{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T13:51:30Z","timestamp":1781790690917,"version":"3.54.5"},"reference-count":36,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Hum Lact"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>There is a scarcity of literature documenting how women facing maternal morbidity issues deal with challenges to breastfeeding. This case study documents challenges faced by two women, one who underwent major abdominal surgery immediately after a Caesarean section at 32\u2009weeks, and the other who had a primary and secondary postpartum hemorrhage with repeated hospital admissions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Issue:<\/jats:title>\n                    <jats:p>In the first case, the key issues for lactation were the mother\u2013infant separation and difficulty in initiation and sustaining breastfeeding due to abdominal surgery after her Caesarean section. Early and frequent removal of milk are critical for establishing and sustaining supply and were challenging for the mother in the intensive care unit for 3 weeks. The second case involved a mother experiencing severe postpartum hemorrhage. Having lost over 3 L of blood, this mother faced a significant risk of a reduction in prolactin and activation of her milk supply. Her subsequent weakness and dyspnoea due to anaemia meant breastfeeding required extraordinary effort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Management:<\/jats:title>\n                    <jats:p>Establishing lactation under these circumstances was challenging. Both mothers needed guidance and encouragement to build up and maintain their supply and the practical support of family to care for the infant. In Case Study 1, donor milk was used and alternated with artificial breastmilk substitutes until the mother re-established her supply after discharge. In Case Study 2, the mother required help to express, position, and hold the baby while she breastfed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Despite overwhelming medical and physiological odds, it is possible to establish exclusive breastfeeding with consistent personalized health-system support\/training and relentless determination.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08903344261420065","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T04:52:11Z","timestamp":1773291131000},"page":"315-323","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Studies to Document Strategies Used by Mothers to Overcome Significant Maternal Morbidity Challenges to Successful Breastfeeding"],"prefix":"10.1177","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6864-8477","authenticated-orcid":false,"given":"Penny","family":"Reimers","sequence":"first","affiliation":[{"name":"University of Kwa Zulu Natal, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Coutsoudis","sequence":"additional","affiliation":[{"name":"University of Kwa Zulu Natal, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"crossref","unstructured":"Alpi K. M. Evans J. J. (2019). Distinguishing case study as a research method from case reports as a publication type. Journal of the Medical Library Association 107(1) 1\u20135. https:\/\/doi.org\/10.5195\/jmla.2019.615","DOI":"10.5195\/jmla.2019.615"},{"key":"e_1_3_3_3_1","doi-asserted-by":"crossref","unstructured":"Alves E. Magano R. Amorim M. Nogueira C. Silva S. (2016). Factors influencing parent reports of facilitators and barriers to human milk supply in Neonatal Intensive Care Units. Journal of Human Lactation 32(4) 695\u2013703. https:\/\/doi.org\/10.5195\/jmla.2019.615","DOI":"10.1177\/0890334416664071"},{"key":"e_1_3_3_4_1","doi-asserted-by":"crossref","unstructured":"Chetwynd E. (2024). Resiliency in breastfeeding and lactation research: A conversation about scholastic transparency bias and systems of support. Journal of Human Lactation 40(1) 7\u20139. https:\/\/doi.org\/10.1177\/08903344231218280","DOI":"10.1177\/08903344231218280"},{"key":"e_1_3_3_5_1","doi-asserted-by":"crossref","unstructured":"Dul J. Hak T. (2008). Case study methodology in business research. Routledge. https:\/\/doi.org\/10.4324\/9780080552194","DOI":"10.4324\/9780080552194"},{"key":"e_1_3_3_6_1","volume-title":"A case for the case study","author":"Feagin J. R.","year":"1991","unstructured":"Feagin J. R., Orum A. M., Sjoberg G. (1991). A case for the case study. UNC Press Books."