{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:06:03Z","timestamp":1790805963229,"version":"4.1.0"},"reference-count":58,"publisher":"Cambridge University Press (CUP)","issue":"10","license":[{"start":{"date-parts":[[2022,12,9]],"date-time":"2022-12-09T00:00:00Z","timestamp":1670544000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Cardiol Young"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S1047951122003808_as1\"><jats:title>Introduction:<\/jats:title><jats:p>Lactating parents of infants hospitalised for critical congenital heart disease (CHD) face significant barriers to direct breastfeeding. While experiences of directly breastfeeding other hospitalised neonates have been described, studies including infants with critical CHD are scarce. There is no evidence-based standard of direct breastfeeding care for these infants, and substantial practice variation exists.<\/jats:p><\/jats:sec><jats:sec id=\"S1047951122003808_as2\"><jats:title>Aim:<\/jats:title><jats:p>To explain how direct breastfeeding is established with an infant hospitalised for critical CHD, from lactating parents\u2019 perspectives.<\/jats:p><\/jats:sec><jats:sec id=\"S1047951122003808_as3\"><jats:title>Materials &amp; Methods:<\/jats:title><jats:p>This study is a qualitative grounded dimensional analysis of interviews with 30 lactating parents of infants with critical CHD who directly breastfed within 3 years. Infants received care from 26 United States cardiac centres; 57% had single ventricle physiology. Analysis included open, axial, and selective coding; memoing; member checking; and explanatory matrices.<\/jats:p><\/jats:sec><jats:sec id=\"S1047951122003808_as4\"><jats:title>Results:<\/jats:title><jats:p>Findings were represented by a conceptual model, \u201cWayfinding through the \u2018ocean of the great unknown\u2019.\u201d The core process of Wayfinding involved a nonlinear trajectory requiring immense persistence in navigating obstacles, occurring in a context of life-and-death consequences for the infant. Wayfinding was characterised by three subprocesses: navigating the relationship with the healthcare team; protecting the direct breastfeeding relationship; and doing the long, hard work. Primary influencing conditions included relentless concern about weight gain, the infant\u2019s clinical course, and the parent\u2019s previous direct breastfeeding experience<\/jats:p><\/jats:sec><jats:sec id=\"S1047951122003808_as5\"><jats:title>Conclusions:<\/jats:title><jats:p>For parents, engaging in the Wayfinding process to establish direct breastfeeding was feasible and meaningful \u2013 though challenging. The conceptual model of Wayfinding explains how direct breastfeeding can be established and provides a framework for research and practice.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s1047951122003808","type":"journal-article","created":{"date-parts":[[2022,12,9]],"date-time":"2022-12-09T09:04:08Z","timestamp":1670576648000},"page":"2000-2011","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":12,"title":["Wayfinding through the \u201cocean of the great unknown\u201d: how lactating parents establish a direct breastfeeding relationship with an infant with critical CHD"],"prefix":"10.1017","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6559-0812","authenticated-orcid":false,"given":"Kristin M.","family":"Elgersma","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne Chevalier","family":"McKechnie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha A.","family":"Sommerness","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn R.","family":"Tanner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nellie Munn","family":"Swanson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2022,12,9]]},"reference":[{"key":"S1047951122003808_ref9","doi-asserted-by":"publisher","DOI":"10.1016\/S0882-5963(05)80033-8"},{"key":"S1047951122003808_ref29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"S1047951122003808_ref30","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511557842"},{"key":"S1047951122003808_ref16","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2015-308296"},{"key":"S1047951122003808_ref19","doi-asserted-by":"publisher","DOI":"10.1111\/1552-6909.12564"},{"key":"S1047951122003808_ref28","doi-asserted-by":"publisher","DOI":"10.1111\/j.1753-4887.2005.tb00128.x"},{"key":"S1047951122003808_ref27","doi-asserted-by":"publisher","DOI":"10.1097\/JPN.0000000000000572"},{"key":"S1047951122003808_ref11","first-page":"e0135047","volume-title":"PLoS ONE","volume":"10","author":"Al-Shehri","year":"2015"},{"key":"S1047951122003808_ref4","doi-asserted-by":"publisher","DOI":"10.1097\/ANC.0000000000000582"},{"key":"S1047951122003808_ref17","doi-asserted-by":"publisher","DOI":"10.1089\/bfm.2020.0379"},{"key":"S1047951122003808_ref3","unstructured":"3. 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