How can I increase breast milk expression?

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SUMMARIES OF STUDIES
Total studies in list: 12
Sorted by publication year
1
AUTHORS
Surekha Khandale
Palak Agrawal
P. A. Uikey
PUBLISHED
2017 in International journal of reproduction, contraception, obstetrics and gynecology
UNRANKED SOURCE
2
Preterm infants’ mothers’ initiation and frequency of breast milk expression and exclusive use of mother's breast milk in neonatal intensive care units
"AIM AND OBJECTIVES To describe preterm infants' mothers' expressing practices and exclusive use of mother's breast milk in neonatal intensive care settings, as well as to explore whether mothers' and infants' characteristics are predictors of the mother's inadequate expressing practices and non-exclusive use of mothers' breast milk. BACKGROUND Use of their own mother's milk decreases preterm infants' mortality and morbidity, but expression is exhausting for the mothers. Mothers' and infants' characteristics are associated with milk output and exclusive breastfeeding at discharge, as well as later in infancy. DESIGN Cross-sectional study. METHODS The data were collected through questionnaires in two neonatal units. Multiple logistic regression was used to determine whether mothers' and infants' characteristics are predictors of late expression initiation (> six hours from birth), inadequate expression frequency (≤ six times per a day), and non-exclusive use of own mother's milk. RESULTS The sample consisted of 129 mothers. One-third of the mothers had adequate expression practices. Half of the infants exclusively received their mother's own breast milk. Previous neonatal intensive care unit experience, poor psychological well-being, an infant's male gender, caesarean section, and high gestational birth age were significant predictors of late expression initiation. None of the studied variables were significant predictors of inadequate expression frequency. Furthermore, lack of previous expression experience, financial woes, and high gestational age were predictors of non-exclusive use of own mother's milk. CONCLUSIONS Expression practices, as well as use of own mother's milk, were suboptimal. High gestational age was associated with both late expression initiation and non-exclusive breast milk use. The mothers maintained expression regardless of their well-being. RELEVANCE TO CLINICAL PRACTICE Counseling and support is needed in order to avoid suboptimal expression practices. Special attention should be paid to mothers with moderately preterm infants, caesarean delivery, poor psychological well-being, and financial woes. This article is protected by copyright. All rights reserved."
AUTHORS
Marja Kaunonen
Mika Helminen
Eija Paavilainen
Riikka Ikonen
PUBLISHED
2017 in Journal of Clinical Nursing
High quality source
3
4
Breast milk and the best means of expression
"When newborn breastfed babies have problems sucking or latching on, it is often recommended that their mothers express breast milk. Observational studies suggest that use of breast pumps may lead to shorter overall duration of breastfeeding than if milk is expressed by hand. Some studies show breast pumping yields more milk than hand expression, although the opposite may be true immediately after birth. In a randomised controlled trial, 68 mothers of full-term newborns aged 12–36 h with feeding difficulties were randomised to 15 min of either bilateral hand pumping or hand expression.[1] The median volume expressed in a single session did not differ significantly. Mothers randomised to hand express were more comfortable being seen expressing than those pumping. At two months, significantly more women expressing by hand (96.1%) than by pump (72.7%) were still breastfeeding. This study should be extended to mothers of preterm babies."
PUBLISHED
2013 in Journal of Paediatrics and Child Health
Q2
5
Associations between high prepregnancy body mass index, breast-milk expression, and breast-milk production and feeding
"Background: Breast-milk expression is widely practiced by Amer-ican mothers, but little is known about who expresses milk, how expression affects breastfeeding, or whether overweight or obese women, who have less breastfeeding success than do normal-weight women, express milk differently. Objectives: We investigated 1) whether breast-milk expression be-havior differed by body mass index (BMI; in kg/m 2) category and 2) whether the different breastfeeding behaviors of overweight (BMI: 25 and ,30) and obese (BMI: 30) women resulted in different breastfeeding outcomes. Design: The subjects (n = 2288) provided information on BMI and breast-milk production, feeding, and expression in mail-in question-naires as part of the Infant Feeding Practices Study II. Longitudinal and cross-sectional data were analyzed by using regression proce-dures adjusted for confounding. Results: Women of different BMI categories overall did not differ in whether, when, or why they expressed breast milk. Before 2 mo postpartum, however, obese women were more likely (P = 0.04, unadjusted) to try milk expression and were less likely (P = 0.01, unadjusted) to express milk successfully. In addition, overweight or obesity was associated (P , 0.03, unadjusted) with a shorter dura-tion of breast-milk production only in women who never expressed milk. In overweight or obese women, those who ever expressed milk had longer durations of breastfeeding (P , 0.003, unadjusted) than did those who never expressed milk. Conclusions: Breast-milk expression behaviors may differ by mater-nal BMI category only in the early postpartum period. In addition, breast-milk expression may reduce differences between BMI catego-ries in the duration of breastfeeding and support longer durations of breastfeeding."
AUTHORS
K. M. Rasmussen
S. R. Geraghty
J. Labiner-Wolfe
S. A. Leonard
PUBLISHED
2011 in American Journal of Clinical Nutrition
High quality source
6
Breast milk expression and maintenance in mothers of very low birth weight infants: supports and barriers.
"The study objective was to identify patterns of factors that supported or hindered initiation of breast milk expression and maintenance of breast milk production after the birth of a very low birth weight (VLBW) infant in a sample of US women with varied prenatal infant feeding intentions. In-depth interviews were conducted 1 to 6 months after delivery in 32 women who initiated breast milk expression after encouragement from hospital staff. Pregnancy complications, anxiety regarding their infant's health, and lack of privacy interfered with initiation of milk expression. After hospital discharge, using manual or small electric breast pumps, travel to the neonatal intensive care unit, return to work, and difficulty with time management interfered with maintenance of breast milk production. Family support, positive attitudes toward pumping, and anticipation of breastfeeding supported maintenance of breast milk production. From these data emerge points of intervention where additional support could improve mothers' experiences and increase duration of breast milk feeding."
AUTHORS
Jenna Tucker
Nikki Parson
Sara Quandt
Paula Sisk
PUBLISHED
2010 in Journal of human lactation : official journal of International Lactation Consultant Association
UNRANKED SOURCE
7
AUTHORS
Louise Goosen
Linda Glynn
PUBLISHED
2005 in Journal of Human Lactation
Q2
8
