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21 August 2026

15 Pages

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

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Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA
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Rush Medical College, Rush University, Chicago, IL 60612, USA
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Department of Health Systems Management, Rush University, Chicago, IL 60612, USA
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Author to whom correspondence should be addressed.
Women2026, 6(3), 55;https://doi.org/10.3390/women6030055
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Abstract

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.

1. Introduction

Mother’s own milk (MOM) provides substantial benefits for preterm (PT; <37 weeks gestational age (GA)) infants, with reduced rates of prematurity-related complications, including necrotizing enterocolitis, late-onset sepsis, and bronchopulmonary dysplasia, and improved neurodevelopment [1]. Despite these benefits, PT infants are less likely to receive any MOM and are fed MOM for shorter durations than term infants [2,3,4,5].
Mothers of PT infants in the neonatal intensive care unit (NICU) face unique challenges providing MOM, especially during their infant’s hospitalization [6]. These mothers are typically pump-dependent, unable to directly breastfeed due to infant prematurity and/or morbidity and may experience delayed lactogenesis with preterm birth [7]. Additionally, they must navigate the logistics of transporting MOM to the NICU while also devoting sufficient time to pumping. Mothers spend an average of two hours per day pumping while their infant is in the NICU, although the actual time varies across mothers and over the course of lactation, depending on pumping frequency [8]. With lengthy NICU stays and often limited maternity leave, mothers may return to work while their infant remains hospitalized to save time off for after discharge. They face competing demands on their time with pumping, paid work, and unpaid work responsibilities (e.g., domestic chores, running errands outside the home, family care) [9].
The challenge of balancing paid and unpaid work responsibilities and MOM provision is complex for mothers of PT infants. Longer (paid or unpaid) maternity leave is associated with higher rates of MOM initiation and duration [10,11]; however, it is unclear how prenatal work experiences may influence decisions about MOM provision. Although an abundance of literature has examined the relationship between return to work and MOM provision, this work has almost exclusively focused on mothers of term infants. Mothers of PT infants are typically subsumed into these larger samples or are excluded entirely [12,13,14,15]. Conversely, the substantial literature on lactation among mothers of PT infants has rarely examined the roles of paid and unpaid work [16,17]. Understanding maternal perspectives on balancing work responsibilities with MOM provision after delivery of a PT infant is essential for developing targeted interventions for supporting mothers in achieving their MOM provision goals. We approached this study with the conceptual expectation, grounded in Becker’s theory of the allocation of time [18], that paid and unpaid work and MOM provision are competing demands on mothers’ finite time—that paid and unpaid work conditions shape mothers’ decisions about whether and for how long to provide MOM, and MOM provision shapes mothers’ decisions about the amount, types, and intensity of paid and unpaid work. Because MOM provision is time-intensive and the degree to which pumping competes with, rather than fits within, paid work varies by socioeconomic factors, Becker’s theory provided a direct lens for understanding the time trade-offs mothers face. Using semi-structured interviews conducted during or after the infants’ NICU hospitalization with mothers of PT infants, we examined how mothers navigated decisions about the often-competing demands of providing MOM and paid and unpaid work—how work conditions influenced MOM provision and how MOM provision influenced paid and unpaid work responsibilities and total workload.

2. Results

2.1. Characteristics of Study Participants

Table 1 describes the characteristics of the 18 study participants. Most mothers were non-White (72%) and insured through Medicaid (72%). Overall, 72% of mothers had worked during their pregnancy, with 46% in service, food, retail or transportation jobs, and 38% in healthcare- or education-related jobs. Only 15% were in prenatal jobs that could be performed from home. Infants were born at a median GA of 32 weeks (interquartile range (IQR) 32–34) and had a median NICU hospitalization length of stay of 29 days (IQR 19–39). Mothers were interviewed at a median of 41 days postpartum. At NICU discharge, 58% of infants received MOM (either exclusive MOM or MOM in combination with formula), and 16% received exclusive MOM throughout the hospitalization.
Table 1. Characteristics of the Study Participants.

