Trading Time: A Qualitative Study of Work, Caregiving and Mother’s Own Milk Provision Among Mothers of Preterm Infants

Mothers of preterm infants (PT; <37 weeks gestational age) face economic barriers to mother’s own milk (MOM) provision, including lack of paid maternity leave and unpaid workload that may prevent sustained MOM provision. The objective of this study was to understand how mothers of PT infants navigate decisions about MOM provision and paid and unpaid work. Semi-structured interviews were conducted with mothers of PT infants between 5 days and 10 weeks postpartum. Interviews included questions about responsibilities in the home, pre-delivery work experience and plans to provide MOM, and postpartum work experience and MOM provision. Data were analyzed using reflexive thematic analysis, following Braun and Clarke’s method. This study included 18 mothers, who were predominantly non-White (79%) and covered by Medicaid (72%) with infants born at a median gestational age of 32 weeks. Three themes emerged: (1) unexpected prenatal events create postpartum job uncertainty; (2) breastfeeding intentions are often derailed after PT delivery; and (3) the unpredictable reality of having a PT infant shifts maternal priorities and obligations related to paid and unpaid workload. PT delivery creates emotional and financial stress and uncertainty for new mothers. Although federal and employment-based paid leave may alleviate some financial stress for mothers employed prior to delivery in the United States, mothers who leave the workforce before delivery will not benefit from these policies. Policies are needed to support all mothers of PT infants in facilitating long-duration MOM provision, independent of employment status.