for infants up to 1 year of age. METHODS: A prospective population-based cohort study was undertaken. Data on breastfeeding, registered in databases in two Swedish counties for 1993-2001, were matched with data on socioeconomic status and paternity leave obtained from Statistics Sweden. Fathers of 51,671 infants were identified and included. RESULTS: Infants whose fathers had a lower level of education, were receiving unemployment benefit and/or had a lower equivalent disposable household income were significantly less likely to be breastfed at 2, 4, 6, 9, and 12 months of age. Infants whose fathers did not take paternity leave during the infant's first year were significantly less likely to be breastfed at 2 (p < 0.001), 4 (p < 0.001), and 6 months (p < 0.001). CONCLUSIONS: This paper shows that an enabling of an increased involvement from fathers during the infants' first year of life, such as by paid paternity leave, may have beneficial effects on breastfeeding up to 6 months of age. A more systematic approach to supporting fathers' involvement may be particularly valuable to those infants whose fathers have a lower socioeconomic status.
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| 48. |
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| 49. |
- Flacking, Renée, et al.
(författare)
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Trustful bonds : A key to "becoming a mother" and to reciprocal breastfeeding. Stories of mothers of very preterm infants at a neonatal unit
- 2006
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Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 62:1, s. 70-80
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Tidskriftsartikel (refereegranskat)abstract
- A preterm birth and subsequent hospitalization of an infant at a neonatal unit (NU) implies an extraordinary life situation for mothers, in which the maternal role and breastfeeding begin and evolve in a medical and unfamiliar setting. Descriptions of how women experience “becoming a mother” and breastfeeding in such a situation are sparse and this question was addressed in the present study. In this qualitative study, inspired by the grounded theory approach, in-depth interviews were conducted with 25 mothers whose very preterm infants had been cared for in seven NUs in Sweden. Findings indicated the importance of quality in social bonds with the infant, father, staff and other mothers at the NU, for “becoming mothers” and experiencing mutually satisfying breastfeeding. Three themes comprised a structure for descriptions of experiences, social bonds and mediated emotions: (1) ‘loss’ of the infant and the emotional chaos—“putting life on hold”; (2) separation—a sign of being unimportant as a person and mother; and (3) critical aspects of becoming more than a physical mother. The qualities were described as trustful or distrustful, characterized by accompanying feelings of pride/trust or shame/distrust. Social bonds were affected not only by the interpersonal interplay but also by the public environment and care routines. In conclusion, the contextual setting and distrustful social bonds impaired the ability to “become mothers” and the sensation of reciprocity i.e. breastfeeding becoming dutiful and not mutually satisfying. As breastfeeding is an intimate interplay and a personal choice it was considered that the best breastfeeding support would seem to be provision of a favorable environment that enhances the mother's confidence in herself. The contextual setting should be modeled such as to create conditions for a trustful and reciprocal mother–infant bond.
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