title: Mothers' decisions to change from formula to mothers' milk for very-low-birth-weight infants.
abstract: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  The study took place in a 52-bed, tertiary urban neonatal intensive-care unit.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: CLE, Rush University, 818 Longford Way, Noblesville, IN 46062, USA. Donna_Miracle@rush.edu
authors.forename: Donna Jo
authors.initials: DJ
authors.lastname: Miracle
authors.forename: Paula P
authors.initials: PP
authors.lastname: Meier
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Bennett
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000523:psychology; D003657:Decision Making; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D007774:Lactation / Q000523:psychology; D009035:Mothers / Q000193:education / Q000523:psychology; D017283:Neonatal Nursing / Q000592:standards*; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D015403:Nursing Evaluation Research; D011446:Prospective Studies; D012494:Sampling Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States; D014505:Urban Population