2.2. Overview

The mothers interviewed for this study described an overarching experience of self-reliance in navigating life with an infant in the NICU. The complexity of their experiences was reflected across multiple codes encompassing the physical, emotional and logistical challenges of PT delivery. The full range of codes is depicted in Supplement File S2. The unexpected reality of the NICU disrupted or complicated their original plans for MOM provision, return to work, and everyday life.
Three major themes shaped participants’ experiences with respect to MOM provision and work during the prenatal and postpartum periods (Table 2). First, unplanned prenatal events created postpartum uncertainty about returning to work. Mothers described uncertainty across multiple dimensions of work, including whether they would return, the timing of going back to work and/or starting to look for a job, and the hours they would be available to work, given the fragility of their infant. Second, although our analysis suggested that mothers may have had prenatal plans to provide MOM, breastfeeding intentions were often derailed following PT delivery. Finally, the unpredictable reality of having a PT infant shifted maternal priorities and obligations related to paid and unpaid work. Taken together, these themes highlight that PT birth creates cascading disruptions in mothers’ plans for MOM provision, return to paid work, and other aspects of family life. The cumulative weight of multiple unplanned events compounded over time, undermining mothers’ prenatal intentions and preparations. These disruptions began before delivery for some mothers, with prenatal illness and pregnancy complications triggering employment changes with consequences that extended beyond delivery and well into the postpartum period.
Table 2. Summary of Themes and Subthemes.

2.3. Theme 1: Unexpected Prenatal Events Create Postpartum Job Uncertainty

Several participants shared that pregnancy-related symptoms (e.g., nausea, shortness of breath), prenatal complications, and a lack of workplace flexibility led them to leave their jobs unexpectedly before delivery. These early departures created economic uncertainty and left mothers without a job to return to postpartum. Additionally, mothers were often unprepared for an unexpected early delivery, without a complete understanding of their benefits or policies related to maternity and/or family leave. As a result, some mothers anticipated returning to work at some point after delivery, but with only tentative timelines for doing so (Table 3).
Table 3. Subthemes and Quotes for Theme 1: Unexpected Prenatal Events Create Postpartum Job Uncertainty.

2.4. Theme 2: Breastfeeding Intentions Are Often Derailed After Preterm Delivery

Decisions about discontinuing MOM were largely unplanned and often shaped by external circumstances (Table 4). Health complications such as COVID-19, hypertension, postpartum depression, and medication side effects frequently disrupted mothers’ pumping routines. For some, a few missed days ultimately resulted in pumping cessation. Practical challenges, including the time demands of pumping, dislike of pumping itself, and the stress of caring for a newborn in the NICU, further complicated their ability to continue. One mother described pumping as “a full-time job.” In effect, decisions about breastfeeding were often passive, determined by medical and life circumstances rather than deliberate planning. Additionally, pump dependence left some mothers disappointed that they were not able to directly breastfeed their infant as originally envisioned.
Table 4. Subthemes and Quotes for Theme 2: Breastfeeding Intentions are Often Derailed After Preterm Delivery.

2.5. Theme 3: The Unpredictable Reality of Having a Preterm Infant Shifts Maternal Priorities and Obligations Related to Paid and Unpaid Workload

Mothers described the postpartum reality as vastly different from what they had anticipated, particularly when caring for a PT infant (Table 5). Instead of the anticipated joys of new motherhood, their priorities shifted dramatically toward managing specialized medical and developmental needs. Many felt isolated, reporting that they had to “figure it out” on their own. Unpaid workload—including childcare and household responsibilities—added to this strain. Participants shared concern about the fragility of their baby, particularly given the specialized care needs, which heightened anxiety about taking their baby to daycare and led mothers to reprioritize care for their baby above other responsibilities. Family support was often complicated: while relatives wanted to help, some were hesitant to interact with the PT infant and avoided physical contact, or mothers themselves were reluctant to use daycare due to concerns about prematurity. This gap between expectations and reality left many mothers navigating postpartum life with limited guidance and support.
Table 5. Subthemes and Quotes for Theme 3: The Unpredictable Reality of Having a Preterm Infant Shifts Maternal Priorities and Obligations Related to Paid and Unpaid Workload.
Mothers who may have planned or hoped to return to work following delivery described uncertainty about when they would return to work due to concerns about infant fragility. Mothers shared that they did not want to send their infant to daycare, and either did not have family to take care of their infant or preferred for themselves or their spouse to take care of their infant.

