Evaluation of a breastmilk hand expression toolkit: the M.I.L.K survey study

Abstract

Background Breastmilk hand expression (BMHE) is recommended to promote lactation, relieve breast engorgement, and collect milk for future infant feedings. Resources to teach this skill are limited and infrequently developed in partnership with the obstetrical population. In collaboration with maternity care experts and individuals with recent breastfeeding experience, we designed a one-page toolkit that describes the process of BMHE and includes step-by-step instructions and images to illustrate the technique. This study aimed to evaluate the readability, clarity of content, layout, and informational value of this BMHE toolkit. Methods Individuals who intended to breastfeed, were currently breastfeeding, or had recently breastfed were electronically surveyed and completed a two-part survey that consisted of radio, multi-select, Likert scale, and open-ended questions. Part one captured sociodemographic factors, obstetrical history, and breastfeeding practices. Part two collected feedback on the BMHE toolkit. Participants were recruited electronically through social media and posters were circulated in antenatal and postnatal care settings in Ottawa, Canada between November 2020 and February 2021. Results Of the 123 participants, 117 (95.1%) had heard of hand expression prior to reviewing the toolkit and 99 (80.5%) had hand expressed before. Among the 48 participants who were no longer exclusively breastfeeding at the time of the survey, 22 (45.8%) had exclusively breastfed their infant for at least six months and 7 (14.6%) had discontinued exclusive breastfeeding within the first month. When asked about the BMHE toolkit, 118 (95.9%) participants said it was informative, 115 (93.5%) said it was easy to understand, and 114 (92.7%) said it was well laid-out. When asked about information seeking behaviours, participants indicated a preference for online resources (58.5%) and video resources (22.0%). Conclusions The BMHE toolkit was well received by participants and the feedback was favourable overall. The survey feedback will be used to create a revised version of the toolkit that has been validated by the obstetrical patient population. Future research should focus on identifying implementation strategies to optimize the use of the toolkit and increase its effectiveness as an educational resource to teach participants correctly BMHE.

Enhancing the maternity nurse's self-efficacy through the skill of hand expression

“…Experts, such as lactation consultants, support breast milk expression manually or with the use of a breast pump, as an alternative for mothers to feed their newborn breast milk when breastfeeding directly isn't possible or convenient. When performed prenatally before a baby is born, hand-expressing can improve a mother's breastfeeding confidence, and colostrum can be collected and used for feeding after delivery 6. When performed postnatally, hand-expressing can relieve breast fullness due to engorgement and blocked duct(s), and allow the mother to store colostrum/milk should she be separated from her baby (if the baby is in the neonatal ICU, or the mother is returning to work).…”

“…When performed prenatally before a baby is born, hand-expressing can improve a mother's breastfeeding confidence, and colostrum can be collected and used for feeding after delivery. 6 When performed postnatally, hand-expressing can relieve breast fullness due to engorgement and blocked duct(s), and allow the mother to store colostrum/milk should she be separated from her baby (if the baby is in the neonatal ICU, or the mother is returning to work). In a study in which a group of mothers was assigned to either hand express or use a breast pumping device, the mothers who hand-expressed were more likely to continue breastfeeding (96.1%) compared with the mothers who used a breast pump (72.7%).…”

Effect of Hand Expression and Lactation Support on Self-Efficacy of Primiparous Mothers and Quality of Breast-feeding

“…However, this evidence did not extend to healthy women with low-risk pregnancies, such as women without gestational diabetes or a history of cesarean delivery. In general, numerous investigations had emphasized on the following advantages of BMHE and breast milk: quicker lactation, increased self-assurance while manually pumping before the baby is born, acquaintance with one's breasts, and increased preparedness and confidence for breastfeeding (Alibhai et al, 2022).…”

Effect of Hand Expression and Lactation Support on Self-Efficacy of Primiparous Mothers and Quality of Breast-feeding

“…Hand squeezing may also be advised throughout the pregnancy period to boost a woman's confidence in nursing prior to delivery and to collect milk shortly for infant feeding after delivery. Prenatal colostrum collection has been recommended for diabetic women in low-risk pregnancies to assist in breastfeeding in the early hours and days following delivery, as it prevents neonatal hypoglycemia, and lessen infant need for formula (Alibhai et al, 2022).…”