Breastfeeding is commonly advocated as the ideal source of newborn nutrition and is linked to several advantages for both mothers and infants 123. However, the actual experience of nursing is frequently more complicated than the idealized narratives that portray it as something that is effortless and instinctive 456. In the United States, approximately 84% of mothers initiate breastfeeding, yet duration declines substantially over time, with about 58% of infants receiving any breast milk at six months and 35% at twelve months, both below Healthy People 2030 targets of 42.4% 12378.

When broken down by race and ethnicity, breastfeeding rates are even lower than they should be. The lower rates experienced by non-Hispanic Black mothers relative to their counterparts reflect larger structural and contextual discrepancies in access to breastfeeding support 910. National estimates indicate breastfeeding initiation rates of approximately 75.4% among non-Hispanic Black mothers, compared with 86.2% among non-Hispanic White mothers and 83.4% among Hispanic mothers 123910.

For mothers who work outside the home or whose infants require medical care, pumping introduces additional physical, emotional, and logistical demands 1112. Unlike direct breastfeeding, pumping often occurs in environments lacking sensory cues associated with the infant and may involve distractions, time pressure, or limited privacy 1112131415. These conditions can interfere with maternal relaxation and attentional focus, both of which are critical for effective milk ejection 1516. As a result, pumping can shift from an experience associated with maternal infant bonding to one characterized by persistence and effort 45151718.

Emerging digital technologies offer potential strategies to address these challenges. Augmented reality (AR) systems overlay digital visual content onto the user's real-world environment, creating immersive experiences that may enhance attentional focus and emotional engagement 19. By presenting infant-related imagery in a more immersive context, AR may help recreate sensory conditions that support the physiological processes underlying milk ejection 16.

This study was guided by the Biopsychosocial Model and psychoneuroendocrine perspectives on lactation, which suggest that biological processes, psychological experiences, and environmental influences interact to shape breastfeeding and pumping outcomes 202122. In the present study, these domains were reflected through physiological responses, emotional engagement, attentional focus, and exposure to infant-related visual cues.

This mixed-methods study examined whether immersive visual technology influences physiological responses and the experiential context of pumping. Using secondary quantitative data from its parent iPUMP study, and primary qualitative data from follow-up interviews, this study integrates physiological measures with participant experiences to better understand how immersive visual technologies may shape both measurable and experiential dimensions of breast pumping.

Successful milk expression during pumping is influenced not only by mechanical pump function but also by maternal psychological state and physiological regulation 2021222324. The milk ejection reflex is mediated by oxytocin release, which can be inhibited by stress, distraction, and negative emotional states 2425. Research has shown that maternal anxiety and psychological distress are associated with challenges in milk let-down and breastfeeding outcomes 2425262728. Conversely, relaxation and emotional connection with the infant can facilitate oxytocin release and support effective milk expression 27. Sensory cues such as visual, tactile, and auditory interaction with the infant play an important role in stimulating this response 242526.

However, mothers who rely on pumping are often separated from their infants and may express milk in environments or other settings where distractions and time pressures are common 141516171821. The absence of infant-related sensory cues, combined with environmental stressors, may disrupt the neuroendocrine processes that support milk ejection 2126. Consistent with these challenges, studies of pump-dependent feeding report that mothers frequently experience stress, performance pressure, and difficulty maintaining focus during pumping sessions 1215162829. Recent advances in digital health technologies have created new opportunities to support patient experiences across healthcare settings 3132. Notably, augmented reality (AR) has emerged as a promising digital technology, with applications in healthcare settings including mental health, ophthalmology, rehabilitation, telemedicine, and clinical practice 31.

AR works by overlaying digital visual content onto the user’s real-world environment, creating immersive experiences that can enhance attention, engagement, and emotional connection 1735. From the clinical perspective, research suggests that immersive visual technologies can improve focus, reduce anxiety, and enhance emotional engagement during medical procedures 303133. For instance, AR-assisted training has enhanced medical students’ understanding of complex physiological processes such as pulmonary mechanics and wound care 3738. Similarly, among nursing students, AR has been shown to improve medication preparation accuracy by visually reducing potential errors 333438. These applications demonstrate how immersive technologies can influence attention, learning, and emotional engagement, mechanisms that may also be relevant for supporting maternal experiences during breast pumping.

The potential relevance of AR for breastfeeding support lies in its ability to recreate sensory experiences associated with maternal–infant interaction. Immersive visual environments may help restore infant-related cues that support oxytocin-mediated milk ejection while simultaneously reducing environmental distractions 3940. Prior studies have explored alternative digital technologies such as virtual reality (VR) to support the breastfeeding parent. For example, Tang et al. (2022) developed Virtual Feed, an immersive VR simulation designed to represent aspects of the lived breastfeeding experience and expose users to common breastfeeding challenges 41. Evaluation of the simulation suggested that immersive technology may promote user engagement, curiosity, and reflection regarding breastfeeding experiences. Although this application focused primarily on antenatal education rather than milk expression, it demonstrates the potential for immersive environments to address experiential dimensions of breastfeeding that may be difficult to reproduce through conventional educational approaches 39404142434445.