3. Discussion

Our findings illustrate how unexpected prenatal events and the realities of having a PT birth may disrupt mothers’ expectations about paid work, unpaid work, childcare, and MOM provision. While reinforcing previous findings, our qualitative study also revealed several unique insights that warrant future research to assess their transferability to other populations and settings. We anticipated identifying challenges mothers face when returning to the workforce; however, we were surprised to find that several had already left the workplace prior to delivery, due to pregnancy complications or inflexible work environments. Significant postpartum health challenges hindered mothers’ ability to provide MOM. The three themes have a common thread—the unexpected delivery of a PT infant translates into uncertainty and unpredictability in multiple aspects of mothers’ lives.
These themes can be understood through Becker’s theory of the allocation of time, which conceptualizes individuals as allocating a fixed amount of time across competing paid and unpaid activities [18]. However, socioeconomic vulnerability limits the range of feasible allocations of time. Mothers in low-wage jobs face the tightest constraints on their time. They have less flexibility to modify their work schedules to accommodate NICU visitation and pumping, are less likely to hold jobs that offer paid leave, and are more likely to face economic consequences that threaten basic needs if they leave employment [19,20]. For these mothers, MOM provision competes not only with caregiving and recovery, but more acutely with the demands of paid work. MOM provision is a time-intensive component of unpaid workload or household activities, requiring sustained and frequent pumping that competes directly with other demands on a mother’s time: recovering from her own illness or complicated delivery, visiting a critically ill infant in the NICU, caring for other children, maintaining the household, and, for some, paid employment. The interviews suggest that paid employment was often perceived as the most substitutable role, because mothers prioritized being present with their critically ill infant, both in the NICU and at home. When the sum of these demands exceeded the time available, mothers prioritized visiting the NICU over paid work. Notably, there was little mention of time spent on household work or other unpaid chores. Viewed through this lens, MOM provision decisions are not isolated decisions, but are constrained allocations of scarce time under conditions of their own illness, caregiving intensity, and the stress of having a critically ill and fragile infant. We draw on Becker’s framework as an interpretive lens for understanding participants’ descriptions of their experiences consistent with the aims of our qualitative study, not to formally test a time-allocation model.
Our findings add depth to an important thread of prior research. Some mothers in our study spoke at length about their breastfeeding intentions being derailed after PT delivery. In a meta-aggregation of qualitative studies of breastfeeding experience of mothers of PT infants, Srichalem and colleagues described the unique personal challenges these mothers face in providing MOM, due to both infant health complications and physical separation from their infant [16]. While LoVerde and colleagues highlighted the significance of prolonged maternal hospitalization as a barrier to MOM provision in this population, our interviews add important nuance to this theme [21]. Mothers described how their own illnesses disrupted pumping routines, beginning with a few missed days, and ultimately leading to pumping cessation overall.
Although two recent systematic reviews synthesized findings from 54 qualitative studies of breastfeeding experiences of mothers of PT infants, their findings did not address the roles of paid and unpaid work [16,17]. Our qualitative interviews suggested that several mothers of PT infants experienced pregnancy-related complications that were compounded by inflexible work environments, leading them to leave their jobs altogether prior to delivery. Because leave benefits in the United States are tied to employment, leaving employment before delivery may create a dual economic disadvantage: mothers lose access to maternity leave benefits and have no job to return to postpartum. Although our small qualitative sample cannot establish how common this experience is, these mothers may represent a vulnerable population that is largely overlooked by workplace policies and legislation designed to support working mothers who remain employed during pregnancy. More broadly, in the United States, women who do not meet the criteria for paid work-based maternity leave, either because they were not employed at the time of birth or because they had insufficient work history to qualify for benefits, have no wage replacement during the postpartum period. Norway, for example, provides a lump-sum grant (engangsstønad) to mothers who do not qualify for the income-based parental benefit, helping