Effect of vacuum profile on breast milk expression using an electric breast pump.
"The authors compared milk expression using 5 experimental vacuum patterns and a commercially available vacuum pattern ranging in cycle times (20 to 78 cycles/min) and vacuum curve dynamics in 30 mothers using an experimental, software-controlled electric breast pump. The volume of milk removed over 5 minutes differed (P = .0072) between patterns (range = 62.8 +/- 6.6 mL to 47.2 +/- 5.1 mL). However, there was no difference in the percentage of available milk removed (range = 99.4% +/- 15.1% to 70.6% +/- 8.6%). The rate of milk removal differed between patterns at both the beginning (1 minute) and end (1.5 minutes) of the expression period (P < .05). Peak vacuum chosen differed between patterns (P = .0085) but was not related to either the volume or percentage of available milk expressed. Breastfeeding characteristics did not differ between poor and successful expressers. These results show that breast milk expression by an electric breast pump can be influenced by the vacuum pattern."
AUTHORS
Peter E Hartmann
Michael Larsson
Lyle C Gurrin
Ching Tat Lai
Leon R Mitoulas
PUBLISHED
2002 in Journal of human lactation : official journal of International Lactation Consultant Association
UNRANKED SOURCE
9
Efficacy of breast milk expression using an electric breast pump.
"The authors compared breastfeeding and expression characteristics in 30 mothers of exclusively breastfeeding, healthy term infants. Mean (+/- SD) volume per breastfeed from one breast was 71.8 +/- 26.3 mL, and mean duration per breastfeed for one breast was 16.6 +/- 10.5 minutes. Mean volume of milk expressed in 5 minutes from one breast was 60.6 +/- 39.0 mL and corresponded to the expression of 99.4 +/- 82.6% of the milk stored in the breast. The rate of milk expression differed greatly between mothers (P = .0001) but remained constant for the first 2.5 minutes before decreasing with time (P = .0001). These results show the mean breastfeed volume was similar to the volume of milk expressed in a 5-minute period. Furthermore, this study is the first to establish protocols that allow for the objective determination of breast pump efficacy."
AUTHORS
Peter E Hartmann
Michael Larsson
Lyle C Gurrin
Ching Tat Lai
Leon R Mitoulas
PUBLISHED
2002 in Journal of human lactation : official journal of International Lactation Consultant Association
UNRANKED SOURCE
10
Randomized Trial Comparing the Efficacy of a Novel Manual Breast Pump With a Standard Electric Breast Pump in Mothers Who Delivered Preterm Infants
"OBJECTIVE: The benefits of human milk for preterm infants are widely recognized, yet technological advances in milk expression have been slow. We compared the efficacy of a standard electric pump (EP; Egnell) used in 94% of United Kingdom neonatal units with a novel manual pump (MP; Avent ISIS) designed to operate more physiologically by simulating the infant's compressive action on the areola during breastfeeding. METHODS: We randomized 145 women who delivered infants of <35 weeks' gestation to use the MP or the EP and measured total milk volume expressed while using the randomized pump during the infant's hospital stay, pattern of milk output and creamatocrit of milk expressed during a test period in the second week, and pump characteristics by maternal questionnaire. RESULTS: Mothers who used the EP, who frequently double pumped, showed shorter expression times but produced no more milk than mothers who used the MP. When both pumped sequentially, however, mothers who used the MP showed significantly greater milk flow and total volume over 20 minutes. Creamatocrit was unaffected by pump type. The MP was rated significantly higher than the EP on 5 major characteristics. CONCLUSIONS: When compared on equal terms (sequential pumping), mothers who used the MP showed greater milk flow, perhaps reflecting more physiologic pump design. Even with double pumping, mothers who used the EP did not advantage their infants with greater milk production. We believe that this novel, effective MP, preferred by mothers and costing a fraction of the EP price, reflects a significant advance in milk expression for high-risk infants.breast pumps, randomized trial, preterm infants."
AUTHORS
A. Lucas
J. S. Ahluwalia
A. Singhal
S. Collier
P. Lucas
M. S. Fewtrell
PUBLISHED
2001 in PEDIATRICS
High quality source
11
Randomized study comparing the efficacy of a novel manual breast pump with a mini-electric breast pump in mothers of term infants.
"The objective of this study was to compare the efficacy of a mini-electric pump (MEP) and a novel manual breast pump (MP) designed to operate more physiologically. Sixty term breastfeeding mothers used the MP and MEP in randomized order 8 weeks postpartum, expressing for 10 minutes from each breast. Milk volume, fat content, and pattern of milk flow were measured. Mothers rated pump characteristics by questionnaire. There was no significant difference in the milk volume or fat content when mothers used the pumps in randomized order. The MP was rated significantly better overall and more comfortable and pleasant to use. Significantly more mothers kept the MP than the MEP. Despite the greater complexity and expense of the MEP, the pumps showed similar efficacy. The MP was preferred by mothers. The novel, more physiological operation of the MP represents an advance in milk expression technology."
AUTHORS
A Lucas
S Collier
P Lucas
M Fewtrell
PUBLISHED
2001 in Journal of human lactation : official journal of International Lactation Consultant Association
UNRANKED SOURCE
12
Manual and pump methods of expression of breast milk
"This study was designed to compare two methods of breast milk expression, namely, the manual and the pumping method using a hand-held cylindric pump. The parameters evaluated were (i) the output of breast milk during milk expression sessions of 15 minutes' duration, and, (ii) the subjective preference of the method by the mothers. In the first phase, 22 mothers whose infants were on gavage feeding in the nursery, had 3 sittings each by the two methods on 4th and 5th postnatal days (66 expression). It was seen that the use of breast pump (Medela) was associated with significantly higher volume of breast milk expressed per session (41.57 +/- 16.05 ml vs. 21.7 +/- 10.5 ml, P < 0.001). In the second phase, 14 mothers had such sessions (42 each) not only on the 4th and 5th postnatal days, but lso on days 8 and 9. It was again seen that, the volume of breast milk expressed was greater by the pump method than the manual expression (on day 5 and 6 (46.8 +/- 26.3 ml vs 31.2 +/- 15.5 ml, P < 0.01) as well as on day 8 and 9 (50.40 +/- 11.2 ml vs 38.49 +/- 13.4 ml, P < 0.01). Subjectively, the pump expression was preferred by the mothers on day 4 {&} 5, while the manual expression was the preference on days 8 {&} 9. The use of breast pump is more efficient than the manual system of expression of breast milk among mothers whose infants are not directly breast-fed. It is recommended that in case the mothers prefer to use the manual method, let them express as much milk as possible by this method initially, and then follow it up with a short period of pumping to ensure complete evacuation of breasts."
AUTHORS
Urmil Taneja
Jamsine Pacheco
Ashok K. Deorari
Meharban Singh
Vinod K. Paul
PUBLISHED
1996 in The Indian Journal of Pediatrics
UNRANKED SOURCE