},{"key":"e_1_3_3_7_1","doi-asserted-by":"crossref","unstructured":"Feldman-Winter L. Goldsmith J. P. Committee on Fetus and Newborn & Task Force on Sudden Infant Death Syndrome. (2016). Safe sleep and skin-to-skin care in the neonatal period for healthy term newborns. Pediatrics 138(3) e20161889. https:\/\/doi:10.1542\/peds.2016-1889.","DOI":"10.1542\/peds.2016-1889"},{"key":"e_1_3_3_8_1","doi-asserted-by":"crossref","unstructured":"Flood M. M. Pollock W. E. McDonald S. J. Cullinane F. Davey M.-A. (2023). Primary postpartum haemorrhage adversely impacts breastfeeding initiation in Victoria Australia. Women and Birth: Journal of the Australian College of Midwives 36(6) e582\u2013e590. https:\/\/doi.org\/10.1016\/j.wombi.2023.05.001","DOI":"10.1016\/j.wombi.2023.05.001"},{"key":"e_1_3_3_9_1","doi-asserted-by":"crossref","unstructured":"Fok D. Aris I. M. Ho J. H. Chan Y. H. Rauff M. Lui J. K. Cregan M. D. Hartman P. Chong Y. S. Mattar C. N. (2019). Early initiation and regular breast milk expression reduces risk of lactogenesis II delay in at-risk Singaporean mothers in a randomised trial. Singapore Medical Journal 60(2) 80\u201388. https:\/\/doi.org\/10.11622\/smedj.2018067","DOI":"10.11622\/smedj.2018067"},{"key":"e_1_3_3_10_1","volume-title":"Resilience: Hard-won wisdom for living a better life. Houghton Mifflin Harcourt","author":"Grietans E.","year":"2015","unstructured":"Grietans E. (2015). Resilience: Hard-won wisdom for living a better life. Houghton Mifflin Harcourt."},{"key":"e_1_3_3_11_1","first-page":"428","volume-title":"Handbook of qualitative research","author":"Huberman A. M.","year":"1994","unstructured":"Huberman A. M., Miles M. B. (1994). Data management and analysis methods. In Denzin N. K., Lincoln Y. S. (Eds.), Handbook of qualitative research (pp. 428\u2013444). Sage Publications, Inc."},{"key":"e_1_3_3_12_1","doi-asserted-by":"crossref","unstructured":"Kehinde J. O\u2019Donnell C. Grealish A. (2023). The effectiveness of prenatal breastfeeding education on breastfeeding uptake postpartum: A systematic review. Midwifery 118 103579. https:\/\/doi.org\/10.1016\/j.midw.2022.103579","DOI":"10.1016\/j.midw.2022.103579"},{"key":"e_1_3_3_13_1","doi-asserted-by":"crossref","unstructured":"Li X. Li Y. Qian L. Han P. Feng H. Jiang H. (2024). Mothers\u2019 experiences of breast milk expression during separation from their hospitalized infants: A systematic review of qualitative evidence. Biomed Central Pregnancy Childbirth 24(1) 124. https:\/\/doi.org\/10.1186\/s12884-024-06323-3","DOI":"10.1186\/s12884-024-06323-3"},{"key":"e_1_3_3_14_1","doi-asserted-by":"crossref","unstructured":"Meier P. P. (2022). More evidence: Mothers\u2019 own milk is personalized medicine for very low birthweight infants. Cell Reports Medicine 163(8) 100710. https:\/\/doi.org\/10.1016\/j.xcrm.2022.100710","DOI":"10.1016\/j.xcrm.2022.100710"},{"key":"e_1_3_3_15_1","doi-asserted-by":"crossref","unstructured":"Meier P. P. Johnson T. J. Patel A. L. Rossman B. (2017). Evidence-based methods that promote human milk feeding of preterm infants: An expert review. Clinics in Perinatology 44(1) 1\u201322. https:\/\/doi.org\/10.1016\/j.clp.2016.11.005","DOI":"10.1016\/j.clp.2016.11.005"},{"key":"e_1_3_3_16_1","doi-asserted-by":"crossref","unstructured":"Mercer R. T. (2004). Becoming