Mothers' Decisions to Change From Formula to Mothers’ Milk for Very-Low-Birth-Weight Infants


  • Donna Jo Miracle RNC, CLE,

    Corresponding author
    1. Doctoral candidate at Rush University, Chicago, Illinois.
      Donna Jo Miracle, RNC, CLE, Rush University, 818 Longford Way, Noblesville, IN 46062. E-mail:
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  • Paula P. Meier RN, DNSc, FAAN,

    1. Director for clinical research and lactation at the Special Care Nursery, Rush University Medical Center, and a professor of maternal child nursing at Rush University College of Nursing, Chicago, Illinois.
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  • Patricia A. Bennett DSN, RN

    1. Professor and director emeritus of the School of Nursing, Anderson University, Anderson, Indiana.
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Donna Jo Miracle, RNC, CLE, Rush University, 818 Longford Way, Noblesville, IN 46062. E-mail:


Objective: The purpose of this study was to examine maternal decisions about providing milk for a very-low-birth-weight (VLBW) infant, when the initial maternal intent was to formula-feed.

Design: Using prospective, purposive sampling, semistructured interviews were conducted with 21 of 23 eligible mothers over a 9-month period. Audio-recorded data were transcribed verbatim, coded, categorized, and subjected to dimensional analysis.

Setting: The study took place in a 52-bed, tertiary urban neonatal intensive-care unit.

Patients/Participants: Mean maternal age was 26.5 years (range = 18–38), and mean infant birth weight and gestational age were 705.4 g (range = 504–1,310), and 25.8 weeks (range = 23–33), respectively. Of the 21 mothers, 76% were African American or Latina; 62% were low income.

Main Outcome Measures: We evaluated mothers’ initial reasons for selecting formula and changing the decision to provide their milk, whether they were made to feel guilty or coerced, the processes of establishing and maintaining lactation, and breastfeeding outcomes at 1-month postbirth.

Results: Mothers initially chose formula because they had no breastfeeding role models and were fearful of pain and lifestyle modifications. They changed this decision after the nurse or physician talked with them about the health benefits for their infant. Of the 21 women, all denied feeling pressured, coerced, or guilty about the decision change, and all identified rewards to themselves and their infants. All mothers provided milk for greater than or equal to 30 days, 19 went on to feed at breast, and 2 became certified breastfeeding peer counselors for the Rush Mothers’ Milk Club.

Conclusion: These findings underscore the role of nurses and physicians in providing evidence-based information about mothers’ milk and indicate that sharing this knowledge does not make mothers of VLBW infants feel pressured, coerced, or guilty.