Intervention Review

Methods of milk expression for lactating women

  1. Genevieve E Becker1,*,
  2. Fionnuala Cooney2,
  3. Hazel A Smith3

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 7 DEC 2011

Assessed as up-to-date: 20 JUN 2011

DOI: 10.1002/14651858.CD006170.pub3

How to Cite

Becker GE, Cooney F, Smith HA. Methods of milk expression for lactating women. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD006170. DOI: 10.1002/14651858.CD006170.pub3.

Author Information

  1. 1

    BEST Services, Galway, Ireland

  2. 2

    HSE West (NW Area), Department of Public Health Medicine, Sligo, County Sligo, Ireland

  3. 3

    UCC (University College Cork), Department of Paediatrics and Child Health, Cork, Ireland

*Genevieve E Becker, BEST Services, 2 Kylemore Park, Taylor's Hill, Galway, Ireland. gbecker@bestservices.ie.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 7 DEC 2011

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Résumé simplifié
  5. Plain language summary

Background

This is an update of a 2008 Cochrane review. Breastfeeding is important. However, not all infants can feed at the breast and methods of expressing milk need evaluation.

Objectives

To assess acceptability, effectiveness, safety, effect on composition, contamination and cost implications of methods of milk expression.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (20 January 2011), CINAHL (1982 to January 2011), conference proceedings, secondary references and contacted researchers.

Selection criteria

Randomised and quasi-randomised trials comparing methods at any time after birth, and crossover trials commencing at least 28 days after birth.

Data collection and analysis

Three authors independently assessed trials, extracted data and assessed risk of bias. Data were checked for accuracy.

Main results

We included 23 studies with 10 studies (632 mothers) providing data for analysis.

Mothers provided with a relaxation tape produced more milk than mothers who were not (mean difference (MD) 34.70 ml/single expression, 95% confidence interval (CI) 9.51 to 59.89, P = 0.007). A lower milk volume over six days was reported when comparing hand expression to the electric pump (standardised mean difference (SMD) -1.00 ml, 95% CI -1.64 to -0.36, P = 0.002); other studies of the same pump using different measures did not find a significant difference (12 to 36 hours postpartum SMD -0.38 cc, 95% CI -0.86 to 0.10, P = 0.12); day five postpartum SMD -0.62 ml/day, 95% CI -1.43 to 0.19, P = 0.13). No evidence of difference in volume was found with simultaneous or sequential pumping, or between manual and electric pumps studied. One study reported a higher sodium concentration in hand expressed milk compared to a manual pump (SMD 0.59 mmol/L, 95% CI 0.22 to 0.96, P = 0.002) and to an electric pump (SMD 0.70 mmol/L, 95% CI 0.32 to 1.09, P = 0.0003), and lower potassium concentration compared to a manual pump (MD -0.37 mmol/L, 95% CI 0.00 to 0.73, P = 0.05) or to an electric pump (SMD -0.32 mmol/L, 95% CI -0.69 to 0.06, P = 0.10). No evidence of difference was found for energy content, milk contamination or adverse effects. Reports of maternal views were not comparable. Economic aspects were not reported.  

Authors' conclusions

The most suitable method for milk expression may depend on the time since birth, purpose of expression and the individual mother and infant. Low cost interventions including early initiation when not feeding at the breast, relaxation, hand expression and lower cost pumps may be as effective, or more effective, than large electric pumps for some outcomes. Small sample sizes, large standard deviations, small number of studies reviewed, and the diversity of the interventions argue caution in applying these results beyond the specific method tested in the specific settings.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Résumé simplifié
  5. Plain language summary

