Hi all
Someone was asking about this recently. Just came in on Medscape today.
Pamela Morrison IBCLC
Rustington, England
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Hand Expression of Breast Milk Allows Longer Breast-Feeding
Laurie Barclay, MD
July 27, 2011 — Hand expression vs breast pumping
in the early postpartum period may allow longer
breast-feeding, according to the results of a
randomized controlled trial reported online July
11 in the Archives of Disease in Childhood Fetal & Neonatal Edition.
"Until now, we didn't know which technique was
preferable in the early postpartum period," said
lead author Valerie J. Flaherman, MD, MPH, an
assistant professor of pediatrics at University
of California–San Francisco (UCSF) and
pediatrician at UCSF Benioff Children's Hospital,
in a news release. "This study provides the first
evidence in favor of hand expression. Based on
our findings, clinicians should consider
recommending hand expression to new moms whose babies are feeding poorly."
The goal of the study was to compare the effects
of bilateral electric breast pumping vs those of
hand expression among mothers of healthy term
infants who were latching or sucking poorly at 12
to 36 hours postpartum. At a well-baby nursery
and postpartum unit, 68 participants were
allocated to undergo either 15 minutes of
bilateral electric pumping or 15 minutes of hand
expression. The primary study endpoints were milk
transfer, maternal pain, confidence in
breast-feeding, and breast milk expression
experience (BMEE) immediately after the
intervention, as well as breast-feeding rates at age 2 months.
With hand expression, the median volume of
expressed milk was 0.5 mL (range, 0 - 5 mL) vs 1
mL (range, 0 - 40 mL) with electric pumping (P =
.07). Both techniques were associated with
similar maternal pain, confidence in
breast-feeding, and BMEE. However, 96.1% of
mothers randomly selected to hand expression were
breast-feeding at 2 months, compared with 72.7%
of mothers randomly assigned to breast pumping (P = .02).
"Mothers who are new to breastfeeding are often
very open to suggestions for improving their
nursing experience since it can be frustrating if
a baby isn't latching well," Dr. Flaherman said.
"If mothers feel strongly about a method of
expression, they should make the choice that is
right for them. However, if mothers are open to
either method of milk expression, providers
should consider teaching hand expression instead
of pumping in the early newborn period."
Limitations of this study include possible bias
or chance affecting the results, study dropout,
lack of randomization, and lack of
generalizability to mothers of younger or older
infants or to mothers expressing milk for other reasons.
"If our interventions during birth
hospitalization can help mothers feel more
comfortable nursing in front of others, it could
contribute to longer breastfeeding duration,"
said senior author Thomas Newman, MD, MPH, a UCSF
professor of epidemiology, biostatistics, and
pediatrics. "Our results are exciting and
underscore the need for further research to
confirm these findings and to explore the reasons
for an association between early expression
practice and later breastfeeding outcomes."
The National Center for Research Resources and
the National Institute of Children Health and
Human Development supported this study. The study
authors have disclosed no relevant financial relationships.
Arch Dis Child Fetal Neonatal Ed. Published online July 11, 2011.
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