Women’s perspectives on antenatal breast expression: a cross-sectional survey

Abstract

BackgroundThe practice of antenatal breast expression (ABE) has been proposed as a strategy to promote successful breastfeeding. Although there has been some focus on the evaluation of the effects of ABE in promotion of breastfeeding, little or no evidence exists on women’s experiences of ABE or opinions on ABE, particularly amongst overweight or obese women.MethodsThis study aimed to explore women’s knowledge, practices and opinions of ABE, and any differences within the overweight and obese subgroups. A cross-sectional survey was undertaken using an online questionnaire distributed by a maternity user group representative via social media. Quantitative data were analysed using Chi-square and Fisher’s exact tests in SPSS. Simple thematic analysis was used for the qualitative data.ResultsA total of 688 responses were analysed; the sample represented a group of breastfeeding mothers, of whom 64.5% had heard of ABE, 8.2% had been advised to do ABE, and 14.2% had undertaken ABE. Of the women who had been advised to do ABE, 67.9% had complied. Most participants (58.6%) were unsure if ABE was a good idea; however 80.9% would consider doing ABE if it was found to be helpful to prepare for breastfeeding. Women in the overweight or obese subgroups were significantly more likely to have heard of ABE (p < 0.001), and positive opinion of ABE also increased with higher BMI groups. The qualitative data demonstrated participants felt ABE may be beneficial when mother or baby have medical problems, and in preparation for breastfeeding, but highlighted their concerns that it may interfere with nature and be harmful, and that they wanted more information and knowledge about ABE.ConclusionsAmongst women who have breastfed, many have heard of ABE, compliance with advice to undertake ABE is relatively high, and ABE is considered an acceptable practice. Further investigation into the benefits and safety of ABE is warranted, to address the needs of childbearing women for evidence-based information about this practice. If the evidence base is established, overweight and obese pregnant women could be an important target group for this intervention.Electronic supplementary materialThe online version of this article (10.1186/s12978-018-0497-4) contains supplementary material, which is available to authorized users.

“It gave me so much confidence”: First‐time U.S. mothers' experiences with antenatal milk expression

“…AME was thought to contribute to breastfeeding success on multiple fronts, most notably in increasing confidence in one's capability to produce milk and express it in the event of postpartum breastfeeding difficulties. Our findings are in line with qualitative and survey research conducted among women in the United Kingdom and Australia, which found that AME was acceptable to women, increased breastfeeding confidence, and contributed to breastfeeding preparation (Brisbane & Giglia, ; Fair et al, ).…”

“…Hand expression, rather than an electric breast pump, is the preferred milk removal strategy when milk volumes are small (as in pregnancy), yielding higher milk output (Ohyama, Watabe, & Hayasaka, 2009). Theory and limited research outside the United States suggest that AME may buoy women's breastfeeding confidence, reduce early formula use through "banking" of a back-up supply of breast milk during pregnancy, and hasten the onset of a more copious milk supply post birth through critical-period endocrine modulation (Chapman, Pincombe, & Harris, 2013;Cox, 2006;East, Dolan, & Forster, 2014;Fair, Watson, Gardner, & Soltani, 2018;Forster et al, 2011;Parker, Sullivan, Krueger, & Mueller, 2015). However, women's receptivity to AME, integration of AME into daily life during the third trimester, and perceived benefits and barriers of AME have not previously been evaluated within a sample of U.S. women.…”

Evaluating antenatal breastmilk expression outcomes: a scoping review

“…Eleven (55.0%) were published within the last 5 years (2015-2019) [21,24,[33][34][35][36][37][38][39][40][41]. Included studies originated from six countries: Australia (n = 7) [13,21,24,[33][34][35][36], New Zealand (n = 1) [42], the United Kingdom (n = 5) [20,39,[43][44][45], Sweden (n = 1) [46], United States (n = 3) [37,38,47], and India (n = 3) [16,40,41]. Three dominant research groups were identified; Forster et al [13,21], Demirci et al [37,38], and Casey et al [35,36], have each published two studies included in our review.…”

“…A detailed summary of the studies included in this scoping review is provided in Table 1. This review included one quality improvement study [33], two case studies/series [38,43], four qualitative and/or cross sectional survey studies of the knowledge, attitudes and experiences of women engaging in aBME [34,35,37,39], three observational cohort studies [20,36,46], and ten interventional studies [13, 16, 21, 24, 40-42, 44, 45, 47] including one RCT [21]. Sample sizes of included studies ranged from 1 to 60 (n = 8) [13,34,35,37,38,42,43,47], 80-230 (n = 8) [16,20,24,33,40,41,44,45], and 300-690 (n = 4) [21,36,39,46] participants.…”

A randomized controlled trial of the effects of antenatal milk expression on breastfeeding among first-time mothers in China

“…AME refers to extracting colostrum from the breast before birth by hand expressing. Limited studies have been conducted to evaluate the impact of AME intervention on breastfeeding for women with diabetes, and indicate that AME might help to enhance women's breastfeeding con dence, prevent delayed lactogenesis II and improve exclusive breastfeeding rate [17][18][19][20]. However, the impacts of AME to women who are not being with diabetes, particularly in rst-time mothers have not previously been evaluated.…”