Howard Mary Beth, Wachman Elisha, Levesque Emily M, Schiff Davida M, Kistin Caroline J, Parker Margaret G
Boston Combined Residency Program in Pediatrics, Boston Children's Hospital, Boston, Massachusetts;
Department of Pediatrics, Boston Medical Center, Boston, Massachusetts; and.
Hosp Pediatr. 2018 Dec;8(12):761-768. doi: 10.1542/hpeds.2018-0116. Epub 2018 Nov 6.
To investigate perspectives of mothers with opioid use disorder regarding breastfeeding and rooming-in during the birth hospitalization and identify facilitators and barriers.
We conducted in-depth qualitative interviews with 25 mothers with opioid use disorder 1-12 weeks after delivery. Grounded theory analysis was used until thematic saturation was reached. Findings were triangulated, with experts in the field and a subset of informants themselves, to ensure data reliability.
Among 25 infant-mother dyads, 36% of infants required pharmacologic treatment, 72% of mothers initiated breastfeeding, and 40% continued until discharge. We identified the following themes: (1) information drives maternal feeding choice; (2) the hospital environment is both a source of support and tension for mothers exerting autonomy in the care of their infants; (3) opioid withdrawal symptoms negatively impact breastfeeding; (4) internal and external stigma negatively impact mothers' self-efficacy; (5) mothers' histories of abuse and trauma affect their feeding choice and bonding; (6) mothers' recovery makes caring for their infants emotionally and logistically challenging; and (7) having an infant is a source of resilience and provides a sense of purpose for mothers on their path of recovery.
Future interventions aimed at increasing breastfeeding and rooming-in during the birth hospitalization should focus on education regarding the benefits of breastfeeding and rooming-in, supporting mothers' autonomy in caring for their infants, minimizing stigma, and maximizing resilience.
调查患有阿片类物质使用障碍的母亲在分娩住院期间对母乳喂养和母婴同室的看法，并确定促进因素和障碍。
我们在分娩后1至12周对25名患有阿片类物质使用障碍的母亲进行了深入的定性访谈。采用扎根理论分析，直至达到主题饱和。研究结果与该领域的专家以及部分受访者本人进行了三角验证，以确保数据的可靠性。
在25对母婴中，36%的婴儿需要药物治疗，72%的母亲开始进行母乳喂养，40%持续到出院。我们确定了以下主题：(1)信息驱动母亲的喂养选择；(2)医院环境对于母亲在照顾婴儿时行使自主权既是支持来源，也是压力来源；(3)阿片类物质戒断症状对母乳喂养产生负面影响；(4)内部和外部的污名化对母亲的自我效能感产生负面影响；(5)母亲的虐待和创伤史影响她们的喂养选择和情感联系；(6)母亲的康复使照顾婴儿在情感和后勤方面都具有挑战性；(7)拥有婴儿是恢复力的来源，并为处于康复道路上的母亲提供了目标感。
未来旨在增加分娩住院期间母乳喂养和母婴同室的干预措施应侧重于宣传母乳喂养和母婴同室的益处、支持母亲在照顾婴儿方面的自主权、尽量减少污名化以及增强恢复力。