ADDITIONAL STUDIES TO CONSIDER ADDING TO LIST
Total additional studies: 39
State of K's algorithms generated the list of studies below based on the studies that were added to the above list. Some of these studies may also examine: "How can I increase breast milk expression?" If a study examines this question, add it to the list by pressing the button.

Only add studies that examine the same question. Do not add studies that are merely on the same topic.

Breastfeeding Women’s Experience of Expressing: A Descriptive Study
"There is an increasing trend in Australia and elsewhere for mothers to express breast milk. The purpose of this study was to explore breastfeeding women's experiences of expressing breast milk. An anonymous online questionnaire was sent to Victorian members of the Australian Breastfeeding Association via an e-mail link. Response fraction was 903 of 3024 (29.9%). The most common reason for expressing milk was to "store extra breast milk" (57%, 479/836). The most important reason was "not enough milk"/"to make more milk" (15%, 118/771). The majority of women (65%, 666/843) used an electric breast pump, and this method of expressing was preferred by 59% (454/769) of women. Adverse effects of pumps were pain (17%, 126/737) and damage to nipples (11%, 86/737). Breast pumps may have a role in enabling women to extend the duration of breast milk feeding, but further research is needed."
AUTHORS
Lisa H. Amir
Sarah N. Clemons
PUBLISHED
2010 in Journal of Human Lactation

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HOW CAN BREAST MILK BE INCREASED?
You can view the abstract at: https://doi.org/10.1097/00000446-191402000-00016
PUBLISHED
1914 in AJN, American Journal of Nursing

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HOW CAN BREAST MILK BE INCREASED?
You can view the abstract at: https://doi.org/10.1097/00000446-191414050-00016
PUBLISHED
1914 in AJN, American Journal of Nursing

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THE CARE OF THE BREASTS AND HOW TO INCREASE BREAST MILK
You can view the abstract at: https://doi.org/10.1097/00000446-191406000-00010
AUTHOR
MARTHA W. MOORE
PUBLISHED
1914 in AJN, American Journal of Nursing

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Comparison of Maternal Milk (Breastmilk) Expression Methods in an African Nursery
"Objective: This study compares maternal milk volumes (MMVs) of Ugandan mothers whose infants were in a special care nursery and who used one of three maternal milk expression techniques: double electric breast pump, single non-electric manual breast pump, and hand breastmilk expression.

Subjects And Methods: A convenience sample of 161 Ugandan mothers of infants who were either too immature or ill to independently feed from the breast yet healthy enough to survive in an environment without ventilator support (birth weights, 0.84-3.8 kg) were assigned to one of three maternal milk expressions: Group 1, double electric breast pump (n=55); Group 2, single non-electric manual breast pump (n=59); and Group 3, hand breastmilk expression (n=47). Data were collected over a 7-day period (from day 1 postpartum to day 7 postpartum), and mean MMVs were measured and compared among the groups.

Results: The mean daily MMVs were as follows: Group 1, mean=647 mL (SD=310); Group 2, mean=520 mL (SD=298); and Group 3, mean=434 mL (SD=291). Results from one-way analysis of variance revealed significant differences in the mean MMV based on the method of maternal milk expression (p=0.0019). Further analysis using Tukey's HSD Test revealed significant differences in the MMV between Groups 1 and 3 (p < 0.01), but not between Groups 1 and 2 or between Groups 2 and 3.

Conclusions: Electric breast pumps provided the highest mean MMV; however, many mothers obtained adequate feeding volumes for their infants' daily nutritional needs with the single non-electric manual breast pump and hand breastmilk expression.

"
AUTHORS
Elizabeth Orodriyo
Eleanor A. Smith
Beverly A. Curtis
Elizabeth M. Keating
Ida L. Slusher
Tina M. Slusher et al
PUBLISHED

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Maternal adherence to guidance on breast milk collection process
"Introduction: Breast milk expression with a breast pump increases the risk of contaminating milk with pathogenic bacteria; how to decontaminate breast pumps is controversial. The aim of this study was to investigate maternal adherence to updated French guidance on the breast milk collection process, including breast pump decontamination, and to identify potential sources of increased bacterial counts in breast milk in order to improve prevention messages to mothers.

Methods: Descriptive prospective study conducted between November 2015 and April 2016 in a French tertiary perinatal center. Oral and written instructions on the breast milk collection process and breast pump decontamination were given to mothers by trained healthcare professionals. Mothers whose neonates were admitted to the neonatal care unit and expressing milk for the human milk bank were eligible if breast milk bacterial counts before pasteurization were≥10

Results: One hundred and fourteen mothers with neonates admitted to the neonatal care unit expressed milk for the milk bank; 44 (39%) were eligible and 29 (66%) included: most of them (76%) with increased counts of total aerobic flora in breast milk and 24% with increased counts of S. aureus. At least three divergences from the guidance provided were reported for 16 mothers (55%). The most frequent ones were inadequate storage of the breast pump collection kit (62%), ineffective decontamination of the breast pump collection kit (52%), inappropriate cleaning of the breast pump (48%), and inadequate breast milk transport from home to hospital (31%).

Conclusion: Despite standardized instructions, mothers with increased bacterial counts in breast milk frequently declared several divergences from the guidance on the breast milk collection process. Giving mothers and any person of their choice repeated clear instructions with illustrated guidance, demonstrations, and practice may help improve the microbiological safety of expressed breast milk.

"
AUTHORS
V. Pierrat
B. Mestdagh
R. Jounwaz
D. Dumoulin
M. Carré
PUBLISHED

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Electric breast pump use increases maternal milk volume in African nurseries.
"Health experts worldwide recognize breastmilk as the superior infant food. Recommendations from the American Academy of Pediatrics and the World Health Organization (WHO) identify exclusive breastfeeding for the first half-year of life and continuation of breastfeeding into toddlerhood as offering maximum protection from illness, providing a substrate for immunological protection. Data from developed countries identify increasing morbidity and mortality rates for infants who have never received breastmilk in life and demonstrate that infants benefit from exclusive breastfeeding, especially, in areas of severe poverty. Preterm infants, most at risk for morbidity and mortality in developing countries, are identified as needing their own mother's milk for survival. Exclusive feeding of own mothers' milk (OMM) is associated with improved infant survival; however, inadequate maternal milk volume (MMV) often necessitates adding artificial feedings or exogenous substances to OMM. The objective of this study was to compare mean daily MMV for mothers of premature or sick infants in special care nurseries (SCN) using one of three methods of OMM expression: electric breast pump, non-electric pedal breast pump, and hand (manual) expression. We studied 65 mothers whose infants were cared for in two SCN in Africa (Kenya and Nigeria) and were unable to feed directly at the breast. In this randomized trial, mothers were randomly assigned to one of three milk expression groups at birth. MMV, the dependent variable, was measured for an average of 8.7 days. MMV for the electric and pedal pump and hand milk expression was 578 +/- 228 ml (n = 22), 463 +/- 302 ml (n = 24) and 323 +/- 199 ml (n = 19), respectively. Data were evaluated using a one-way ANOVA (p = 0.014). The Tukey revealed significant differences (p < 0.01) between electric breast pump expression and hand expression but not between the electric and pedal pump or the pedal pump and hand expression. Findings revealed greater MMV with electric breast pumps than hand-expression for mothers of infants in African nurseries. This data has important implications for international policy if exclusive OMM feeding is to be achieved for the vulnerable infant. Funded by West Virginia University Department of Research and Graduate Studies HSC Grant # 2U023U; Non-monetary donations of breast pumps and breast pump kits were made by Medela (Medela, Inc., McHenry, IL, USA).
"
AUTHORS
Paula Meier
Beverly A Curtis
Fidelia Bode-Thomas
Margaret Biomdo
Ida L Slusher
Tina Slusher
PUBLISHED
2007 in Journal of Tropical Pediatrics

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MicroRNA as a new immune-regulatory agent in breast milk.
"Background: Breast milk is a complex liquid that provides nutrition to the infant and facilitates the maturation of the infant's immune system. Recent studies indicated that microRNA (miRNA) exists in human body fluid. Because miRNAs are known to regulate various immune systems, we hypothesized that human breast milk contains miRNAs that may be important for the development of the infant's immune system.

Findings: We profiled miRNA expression in human breast milk and detected high expression levels of immune-related miRNAs in the first 6 months of lactation. Furthermore, these miRNA molecules are stable even in very acidic conditions, indicating that breast milk allows dietary intake of miRNAs by infants.

