title: Preterm Infants' Mothers' Experiences With Milk Expression and Breastfeeding: An Integrative Review.
abstract: BACKGROUND
  Preterm infants' mothers face several challenges when providing critical breast milk for their infants; therefore, sensitive and evidence-based counseling and support are needed. However, a general view of the experiences preterm infants' mothers can face during their infants' hospitalization and after discharge is lacking.
  
  
  OBJECTIVE
  The aim of this integrative review was to explore practical and emotional experiences of preterm infants' mothers with respect to breast milk expression and breastfeeding, from the birth of the preterm infant, during the neonatal intensive care unit (NICU) stay, and postdischarge until the cessation of breastfeeding.
  
  
  METHODS
  A systematic literature search from MEDLINE, CINAHL, PsycInfo, and Cochrane databases were performed. The search resulted in 20 qualitative and 3 quantitative studies. The data were analyzed by thematic analysis.
  
  
  RESULTS
  Coping was the central theme in mothers' experiences. The benefits of breast milk served both as a supportive factor and an obstructive factor for the mothers, and breastfeeding was used to rebuild connection and motherhood. Simultaneously, the mothers needed to cope with new demands, interfering NICU environment, demanding expressing, and difficulties with breastfeeding.
  
  
  CONCLUSIONS
  Expressing and breastfeeding are important for the mothers to contribute to their infants' care and to rebuild the interrupted connection. Evidence-based and sensitive informational and practical counseling are vital for the mothers. Intensive emotional support is important during encountered problems and during cessation.
  
  
  CONCLUSIONS
  Future research is needed about mothers' experiences using supplementation methods, test-weighing, exploring experiences of mothers of late-preterm infants, and the validity of the concept of coping with this phenomenon.
authors.affiliation: School of Health Sciences, University of Tampere, Tampere, Finland (Ms Ikonen and Drs Paavilainen and Kaunonen); Etelä-Pohjanmaa Hospital District, Seinäjoki, Finland (Dr Paavilainen); and Pirkanmaa Hospital District, General Administration, Tampere, Finland (Dr Kaunonen).
authors.forename: Riikka
authors.initials: R
authors.lastname: Ikonen
authors.forename: Eija
authors.initials: E
authors.lastname: Paavilainen
authors.forename: Marja
authors.initials: M
authors.lastname: Kaunonen
mesh_terms: D000223:Adaptation, Psychological; D001942:Breast Feeding; D061186:Breast Milk Expression / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D009034:Mother-Child Relations / Q000523:psychology*; D009035:Mothers / Q000523:psychology*; D047928:Premature Birth; D013315:Stress, Psychological