The volume of milk produced by a pump-dependent mother is the strongest determinant of the duration and exclusivity of breast-feeding the very low birth weight (VLBW, < 1,500 g) infant. In a study by Hill et al (2005), milk output reached a maximum at 2 weeks postpartum and then gradually declined over the next 3 weeks, and milk production was lower in mothers of VLBW infants compared with mothers of term infants. In the first days after delivery, some mothers can express drops of colostrum by hand but are unable to collect any amount with electrical pumping. We investigated the use of hand expression in the first 3 days to determine if this technique when used in conjunction with electric pumping would influence milk production at 2 weeks. Sixty-six mothers of VLBW infants, who were ≤ 3 6/7 weeks gestation, were recruited over 2 years. Mothers recorded pumping time duration and volume of milk pumped from each breast daily for 8 weeks. All mothers received individual hand expression instruction from one breastfeeding expert. Of these mothers, 41 (62.1%) recorded their use of hand expression in the first 3 days. They were then stratified into three groups based on the reported frequency of hand expression: group I (no/low, < 2 per day, n = 8); group II (medium, 2-5 per day, n = 17); and group III (high, > 5 per day, n = 16). The mean frequency of pumping in groups I, II, and III over the first 3 days postpartum was 3.7 ± 0.8, 4.4 ± 1.7, and 5.1 ± 1.7/d, respectively, and the mean frequency over 14 days was 5.7 ± 1.0, 5.8 ± 1.3, and 6.5 ± 1.3/d, respectively. No statistical differences were found between the three groups at either time points. By week 2, group I, II, and III mothers produced a mean milk volume of 497 ± 226, 484 ± 352, and 802 ± 540 mL/d, respectively. There was a statistically significant difference in milk production by group III mothers compared with groups I and II (p ≤.04 and < .01, respectively). We conclude that pump-dependent mothers of VLBW preterm infants, who hand-express frequently (> 5 per day) in the first 3 postpartum days, can produce larger than average volumes of breast milk by week 2. This suggests that mothers with risk factors for underproduction (eg, preterm or near-term delivery, cesarean section, separation of mother and infant) may benefit from using hand expression in conjunction with pumping or breast-feeding to reduce the likelihood of insufficient milk production, the most common reason given by mothers for early termination of breast-feeding.
Supported in part by grant M01 RR-00070 from the National Center for Research Resources, National Institutes of Health, and by Medela, Inc. We thank P. Hartsell, D. Inguillo, B. Kogut, and B. Piane for their invaluable help.
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