Conclusions: Our findings provide new insight into how breast milk can modulate the development of the infant's immune system. This study suggests the transfer of genetic material as miRNA from human to human occurs by means other than through sexual reproduction.

"
AUTHORS
Kazunori Sekine
Hirohisa Izumi
Takahiro Ochiya
Nobuyoshi Kosaka
PUBLISHED
2010 in Silence

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Fathers’ and co-mothers’ voices about breastfeeding and equality – A Swedish perspective
"Background: Breastfeeding has benefits for mother and child and the partner's support influences the decision as well as the duration of breastfeeding. The aim of this study was to describe partners' knowledge and feelings regarding breastfeeding and how they reason about equality and involvement during the lactation period.

Methods: A qualitative study using semi-structured interviews with 7 male and 2 female partners (labelled co-mothers) of breastfeeding mothers. The interviews were transcribed and analysed using a phenomenological approach.

Results: The main theme Wish for the child to be breastfed/get breast milk described the informants' desire that their child was breastfed and this desire was based on knowledge of benefits of breastfeeding but also on intuitive feelings of breastfeeding as something natural. The main theme Effect of breastfeeding on fathers/co-mothers described how breastfeeding affected the informants and their relationship to the child and the mother in different ways. The main theme Adaptation and acceptance described how informants accepted the impact that breastfeeding had and/or adapted to it and continued to wish for the child to receive breast milk.

Conclusion: The informants desired that their children be breastfed/get breast milk. Breastfeeding affected the informants in different ways, which they handled by adapting to and accepting the situation, and they expressed a continued desire that their children be breastfed/get breast milk. Parental classes should include both parents to be and address how breastfeeding can be successfully performed and supported without threatening the equality between the parents.

"
AUTHORS
Margareta Larsson
Josefine Zäther
Hanna Palmqvist
PUBLISHED
2015 in Women and Birth

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Assessing Child Care Providers’ Knowledge and Attitudes Regarding Support of Breastfeeding in a Region with Low Breastfeeding Prevalence
"Background: Working mothers who place their infants into out-of-home child care face many challenges to sustaining breastfeeding. Child care providers, who are in frequent close contact with young families, may be potential resources for promoting breastfeeding.

Objectives: This study focused on identifying child care providers' attitudes toward and knowledge about breastfeeding as well as providers' perceptions about strategies to increase breastfeeding rates among mothers of infants in child care centers.

Methods: Seventy-five providers from 11 child care centers in the Baton Rouge, Louisiana, area were surveyed using paper and pencil questionnaires. Self-reported demographics, attitudes, knowledge, and perceptions about breastfeeding were collected.

Results: Responses demonstrated a generally positive attitude toward breastfeeding among child care providers but a knowledge deficit in terms of the health impacts and proper handling of breast milk. A minority of providers reported that their center's staff currently receives breastfeeding education, but most providers believed that measures to promote the use of breast milk in their center should target parents rather than the center staff.

Conclusion: Child care providers need resources about the benefits of human milk, proper handling of expressed milk, and ways to make centers more breastfeeding friendly. Many providers feel ineffective in supporting breastfeeding and are unaware of the role they may play in mothers' infant feeding decisions. Though child care providers do not appear to believe they can influence parents' decisions about breastfeeding, educating and empowering them could play an important role in increasing breastfeeding rates.

"
AUTHORS
Kacie Sims
Emily Kosh
Annette Knobloch
Marci Brewer Asling
Ashley Lucas
Pamela M. McMahon
PUBLISHED
2013 in Journal of Human Lactation

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Using mPINC data to measure breastfeeding support for hospital employees.
"Background: Employer support is important for mothers, as returning to work is a common reason for discontinuing breastfeeding. This article explores support available to breastfeeding employees of hospitals that provide maternity care.

Objectives: This study aimed to describe the prevalence of 7 different types of worksite support and changes in these supports available to breastfeeding employees at hospitals that provide maternity care from 2007 to 2011.

Methods: Hospital data from the 2007, 2009, and 2011 Centers for Disease Control and Prevention Survey on Maternity Practices in Infant Nutrition and Care (mPINC) were analyzed. Survey respondents were asked if the hospital provides any of the following supports to hospital staff: (1) a designated room to express milk, (2) on-site child care, (3) an electric breast pump, (4) permission to use existing work breaks to express milk, (5) a breastfeeding support group, (6) lactation consultant/specialist available for consult, and (7) paid maternity leave other than accrued vacation or sick leave. This study was exempt from ethical approval because it was a secondary analysis of a publicly available dataset.

Results: Of the 7 worksite supports in hospitals measured, 6 increased and 1 decreased from 2007 to 2011. Across all survey years, more than 70% of hospitals provided supports for expressing breast milk, whereas less than 15% provided direct access to the breastfeeding child through on-site child care, and less than 35% offered paid maternity leave. Results differed by region and hospital size and type. In 2011, only 2% of maternity hospitals provided all 7 worksite supports; 40% provided 5 or more.

Conclusion: The majority of maternity care hospitals (> 70%) offer breastfeeding supports that allow employees to express breast milk. Supports that provide direct access to the breastfeeding child, which would allow employees to breastfeed at the breast, and access to breastfeeding support groups are much less frequent than other supports, suggesting opportunities for improvement.

"
AUTHORS
Cria G Perrine
Jessica A Allen
Brook Belay
PUBLISHED
2014 in Journal of human lactation : official journal of International Lactation Consultant Association

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Expressed Breast Milk
AUTHORS
Charlotte Huber
Monica M. Davis
Mary E. Blanco
PUBLISHED
2009 in AJN, American Journal of Nursing

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Expression of breast milk.
AUTHOR
C J Clements
PUBLISHED
1982 in Midwives chronicle

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Highly regarded source
Trends in breastfeeding: it is not only at the breast anymore.
"The past characterisations of breastfeeding as being only at the breast of the mother may no longer be applicable in the United States as mothers now frequently express their milk. We conducted a retrospective cohort study with women who visited the Cincinnati Children's Breastfeeding Medicine Clinic to understand breast milk feeding behaviours of healthy mothers and infants, which included questions specifically about breast milk expression. All 40 mothers in the cohort expressed their milk and all 40 infants were fed expressed milk. One infant was fed another mother's milk for 30 days. Two-thirds (13/40) of infants received their mother's expressed milk at least a week after it was first expressed and 25% (10/40) of infants continued to be fed expressed breast milk after mothers had stopped expressing milk. There were 14 sequences of breast milk production by the mothers and 16 sequences of consumption by the infants. Early in the post-partum period, mothers started expressing milk even though their infants were consuming all of the breast milk that they needed at the breast. As a result of breast milk expression by all mothers in this cohort, we observed highly variable patterns of maternal breast milk production and infant breast milk consumption, which were not necessarily synchronous within a dyad. It is now time to develop appropriate ways to characterise the production and consumption of breast milk more accurately and investigate whether these behaviours have consequences for the health of mothers and infants."
AUTHORS
Sheela R Geraghty
Kathleen M Rasmussen
Heidi Sucharew
PUBLISHED
2013 in Maternal & Child Nutrition

