Informed decision – Effective initiation interventions

Providing parents with scientific facts, prompts mothers to almost always decide to initiate milk expression. Understanding that their milk is a crucial medical intervention that no one else can provide empowers them when their infant is hospitalised in the NICU.

Healthcare professional informs mother about the importance of own mothers milk

What is informed decision?

A decision based on the knowledge of facts. This is facilitated by the process of providing clear, concise, consistent and evidence-based information that involves conversations on the benefits, risks and alternatives with respect to the provision of own mother’s milk (OMM). Such conversations empower and enable parents to make knowledgeable lactation decisions.

Why is informed decision important?

The science of human milk is powerful and compelling.1 When parents are given scientific and factual information, mothers almost always decide to initiate milk expression because they understand their milk is an essential medical intervention that no one else can provide.2-4 

Mothers and families of NICU infants are often in a state of shock, despair and helplessness.5 Discussion and information about the critical value of own mother’s milk and tailored lactation information specific to NICU infants and their circumstances provides parents with:6,7

  • A positive focus and an integral role in their baby’s care
  • A change of outlook towards one of hope
  • A strong commitment to optimise infant health outcomes

How to implement informed decision

  • Ensure all HCPs are provided regular education on the value of human milk to reduce the associated risks of neonatal co-morbidities in and on lactation best practices. For further information, watch 'Getting it right: The critical window of opportunity to establish lactation and improve patient satisfaction'  webinar by Professor Diane Spatz.
  • Ensure all mothers are given evidence-based information on the science of OMM
  • Ensure that pregnant and perinatal women with known risk factors for lactation delay are provided with pre and perinatal education focused on the value of OMM and how to initiate and build milk supply. This information should concentrate on the importance of:
    • OMM as a medical intervention for NICU infants
    • Initiating expression within 3 hours of birth
    • Expressing 8 or more times every 24 hours
    • Tracking milk volumes from birth with a pumping log 
    • The first 72h to effectively initiate secretory activation and the first 14 days to come to volume– the critical window of opportunity for appropriate lactation initiation
  • Collaborative working with Maternity (prenatal, delivery suite, postnatal) and NICU HCPs
  • Documenting in maternal and infant medical records the consultations where lactation best practices have been discussed

How to monitor informed decision

Collect data on frequency and quality of discussions with pregnant women and perinatal mothers with a data collection tool.

Strategies to measure best practice include auditing maternal and infant medical records

  • if antenatal lactation discussion on the science of OMM for the NICU infant occurred
  • if postnatal lactation discussion on the science of OMM for the NICU infant occurred

Informing mums - effective initiation


1 Meier PP et al. Human milk in the neonatal intensive care unit. In: Family Larsson-Rosenquist Foundation, editor. Breastfeeding and breast milk - From biochemistry to impact: A multidisciplinary introduction. 1st ed. Stuttgart: Thieme; 2018.

2 Miracle DJ et al. Mothers' decisions to change from formula to mothers' milk for very-low-birth-weight infants. J Obstet Gynecol Neonatal Nurs. 2004; 33(6):692–703.

3 Spatz DL. Ten steps for promoting and protecting breastfeeding for vulnerable infants. J Perinat Neonatal Nurs. 2004; 18(4):385–396.

4 Meier PP et al. Evidence-based methods that promote human milk feeding of preterm infants: An expert review. Clin Perinatol. 2017; 44(1):1–22.

5 Sisk PM et al. Lactation counseling for mothers of very low birth weight infants: Effect on maternal anxiety and infant intake of human milk. Pediatrics. 2006; 117(1):e67-75.

6 Thomson G et al. Parents' experiences of emotional closeness to their infants in the neonatal unit: A meta-ethnography. Early Hum Dev. 2020; 149:105155.

7 O'Brien K et al. Effectiveness of Family Integrated Care in neonatal intensive care units on infant and parent outcomes: A multicentre, multinational, cluster-randomised controlled trial. Lancet Child Adolesc Health. 2018; 2(4):245–254.