However, because VR replaces the user’s real-world environment with a fully simulated one, it may limit situational awareness, which is often necessary for mothers pumping in workplaces or clinical settings 17. In contrast, AR provides immersive visual engagement while maintaining awareness of the surrounding environment, making it potentially more suitable for pump-based milk expression 17404244.

Despite the growing use of immersive technologies in healthcare, research examining the use of AR specifically during breast pumping remains limited. Most breastfeeding interventions focus on education, counseling, or workplace accommodations rather than addressing the emotional and attentional context of pump-based milk expression 9111213. Understanding how immersive technologies influence these conditions may therefore help identify new strategies to support mothers who rely on pumping during periods of separation from their infants.

Guided by the biopsychosocial and psychoneuroendocrine perspectives on lactation, the present mixed-methods study examined whether an immersive environment may influence maternal focus, perceived stress, and physiological responses during breast pumping 192021. To that aim, this study addressed the following research questions:

1. What is the impact of AR-based visual support on physiological markers?

2. What factors influence the usability and feasibility of AR technology in lactation environments?

3. How do mothers describe their emotional experience when using AR versus standard digital media?

Results are presented in alignment with the study research questions, including quantitative findings related to physiological responses, followed by qualitative findings describing participant experiences.

The current mixed-methods study examined the influence of immersive visual technology, specifically augmented reality (AR), on physiological responses and the experiential context of breast pumping. Quantitative findings demonstrated modest and variable changes in heart rate and blood pressure across conditions, with no statistically significant differences observed between tablet and AR sessions. However, feasibility ratings differed significantly between conditions, suggesting that participants perceived meaningful differences in the usability and practicality of the technologies. Qualitative findings further revealed that AR enhanced focus, immersion, emotional engagement, and perceived support during pumping. Together, these findings suggest that immersive visual technologies may influence the pumping experience primarily through emotional and attentional pathways rather than through immediate physiological changes.

The qualitative findings provide important insight into the potential mechanisms underlying these experiences. Participants consistently described AR as more immersive and less distracting than tablet-based viewing, allowing them to focus more fully on pumping and infant imagery. These findings align with biopsychosocial and psychoneuroendocrine perspectives, which recognize that emotional state, environmental context, attentional focus, and physiological regulation may interact during lactation-related processes 1920. Prior research has shown that maternal psychological state, stress, and relaxation can influence milk ejection during breast pumping 252627. Similarly, studies examining immersive technologies have reported that increased presence and attentional engagement may enhance emotional involvement while reducing awareness of external distractions 5758. The current findings extend this literature by suggesting that AR may provide a uniquely immersive environment that supports maternal focus during pumping.

Participants frequently reported feeling calmer, more present, and more emotionally connected to their infants while using AR. These findings are consistent with evidence demonstrating that maternal relaxation and reduced psychological distress can positively influence lactation outcomes and maternal well-being 212324252627. Relaxation-based interventions have been associated with reductions in stress and anxiety as well as improvements in milk production, suggesting that emotional and psychological states play an important role in breastfeeding and pumping experiences 59. However, unlike some studies that have reported measurable physiological benefits associated with stress-reduction interventions, the present study did not observe statistically significant physiological differences between conditions. This discrepancy may reflect the complex and multifactorial nature of lactation physiology, in which subjective experiences do not always correspond to immediately detectable physiological changes. The variability observed in the present findings is also consistent with emerging evidence regarding immersive technologies in breastfeeding support. In a recent systematic review and meta-analysis, Raghav et al. (2026) found that VR-based interventions demonstrated potential benefits for selected outcomes, including prenatal breastfeeding self-efficacy, motivation, breastfeeding technique, and earlier breastfeeding initiation; however, significant effects were not observed for postnatal self-efficacy, exclusive breastfeeding, or maternal anxiety 57. The authors further noted low to very low certainty of evidence across outcomes, highlighting the preliminary and inconsistent nature of the current evidence base. These findings parallel the present study, in which participants described meaningful experiential benefits despite the absence of statistically significant differences in immediate physiological responses. Together, this emerging literature suggests that immersive technologies may initially influence experiential, attentional, or behavioral dimensions of breastfeeding support more readily than measurable physiological or longer-term breastfeeding outcomes.

Environmental context emerged as a crucial factor. Participants contrasted the calm laboratory environment with the competing demands and distractions of home or work. This aligns with previous research showing that interruptions, lack of privacy, and competing responsibilities negatively impact pumping experiences 69121328. Mental visualization and infant-related imagery trigger or support milk ejection reflexes, especially when physically separated from infants 28. Workplace and home-based barriers to pumping hinder lactation goals, especially for individuals juggling caregiving, employment, and household responsibilities 2829. This may be particularly relevant for individuals pumping while separated from their infants, as visual imagery and mental visualization can facilitate milk ejection responses even without direct infant contact 4041424344.

The qualitative findings suggest that immersive visual technologies may help reduce environmental distractions and promote focused engagement, even when direct physiological effects are not readily detectable.

