Pumping

Expressing breast milk

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There are many reasons why mothers express breast milk. Initially, some mothers face separation from their baby, making it difficult for mothers to be available for every feed. In other cases the baby may be unable to breastfeed initially due to prematurity or issues with coordinating the suck-swallow-breathe reflex. Mothers may also need a pump to increase milk supply, or more often, need to provide expressed breast milk when returning to work, and to allow some lifestyle flexibility. In any case, knowledge of evidenced based protocols to aid in expression is essential.

Prior to expression

Pumping mothers are recommended to wash their hands with soap and water, thoroughly prior to pumping. Reduced bacteria at the time of expression is associated with reduced bacterial growth during storage. In addition to hand cleaning, the benefit of breast cleaning beyond daily hygiene has not been shown. Breast washing with skin detergent was shown to be no more effective than water alone in reducing bacteria, and therefore only regular breast hygiene practices are recommended.

Expression

Breast milk expression can be achieved by hand or with a pump. The choice of pump depends on the anticipated frequency of expression, time constraints, cost and access to electricity.

When the baby cannot be fed at the breast or cannot effectively remove milk from the breast, the mum may require assistance to initiate, build and maintain a sufficient milk supply. Good management in the first two weeks post-partum is critical for the mum's long-term milk production. The following interventions are very important for the mum’s ability to produce adequate volumes of milk in the weeks that follow:

Skin-to-skin contact at birth: this has been shown to improve breastfeeding duration and should be encouraged
Teaching mums how to use their hands for breast massage
Double pumping (simultaneous pumping) both breasts: this results in increased milk removal
Removing milk early after birth: this is important – pumping within the first hour of birth helps to remove more milk than pumping within the first six hours, and it increases significantly milk production in subsequent weeks
Using initiation technology (Symphony PLUS) after birth, followed by a 2-Phase pump pattern after secretory activation (milk coming in) is associated with increased milk production at days 6-13 post-partum
Expressing frequently is also important. Pump-dependent mums who express their milk more than six times a day have greater milk production than mums who pump less frequently. Pump-dependent mums are recommended to pump approximately eight times per 24 hours
Pumping between feeds: for mums who occasionally express milk for their breastfed baby and have an abundant supply, a pumping session can take place between breastfeeds
Using breast shields that fit well, they should be comfortable, not compress the breasts or damage the nipples; a range of breast shield sizes are available if the tunnel is too tight
Holding the breast shield gently against the breast: this will prevent the milk ducts from becoming blocked and support adequate breast drainage

After expression

After expression, clean according to Instructions for use.

Breast pump suction patterns that mimic the human infant during breastfeeding: greater milk output in less time spent pumping for breast pump-dependent mothers with premature infants

The objective of this study was to compare the effectiveness, efficiency, comfort and convenience of newly designed breast pump suction patterns (BPSPs) that mimic sucking ...

Meier PP, Engstrom JL, Janes JE, Jegier BJ, Loera F (2012)

J Perinatol. 32(2):103-10 Simultaneous breast expression in breastfeeding women is more efficacious than sequential breast expression

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 ...

Prime DK, Garbin CP, Hartmann PE, Kent JC (2012) Breastfeed Med. 7(6):442-7

References

Eglash, A. ABM clinical protocol #8: Human milk storage information for home use for full-term infants (original protocol March 2004; revision #1 March 2010). Breastfeed Med 5, 127-130 (2010).

Eteng, M.U., Ebong, P.E., Eyong, E.U. et al. Storage beyond three hours at ambient temperature alters the biochemical and nutritional qualities of breastmilk. Afr J Reprod Health 2001;5:130–134.

Hill, P.D., Aldag, J.C., Chatterton, R.T. Initiation and frequency of pumping and milk production in mothers of non-nursing preterm infants. J Hum Lact. 2001;17(1):9-13

Hill, P.D., Aldag, J.C., Chatterton, R.T., Zinaman, M. Comparison of Milk Output Between Mothers of Preterm and Term Infants: The First 6 Weeks After Birth. J Hum Lact. 2005 February 1, 2005;21(1):22-30.

Human Milk Banking Association of North America 2011 Best practice for expressing, storing and handling human milk in hospitals, homes, and child care settings (HMBANA, Fort Worth,( 2011).

Kent, J.C. et al. Importance of vacuum for breastmilk expression. Breastfeed Med 3, 11-19 (2008).

Meier, P.P., Engstrom, J.L., Janes, J.E., Jegier, B.J. & Loera, F. Breast pump suction patterns that mimic the human infant during breastfeeding: Greater milk output in less time spent pumping for breast pump-dependent mothers with premature infants. J Perinatol 32, 103-110 (2012).

Morton, J., Hall, J.Y., Wong, R.J., Benitz, W.E. & Rhine, W.D. Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. J Perinatol 29, 757-764 (2009).

Parker, L.A., Sullivan, S., Krueger, C. & Mueller, M. Association of timing of initiation of breastmilk expression on milk volume and timing of lactogenesis stage II among mothers of very low-birth-weight infants. Breastfeed Med (2015).

Prime, D.K., Garbin, C.P., Hartmann, P.E. & Kent, J.C. Simultaneous breast expression n breastfeeding women is more efficacious than sequential breast expression. Breastfeed Med 7, 442-447 (2012).

Torowicz, D.L., Seelhorst, A., Froh, E.B., Spatz, D.L. Human milk and breastfeeding

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