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An Intervention to Promote Breast Milk Production in Mothers of Preterm Infants
"A pilot study was conducted to estimate the effects of a breast milk expression education and support intervention on breast milk production outcomes in mothers of very and extremely preterm infants. Forty mothers of hospitalized preterm infants (<30 weeks of gestation) were randomized to the experimental intervention or standard care for 6 weeks. Duration and frequency of breast milk expressions and volume of expressed breast milk were measured daily. Samples of breast milk were collected thrice during the study and analyzed for their lipid concentration. Mothers in the experimental group had a statistically significant higher duration of breast milk expression in min/day (p= .043). Differences observed between the two groups regarding the frequency of breast milk expression, volume of breast milk, and lipid concentration were not statistically significant. Results suggest that the experimental intervention may promote breast milk production in mothers of very and extremely preterm infants. "
AUTHORS
Emile Levy
Anne Monique Nuyt
Carole Garofalo
Céline Goulet
Marjolaine Héon
PUBLISHED
2014 in Western Journal of Nursing Research

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The Association of Low Social Support with Breast Milk Expression in Low-Income Mother–Preterm Infant Dyads
"BACKGROUND: Premature infants benefit from receiving expressed breast milk (BM), but expressing breast milk is difficult for new mothers. Little is known about mothers' social support and BM expression during the premature infant's hospital stay. METHODS: We examined whether low maternal social support was associated with breast milk expression initiation and low breast milk expression among low-income mothers of premature infants. Maternal intake interview data and daily infant data on proportion of nutrition from BM during hospitalization were analyzed from a larger randomized trial testing a developmental intervention on 181 mother-premature infant dyads with at least 2 of 10 social-environmental risks. Multivariable modified Poisson regression was used to examine the relationship between social support (Personal Resources Questionnaire 2000; dichotomized as low for lowest quartile), initiation (any breast milk expressed vs none), and low breast milk expression (if BM was < 30% of infant total milk/formula intake during hospitalization). RESULTS: Breast milk expression was initiated by 70.2% of mothers, and 32.3% of those mothers had low breast milk expression. In adjusted multivariable analyses, social support did not relate to the initiation of breast milk expression but was significantly associated with low breast milk expression among mothers who initiated (adjusted relative risk = 1.57; 95% confidence interval, 1.00-2.47). CONCLUSIONS: Low social support was not associated with initiation but was associated with low breast milk expression during hospitalization. Interventions to enhance social support for mothers of premature infants, especially those reporting low social support from family and friends, may increase in-hospital expression and long-term breastfeeding."
PUBLISHED
2015 in Journal of Human Lactation

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Literature review
Prevalence and outcomes of breast milk expressing in women with healthy term infants: a systematic review.
"Background: Expressing breast milk has become increasingly prevalent, particularly in some developed countries. Concurrently, breast pumps have evolved to be more sophisticated and aesthetically appealing, adapted for domestic use, and have become more readily available. In the past, expressed breast milk feeding was predominantly for those infants who were premature, small or unwell; however it has become increasingly common for healthy term infants. The aim of this paper is to systematically explore the literature related to breast milk expressing by women who have healthy term infants, including the prevalence of breast milk expressing, reported reasons for, methods of, and outcomes related to, expressing.

Methods: Databases (Medline, CINAHL, JSTOR, ProQuest Central, PsycINFO, PubMed and the Cochrane library) were searched using the keywords milk expression, breast milk expression, breast milk pumping, prevalence, outcomes, statistics and data, with no limit on year of publication. Reference lists of identified papers were also examined. A hand-search was conducted at the Australian Breastfeeding Association Lactation Resource Centre. Only English language papers were included. All papers about expressing breast milk for healthy term infants were considered for inclusion, with a focus on the prevalence, methods, reasons for and outcomes of breast milk expression.

Results: A total of twenty two papers were relevant to breast milk expression, but only seven papers reported the prevalence and/or outcomes of expressing amongst mothers of well term infants; all of the identified papers were published between 1999 and 2012. Many were descriptive rather than analytical and some were commentaries which included calls for more research, more dialogue and clearer definitions of breastfeeding. While some studies found an association between expressing and the success and duration of breastfeeding, others found the opposite. In some cases these inconsistencies were compounded by imprecise definitions of breastfeeding and breast milk feeding.

Conclusions: There is limited evidence about the prevalence and outcomes of expressing breast milk amongst mothers of healthy term infants. The practice of expressing breast milk has increased along with the commercial availability of a range of infant feeding equipment. The reasons for expressing have become more complex while the outcomes, when they have been examined, are contradictory.

"
AUTHORS
Della A Forster
Lisa H Amir
Helen L McLachlan
Helene M Johns
PUBLISHED
2013 in BMC Pregnancy and Childbirth

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Simultaneous breast expression in breastfeeding women is more efficacious than sequential breast expression.
"Introduction: Simultaneous (SIM) breast expression saves mothers time compared with sequential (SEQ) expression, but it remains unclear whether the two methods differ in milk output efficiency and efficacy.

Subjects And Methods: The Showmilk device (Medela AG, Baar, Switzerland) was used to measure milk output and milk ejection during breast expression (electric pump) in 31 Australian breastfeeding mothers of term infants (median age, 19 weeks [interquartile range, 10-33 weeks]). The order of expression type (SIM/SEQ) and breast (left/right) was randomized.

Results: SIM expression yielded more milk ejections (p ≤ 0.001) and greater amounts of milk at 2, 5, and 10 minutes (p ≤ 0.01) and removed a greater total amount of milk (p ≤ 0.01) and percentage of available milk (p<0.05) than SEQ expression. After SIM expression the cream content of both the overall (8.3% [p ≤ 0.05]) and postexpression (12.6% [p ≤ 0.001]) milk were greater. During SEQ expression, the breast expressed first had a shorter time to 50% and 80% of the total amount of milk than the breast expressed second (p ≤ 0.05), but, overall, a similar percentage of available milk was removed from both breasts.

Conclusions: SIM expression stimulated more milk ejections and was a more efficient and efficacious method of expression, yielding milk with a higher energy content.

"
AUTHORS
Peter E Hartmann
Jacqueline C Kent
Danielle K Prime
Catherine P Garbin
PUBLISHED
2012 in Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine

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Breast Milk Expression and Maintenence in Mothers of Very Low Birth Weight Infants: Supports and Barriers
"OBJECTIVE: The study objective was to identify patterns of factors that supported or hindered initiation of breast milk expression and maintenance of breast milk production after the birth of a very low birth weight (VLBW) infant in a sample of US women with varied prenatal infant feeding intentions. METHODS: In-depth interviews were conducted 1 to 6 months after delivery in 32 women who initiated breast milk expression after encouragement from hospital staff. RESULTS: Pregnancy complications, anxiety regarding their infant's health, and lack of privacy interfered with initiation of milk expression. After hospital discharge, using manual or small electric breast pumps, travel to the neonatal intensive care unit, return to work, and difficulty with time management interfered with maintenance of breast milk production. Family support, positive attitudes toward pumping, and anticipation of breastfeeding supported maintenance of breast milk production. CONCLUSIONS: From these data emerge points of intervention where additional support could improve mothers' experiences and increase duration of breast milk feeding."
PUBLISHED
2010 in Journal of Human Lactation