Methods of milk expression for lactating women

Babies who do not receive human milk are more likely to suffer health problems as newborns and later. Not all babies are able to feed at the breast because they are premature, ill or separated from their mothers; thus expressed milk is needed. Mothers may express milk for their own comfort, to increase supply, or to leave milk for their baby. This updated review includes 23 randomised controlled studies with 10 (632 mothers) providing data for analysis. It includes mothers of infants in neonatal units in the USA, UK, Malaysia, Brazil, Egypt, Kenya and Nigeria, as well as term infants in the USA and UK. A greater milk volume was associated with providing a relaxation tape (one study), and when the mothers made an earlier start after birth of expressing milk for an infant unable to breastfeed. In another study, a large electric pump provided a greater mean volume of milk than hand expression over six days in the first two weeks after birth, though a greater volume was not found in two other studies of the same pump looking at 12 to 36 hours postpartum or on day five. No difference in volume was evident between the manual and electric pumps studied or with single versus double pumping. Sodium concentration was found to be higher in hand expressed milk, which may be important for preterm infants. Any milk contamination was similar comparing hand-expressed and pumped milk, and the level of maternal breast or nipple pain was no different between methods. All studies were small and results may not apply to pumps other than those tested or in different situations. No study asked mothers if they had achieved their own goals for expressing. None of the studies examined costs involved with methods. Twelve of the 18 studies that evaluated pumps or products had support from the manufacturers. The available evidence indicates that low-cost measures such as early initiation of expressing for an infant unable to breastfeed, relaxation, hand expression, and lower cost pumps may be as effective, or more effective, than large electric pumps for some outcomes. Not all the studies mentioned whether basic supports were provided, particularly for mothers with hospitalised children, including access to food and fluid, a place to rest near their baby, and the availability of knowledgeable health workers. These supports could affect milk expression.

 

Résumé simplifié

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Résumé simplifié
  5. Plain language summary

Méthodes d’expression du lait chez les femmes qui allaitent

Les bébés qui ne reçoivent pas de lait maternel ont plus de chances d’avoir des problèmes de santé à la naissance et dans les années qui suivent. Les bébés ne peuvent pas tous téter lorsqu’ils sont prématurés, malades ou séparés de leur mère ; dans ces cas, il est nécessaire d’extraire son lait. Les mères peuvent extraire leur lait pour leur propre confort, pour favoriser la lactation ou pour laisser du lait pour leur bébé. Cette révision mise à jour inclut 23 essais contrôlés randomisés dont 10 (632 mères) fournissant les données à analyser. Elle est composée de mères de bébés hospitalisés en unités néonatales aux USA, au RU, en Malaisie, au Brésil, en Egypte, au Kenya et au Nigeria, ainsi que de bébés nés à terme aux USA et au RU. Un volume plus important de lait a été associé à l’utilisation de la cassette de relaxation fournie (une étude), et lorsque les mères ont commencé à exprimer leur lait plus tôt après la naissance pour un enfant incapable de prendre le sein. Dans une autre étude, une grande pompe électrique a fourni un volume moyen de lait plus important qu’avec une expression manuelle sur six jours au cours des deux premières semaines suivant la naissance, bien qu'un volume plus important n'ait pas été démontré dans deux autres études sur la même pompe analysant les volumes à 12 à 16 heures postpartum ou au jour cinq. Aucune différence de volume n’a été démontrée entre les pompes manuelles et les pompes électriques étudiées ou entre un pompage simple et un double pompage. Il a été découvert que la concentration en sodium était plus élevée dans le lait exprimé manuellement, ce qui peut se révéler important pour les bébés nés avant terme. La contamination du lait était similaire dans la comparaison entre le lait exprimé manuellement et le lait pompé, et le niveau de douleur au niveau du sein ou du mamelon n’était pas différent entre les méthodes. Toutes les études étaient petites et les résultats peuvent ne pas s'appliquer aux pompes autres que celles testées ou dans des situations différentes. Aucune étude n’a demandé aux mères si elles avaient atteint leurs propres objectifs en termes d’extraction du lait. Aucune des études n’a examiné les coûts impliqués par les méthodes. Douze des 18 études qui ont évalué les pompes ou les produits étaient soutenues par les fabricants. Les preuves disponibles indiquent que les mesures à faible coût telles que l’initiation précoce à l’expression du lait pour un enfant incapable de prendre le sein, la relaxation, l’expression manuelle et les pompes moins onéreuses peuvent être aussi efficaces, voire plus efficaces, que les grandes pompes électriques pour certains résultats. Les études n’ont pas toutes mentionné si les soutiens basiques étaient fournis, en particulier pour les mères qui ont des enfants hospitalisés, y compris l’accès à la nourriture et aux boissons, un endroit pour se détendre auprès de leur bébé, et la disponibilité de travailleurs de santé compétents. Ces soutiens peuvent affecter l’extraction du lait.

