The University of Texas Health Science Center, Houston
The purpose of this study is to adapt, refine, and test the feasibility, acceptability, and implementation of a novel Motivational Interviewing (MI) and Acceptance and Commitment Therapy (ACT) (MIACT) intervention delivered by lactation specialists to increase Black mothers' own milk (MOM) feeding with their infants and to pilot test the efficacy of the MIACT intervention in a sample of Black mothers and their infants to increase MOM-feeding initiation and duration and improve secondary infant and maternal outcomes (e.g., infant length-of-stay, maternal stress), compared to usual lactation support in a neonatal intensive care unit (NICU). The goals of MIACT are to increase mothers' psychological flexibility and motivation for MOM feeding by increasing acceptance and willingness to experience ambivalent and/or uncomfortable thoughts, feelings, and physical sensations related to MOM feeding, with particular attention to the unique needs of Black mothers. Concerns, views, and feelings around MOM feeding will be identified, followed by discussion and practice of acceptance and mindfulness skills. Maternal values will be elicited and goals based on personal values will be set.
Inclusion Criteria: * mother identifies as Black * speaks, reads, and writes English * able to provide MOM * has a NICU-admitted infant able to receive MOM Exclusion Criteria: * A medical (e.g., maternal HIV+, infant galactosemia) or physical condition (e.g., total mastectomy) preventing MOM feeding (e.g., to avoid HIV transmission) * infants placed in adoptive care, precluding follow-up * an infant life-limiting condition (e.g., Trisomy 13, 18)
MIACT interventions will occur within conventional lactation visits, during which specialists often guide, observe, and troubleshoot with mothers. The lactation service consults mothers in \<24 hours, again \<48 hours, and at 1-week and 2-weeks post-delivery, and additional lactation consults at common periods of MOM decline (e.g., 1 month) will be offered. Sessions span 10-60 minutes and lactation specialists will use MIACT strategies, based on each mothers' needs to: (1) assess current MOM-feeding motivation (via R-I-C rulers \[see Table 1\]), (2) discuss challenges; (3) identify obstacles (e.g., lack of perceived control); (4) foster learning/practice of acceptance and willingness (i.e., alternative skills); and, (5) encourage value-based goals (i.e., initiate/sustain MOM feeding). Follow-up consults will revisit content and obstacles, review progress, re-assess motivation, practice alternative skills, identify new strategies, and affirm value-based action.
Conventional lactation visits, during which specialists often guide, observe, and troubleshoot with mothers. The lactation service consults mothers in \<24 hours, again \<48 hours, and at 1-week and 2-weeks post-delivery.