Human milk feeding, milk expression, and breastfeeding experiences among mothers of preterm infants: a systematic review and meta-synthesis

Having a preterm infant can be an unexpected and overwhelming experience, particularly regarding breastfeeding and milk expression. This systematic review and meta-synthesis aimed to synthesize qualitative evidence to gain deep insights into mothers’ experiences as they navigate breastfeeding their preterm infants. The study was reported in accordance with the ENTREQ guidelines and registered in PROSPERO (CRD42023417526). Systematic searches were conducted across five major databases MEDLINE, CINAHL, APA PsycInfo, Web of Science, and Scopus for English-language qualitative studies published between January 2008 and June 2026. Studies exploring maternal experiences of breastfeeding preterm infants were included. Methodological quality was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research (JBI-QARI). A total of 44 studies were included in the meta-synthesis. Data analysis yielded four overarching analytical themes: (1) To Be Thrown to an Unexpected Reality , (2) From Objectification to Agency: Transforming the Role of Milk Expression , (3) From Disempowerment to Meaning-Making: Emotional Recalibration in the NICU , and (4) Building Maternal Identity Through Connection in Shared Spaces of Care . Despite experiencing initial feelings of guilt, powerlessness, and inadequacy, mothers demonstrate remarkable resilience, transforming milk expression into a vehicle for maternal agency and bonding. Healthcare providers, family members, and peer networks play a pivotal role in maternal empowerment. Providing empathetic, practical, and individualized support alleviates maternal stress, enhances confidence, and fosters maternal identity development. These findings underscore the imperative for trauma-informed, family-centered care systems in neonatal settings. CRD42023417526