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Literature review
Breast-feeding the premature infant.
"Although some controversy persists regarding the nutritional adequacy of breast milk for the very low birth weight infant, most authorities agree that milk expressed from the infant's biologic mother and fortified with additional minerals and protein is a proper source of nutrition. Proper support of the preterm infant and mother during expression of breast milk and during the transition to nursing requires a broad knowledge base and familiarity with the practical aspects of breast-feeding."
AUTHORS
J A Lemons
M Stuart
P Lemons
PUBLISHED
1986 in Clinics in Perinatology

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Human donor milk for the vulnerable infant: a Canadian perspective.
"Breast milk is the normal way to feed infants and is accepted worldwide as the optimal first source of nutrition. Though the majority intend to breastfeed, many mothers of sick, hospitalized newborns, particularly those of very low birth weight, are unable to provide a full volume of milk due to numerous physical and emotional barriers to breastfeeding. This vulnerable population of infants may benefit most from receiving breast milk nutrition and thus pasteurized donor milk should be the first consideration for supplementation when there is an inadequate supply of mother's own milk. This commentary will briefly review the history of milk banking in Canada, as well as the best available evidence for donor milk use in the very low birth weight population, including available economic analyses, with a view to advocate for its use in these vulnerable infants. "
AUTHORS
Shoo K Lee
Deborah O'Connor
Sharon Unger
Julia Panczuk
PUBLISHED

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Breastfeeding of Very Low Birth Weight Infants
"This research examines the rate of breastfeeding among mothers of very low birth weight infants (VLBW, < 1500 grams), and the correlates of breast milk pumping and transition to nursing at the breast. Eighty-two mothers and their 69 singleton and 21 twin VLBW infants admitted to the Neonatal Intensive Care Unit (January 1-June 30, 1995) of an urban tertiary care hospital. Maternal demographic, infant birth, and neonatal data were compared according to breast or bottle feeding, and a telephone interview was administered retrospectively to mothers pumping breast milk at the time of the infant's discharge home. Of 39 mothers who chose to pump breast milk, 19 were still pumping at the time of the infant's discharge home. Only 8 made a successful transition to nursing at the breast. Mothers who continued pumping tended to be white, married, and older, and their infants had fewer neonatal complications. The rates of prolonged breast milk pumping and of nursing are very low. Specific interventions and better support might improve the success rates."
AUTHORS
Maureen Hack
Nori Mercuri Minich
Lydia Furman
PUBLISHED
1998 in Journal of Human Lactation

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Impact of Quality Improvement Program on Expressed Breastmilk Usage in Very Low Birth Weight Infants.
"Objective: To improve the usage of expressed breast milk in very low birth weight infants admitted in the neonatal intensive care unit of a tertiary centre in India.

Methods: Between April 2015 and August 2016, various Plan-do-act-study cycles were conducted to test change ideas like antenatal counselling including help of brochure and video, post-natal telephonic reminders within 4-6 hours of birth, standardization of Kangaroo mother care, and non-nutritive sucking protocol. Data was analyzed using statistical process control charts.

Results: 156 very low birth weight infants were delivered during the study period, of which 31 were excluded due to various reasons. Within 6 months of implementation, the proportion of very low birth weight infants who received expressed breast milk within 48 hours improved to 100% from 38.7% and this was sustained at 100% for next 8 months. The mean time of availability and volume of expressed breast milk within 48 hours, improved gradually from 73.3 h to 20.9 h and 4.7 mL to 15.8 mL, respectively. The mean proportion of expressed breast milk once infant reached a feed volume of 100 mL/kg/day also improved from 61.3% to 82.3%.

Conclusions: Quality improvement interventions showed promising results of increased expressed breast milk usage in very low birth weight infants.

"
AUTHORS
Neelam Kler
Priya Gandhi
Anup Thakur
Anita Singh
Pankaj Garg
PUBLISHED
2018 in Indian Pediatrics

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Exclusive Breastfeeding and the Acceptability of Donor Breast Milk for Sick, Hospitalized Infants in Kupang, Nusa Tenggara Timur, Indonesia
"Background: The eastern Indonesian province of Nusa Tenggara Timur (NTT) has an infant mortality rate of 45 per 1000, higher than the national average (28/1000). Exclusive breastfeeding, important for improving newborn and infant survival, is encouraged among hospitalized infants in Kupang, the provincial capital of NTT. However, barriers to hospitalized infants receiving breast milk may exist.

Objectives: This study explored the barriers and enablers to exclusive breastfeeding among sick and low birth weight hospitalized infants in Kupang, NTT. The attitudes and cultural beliefs of health workers and mothers regarding the use of donor breast milk (DBM) were also explored.

Methods: A mixed-methods study using a convergent parallel design was conducted. A convenience sample of 74 mothers of hospitalized infants and 8 hospital staff participated in semi-structured interviews. Facility observational data were also collected. Analysis was conducted using Davis's barrier analysis method.

Results: Of the 73 questionnaires analyzed, we found that 39.7% of mothers retrospectively reported exclusively breastfeeding and 37% of mothers expressed breast milk. Expressing was associated with maternal reported exclusive breastfeeding χ(2) (1, N = 73) = 6.82, P = .009. Staff supported breastfeeding for sick infants, yet mothers could only access infants during set nursery visiting hours. No mothers used DBM, and most mothers and staff found the concept distasteful.

Conclusions: Increasing mothers' opportunities for contact with infants is the first step to increasing exclusive breastfeeding rates among hospitalized infants in Kupang. This will facilitate mothers to express their breast milk, improve the acceptability of DBM, and enhance the feasibility of establishing a DBM bank.

"
AUTHORS
Sean Beggs
Jennifer E. Ayton
Rahel Rara Woda
Simplicia Maria Anggrahini
Linda Murray
PUBLISHED
2016 in Journal of Human Lactation

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Breast-feeding among Mothers of Low Birth Weight Infants.
"The physical and emotional condition of the mother delivering a premature or low birth weight infant may be quite different than that of the mother of a healthy term infant when initiating breast-feeding. Despite this difference, incidence and duration of lactation among mothers of pre-term or low birth weight infants was found to be quite good compared with that of mothers of term infants. Considerable problems, however, are encountered by premature or low birth weight infants when breast-feeding, including delayed first suckling, poor or no suction, need for daily supplemental bottle feeding, and culminating sometimes in weaning off breast milk before discharge. Optimal milk production has been associated with five or more milk expressions daily and with pumping durations of 100 minutes or more daily and initiation of pumping early in the first post-partum days."
AUTHOR
F Lefebvre
PUBLISHED
1990 in Canadian family physician Medecin de famille canadien

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Breast Milk Quality Improvement Bundle for Very Low Birth Weight Neonates.
"Purpose: To assess the effect of a quality improvement (QI) bundle on improving breast milk output among very low birth weight (VLBW) mothers.

Design: Before and after nonrandomized QI project.

Sample: Mothers who delivered a VLBW infant in October and November 2015 were the prospective cohort. Those who delivered a VLBW infant in August and September 2015 were the retrospective cohort. The QI bundle consisted of early expression of milk, use of breast pumps, frequent expressions, videos, and regular counseling. This bundle was done for the prospective cohort.

Outcomes Measures: Quantity of expressed breast milk on day 7.

