Fathers' experiences of feeding their extremely preterm infants in family-centred neonatal intensive care: a qualitative study

"I was doubtful of being the true father of the preterm baby": factors affecting fathers' involvement in the care of preterm babies admitted in the neonatal unit at Kawempe National Referral Hospital, Uganda. a qualitative study

BACKGROUND

Fathers' involvement in the care of preterm babies has been associated with good health outcomes for the mother and the baby. However, fathers' involvement in the Neonatal Unit (NU) in Uganda remains sub-optimal and factors influencing this are not well understood. Therefore, this study aimed at exploring the factors affecting fathers' involvement in the care of preterm babies admitted in neonatal unit at Kawempe National Referral Hospital (KNRH).

METHODS

This was a qualitative exploratory study conducted in the NU at Kawempe National Referral Hospital between April and July 2023. It included fathers whose preterm babies were admitted in the NU and were stable at the time of study. Data was collected using an in-depth interview guide with 24 fathers of preterm babies and key informant interview guide with the nine health workers who were working in the NU. Data was analyzed using manual thematic analysis.

RESULTS

The fathers in this study had a mean age of 33 years, most of them were married and were employed in the informal sector. The perceived and actual roles of fathers of admitted preterm babies reported in this study mostly included providing financial support, direct childcare activities, providing emotional and physical support to the mother. The key facilitators to fathers' involvement in the care of the preterm babies were; at individual level; improvement in health condition of the preterm baby, desire to fulfil responsibility, at interpersonal level, support from friends and relatives; at health facility level, the good quality of service delivery; and at community level, the positive cultural and religious beliefs. Barriers included the fear of preterm babies, financial constraints, busy work schedules of fathers, discouragements from peers, poor relationship between couples; poor attitude of hospital staff, long hospital stay and inhibiting interaction between the father of preterm and mother-in-law.

CONCLUSION

Most perceived roles were actually played by fathers whose preterm babies were admitted in the NU and various facilitators encouraged them to get involved in the care. However, fathers faced multiple barriers which needed to be resolved to increase their involvement.

"I am a guest man in a world of women": The lived experiences of gay fathers utilizing human milk donations for their babies

This study explores the lived experiences of gay fathers in Israel who receive human milk donations for their infants born abroad through surrogacy. Unlike regulated milk banks, peer-to-peer milk sharing is an informal, unregulated practice often facilitated through online platforms, where health risks and personal trust become central concerns. Using a phenomenological multiple case study approach, semi-structured interviews were conducted with eight families, yielding four main themes: (1) Interruption versus continuity, (2) Lack and compensation, (3) Inclusion and exclusion, and (4) Concrete and symbolic attributes of human milk. Guided by Judith Butler's queer theory and Karl Marx's conflict theory, this study shows how these fathers both conform to and disrupt traditional gender norms. Their pursuit of human milk not only addresses infant health needs but also challenges conventional boundaries of caregiving and reproductive labor, creating a counter-narrative to traditional family structures. The findings reveal that the fathers' actions blur established gender roles, embody a nurturing role traditionally associated with mothers, and assert their parental legitimacy within a heteronormative society. This study highlights how human milk sharing fosters connections between LGBTQ + families and human milk donors, introducing new models of family, kinship, and caregiving. The research expands understandings of non-traditional parenting and human milk sharing, offering insights into the cultural and social complexities of family dynamics in Israeli society.

An Integrated Review of Transitional Care for Families of Pre-Term Infants

This study was conducted to identify the key elements of transitional care for families with pre-term infants in South Korea. We used an integrative review methodology proposed by Whittemore and Knafle. During the problem identification step, the review question was constructed via the population, intervention, outcome, and timeframe (PIOT) format. During the literature search step, integrative reviews of the published literature from nine electronic databases were undertaken and a total of 14 studies were reviewed that met our inclusion criteria. During the data evaluation step, the quality of the literature was assessed using the Mixed Methods Appraisal Tool (MMAT) developed by Hong et al. We identified three domains and 10 key attributes of transitional care for families of pre-term infants. The parenting empowerment domain included growth and development, developmental promotion, nutrition, safe environment, general parenting, and parent-infant interaction. The emotional support domain included counseling, advocacy, and community network. The social support domain included professional collaboration. Efforts should continue to further develop programs and policies to enhance transitional care for families of pre-term infants that reflect South Korean nursing practices.

