Mothers of preterm infants face guilt, pumps and fragile support in breastfeeding, review finds

Mothers who breastfeed preterm infants experience the process not simply as a way of feeding their babies but as a demanding, identity-shaping journey marked by guilt, emotional distress, exhausting milk expression and inconsistent support, according to a systematic review and meta-synthesis of qualitative studies published in Archives of Gynecology and Obstetrics. The synthesis, conducted in line with PRISMA and ENTREQ reporting guidelines, brought together 47 peer-reviewed qualitative studies of mothers of infants born before 37 weeks of gestation and organized their accounts into five overarching themes.

The first theme, described by the researchers as the fractured transition to motherhood, captures how preterm birth disrupts maternal identity. Mothers in the underlying studies reported guilt and emotional distress alongside the loss of the uninterrupted early bonding that many had expected. The second theme frames the breast pump as both lifeline and burden: milk expression was portrayed as necessary for providing milk to fragile infants, yet also physically and emotionally exhausting, turning a feeding relationship into a round-the-clock technical routine.

A third theme characterizes the neonatal intensive care unit as a paradoxical space. Mothers described inconsistent professional support, a sense of being watched or judged, and limited autonomy over their own infants’ feeding. The fourth theme concerns the struggle for reciprocity in breastfeeding itself, reflecting the difficulties posed by infant immaturity, the challenge of reading feeding cues in babies too young to signal clearly, and the gradual transition from tube feeding to direct breastfeeding. The fifth theme follows mothers after discharge, from surveillance to self-governance, as they slowly rebuild maternal confidence and autonomy once they are home.

Methodologically, the review team searched PubMed/MEDLINE, Scopus, Web of Science, CINAHL, Embase, PsycINFO and ProQuest for literature published from January 2006 to April 2026, using the SPIDER framework to define eligibility. Two reviewers independently carried out study selection, quality appraisal with the Critical Appraisal Skills Programme checklist, and data extraction. Findings were combined using the thematic synthesis approach of Thomas and Harden, and confidence in each synthesized finding was assessed with GRADE-CERQual, a method designed to indicate how much trust can be placed in conclusions drawn from qualitative evidence.

The authors conclude that breastfeeding a preterm infant is a complex and emotionally demanding process that extends well beyond milk provision, and that consistent, compassionate, family-centered support across both hospital and community settings is essential to strengthen maternal confidence, reduce emotional burden and improve breastfeeding outcomes for preterm infants and their families. As with any meta-synthesis, the findings interpret the included studies rather than measuring outcomes directly, and the review is presented as an early-release, citable version subject to further editorial refinement.

Subject of Research: Qualitative experiences of breastfeeding among mothers of preterm infants

Article Title: Exploring breastfeeding experiences of mothers with preterm infants: a systematic review and meta-synthesis

Article References: Safavi Ardabili, N., Mazhari, Z., Shaterian, N., Mirghafourvand, M., Fallah, S., & Abdi, F. (2026). Exploring breastfeeding experiences of mothers with preterm infants: a systematic review and meta-synthesis. Archives of Gynecology and Obstetrics. https://doi.org/10.1007/s00404-026-08598-7

Image Credits: AI Generated

DOI: 10.1007/s00404-026-08598-7

Keywords: breastfeeding, preterm infants, meta-synthesis, systematic review, qualitative research, neonatal intensive care, maternal mental health, milk expression, GRADE-CERQual, Archives of Gynecology and Obstetrics, Exploring, experiences