a mother versus maternal role attainment. Journal of Nursing Scholarship 36(3) 226\u2013232. https:\/\/doi:10.1111\/j.1547-5069.2004.04042.x","DOI":"10.1111\/j.1547-5069.2004.04042.x"},{"key":"e_1_3_3_17_1","volume-title":"Revised and expanded from \u201cCase Study Research in Education\u201d: ERIC","author":"Merriam S. B.","year":"1998","unstructured":"Merriam S. B. (1998). Qualitative research and case study applications in education. Revised and expanded from \u201cCase Study Research in Education\u201d: ERIC (2nd ed.). Toward Developing a Framework for Conducting Case Study Research. Jossey-Bass.","edition":"2"},{"key":"e_1_3_3_18_1","doi-asserted-by":"crossref","unstructured":"Modak A. Ronghe V. Gomase K. P. (2023). The psychological benefits of breastfeeding: Fostering maternal well-being and child development. Cureus 915(10) e46730. https:\/\/doi.org\/10.7759\/cureus.46730","DOI":"10.7759\/cureus.46730"},{"key":"e_1_3_3_19_1","doi-asserted-by":"crossref","unstructured":"Mulcahy H. Philpott L. F. O\u2019Driscoll M. Bradley R. Leahy-Warren P. (2022). Breastfeeding skills training for health care professionals: A systematic review. Heliyon 8(11): e11747. https:\/\/doi.org\/10.1016\/j.heliyon.2022.e11747","DOI":"10.1016\/j.heliyon.2022.e11747"},{"key":"e_1_3_3_20_1","doi-asserted-by":"crossref","unstructured":"Naja F. Chatila A. Ayoub J. J. Abbas N. Mahmoud A. Mina Collaboraters Ali Abdulmalik M. Nasreddine L. (2022). Prenatal breastfeeding knowledge attitude and intention and their associations with feeding practices during the first six months of life: A cohort study in Lebanon and Qatar. International Breastfeeding Journal 17(1) 15. https:\/\/doi.org\/10.1186\/s13006-022-00456-x","DOI":"10.1186\/s13006-022-00456-x"},{"key":"e_1_3_3_21_1","doi-asserted-by":"crossref","unstructured":"Neovita Study Group. (2016). Timing of initiation patterns of breastfeeding and infant survival: Prospective analysis of pooled data from three randomised trials. Lancet Global Health 4(4) e266\u2013e275. https:\/\/doi.org\/10.1016\/S2214-109X(16)00040-1","DOI":"10.1016\/S2214-109X(16)00040-1"},{"key":"e_1_3_3_22_1","doi-asserted-by":"crossref","unstructured":"Odom E. C. Li R. Scanlon K. S. Perrine C. G. Grummer-Strawn L. (2013). Reasons for earlier than desired cessation of breastfeeding. Pediatrics 131 e726\u2013e732. https:\/\/doi.org\/10.1542\/peds.2012-1295","DOI":"10.1542\/peds.2012-1295"},{"key":"e_1_3_3_23_1","doi-asserted-by":"crossref","unstructured":"P\u00e9rez-Escamilla R. Martinez J. L. Segura-P\u00e9rez S. (2016). Impact of the baby-friendly hospital initiative on breastfeeding and child health outcomes: A systematic review. Maternal & Child Nutrition 12(3) 402\u2013417. https:\/\/doi:10.1111\/mcn.12294.","DOI":"10.1111\/mcn.12294"},{"key":"e_1_3_3_24_1","doi-asserted-by":"crossref","unstructured":"P\u00e9rez-Escamilla R. Tomori C. Hern\u00e1ndez-Cordero S. Baker P. Barros A. J. D. B\u00e9gin F. Chapman D. J. Grummer-Strawn L. M. McCoy D. Menon P. Ribeiro Neves P. A. Piwoz E. Rollins N. Victora C. G. Richter L. & 2023 Lancet Breastfeeding Series Group. (2023). Breastfeeding: Crucially important but increasingly challenged in a market-driven world. Lancet 401(10375) 472\u2013485. https:\/\/doi.org\/10.1016\/S0140-6736(22)01932-8","DOI":"10.1016\/S0140-6736(22)01932-8"},{"key":"e_1_3_3_25_1","doi-asserted-by":"crossref","unstructured":"Rafii F. Alinejad-Naeini M. Peyrovi H. (2020). Maternal role attainment in mothers with term neonate: A hybrid concept analysis. Iranian Journal of Nursing and Midwifery Research 25(4) 304\u2013313. https:\/\/doi.org\/10.4103\/ijnmr.IJNMR_201_19","DOI":"10.4103\/ijnmr.IJNMR_201_19"},{"key":"e_1_3_3_26_1","doi-asserted-by":"crossref","unstructured":"Rieth E. F. Barnett K. M. Simon J. A. (2018). Implementation and organization of a perioperative lactation program: A