Barriers and Facilitators in Lactation Support for the Preterm Mother-Infant Dyad: An Integrated Approach

Breastfeeding offers significant health benefits for both mothers and infants, particularly preterm infants, where it serves as a therapeutic strategy to reduce mortality and morbidities. However, breastfeeding practices are threatened globally by societal norms and systemic barriers at both micro and macro levels. This paper explores the complex interplay of these barriers and facilitators, focusing on the Neonatal Intensive Care Unit (NICU) setting. Preterm infants face specific feeding challenges due to immature physiological functions, yet evidence supports that strategies like cue-based feeding and individualized care can enhance feeding success and health outcomes. For mothers, initiating and maintaining lactation after preterm birth is critical but challenging, with early lactation support and achieving sufficient milk volume being key predictors of success. Partner support significantly influences lactation outcomes, although more inclusive research is needed for diverse family structures. In the NICU, a multidisciplinary approach to lactation care is vital, emphasizing the need for experienced staff and family-centered practices. NICU design, policies promoting parental presence, and adherence to Baby-friendly Hospital Initiative guidelines further support breastfeeding. This paper aims to provide directives for local breastfeeding policies through an integrated approach, considering societal attitudes and healthcare practices. The findings advocate for improved lactation support in NICUs, inclusive language and policies, and further research into diverse familial and gender roles in breastfeeding.

Factors influencing fathers' involvement in the care of hospitalized preterm newborns in Balaka, Malawi

BACKGROUND

Malawi has one of the highest incidences of premature birth, with twice the mortality compared to full-term. Excluding fathers from preterm newborn care has negative consequences, including father feeling powerless, missed bonding opportunities with the newborn, additional strain on the mother, and negative family dynamics such as breakdown in communication, reduced trust, and strained relationships. In Malawi, there is no deliberate policy to have fathers involved in preterm care despite having high incidence of preterm birth and neonatal mortality. There is also limited literature on the factors that influence fathers' involvement in the care. The aim of the study was to explore factors influencing fathers' involvement in the care of hospitalized preterm newborns.

METHODS

A descriptive qualitative study design was used, guided by Theory of planned behaviour and the model proposed by Lamb on male involvement. Sixteen in-depth interviews were conducted with fathers of preterm infants purposively and conveniently sampled in June 2021. Interviews were digitally recorded and transcribed verbatim. Data were organized and analyzed using Nvivo software and thematic analysis approach was used because the approach allows deeper understanding of the data, identification of patterns and themes, and provides rich insights into participants' experiences and perspectives.

RESULTS

The barriers and facilitators that influence a father's involvement in the care of preterm newborn babies include: perceived difficulty with care activities and benefits of involvement, gender roles and socio-cultural beliefs, work and other family responsibilities, social support, baby's physical appearance/nature and health status, feedback from the baby, multiple births, and hospital's physical environment and provision of basic needs.

CONCLUSION

The study found that fathers value their involvement in caring for hospitalized preterm newborns but face barriers. Evidence-based interventions like education programs, training sessions, and support groups can help fathers overcome barriers and promote better outcomes for infants and families.

How parents and health professionals experience prematurity in an Italian neonatal intensive care: A grounded theory study

PURPOSE

The aim of this study was to explore prematurity as a psycho-social process from the point of view of both parents and healthcare professionals.

DESIGN AND METHODS

We conducted a Grounded Theory study through semi-structured interviews. Participants were from an Italian Neonatal Intensive Care Unit, including parents of premature children, and health professionals. Interviews were analyzed according to Grounded Theory coding strategies, to hypothesize a theoretical model.

RESULTS

On one side, behaviors, emotions, and feelings of parental couples; on the other one, the activities and reactions of professionals have been interpreted in a four-phase negotiated process: 1) the initial breakup; 2) the floating family; 3) the event processing; 4) the reconstruction of a new family.

CONCLUSIONS

Managing prematurity is a negotiated process which could be better managed through a family-centered approach as fundamental in neonatal and pediatric services. Being open in listening, coherent in the given answers, and knowing the entire process and story of being suddenly parents of a premature child can make the difference in the future definition of a new family.

PRACTICE IMPLICATIONS

Perinatal care would benefit from the following suggested practical implications: i) reducing feelings of separation and solitude by integrating diverse professionals around the family systems; ii) expediting prematurity-related changes through peer-support during hospitalization and attention to rooms' organization; iii) enhancing information exchange between all professionals involved in the care of dyads/parents and new-borns, starting since the pregnancy and continuing after the child's birth by implementing multidisciplinary meetings or appropriate care pathways.

Supporting Premature Infants’ Oral Feeding in the NICU—A Qualitative Study of Nurses’ Perspectives

One major task in the neonatal intensive care unit (NICU) involves ensuring adequate nutrition and supporting the provision of human milk. The aim of this study was to explore nurses’ experiences of the oral feeding process in the NICU when the infant is born extremely or very preterm. We used a qualitative inductive approach. Nine nurses from three family-centered NICUs were interviewed face-to-face. The interviews were transcribed verbatim and analyzed using content analysis. Five sub-categories and two generic categories formed the main category: ‘A complex and long-lasting collaboration.’ The nurses wished to contribute to the parents’ understanding of the feeding process and their own role as parents in this process. The nurses’ intention was to guide and support parents to be autonomous in this process. They saw the family as a team in which the preterm infant was the leader whose needs and development directed the feeding and the parents’ actions in this process. Written and verbal communication, seeing all family members as important members of a team and early identification of the most vulnerable families to direct the emotional and practical feeding support accordingly can strengthen the feeding process in the NICU.