Symphony for Healthcare Professionals

• The time between birth and secretory activation  (milk ‘coming in’) is critical for safeguarding future milk supply.¹
• The first hours after delivery are a crucial time window for priming the breast tissue and making use of the natural rise and fall in maternal hormones. Specifically, the rapid fall in progesterone and the elevated levels of oxytocin and prolactin shortly after birth switch on the lactocytes (milk-making cells).² Together with breast stimulation they are the physiological triggers for the onset of significant milk production (milk ‘coming in’) between 24 and 72 hours.
• Only when milk is removed frequently (8-12 times in 24 hours)³ and the breasts are drained effectively, can an adequate milk supply be built and the mammary gland is programmed for long-term lactation.

• There are multiple risk factors for delayed milk production and suppressed lactation.
• Some can be assessed before birth such as primiparity, obesity, diabetes, maternal age over 30 and planned caesarean sections.
• Some may be noted only during or after birth, among them unplanned caesarean sections, preterm or late preterm infant, postpartum haemorrhage, mother-infant- separation and more.
• Having identified mothers who are at risk for delayed or suppressed milk production, you should increase your surveillance of the infant feeding progress and intervene as needed.

For a detailed infographic on all risk factors see download section.

• Symphony was developed to support mothers at all stages of her breastfeeding journey to effectively initiate, build and maintain a good milk supply.
• Clinical evidence suggests infant feeding behaviors have an important role in determining lactation success. These unique infant sucking patterns in the first few days of life appear to program mothers’ breasts for optimal milk production.
• This is why Symphony comes with two research-based programs: INITIATE and MAINTAIN, to mimic the natural nursing behavior of an infant during the different stages of lactation.
  • INITIATE is meant to support mothers directly after giving birth. It mimics the sucking and pausing rhythm of a newborn during the first days of lactation
  • MAINTAIN imitates the sucking rhythm of a healthy baby during established lactation, based on the 2-Phase Expression technology with stimulation and extraction phase.

To support you best, Symphony offers two research-based programs, INITIATE and MAINTAIN. It is crucial you always use the correct program!

• INITIATE is meant to support you directly after giving birth. It mimics the sucking and pausing rhythm of a newborn during the first days of lactation. 
• Use MAINTAIN after your milk has “come in” or at the latest on day 6. This program then imitates the sucking rhythm of a healthy baby during established lactation.

*Based on market feedback and new data analysis, Medela has recently updated the protocol for when to switch from the INITIATE to the MAINTAIN program on the Symphony® breast pump. The current protocol recommends that the mother switches to MAINTAIN after pumping 20 mL of milk in three consecutive sessions from both breasts combined. New evidence supports earlier switch to MAINTAIN program when 20 mL or more is expressed from both breasts combined, in one pumping session.
We recommend the new protocol of switching after pumping 20 mL in one session, as it simplifies the process for both healthcare providers and mothers. As this change is implemented gradually, users may encounter both protocols during this transition period. We want to reassure that both versions (1x20mL and 3x20mL) are safe.

How to pump in INITIATE

How to pump in INITIATE

Good to know:

• The INITIATE program will run for 15 minutes including pauses, then stop automatically.
• The MAINTAIN program will run in two phases: The stimulation phase will run for about 2 minutes, then switch automatically to the expression phase. You may also change to expression phase manually, if your milk starts flowing earlier.
  NOTE: The MAINTAIN program does not stop automatically, but has to be switched off manually after you are finished. Generally we recommend double pumping for approximately 15 minutes per session.

1. Always make sure the mother is using her correct breast shield size to ensure successful milk removal and comfort!
2. Always facilitate double pumping.  Research suggests that double pumping 8 times in 24 hours –at least once during the night and with no break longer than 5 hours – yields the best results with up to 18% more milk with  a higher energy content and better breast drainage.⁴
3. Always ensure the mother is pumping in the correct pumping program.
4. Make sure the mother is pumping at her Maximum Comfort Vacuum.

For more information on breasts shield fitting see downloads section; for information on double pumping see links section.

• A badly fitting breast shield can reduce the amount of milk expressed and cause pain during pumping.
• Every breast is different. This means mothers may even need adifferently sized breast shield on each side.
• The size of the nipple is the deciding factor here: The breast shield tunnel should surround the nipple closely, but leave enough space for it to move back and forth freely without rubbing on the sides of the tunnel.
• During pumping, make sure not too much of the areola is pulled into the tunnel.

See "Downloads" for more information on how to determine the right breast shield size.

The mother can set the comfort vacuum by rotating the vacuum adjustment knob as follows:

• First rotate the knob gradually to the right to increase the vacuum slowly to the point where the mother feels a slight discomfort.
• Then rotate left again to reduce the vacuum by one bar and reach her indivuidual  Maximuum Comfort Vacuum setting.

• The first hours, days and weeks are critical to building good milk volumes.
• If infants are not yet breastfeeding exclusively when discharged, it is important that mothers are given the right information to effectively continue increasing their milk volumes at home.
• Facilitate the transition to home and  make sure every mum and infant who need it come home to a hospital-grade rental pump!

Click here for everything you need to know about Symphony rentals.

For more information on the transition hospital to home see downloads section.

At-risk conditions that impact breastfeeding

Initiating milk production

Optimising milk removal

White Paper: Improving delayed Lactogenisis and supressed Lactation in At-Risk Mothers

Breast shield fitting

Breastfeeding support from hospital to home

QuickCard in multi languages

Symphony breast pump – for healthcare professionals Instructions for use

1. Spatz DL. Infant. 2020; 16(2):58–60.

2. Pang WW, Hartmann PE. J Mammary Gland Biol Neoplasia. 2007; 12(4):211–221

3. Spatz DL et al. J Perinat Educ. 2015; 24(3):160–170

4. Prime DK, Kent JC, Hepworth AR, Trengove NJ and Hartmann PE. Dynamics of milk removal during simultaneous breast expression in women. Breastfeeding Medicine 2011a; Vol 0(0); 1-6