The current situation and challenges of care to promote breast milk production for mothers of preterm infants in the maternity ward This study reveals obstetric nurses' current situation and challenges to promote breast milk production for mothers of preterm infants, as well as the actual outcome of mothers' status of breast milk expression during the same period of time. Methods We surveyed two mothers who gave birth to preterm infants: at 28 and at 30 weeks' gestation. To describe the current

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... situation of mother's breast milk expression we collected the following data: time of starting and ending breast milk expression, frequency of breast milk expression per day, amount of breast milk per day, method of breast milk expression, place of breast milk expression, event before and after breast milk expression, and daily mood during the first month after giving birth. In addition, we conducted a focus group interview with four midwives, each with four years of clinical experience and who worked on the obstetric ward. They were prompted to discuss aspects of their nursing care to promote breast milk production for mothers of preterm infants. The interview content was analyzed using thematic analysis. Results With regard to two mothers' status of breast milk expression during the first month after giving birth, we found the times at which the mothers begin breast milk expression to be delayed more than one hour after birth. Except for the birth day, the average frequency of breast milk expression per day of mother A was 6.83 times, and that of mother B was 6.67 times. Moreover, during the first month after giving birth, both mothers had difficulty stabilizing their milk volume to at least 500mL per day. The midwifery focus group results revealed six categories impinging on their care to promote breast milk production for mothers of preterm infants on maternity wards: "implicit care policies", "difficulty initiating early breast milk expression after a cesarean delivery", "difficulty establishing mothers' rhythm of breast milk expression", "lack of opportunities to provide care after discharge", "difficulty providing care in cooperation with the neonatal intensive care unit", and "difficulty maintaining mothers' motivation for breast milk expression". Conclusion Mothers of preterm infants had delayed breast milk expression more than one hour after birth. The frequency of breast milk expression was low. Obstetric nurses encountered some barriers in their attempts to provide care to promote breast milk production for mothers. There was a gap in the recognition of nurses and practice especially, for the first time starting breast milk expression. We found the time at which not only the mother of cesarean section but also of vaginal delivery begins breast milk expression to be delayed. Building on the findings from this research, the next phase is to develop an educational program that enables nurses working on obstetric wards to set the standard of and provide care to promote breast milk production such as early and frequent breast milk expression for mothers of preterm infants.