The study from Africa you are thinking about, Jane, was one in which the 
mothers had no counseling about how much milk to express, so they would 
just express however much their preemie needed for that feeding. The 
mothers who used pumps were told to pump for a certain period of time. 
In other hospitals where hand expression is used in Africa and South 
America, moms get plenty of milk by manually expressing, because they 
all sit together to express and are encouraged to get as much milk as 
they can.

I bet the results of this new study that moms taught to hand express 
rather than pump in postpartum have better bf outcomes will turn out to 
be confirmed in further research. Breastfeeding self-efficacy can be 
improved if the mom is using her own body to express. The pump can also 
seem easier for some moms, and they can wind up bottle feeding expressed 
milk.

I too am a proponent of the right tool for the right job. I teach every 
mom who is willing to learn how to hand express, and recommend 
appropriate pumps for mothers who are separated from their babies or 
have special situations.

Catherine Watson Genna BS, IBCLC  NYC  cwgenna.com


On 7/28/2011 10:27 AM, [log in to unmask] wrote:
> Not to beat a dead horse - but if you pay close attention to the physiology of breast pumps - how they work is by stimulating EMR and attempting to sustain forward motion of milk through the ducts as long as possible to remove maximum percentage of milk possible - and really don't take 100% of available milk ever. And neither does a baby.  In the live ultrasounds I have witnessed, milk starts retracting into the breast within about a minute until the force of forward motion is completely stopped.  Further MER's bring more milk.  With hand-expression you can extract some milk even without MER by the method Jean Cotterman was discussing.  When I milk a cow, part of the process of preparing her is to bring her to the same place, give her some food, restrain her if needed, clean the teats, then either apply the pump or begin manual expression.  Usually, manual express a moment or two before applying the pump.  If there are sores from the calf ( who gets to be on her during the day but not at night, since milking for family use is just once a day), we put on bag balm.  Calves can cause bad nipple damage too!   Wish we had a nipple shield for cows sometimes!  You can tell when she is in pain. And calves don't care as long as they get their milk!  I have seen great results with modifying pumps, using a pump to help a mom gauge the strength of her baby's suck, etc.  They have their place.  In reference to this study, I think I saw one out of Africa showing that mothers who used good pumps instead of hand-expression had better supplies and nursed longer with their preemie babies.  Every study has its limitations and just looking at one part of the picture without all the components can lead to false conclusions.  I think the Hand expression vs. pumping is setting up a straw man argument.  This is one case where the both/and situation applies because mothers and babies are not just mathematical problems that need to be solved!
>
> -----Original Message-----
> From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Pamela Morrison
> Sent: Wednesday, July 27, 2011 4:36 PM
> Subject: Hand expression vs pumping
>
> Hi all
>
> Someone was asking about this recently.  Just came in on Medscape today.
>
> Pamela Morrison IBCLC
> Rustington, England
> -----------------------------------
> Hand Expression of Breast Milk Allows Longer Breast-Feeding
>
> Laurie Barclay, MD
>
> July 27, 2011 Â- 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 CaliforniaÂ-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 =2).
>
> "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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