to offset some of the costs of having a child (NOK 92,648 as of 2026, or approximately $9700 USD at August 2026 exchange rates) [22]. We did not evaluate such policies, and we highlight the Norwegian model to illustrate one alternative benefit structure that does not condition support on prior employment. Specifically, population-level studies are needed to determine whether mothers who deliver PT infants are at greater risk of leaving employment prior to delivery. Although mothers of PT infants face elevated health risks during pregnancy, including diabetes mellitus and hypertension [23], scant data quantify how symptoms or management of these conditions may lead women to leave employment before delivery, or the economic implications for mothers and families that may persist after delivery.
Even mothers who remain employed throughout pregnancy may face significant barriers to maternity leave eligibility. Frequent job changes limit eligibility, because many employers require a minimum tenure (e.g., 3 to 12 months) before employees qualify for benefits. Moreover, eligibility for employer-based paid leave varies by industry and hours worked per week, excluding many employed mothers, particularly those in service and sales occupations and those who work part-time [20]. At the federal level, the Family and Medical Leave Act restricts eligibility to workers employed for at least 12 months who have worked at least 1250 h prior to leave, and the leave it guarantees is unpaid [24]. These requirements exclude substantial portions of pregnant, working women: in 2024, 50% of women ages 20 to 24 and 29% of women ages 25 to 34 had been with their current employer for 12 months or less [25]. Even for mothers who qualify, the duration of federally mandated leave may be insufficient for families of PT infants. NICU stays for PT infants range from an average of 29 days for infants born at 31–32 weeks GA to 80 days or more for infants born at 24 weeks GA, far exceeding the duration of most leave policies [26]. In contrast, some Nordic countries offer more comprehensive support. Norway, for example, provides up to 49 weeks of paid parental leave at full pay per child, including leave reserved for mothers before and after birth, and Denmark offers 18 weeks of paid leave, with up to 4 weeks available before birth [27]. We did not evaluate these policies but note that features such as standardized benefits that are not tied to a particular employer represent one approach that would not exclude mothers on the basis of occupation or job tenure.
PT delivery also affected breastfeeding intentions. Notably, although more than half of infants in our sample received MOM at NICU discharge, only 16% received exclusive MOM throughout the NICU hospitalization, a gap that our qualitative findings help to contextualize. The unexpected realities of pumping differed sharply from mothers’ expectations, and some mothers described their breastfeeding intentions as derailed following PT delivery. Mothers shared that the medical demands of their own recovery, coupled with the intensive needs of their infant, limited their ability to initiate or sustain MOM provision. Mothers experienced pumping in the NICU as markedly different from direct breastfeeding, leading to disappointment when they did not meet their original feeding goals. The emotional strain of having a medically fragile infant—paired with logistical challenges and competing obligations at home and work—further constrained their capacity to provide MOM as intended. Several qualitative studies examining MOM provision in this population have similarly described how PT delivery complicates breastfeeding [28,29,30]. Palmér and Ericson characterized this experience as “navigating with a struggle,” noting that mothers felt sadness and regret related to breastfeeding cessation as well as stress and exhaustion related to breastfeeding [30]. Niela-Vilen and colleagues collected qualitative data from 80 mothers of PT infants using an open-ended survey question about their emotions and thoughts on breastfeeding at multiple time points in the first year after delivery [28]. They created a typology of breastfeeding mothers of PT infants, with one group characterized by deep disappointment in not breastfeeding, despite having expectations, excitement, and confidence in it. Our findings extend prior research by providing deeper insight into how breastfeeding intentions are derailed by PT delivery, including the role of maternal illness and continued MOM provision, and the significant stress of having a PT infant in the NICU. These findings underscore the need for ongoing, evidence-based lactation care and psychosocial support throughout the NICU hospitalization and beyond to support mothers in navigating postpartum illness and recovery, the stress of PT delivery, and providing MOM. Future work should evaluate innovative interventions that holistically address these interconnected challenges, recognizing that they frequently co-occur or can compound one another in ways that ultimately undermine MOM provision.

