> We are examining expressing and I am unable to find any written material to
> support the commonly held view (here) that in the immediate postpartum period
> that it is best to commence expression by hand.  There is plenty of reasoned
> debate in the group but I would like to find evidence if possible.

I cant help with research regarding the efficacy of hand expression vs
pumping although the basis, I think, for preference for hand expression
relates to the nature of colostrum - being a very thick viscous like fluid -
it is easier to remove larger quantities through hand expression (more like
the baby's milking action) rather than through suction. However most units I
am familiar with all use pumps these days immediately from birth, rather
than hand expression, - this is because it is more time efficient for the
staff and as you say no research to show one is better than the other (that
I'm aware of anyway).

However as a side issue on expressing there has been research on pre-term
delivery and breast expression and its consequences for initiating
lactation. This research demonstrated that pre term expressing women (using
pumps) produce lower volumes of milk at Day 10 post partum than both
breastfeeding and full term expressing women. The cause for compromised
lactation in pre term expressing mothers was not elucidated, however they
discussed the possible effects of betamethasone given prior to  pre term
birth, or incomplete milk removal due to inhibition of the MER,  as being
possibly implicated.

Cregan M; DeMello T; Hartmann PEH. 2000. Pre term delivery and breast
expression: consequences for intiating lactation. IN: Sort and Long Term
Effects of Breast Feeding on Child Health. Ed Kolettzo, B et al. Kluwer
Academic/ Plenum Publishers. P:427-428.

Cathy Fetherston RM MSc IBCLC
Western Australia

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