Results: There were 13 mothers in the retrospective cohort and 18 mothers in the prospective one. The mean birth weight (1297.80 and 1207.70 g, p = .19) and gestation (32.5 and 31.5 wk, p = .27) were similar. There was a significant increase in the milk output on day 7 in the prospective group 113.6 ± 45 vs 182 ± 63 mL (p = .001).

"
AUTHORS
Suman P N Rao
Saudamini Vijay Nesargi
Akshatha Mallikarjuna
PUBLISHED
2019 in Neonatal network : NN

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BREAST MILK SUPPLEMENTATION FOR PRETERM INFANTS: PARENTAL PREFERENCES AND POSTDISCHARGE LACTATION DURATION
"Breast milk supplementation is frequently used to improve preterm infant growth and to achieve satisfactory intakes of minerals and vitamins. In the North American market there are commercial preparations: two powders and a liquid. The nutritional data available suggest these products are similar and their utilization is based on healthcare team choice. Parental perception about supplementation has not been previously evaluated although parental attitudes are known to impact on lactation success. The objectives of this paper are to determine parental preference and breastfeeding duration for very-low-birth-weight infants given commercial breast milk enrichment products. The study design is a randomized clinical trial with parental interviews. Sixty-three families with 71 infants were enrolled. Parents expressed their preference for the addition of a powder over a liquid preparation (p<0.01). Those mothers whose infants received the liquid enrichment had a shorter lactation relative to their goal, compared with the mothers of the infants who received the powder (p = 0.017). Parents prefer a powder product for breast milk supplementation and this choice positively impacts on the duration of breastfeeding for very-low-birth-weight infants."
AUTHORS
Jaques Belik
Suzanne C. Tough
Tanis R. Fenton
PUBLISHED
2000 in American Journal of Perinatology

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Efficacy of Breast Milk Expression Using an Electric Breast Pump
"DESIGN: The authors compared breastfeeding and expression characteristics in 30 mothers of exclusively breastfeeding, healthy term infants. RESULTS: Mean ({+/-} SD)volume per breastfeed from one breast was 71.8 {+/-} 26.3 mL, and mean duration per breastfeed for one breast was 16.6 {+/-} 10.5 minutes. Mean volume of milk expressed in 5 minutes from one breast was 60.6 {+/-} 39.0 mL and corresponded to the expression of 99.4 {+/-} 82.6% of the milk stored in the breast. The rate of milk expression differed greatly between mothers (P = .0001) but remained constant for the first 2.5 minutes before decreasing with time (P = .0001). CONCLUSIONS: These results show the mean breastfeed volume was similar to the volume of milk expressed in a 5-minute period. Furthermore, this study is the first to establish protocols that allow for the objective determination of breast pump efficacy."
PUBLISHED
2002 in Journal of Human Lactation

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The Mechanics of Breast Pumping: Compression Stimuli Increased Milk Ejection
"Background: The use of breast pumps with a compression component has shown their higher efficacy compared with vacuum pumps. However, the direct role of the compression stimulus is not sufficiently proven in the removal of milk from the main milk ducts of the breast. The aim of this study was to determine the contribution pulsating compression component of the breast pump has on total volume milk ejection by vacuum and compression stimuli.

Subjects And Methods: Twenty-four lactating women of 21-30 years of age, who volunteered to be included in this study, were examined. Experimental breast pump with vacuum and compressive components were used to express breast milk.

Results: It was found that volume milk ejection together with vacuum and compression stimuli was 10-46% more than expressing only with vacuum stimuli. Average values were 40.5% ± 5% for expression only with vacuum stimuli and 59.5% ± 5% for expression with vacuum and compression stimuli.

Conclusions: Compression stimuli increased the efficacy of the breast pump, which is not only due to the effective formation milk ejection reflex but also directly to an additional squeezing of milk from the breast.

"
AUTHORS
Vladimir I. Ilyin
Nikolay P. Alekseev
PUBLISHED

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Breast Pump Adverse Events: Reports to the Food and Drug Administration
"Breast pumps are medical devices used to express milk and maintain the milk supply. The purpose of this study was to characterize adverse events reported to the United States Food and Drug Administration (FDA) on breast pumps. Thirty-seven adverse event reports on breast pumps were identified from the Manufacturer and User Facility Device Experience database between 1992 and 2003. Four additional reports were found in the Device Experience Network database from 1992 to 1996. The most commonly reported adverse events for electric breast pumps were pain, soreness, or discomfort; the need for medical intervention; and breast tissue damage. Most frequently reported problems for manual breast pumps were breast tissue damage and infection. Contamination of breast milk during pumping was also reported. Breast pump adverse events are likely underreported to the FDA. Reporting adverse events is important for improving the design and manufacture of breast pumps and subsequently decreasing adverse events."
AUTHORS
Diane E. Dwyer
Betsy Foxman
S. Lori Brown
Roselie A. Bright
PUBLISHED
2005 in Journal of Human Lactation

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Low Breast Milk Supply Demystified—The New Edition of Making More Milk: The Breastfeeding Guide to Increasing Your Milk Production
"PurposeLow breast milk supply is a common concern among breastfeeding families and is cited as being one of the top reasons a family might stop breastfeeding. Research on the causes of low breast milk production and how to improve the rate of breast milk production is still emerging and not always in the field of human lactation.MethodBarbara D. Robertson interviewed Lisa Marasco in June 2019 about her new book, co-authored by Diana West, Making More Milk: The Breastfeeding Guide to Increasing Your Milk Production, 2nd Edition to see how this new edition can help IBCLCs in their clinical work with families.ResultsMaking More Milk: The Breastfeeding Guide to Increasing Your Milk Production, 2nd Edition is a valuable tool that can help clinicians assess if the individual families they are working with do indeed have a low milk supply, and then, if the family is struggling with low milk supply, provide a framework to investigate why the supply is low and what might be done to help improve the rate of breast milk production.ConclusionsAfter the interview with Lisa Marasco and reading her manuscript, this new edition of Making More Milk: The Breastfeeding Guide to Increasing Your Milk Production, 2nd Edition is a valuable contribution to the field of human lactation."
AUTHOR
Barbara D. Robertson
PUBLISHED
2019 in Clinical Lactation

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Breast milk and infection
"Three viruses (CMV, HIV, and HTLV-I) frequently cause infection or disease as a result of breast-milk transmission. Reasonable guidelines have been pro-posed for when and how to avoid breast milk in the case of maternal infection. For other viruses, prophylactic immune therapy to protect the infant against all modes of transmission are indicated (VZV, varicella-zoster immunoglobulin, HAV and immunoglobulin, HBV, and HBIg + HBV vaccine). In most maternal viral infections, breast milk is not an important mode of transmission, and continuation of breastfeeding is in the best interest of the infant and mother (see Tables 2 and 3). Maternal bacterial infections rarely are complicated by transmission of infection to their infants through breast milk. In a few situations, temporary cessation of breastfeeding or the avoidance of breast milk is appropriate for a limited time (24 hours for N gonorrheae, H infiuenzae, Group B streptococci, and staphylococci and longer for others including B burgdorferi, T pallidum, and M tuberculosis). In certain situations, prophylactic or empiric therapy may be advised for the infant (eg, T pallidum, M tuberculosis, H influenzae) (see Table 1). Antimicrobial use by the mother should not be a reason not to breastfeed. Alternative regimens that are compatible with breastfeeding can be chosen to treat the mother effectively. In most cases of suspected infection in the breastfeeding mother, the delay in seeking medical care and making the diagnosis means the infant has been ex-posed already. Stopping breastfeeding at this time only deprives the infant of the nutritional and potential immunologic benefits. Breastfeeding or the use of expressed breast milk, even if temporarily suspended, should be encouraged and supported. Decisions about breast milk and infection should balance the potential risk compared with the innumerable benefits of breast milk."
AUTHORS
Ruth A. Lawrence
Robert M. Lawrence
PUBLISHED
2004 in Clinics in Perinatology

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Breast milk expression among formally employed women in urban and rural Malaysia: A qualitative study.
"Background: Many women are unable to practice exclusive breastfeeding because they are separated from their infants while working. Expressing their breast milk helps them to continue breastfeeding. This study explores the perception and experiences related to the feasibility, acceptability and safety of breast milk expression among formally employed women in Kelantan, Malaysia.

