First expression

Early pumping is an evidence based intervention to achieve effective initiation of lactation. When the infant cannot breastfeed effectively, pumping within 3 hours after birth has been shown to have a significant impact on future milk supply, infant feeding, and subsequent health outcomes.

What is time to first expression?

Time between delivery and a mother’s first pumping session. For healthy term infants who have normal births, the first breastfeed should occur within the first hour.¹

The focus of this measure is early pumping, defined as within three hours of delivery.^2-4

Why is time to first expression important?

Early breast stimulation (feeding or pumping ) after birth has significant impact on future milk supply and subsequent feeding outcomes.^2,3,5

Studies highlight that NICU mothers who initiate pumping within three hours after birth significantly:

• reduce the time to secretory activation (milk ’coming in’)⁶
• have higher daily and cumulative milk volumes over time ^2,3
• are more likely to be pumping at six weeks after birth²
• have infants more likely to breastfeed on discharge and for extended periods⁶

How to implement time to first expression

• In the antenatal period, identify and provide women with known risk factors women with known risk factors, information around importance of early initiation within three hours of birth
• Support mothers whose infants cannot breastfeed in the first hours or have a poor, ineffective breastfeed to begin pump expression within three hours of birth
• Ensure that early expression starts within the delivery or recovery room
• Start with a hospital-grade double pump with research-based initiation technology^7,8
• Implement strategies to identify a delay in time to first expression greater than three hours
• Support cohesive lactation practices within maternity and NICU services to initiate expression within three hours of birth
• Track and document time of first expression in a pumping log
• Track and document the reasons for delayed first expression in maternal medical records

How to monitor time to first expression

Collect data on time to first expression after delivery with a data collection tool

• Review maternal midwifery records, medical records, pumping logbooks and data for the ‘time to first expression’ after delivery
• Regularly audit the data to measure the % proportion of mothers who initiate expression within three hours of delivery
• Identify hospital practices that result in a delay in time to first expression
• Identify associated risk factors such as caesarean section, which may influence time to first expression
• Communicate findings and recommendations regularly to all departments to improve and sustain best practice

Downloads

Time to first expression (pdf)

Initiating milk production (pdf)

At-risk factors (pdf)