Limitations

We recognize that the themes developed from our interviews are interpretive and informed by our experiences, expertise, and perspectives. Consistent with reflexive thematic analysis, we treat this positioning as integral to the analysis, rather than a source of bias. We also note that the aim of this qualitative study was not to measure or model breastfeeding intention, maternal health, or specific socioeconomic factors as predictors of MOM provision, but to understand how mothers thought about paid and unpaid work relative to MOM provision to inform future quantitative research. Our primary research questions related to mothers’ allocation of time and how they made decisions about competing demands. The application of different theoretical frameworks, such as a social determinants of health framework, may have led us to construct different themes.
Several limitations should be noted. First, participants were recruited from a single NICU, and eligibility was limited to English-speaking mothers who were citizens or legal residents. Mothers who fall outside these eligibility criteria may have different employment experiences that our study did not capture. Second, because we recruited in parallel with a lactation-focused randomized controlled trial that enrolled infants born <32 GA, this study predominantly represents mothers of moderate and late preterm infants, with two-thirds of infants born at 32–34 weeks GA. The perspectives of mothers of very and extremely preterm infants may not have been fully captured and may differ from the themes we have reported. Third, the sample size was relatively small, which may limit the transferability of the findings to other populations and settings. Notably, the finding that some mothers left employment before delivery emerged from a subset of participants, and population-level studies are needed to confirm whether this experience transfers to the broader population of mothers of PT infants. Fourth, interviews were conducted by study team members affiliated with the NICU, and we recognize that these relationships may have shaped what mothers shared. Consistent with reflexive thematic analysis, we treat the interviewer’s background, experience, and expertise as part of the interpretive context, rather than a source of bias to remove. Additionally, mothers were interviewed between 5 days and 10 weeks after delivery, spanning different time points during the NICU stay and following discharge. Their perceptions at the time of interview, and how they described their experiences of work and MOM provision, may not reflect their experiences at other time points. One qualitative study of Swedish mothers of PT infants described the breastfeeding experience as a journey, “like following a winding path” [30]. As such, the perceptions of MOM provision reported here reflect a single point in time, rather than static or fixed perceptions. Finally, we did not collect detailed sociodemographic information, such as educational attainment, household income, or marital status, all of which are intertwined with paid and unpaid workload and MOM provision [6,31,32,33]. For example, financial pressures to return to work and the availability of support at home vary by household income and marital status. The absence of these variables limits our ability to place our findings within the broader socioeconomic context, and the themes we have reported should be considered in light of this limitation.

4. Materials and Methods

We used a qualitative design to explore the personal, complex, and context-dependent nature of the relationship between maternal paid and unpaid work responsibilities and MOM provision. We conducted semi-structured interviews with mothers of infants born <37 weeks GA and hospitalized in the NICU at Rush University Medical Center in Chicago, IL, USA. The study was approved by the Rush University Medical Center Institutional Review Board (protocol code 22072801-IRB01), and we obtained written informed consent from participants prior to the interviews. Interviews were conducted between 13 October 2023 and 13 August 2024, either in-person at the medical center or virtually via Microsoft Teams video.

