Distress, trauma are common themes among mothers of very preterm and low birthweight babies, UNC study finds

February 10, 2020

As the incidence of preterm births (before 37 weeks of pregnancy) rises, advances in medical care and technology have allowed hospitals and neonatal intensive care units (NICUs) to improve infant survival rates. However, this clinical setting creates significant challenges in mother-infant bonding, feeding or caregiving. A new study that includes research from UNC-Chapel Hill has found that having a baby in the NICU can exacerbate postpartum distress related to birth trauma and disrupt lactation.

Dr. Aunchalee Palmquist

Aunchalee Palmquist, PhD, MA, IBCLC, assistant professor of maternal and child health at the UNC Gillings School of Global Public Health, is lead author on the study, published in Social Science & Medicine in January. It sought to understand mothers’ experiences with preterm birth and infant feeding in NICUs across the United States.

While most premature infants have a higher risk of medical complications, those born with very low birth weight (VLBW) – usually under 1500 grams – are susceptible to very serious complications, especially if they are formula-fed. The American Academy of Pediatrics recommends exclusive human feeding (EHM) for infants with VLBW, but numerous factors can inhibit consistent EHM while in the NICU.

Mothers of preterm babies are often undergoing their own recovery and may spend extended time separated from their newborns. That separation time increases if a mother is discharged while her infant is still in the NICU. Breastfeeding is often discouraged in the NICU for a variety of reasons, including concerns about physical contact with VLBW infants and an inability to monitor the amount of milk consumed in a feed. This means that mothers must express milk regularly with a pump or use pasteurized donor human milk (PDHM), which is not universally available or accessible in all circumstances.

Palmquist’s team performed a narrative study in which they interviewed mothers who had given birth to VLBW infants. They found common themes in the ways participants communicated their emotional suffering in response to medicalized infant feeding and their systemic marginalization in the NICU.

The physical and emotional trauma of preterm birth impacted the lactation experience, and infant separation exacerbated this. Most mothers in the study expressed an intent to breastfeed their babies, but only a few of them were able to successfully do so.

Mothers described feeling marginalized and dehumanized by the clinical attitudes of NICU staff. Some were intimidated by the highly technical and authoritative language used by doctors, and others were talked down to or ignored altogether by staff, even when they were present for physician rounds. Many felt their primary value came in their ability to provide pumped milk.

At the same time, many mothers found ways to resist barriers to care and seek out skilled lactation support. The role of lactation consultants in championing breastfeeding to mothers, sometimes against physician orders or in the face of physician skepticism, was critical to helping mothers feel validated amongst a medicalized feeding setting.

The study’s results emphasized that when seeking to improve NICU care, it is necessary to understand the lived experiences and idioms of distress that surround preterm birth and infant feeding in NICU settings. The findings also speak to a need for radical change in the structure of NICU care.

“Our study found that even in hospitals with comprehensive family-centered care, mothers still described experiencing trauma and violence in the NICU,” said Palmquist. “We are simply not doing enough to address the mental health needs of people who give birth preterm. We need to take care of mothers as whole people, not simply as lactating bodies. Like one mother said to us, ‘I’m not here just to make milk!'”

Studies in the future will require a focus on effective solutions to increase equitable access to quality care in NICUs, especially for communities that historically bear the burden of the most racism and obstetric trauma associated with preterm birth.

Palmquist has also authored a chapter on the anthropological impact of cooperative lactation in The Mother-Infant Nexus in Anthropology, published in November 2019 by Springer.

Contact the Gillings School of Global Public Health communications team at sphcomm@unc.edu.