descriptive study. Breastfeeding Medicine 13 97\u2013105. https:\/\/doi.org\/10.1089\/bfm.2017.0193","DOI":"10.1089\/bfm.2017.0193"},{"key":"e_1_3_3_27_1","doi-asserted-by":"crossref","unstructured":"Rostom H. Meng X. Price H. Fry A. Elajnaf T. Humphrey R. Guha N. Kennedy S. H. (2022). Protocol for an observational study investigating hormones triggering the onset of sustained lactation: The INSIGHT study. British Medical Journal Open 12(8) e062478. https:\/\/doi.org\/10.1136\/bmjopen-2022-062478","DOI":"10.1136\/bmjopen-2022-062478"},{"key":"e_1_3_3_28_1","unstructured":"Shrestha S. Adachi K. Petrini M. A. Shrestha S. (2019). Maternal role: A concept analysis. Journal of Midwifery and Reproductive Health 7(3) 1732\u20131741. https:\/\/doi.org\/10.22038\/jmrh.2019.31797.1344"},{"key":"e_1_3_3_29_1","volume-title":"The art of case study","author":"Stake R. E.","year":"1995","unstructured":"Stake R. E. (1995). The art of case study. Sage."},{"key":"e_1_3_3_30_1","doi-asserted-by":"crossref","unstructured":"Tomlin G. Borgetto B. (2011). Research pyramid: A new evidence-based practice model for occupational therapy. American Journal of Occupational Therapy 65(2) 189\u2013196. https:\/\/doi.org\/10.5014\/ajot.2011.000828","DOI":"10.5014\/ajot.2011.000828"},{"key":"e_1_3_3_31_1","doi-asserted-by":"crossref","unstructured":"Vetulani J. (2013). Early maternal separation: A rodent model of depression and a prevailing human condition. Pharmacological Reports 65 1451\u20131461. https:\/\/doi.org\/10.1016\/s1734-1140(13)71505-6","DOI":"10.1016\/S1734-1140(13)71505-6"},{"key":"e_1_3_3_32_1","doi-asserted-by":"crossref","unstructured":"Watson J. Hermann S. Johnson B. (2013). Developing a policy to support breastfeeding in women who are hospitalized and acutely ill. Nursing Women\u2019s Health 17 188\u2013196. https:\/\/doi.org\/10.1111\/1751-486X.12032","DOI":"10.1111\/1751-486X.12032"},{"key":"e_1_3_3_33_1","doi-asserted-by":"crossref","unstructured":"Wilson D. R. Cooper C. Plunk K. Severson M. (2012). Overcoming breastfeeding challenges: A qualitative inquiry. Clinical Lactation 3(4) 155\u2013160. https:\/\/doi.org\/10.1891\/215805312807003771","DOI":"10.1891\/215805312807003771"},{"key":"e_1_3_3_34_1","unstructured":"World Health Organization & United Nations Children\u2019s Fund (UNICEF). (2003). Global strategy for infant and young child feeding. World Health Organization. https:\/\/iris.who.int\/handle\/10665\/42590"},{"key":"e_1_3_3_35_1","volume-title":"Case study research: Design and methods","author":"Yin R.K.","year":"1989","unstructured":"Yin R.K.(1989). Case study research: Design and methods. Sage."},{"key":"e_1_3_3_36_1","volume-title":"Applications of case study research","author":"Yin R.","year":"1993","unstructured":"Yin R. (1993). Applications of case study research. Sage."},{"key":"e_1_3_3_37_1","volume-title":"Case study research: Design and methods","author":"Yin R.K.","year":"1994","unstructured":"Yin R.K. (1994). Case study research: Design and methods. (2nd ed.). Sage","edition":"2"}],"container-title":["Journal of Human Lactation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08903344261420065","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/08903344261420065","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08903344261420065","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T12:56:47Z","timestamp":1781787407000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/08903344261420065"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,11]]},"references-count":36,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1177\/08903344261420065"],"URL":"https:\/\/doi.org\/10.1177\/08903344261420065","relation":{},"ISSN":["0890-3344","1552-5732"],"issn-type":[{"value":"0890-3344","type":"print"},{"value":"1552-5732","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,11]]}}}