Effect of early breast milk expression on milk volume and timing of lactogenesis stage II among mothers of very low birth weight infants: a pilot study

Abstract

Objective: The purpose of this randomized pilot study was to collect preliminary data regarding the feasibility and effects of early initiation of milk expression on the onset of lactogenesis stage II and milk volume in mothers of very low birth weight (VLBW) infants.Study Design: Twenty women were randomized to initiate milk expression within 60 min (group 1) or 1 to 6 h (group 2) following delivery. Milk volume and timing of lactogenesis stage II was compared between groups using Wilcoxon's rank sum tests.Result: Group 1 produced statistically significantly more milk than group 2 during the first 7 days (P ¼ 0.05) and at week 3 (P ¼ 0.01). Group 1 also demonstrated a significantly earlier lactogenesis stage II (P ¼ 0.03). Conclusion:Initiation of milk expression within 1 h following delivery increases milk volume and decreases time to lactogenesis stage II in mothers of VLBW infants.

Association of Timing of Initiation of Breastmilk Expression on Milk Volume and Timing of Lactogenesis Stage II Among Mothers of Very Low-Birth-Weight Infants

“…17,24 In addition, many factors negatively influencing milk production in these mothers are nonmodifiable, making interventions to increase milk production in this population critically important. 21 Although initiation of milk expression prior to 1 hour following delivery appears to increase milk production in mothers of VLBW infants, [26][27][28] these mothers often delay milk expression for many hours to days following delivery, likely reducing volume of milk produced. Recommendations for early initiation of milk expression should be incorporated into breastfeeding protocols, and mothers should be encouraged and provided with support to initiate milk expression as soon after delivery as possible.…”

“…Although results from this study are not congruent with other study findings regarding a relationship between earlier initiation of milk expression and increased milk volume, [24][25][26][27] they do support our previous report of an increased milk volume in mothers who begin milk expression within 1 hour following delivery. 28 In addition, differences in milk volume and timing of lactogenesis stage II may have been apparent had mothers initiated milk expression earlier in the 1-6-hour time frame. Although this study is the first to investigate the influence of milk expression within 6 hours following delivery on milk volume and timing of lactogenesis stage II in mothers of VLBW infants, Furman et al 23 found a positive association between initiation of milk expression prior to 6 hours following delivery and prolonged lactation over 40 weeks' postmenstrual age.…”

“…Group I (early initiation) (n = 20) participants, who began milk expression within 6 hours following delivery, were part of our previous study that compared the impact of timing of initiation of milk expression within 1 hour to initiation between 1-6 hours following delivery. 28 Group II (late initiation) (n = 20) participants commenced milk expression after 6 hours following delivery per usual hospital protocol, which varied depending on parent preference as well as the availability of nursing staff.…”

“…This contrasts an earlier finding indicating an earlier lactogenesis stage II in mothers who began milk expression earlier following delivery. 28 Determination of lactogenesis stage II was through maternal report of a sudden feeling of breast fullness. Although this may be a valid indicator of the onset of lactogenesis stage II in mothers of term infants, it is unknown whether the same is true in mothers who deliver prematurely.…”

“…28 Unfortunately, owing to the often critical clinical status of the mother and frequent need for cesarean section, initiation of milk expression this early following delivery may not always be feasible. Therefore, the purpose of this prospective cohort pilot study was to compare milk volume and timing of lactogenesis stage II in mothers of VLBW infants who initiated breastmilk expression within 6 hours following delivery versus those who initiated milk expression after 6 hours of delivery.…”