Practical considerations should also be considered when interpreting these findings. Although participants generally viewed AR as engaging and supportive, concerns regarding portability, convenience, and setup time were frequently discussed. In comparison, tablet-based viewing was often perceived as more practical for everyday use due to its familiarity and ease of access. Similar concerns have been reported in broader immersive technology research, where usability, accessibility, and convenience are important determinants of sustained adoption despite positive user experiences 4244. These findings mirror broader technology adoption literature, which suggests that perceived usefulness must be balanced with convenience and ease of implementation for sustained use 303558. Future technological advancements that improve portability and reduce setup burden may increase the feasibility of immersive technologies for routine pumping support.

Taken together, our findings suggest that the primary value of immersive visual support may lie in improving the quality of the pumping experience rather than producing immediate physiological changes. By enhancing focus, emotional connection, and perceived support during pumping, immersive technologies may contribute to a more positive and sustainable pumping experience. Given that stress, frustration, and perceived inefficiency are commonly cited reasons for discontinuing pumping, interventions that improve the overall pumping experience may have important implications for breastfeeding continuation and maternal well-being. Existing evidence suggests that maternal psychological distress may adversely affect lactation outcomes, while relaxation-based interventions may improve both milk production and maternal well-being 5859. Therefore, technologies that support relaxation, emotional connection, and sustained engagement may represent a valuable adjunct to breastfeeding support strategies.

This study has several notable strengths. First, the mixed-methods design allowed quantitative findings to be interpreted alongside participant experiences, providing a more comprehensive understanding of visually supported pumping. The integration of physiological measures, feasibility data, and qualitative interviews allowed for triangulation of findings across multiple sources of evidence. In addition, the use of both laboratory and home-based data collection enhanced ecological relevance and provided insight into the variability of real-world pumping experiences. The repeated-measures design reduced the influence of individual differences by allowing within-participant comparisons across study sessions.

Several limitations should also be considered. The parent iPUMP study was designed as a pilot feasibility study and therefore included a modest sample size, limiting statistical power to detect small intervention effects. In addition, session order was not counterbalanced: all participants completed the tablet condition during the first laboratory session, while participants assigned to the intervention sequence completed the AR condition during the second session. Consequently, potential session-order effects, including increased familiarity with the pumping protocol, study environment, or equipment during the second visit, cannot be fully distinguished from effects associated with AR exposure. Although pumping duration was replicated across sessions to improve within-participant consistency, the possibility of learning or carryover effects should be considered when interpreting differences between the tablet and AR conditions.

Additionally, physiological responses to pumping are influenced by numerous factors, including feeding schedules, hydration status, fatigue, stress, and individual differences in lactation physiology. These factors may have contributed to variability across participants and reduced the likelihood of detecting measurable differences between conditions. Repeated stress survey data were incomplete for some participants, limiting the ability to examine changes in perceived stress over time. A small number of observations were also missing for individual physiological and feasibility measures; therefore, paired analyses were conducted using available complete observations for each outcome without imputation. This resulted in slight variation in analytic sample size across outcomes.

The intervention was also limited to a single AR exposure during one laboratory pumping session. Accordingly, the present findings reflect participants’ immediate responses to AR rather than the effects of repeated or sustained use. A single exposure may not be sufficient to determine whether the experiential benefits described by participants persist over time or translate into measurable changes in physiological responses, pumping behaviors, or longer-term breastfeeding outcomes. Future studies should evaluate repeated AR exposure across multiple pumping sessions and settings and incorporate longer follow-up periods to assess the durability and potential cumulative effects of immersive visual support.

Furthermore, qualitative interviews were conducted following completion of the parent study, and in some cases several months had elapsed between study participation and interview completion. As a result, participant recollections may have been influenced by recall bias.

Finally, practical concerns related to device portability, setup requirements, and convenience may affect the real-world adoption of immersive technologies in pumping contexts. Despite these limitations, the study provides valuable insight into both the measurable and experiential dimensions of technology-assisted pumping.

This mixed-methods study explored the role of immersive visual technology in shaping the breast pumping experience. Quantitative findings demonstrated modest and variable physiological responses across conditions, while qualitative findings consistently highlighted meaningful differences in participant experiences. Participants described augmented reality as more immersive, less distracting, and more emotionally engaging than tablet-based viewing. Many participants also reported increased focus, relaxation, and perceived support during pumping sessions.

These findings suggest that immersive visual technologies may influence pumping experiences through emotional and attentional mechanisms rather than through immediate physiological changes. By reducing environmental distractions and promoting focused engagement with infant imagery, AR environments may help create conditions that support maternal focus, relaxation, and engagement during pumping. Although additional research with larger samples, repeated AR exposure, and longer follow-up periods is needed, the findings provide preliminary evidence that immersive technologies may represent a promising approach for supporting individuals who rely on breast pumps during periods of separation from their infants.

Future research should continue to examine how immersive technologies can be integrated into maternal health interventions, including whether repeated use across diverse pumping environments produces sustained experiential or physiological effects and whether improvements in pumping experiences contribute to longer-term outcomes such as pumping adherence, breastfeeding continuation, and maternal well-being.

Funding for the parent study was supported by the Charles R. Drew University Black Maternal Health Center of Excellence Biddy Mason Fellowship (PI: Blackman). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding source. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

Supplementary Data