4.1. Participants

Mothers were approached in person in the NICU. Maternal eligibility included maternal age 18 or older, US citizen or legal resident, and English fluency. Mothers were eligible regardless of whether they provided any MOM. Mothers were excluded if they had one or more health conditions incompatible with MOM provision (e.g., HIV positive status, cocaine or heroin drug use, or not intending to parent the infant), or if their infant had significant congenital anomalies or chromosomal defects or was unlikely to survive in the neonatologist’s opinion (e.g., extreme prematurity, potentially lethal congenital anomalies). Additionally, mothers were not approached if they were already participating in an ongoing lactation-focused randomized controlled trial to avoid overly burdening participants. Recruitment and data collection were guided by Malterud et al.’s concept of information power [34]. Given the study’s focused aims and the depth of the interviews and analysis, we judged the final sample of 18 mothers to provide sufficient information power to address the research question.

4.2. Data Set Generation

Maternal and infant demographic characteristics were collected from self-report and the hospital’s electronic medical record (EMR). Maternal characteristics included age, race and ethnicity, source of health insurance coverage, and prenatal work status. For those who worked during pregnancy, we also recorded whether they left their job prior to delivery, self-reported occupation, and whether they could work from home in their prenatal job. Infant characteristics included GA at birth, multiple birth status, whether the infant was born at the study hospital or transferred from another hospital, and length of birth hospitalization (days). Infant feeding data were collected from the hospital’s EMR and included receipt of any MOM during the NICU stay, discharged receiving MOM, and receipt of exclusive MOM during the NICU stay.
Semi-structured interviews lasting 30–60 min were conducted between 5 days and 10 weeks postpartum and took place either while their infant was hospitalized in the NICU or after their infant was discharged. Each subject participated in one interview. Interviews were held either in-person or virtually through Microsoft Teams video and included the interviewer and mother. The mother’s infant or her other children may have been present during the interview. In-person interviews were audio-recorded using Microsoft 365, and video interviews were recorded through Microsoft Teams. Two female authors (Authors MD, CA) conducted the interviews. The interviewers briefly introduced themselves, their professional roles as medical students who had completed clinical rotations in the NICU, and the purpose of the study. Interviews were conducted using an interview guide comprising predetermined questions and prompts across five key thematic areas to ensure consistency across participants while allowing flexibility to explore emerging ideas. The five thematic areas included general questions about responsibilities in the home, such as caregiving, housework, childcare, and transportation; their pregnancy journey; pre-delivery work experience and plans to provide MOM; work and MOM provision while their baby was in the NICU; and post-delivery work experiences and MOM provision (for mothers who had returned to work). The full interview guide is provided as Supplement File S1.
Interviews were auto-transcribed through Microsoft 365/Microsoft Teams (Microsoft Corp., Redmond, WA, USA) and coded with a study identifier. Two authors compared the transcripts with audio recordings and edited the transcripts for accuracy. Participants were provided $100 compensation for their time using a debit card that was compliant with the Health Insurance Portability and Accountability Act.

4.3. Data Analysis

Five female authors, including three neonatologists, one health economist, and one research coordinator (Authors SK, LH, AP, TJ, JO), participated in the qualitative analysis using reflexive thematic analysis. After the interviews were completed and transcripts were edited for accuracy, the authors used an iterative process to develop the codes and themes. The authors initially read 2–4 transcripts to familiarize themselves with the interview content, then met to discuss their general observations and reactions. These authors continued to iteratively read through transcripts, meeting periodically to discuss their observations and reactions, until two authors had reviewed each transcript. In the coding phase, authors independently reviewed transcripts and initially coded 1–2 transcripts in a shared Dedoose project [35]. Following Braun and Clarke’s method of reflexive thematic analysis, the team met to collaboratively reflect on the coding and discuss each author’s interpretations of the data. The purpose of these discussions was to enrich the analysis rather than establish coding consensus [36,37]. Consistent with reflexive thematic analysis, we did not use a fixed codebook or predetermined coding frame and did not assess inter-rater reliability [36]. Codes were treated as interpretive and evolved throughout the analysis, rather than being applied uniformly across coders. Throughout the process, the authors met regularly to address questions, share observations, and discuss emerging codes, with two authors reviewing and coding each transcript. The team collaboratively generated initial themes from the codes, then refined these themes in an iterative process by examining the underlying codes to provide richer context and analytic depth. It is important to note that the authors’ diverse backgrounds (neonatology, economics, medicine, pediatrics), expertise, and lived experiences shaped our interpretation of the transcripts and the development of codes and themes. Several authors were mothers who had provided MOM to their own infants and had returned to work at varying time points, and the neonatologist authors had over 25 years of combined experience observing how NICU families make decisions about MOM provision. In particular, these perspectives informed the research team’s understanding of the challenges facing mothers of PT infants in the NICU and of balancing work and MOM provision. Consistent with reflexive thematic analysis, the number of participants contributing to each theme was not quantified. Themes represent analytic constructs of patterns of shared meaning across the data set rather than frequencies. We followed the Reflexive Thematic Analysis Reporting Guidelines of Braun and Clarke [38].

