Date of Award


Document Type


Copyright Status, No Creative Commons License

All Rights Reserved

Degree Name

Doctor of Philosophy (Ph.D.) Nursing





Research demonstrates better health outcomes for both women and their infants when infants are breast-fed. There is evidence that an increasing number of full-term, normal birth weight infants are being admitted to the Neonatal Intensive Care Unit (NICU) and that these infants receive less breast milk than their well full-term and preterm infant counter parts. The effect of short-term admission of full-term infants to the NICU on maternal breastfeeding self-efficacy and breastfeeding exclusivity and duration, and the facilitators of and barriers to breastfeeding success reported by these mothers, has not been well explored.


The purpose of this study was to explore the relationship of breast feeding self-efficacy to breastfeeding duration and breastfeeding exclusivity of full-term infants discharged from the NICU and to explore the facilitators and barriers that influence breastfeeding success for a woman with a full-term infant in the NICU. Factors that may affect the breastfeeding self-efficacy of mothers with a full-term infant in the NICU were also explored.


This was a mixed method study where quantitative and qualitative data were collected concurrently. The Critical Incident Technique (CIT) was used to identify the facilitators and barriers to breastfeeding success. The breastfeeding self-efficacy scale for preterm and ill infants (BFSE-SF-IP) was used to measure the mothers’ breastfeeding self-efficacy. One week after the infant’s discharge, the researcher contacted the mothers, who completed the BSFE and described what they thought facilitated or hindered their breastfeeding success. Mothers were contacted three weeks later to ascertain breastfeeding status and formula usage. Data on other maternal and infant variables were also collected. All data was interpreted and integrated to form a phenomenon of a successful mother breastfeeding a full-term infant in the NICU.


The sample was comprised of 41 ethnically diverse postpartum women who were predominately married, well educated, first-time mothers, and delivered by cesarean section. Most had no prior breastfeeding experience. The Cronbach’s alpha of the BSEF-SF-IP in this sample was .953. Regression analyses using the BFSE score and other factors revealed the BFSE to be the only significant predictor of breastfeeding duration and exclusivity at four weeks after discharge and accounted for 47 percent of the variance in the amount of formula used at four weeks. There was a positive correlation between breastfeeding experience, number of live births, breastfeeding at one and four weeks and BFSE scores. There was also a strong negative correlation between breastmilk pumping at one week, formula usage at one and four weeks and BFSE scores.

Mothers identified 67 critical incidents as facilitators for and barriers to breastfeeding success in the NICU and one week postpartum. The most frequently cited facilitators in the NICU were nurses/lactation consultant support, and breastfeeding skills. The most common cited barriers to breastfeeding success were feeding the infant formula, separation from the baby, scheduled feedings and not enough breastmilk. After the baby was home for one week, mothers most often reported the facilitators to be family support, determination, and staying with the baby. Not having enough milk and infant not taking the breast were the most frequently cited barriers to breastfeeding success at one week.


Women with a moderate to high BFSE score were more likely to be exclusively breastfeeding one-week post discharge. These women generally were experienced mothers with other children. They identified the use of formula, scheduled feedings, and separation from their infants as barriers to breastfeeding success in the NICU. Family support and determination was their key to facilitators for breastfeeding success at one-week at home time frame.

First time mothers with a moderate to high BFSE identified facilitators for breastfeeding success in the NICU as the nurse/lactation consultant support and developing breastfeeding skills. They had a fear of not producing enough milk in the NICU and at home. They also spoke of determination and support as a facilitator to breastfeeding success.

Mothers with a lower BFSE scores, were predominately first-time mothers. They all reported not enough milk as a barrier to successful breastfeeding. The majority of these mothers also reported the infant not latching. First-time mothers were also the only ones in the study who identified physically not feeling well or having a cesarean section as a barrier to successful breastfeeding in the NICU.

Summary and Recommendations

This study demonstrated positive breastfeeding self-efficacy can determine successful breastfeeding at one and four weeks after discharge. The research and practice implications of this study suggest that breastfeeding self-efficacy enhances breastfeeding success and warrants further study.

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Nursing Commons