Methods: A qualitative method using in-depth interviews was conducted from December 2008 to December 2009 among Malay women from urban and rural areas. A snowball sampling method was used to recruit the informants, and the interviews, which were facilitated by an interview guide, were audio-recorded and transcribed verbatim. Thematic analysis was conducted, with construction of codes and themes from each interview.

Results: Analysis of the interviews with 20 informants identified three themes related to breast milk expression. The themes were as follows: (i) lack of feasibility of expressing breast milk, (ii) negative feelings about expressing breast milk, and (iii) doubts about the safety and hygiene of expressed breast milk. The informants who did not practice exclusive breastfeeding believed that expressing their breast milk was not feasible, commonly because they felt there were not enough facilities for them. They also had negative feelings such as embarrassment. The safety and hygiene of the expressed breast milk was also their main concern.

Conclusion: More practical and focused education, as well as provision of facilities, is needed for women to effectively and safely express and store their breast milk. The issue of inadequate milk production should be emphasized, especially by encouraging them to express their breast milk as a way to improve milk production.

"
AUTHORS
Nik Normanieza Nik Man
Wan Manan Wan Muda
Rohana Jalil
Zaharah Sulaiman
Tengku Alina Tengku Ismail
PUBLISHED
2012 in International Breastfeeding Journal

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Breast milk expression among formally employed women in urban and rural Malaysia: A qualitative study
"BACKGROUND: Many women are unable to practice exclusive breastfeeding because they are separated from their infants while working. Expressing their breast milk helps them to continue breastfeeding. This study explores the perception and experiences related to the feasibility, acceptability and safety of breast milk expression among formally employed women in Kelantan, Malaysia. METHODS: A qualitative method using in-depth interviews was conducted from December 2008 to December 2009 among Malay women from urban and rural areas. A snowball sampling method was used to recruit the informants, and the interviews, which were facilitated by an interview guide, were audio-recorded and transcribed verbatim. Thematic analysis was conducted, with construction of codes and themes from each interview. RESULTS: Analysis of the interviews with 20 informants identified three themes related to breast milk expression. The themes were as follows: (i) lack of feasibility of expressing breast milk, (ii) negative feelings about expressing breast milk, and (iii) doubts about the safety and hygiene of expressed breast milk. The informants who did not practice exclusive breastfeeding believed that expressing their breast milk was not feasible, commonly because they felt there were not enough facilities for them. They also had negative feelings such as embarrassment. The safety and hygiene of the expressed breast milk was also their main concern. CONCLUSION: More practical and focused education, as well as provision of facilities, is needed for women to effectively and safely express and store their breast milk. The issue of inadequate milk production should be emphasized, especially by encouraging them to express their breast milk as a way to improve milk production."
PUBLISHED
2012 in International Breastfeeding Journal,

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The Association of Low Social Support with Breast Milk Expression in Low-Income Mother-Preterm Infant Dyads.
"Background: Premature infants benefit from receiving expressed breast milk (BM), but expressing breast milk is difficult for new mothers. Little is known about mothers' social support and BM expression during the premature infant's hospital stay.

Objective: We examined whether low maternal social support was associated with breast milk expression initiation and low breast milk expression among low-income mothers of premature infants.

Methods: Maternal intake interview data and daily infant data on proportion of nutrition from BM during hospitalization were analyzed from a larger randomized trial testing a developmental intervention on 181 mother-premature infant dyads with at least 2 of 10 social-environmental risks. Multivariable modified Poisson regression was used to examine the relationship between social support (Personal Resources Questionnaire 2000; dichotomized as low for lowest quartile), initiation (any breast milk expressed vs none), and low breast milk expression (if BM was < 30% of infant total milk/formula intake during hospitalization).

Results: Breast milk expression was initiated by 70.2% of mothers, and 32.3% of those mothers had low breast milk expression. In adjusted multivariable analyses, social support did not relate to the initiation of breast milk expression but was significantly associated with low breast milk expression among mothers who initiated (adjusted relative risk = 1.57; 95% confidence interval, 1.00-2.47).

Conclusion: Low social support was not associated with initiation but was associated with low breast milk expression during hospitalization. Interventions to enhance social support for mothers of premature infants, especially those reporting low social support from family and friends, may increase in-hospital expression and long-term breastfeeding.

"
AUTHORS
Rosemary White-Traut
Rohitkumar Vasa
Joseph C Yoder
Kathleen Norr
Kristin Rankin
Camille Fabiyi
PUBLISHED
2015 in Journal of human lactation : official journal of International Lactation Consultant Association

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PERBANDINGAN TEKNIK PEMERAHAN ASI TANGAN DENGAN MANUAL BREAST PUMP TERHADAP KENYAMANAN IBU DAN KUALITAS ASI
"The scope of exclusive breastfeeding is low caused by many factors, one of which is a working mother. The government supports the program of exclusive breastfeeding for mothers by promoting breastfeeding by expressed breast milk. Expressed breast milk can be done by hand and manual tools such as pump. Expressed breast milk can be influenced by mother’s experience and the pain at the time of expressing breast milk, this can lead to a sense of comfort. The differences in expressing techniques might lead to contamination of different bacteria and fungi. the purpose of this research is to analyze the differences in hand milking techniques and manual breast pump on the comfort of the mother and the quality of breast milk This was an observational study with cross sectional approach and conductive in Taman Sari district, Bandung. The samples were 35 mothers who fulfilled the inclusion and exclusion criteria. Mann Whitney, Wilcoxon and McNemar were used in examining mothers’ comfort and breast milk quality. The result of of comfort score showed 65.6 in hand expressed and 59.5 has in manual breast pump. There were several significant differences in expressing  techniques to mothers’comfort (p = 0.046). Hand expressing were contaminated by yeast (60%), total mesophilic bacteria (20%), and enterobacter (17.1%). Manual breast pump was contaminated by yeast (80%), total mesophilic bacteria (8.6%), and enterobacter (20%). Breast milk quality in hand expressed was better than the manual breast pump (p = 0.032). It was concluded that hand expressed more comfortable and had better quality  breast milk than manual breast pump techniques."
AUTHORS
Meita Dhamayanti
Heda Melinda N Natapawira
Siti Sopiatun
PUBLISHED
2020 in JOMIS (Journal of Midwifery Science)

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