5. Conclusions

Our findings suggest that mothers of PT infants frequently navigate pregnancy and the postpartum period without the structural or social supports typically designed for working parents. When mothers of PT infants leave the labor force before delivery due to prenatal complications, as some mothers in our study did, traditional protections such as parental leave, workplace accommodations, or job-based benefits become irrelevant. These mothers may then face the dual challenge of caring for a medically vulnerable infant while trying to reestablish their own economic footing, often without adequate resources or guidance. One study of labor force participation before and after the birth of a first child found that women were 12 percentage points less likely to be employed in the three months before birth than before pregnancy; however, it did not distinguish mothers of PT from mothers of term infants [39]. Population-based studies are needed to quantify rates of pre-delivery workplace departure in this population to inform targeted policy and workplace interventions.
Mothers of PT infants require additional support both before and after delivery to sustain MOM provision. While paid leave policies are designed to support mothers who take leave prior to delivery, these benefits do not extend to mothers who leave the labor force altogether. This exclusion is likely to disproportionately affect the most economically vulnerable women, as low-wage jobs are the least likely to offer maternity benefits and workplace flexibility [19,20]. Future research should examine how pregnancy complications shape pre-delivery employment trajectories and identify strategies to support women who wish to continue working despite high-risk pregnancies or pregnancy-related illnesses. Policies and resources must facilitate sustained MOM provision for mothers of PT infants, regardless of employment status.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/women6030055/s1, File S1: Interview Guide; File S2: Summary of Codes.

Author Contributions

Conceptualization: T.J.J., A.L.P.; Data Curation: C.A., M.C.D., J.O., T.J.J., A.L.P. Formal Analysis: L.M.H., T.J.J., S.K., J.O., A.L.P.; Funding Acquisition: T.J.J., A.L.P.; Investigation: M.C.D., T.J.J., S.K., A.L.P.; Methodology: S.E.B., L.M.H., T.J.J., S.K., A.L.P.; Software: S.K., J.O.; Validation: L.M.H., T.J.J., S.K., A.L.P.; Roles/Writing—Original Draft: M.C.D., T.J.J., S.K., A.L.P.; Roles/Writing—Review and Editing: C.A., S.E.B., M.C.D., L.M.H., T.J.J., S.K., J.O., A.L.P.; Visualization: S.K. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by Rush University College of Health Sciences Research Fund.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board of Rush University Medical Center (protocol code 22072801-IRB01, 11 January 2023 and 26 September 2023).

Data Availability Statement

The data are not publicly available because they consist of in-depth qualitative interviews with a small sample of mothers of preterm infants recruited from a single NICU. The interview data cannot be adequately deidentified without compromising their integrity. Request to access the data will be considered by the corresponding author in accordance with the terms of the study’s Institutional Review Board approval and participant consent.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
EMRElectronic medical record
GAGestational age
MOMMother’s own milk
NICUNeonatal intensive care unit
PTPreterm

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Health Literacy and Health-Related Quality of Life Across Late Pregnancy in Women with and Without Gestational Hypertension: A Longitudinal Study in Penang, Malaysia
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