Effective initiation to build and maintain milk supply

Early, frequent and effective expression is key to achieving a copious milk supply for establishing and sustaining lactation and breastfeeding. Research has shown that mothers achieving daily volumes ≥500 ml before day 14 have significantly higher breastfeeding rates at discharge.⁵

The first hours and days after delivery are a decisive time for the onset of lactation. The transition from secretory differentiation to onset of milk ‘coming in’ (secretory activation), normally occurs within 24-72 hours after birth, and has an impact on long-term milk production. That is why timely interventions to avoid a delay in milk ‘coming in’ (>72 hrs after delivery) are critical.

When vulnerable infants receive high dose, long exposure to own mother’s milk (OMM), research has shown a dose-response relationship exists between the amount of OMM received by prematurely-born infants and the risk of clinical morbidities.⁶

Effective initiation

Informed decision – Effective initiation interventions

Effective initiation

Time to first expression - Effective initiation interventions

Effective initiation

Frequent expression – Effective initiation interventions

Effective initiation

Time to milk ‘coming in’ – Effective initiation results

Effective initiation

Coming to volume – Effective initiation results

Effective initiation

Dose of own mother's milk (OMM) – Effective initiation results

Effective initiation

Informed decision – Effective initiation interventions

Effective initiation

Time to first expression - Effective initiation interventions

Effective initiation

Frequent expression – Effective initiation interventions

Effective initiation

Time to milk ‘coming in’ – Effective initiation results

Effective initiation

Coming to volume – Effective initiation results

Effective initiation

Dose of own mother's milk (OMM) – Effective initiation results

References

1 Bigger HR et al. Quality indicators for human milk use in very low-birthweight infants: are we measuring what we should be measuring? J Perinatol. 2014; 34(4):287–291.

2 Spatz DL et al. Pump Early, Pump Often: A Continuous Quality Improvement Project. J Perinat Educ. 2015; 24(3):160–170.

3 Spatz DL. Getting it right – the critical window to effectively establish lactation. Infant. 2020; 16(2):58–60.

4 Meier PP. Prioritizing High-Dose Long Exposure to Mothers' Own Milk During the Neonatal Intensive Care Unit Hospitalization. Breastfeed Med. 2019; 14(S1):S20-S21.

5 Hoban R et al. Milk volume at 2 weeks predicts mother's own milk feeding at neonatal intensive care unit discharge for very low birthweight infants. Breastfeed Med. 2018; 13(2):135–141.

6 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.

7 Snyder R et al. Early provision of oropharyngeal colostrum leads to sustained breast milk feedings in preterm infants. PediatrNeonatol. 2017; 58(6):534–540.

8 Kumar J et al. Oropharyngeal application of colostrum or mother's own milk in preterm infants: a systematic review and meta-analysis. Nutr Rev. 2023; 81(10):1254–1266.

9 Acuña-Muga J et al. Volume of milk obtained in relation to location and circumstances of expression in mothers of very low birth weight infants. J Hum Lact. 2014; 30(1):41–46.

10 Haase B et al. The development of an accurate test weighing technique for preterm and high-risk hospitalized infants. Breastfeed Med. 2009; 4(3):151–156.

11 Narayanan I et al. Sucking on the 'emptied' breast: non-nutritive sucking with a difference. Arch Dis Child. 1991; 66(2):241–244.