Breastfeeding and milk expression challenges for Japanese mothers of Neonatal Intensive Care Unit Infants: A narrative review

In contemporary Japan, the number of newborns admitted to neonatal intensive care units (NICUs) is on the rise. Breast milk remains the optimal source of nutrition for such infants. However, a particular challenge arises: maternal milk production is often impeded by the separation of mother and child. This review analyzes the difficulties mothers of NICU-admitted infants face in maintaining milk expression from multiple perspectives and considers future support methods. The Medical Abstracts of Japan database was used, with search keywords including ‘NICU’, ‘milk expression’, and ‘breastfeeding’. A total of 15 Japanese-language articles were analyzed to identify challenges regarding milk expression and breastfeeding in NICUs. Using NVivo 14 software, categories and themes were extracted from the analyzed papers. Two themes emerged regarding mothers of infants admitted to the NICU who continued to express milk and breastfeed: those related to the mother or infant, and those related to the midwife. Factors attributable to the mother or infant were categorized into five themes: ‘difficulty developing attachment to the infant’, ‘insufficient support at home’, ‘pressure, anxiety and conflict’, ‘physical pain’, and ‘mental distress’. Factors attributable to the midwife were identified as a lack of skills to support both expressing milk and direct breastfeeding. Supporting breastfeeding for mothers in the NICU requires reducing physical, psychological, and social burdens while providing ongoing assistance, enabling mothers to successfully express milk and breastfeed, thereby promoting their infant’s healthy development.