Notes de traduction

Traduit par: French Cochrane Centre 1st January, 2012
Traduction financée par: Ministère du Travail, de l'Emploi et de la Santé Français

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Résumé simplifié
  5. Plain language summary

Metode izdajanja majčinog mlijeka

Metode izdajanja majčinog mlijeka

Djeca koja se ne hrane majčinim mlijekom imaju veći rizik za razvoj različitih zdravstvenih problema u novorođenačkoj dobi i kasnije. Sva djeca ne mogu se dojiti, primjerice zato jer su rođena prijevremeno, bolesna ili razdvojena od majke, i tada je nužno izdajati mlijeko. Majke izdajaju mlijeko da bi se bolje osjećale, da bi povećale količinu mlijeka za dijete, ili da bi pripremile mlijeko za dijete. U ovom obnovljenom Cochrane sustavnom pregledu uključene su 23 randomizirane kontrolirane studije, od kojih je 10 (632 majke) dalo podatke za analizu. Studije uključuju majke novorođenčadi u neonatalnim jedinicama u SAD-u, Velikoj Britaniji, Maleziji, Brazilu, Egiptu, Keniji i Nigeriji, kao i majku djece rođene na termin u SAD-u i Velikoj Britaniji. Veća količina mlijeka dobivena je korištenjem relaksacijske vrpce (jedna studija) i kad su majke ranije nakon rođenja počele izdajati mlijeko za djecu koja nisu mogla dojiti. U drugoj je studiji velika elektronička pumpa omogućila izdajanje veće količine mlijeka nego izdajanje rukom tijekom šest dana u prva dva tjedna nakon porođaja, ali veći volumen mlijeka nije dobiven u druge dvije studije u kojima je korištena ista pumpa 12-36 h nakon porođaja ili nakon pet dana. Nije uočena razlika u količini mlijeka između ručne i električne pumpe, ili kad se usporedi jednostruko i dvostruko izdajanje. Koncentracija natrija bila je veća u mlijeku izdojenom rukom, što može biti važno za nedonoščad. Kontaminacija mlijeka bila je slična kod mlijeka izdojenog rukom i pumpom, a intenzitet boli u dojci ili bradavici nije bio značajno drugačiji pri različitim metodama. Sve studije bile su malene i rezultati se ne moraju nužno odnositi i na pumpe koje nisu provjerene u spomenutim istraživanjima. Nijedna studija nije pitala majke jesu li izdajanjem uspjele postići svoj cilj. Nijedna studija nije se bavila troškovima različitih metoda izdajanja. Dvanaest od 18 studija u kojima su korištene pumpe ili različiti proizvodi bilo je financirano od strane proizvođača. Dokazi koji su nam na raspolaganju pokazuju da jeftine mjere kao što je rani početak izdajanja za djecu koja ne mogu dojiti, relaksacija, izdajanje rukom i jefinije pumpe mogu biti jednako učinkovite ili čak i učinkovitije od velikih električnih pumpi za neke ishode. Sve studije nisu navele da li je majkama hospitalizirane djece pružena ikakva potpora, u vidu hrane i tekućine, mjesta za odmor blizu djeteta i pomoć stručnih zdravstvenih djelatnika. Takve vrste potpore mogu utjecati na izdajanje mlijeka.

Translation notes

Translated by: Croatian Branch of the Italian Cochrane Centre