Over reliance on electric breast
pumps may be associated with underproduction of breastmilk, the
conclusion reached by Jane Morton and her Stanford colleagues in a study
to be published by the Journal of Perinatology.
They report the effect on milk production of 2 manual techniques
used by mothers of infants less than 30 weeks gestation. These mothers
typically remain pump-dependent for weeks to months before they can rely
on the breastfeeding infant to maintain their supply. This is the first
report of a steady increase in production over 8 weeks, which surpassed
reference levels for mothers of term infants.
Demonstrated online, mothers
were first taught hand expression of colostrum. (Hand
Once milk came in, they were instructed in the second technique,
“hands-on pumping”. (Hands-on
During instructional sessions, milk was collected into bottles
placed on electric scales, which were computer-linked to record milk
removal While simultaneously compressing their breasts and massaging
firmer areas, mothers would observe sprays of milk in the tunnel of the
breast shield, guiding them as to where and how to use their hands.
Additionally, they could watch the computer screen demonstrate milk
removal from each breast. (See
illustration) If study mothers were dependent solely on pump suction,
stopping when the flow ended, available milk would have remained
Most remarkable was the
unfaltering and impressive milk output of these preterm infant mothers,
who are considered to be at high risk for impaired milk production.
Production steadily rose over 8 weeks, exceeding published
averages for mothers of term infants.
Frequency of hand expression in the first 3 postpartum days
correlated with subsequent production. The self-selected mothers who used frequent hand expression (over 5 times per day) and then
“hands-on pumping” once milk came in produced an average of 955
mL/day (about 32 ounces) by 2 months. The
average intake for a healthy 3-month-old breastfed term baby is about 27
oz/day. Impressively, these mothers
were able to reduce time spent pumping and extend their unpumped
sleeping interval. By the 8th week, mothers pumped an average
of 6 times a day with a 7 hour uninterrupted interval for sleep.
The study underscores the
long-term importance of the first 3 days when frequent and effective
removal of colostrum is critical. Factors speculated to compromise
production such as advanced maternal age, preterm delivery, high BMI,
C-section delivery, IVF and primiparity had no impact.
Acceptance was so positive mothers volunteered to demonstrate
these techniques and share their impressions for internet viewing posted
Morton does not challenge
the importance of pumps, but suggests that suction alone may remove only
a fraction of available milk, thus compromising production.
85% of mothers of infants less than 4.5 months rely on an
electric pump. (Labiner-Wolfe J, Pediatrics 2008)
No electric pump comes with instructions for a “hand-on”
approach. In fact, the
usual advice for a mother with low production is simply to pump more.
Impaired breastmilk production
is a pervasive problem in our culture.
Insufficient milk supply is the most common reason given by
mothers for discontinuing efforts to breastfeed over the course of the
first year. (Ruowei Li, Pediatrics 2008) The most common reason for
re-hospitalization of newborns relates to reduced breastmilk intake.
Compromised production is 3 times more common in mothers of preterm vs.
The AAP’s new
Breastfeeding Curriculum for Residents recognizes hand expression as one
of the key learning objectives for physicians to teach all new mothers.
There are many unforeseeable scenarios in which reliance only on
the baby or the baby plus the pump may not be enough to stimulate or
maintain a robust supply. Ideally,
expectant mothers could watch these videos to learn about the importance
of the first 3 days and an effective technique which may possibly
prevent subsequent production problems.
Whether these preliminary
findings can be duplicated to the advantage of a wider spectrum of
mothers remains to be studied. Yet the solution at hand (literally) may
be learning a simple skill which involves no cost, no paraphernalia, no
discomfort, no drugs and no risk.
Computerized pictorial of milk
expression from one breast as a study mother is taught “hands-on
pumping”. Gradual ascending line represents cumulative volume;
saw-toothed line depicts rate of expression over 30 minutes. Coincident
with compression over areas of full breast tissue, spikes in output are