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Commentary by Gill

Substantial evidence is available documenting the superiority of breastfeeding and human milk for infants, especially preterm infants. Despite this evidence, many mothers discontinue breastfeeding or pumping milk for their preterm infant soon after delivery. Mothers often cite insufficient milk supply as reason for discontinuing breastfeeding or pumping. Oftentimes, lactation insufficiency is blamed on stressors such as fatigue, lack of sleep, delivery of a preterm infant, or other reasons. Few previous studies have examined the impact of stress on milk production; no other studies have examined the effect of psychological distress on milk production. The purpose of this study was to compare psychological distress during the first 6 weeks postpartum between mothers of term and preterm infants and to determine whether the addition of psychological distress to a previous model predicts milk volume at 6 weeks. Investigators invited 350 to participate in this study; 114 women declined. Another 41 women dropped out of the study, and investigators eliminated 2 additional women due to incorrect milk measurement. In the end, 193 women completed the study. Approximately 45% of women asked to participate in this study declined or dropped out. The authors reported that women declined to participate because the study was too much work and because they did not want the added responsibility. Mothers who dropped out of the study said that they were too overwhelmed and that the study was too much work. Comparative demographic characteristics were not provided for the 236 women who participated and the 114 women who declined to participate. Did more primiparas decline participation than multiparas? Were there important demographic differences in mothers who participated compared to mothers who did not participate? Participant burden is the amount of work required to complete the necessary measurement requirements. For purposes of this study, preterm mothers pumped 8 times per day for 12 minutes for 42 days following delivery. For each expression, they recorded date, start time of milk expression, number of minutes pumped, and the amount of milk expressed in milliliters (Hill, Aldag, Chatterton, & Zinaman, 2005). Term mothers weighed their infant prior to and after each feeding and recorded the milk intake. Term infants typically feed 8 to 12 times per day. All mothers completed stress, sleep, and fatigue scales daily.