The strongest determinant of the duration and exclusivity of breast-feeding the very low birth weight (VLBW, ≤ 1,500 g) infant is the volume of milk produced by the pump-dependent mother. Hill et al (2005) demonstrated that volumes level off 2 to 3 wks postpartum and then decline during the next 3 weeks and are lower in mothers of VLBW infants compared with mothers of term infants. In contrast, we have found that mean volumes continue to increase over 8 weeks and surpass, as reported by Hill, the mean production by mothers of preterm and term infants, who pumped with the same frequency. Therefore, we investigated whether the increases in milk volumes were associated with the use of breast massage/hand expression in conjunction with electrical pumping. Sixty-six mothers of VLBW infants (≤ 306/7 weeks' gestation) were recruited and asked to record milk volumes and duration of each pumping session over an 8-week period. Fifty-five percent (36 of 66) recorded all measurements and completed at least two separate computerized pumping sessions using the Symphony pump (Medela Inc, Switzerland), during which they were instructed by a single breast-feeding expert to combine electrical pumping with breast massage/hand expression. The first instructional session occurred 19.8 ± 9.9 days postpartum. For each mother, mean daily volumes collected over 3 days preinstruction was compared with her mean volume collected postinstruction over the last 3 days of the 8-week study. Volumes were unchanged or decreased in 14% (5 of 36) of mothers. For 31 (86%) mothers, mean volumes pre- and postinstruction were 537 ± 333 and 862 ± 567 mL, respectively, with a mean percent increase of 93 ± 127% (range 2-611%). In all 36 mothers, there was no significant change in the frequency or duration of pumping sessions pre- and postinstruction. We conclude that increased milk volumes appear to be associated with completeness of emptying rather than with increased frequency or duration of pumping sessions. In contrast to Hill's observations, these preliminary results suggest that mothers of preterm infants can attain and sustain high production levels by combining the use of breast massage/hand expression and electrical pumping. Furthermore, we speculate that reliance on electrical pumping alone may compromise milk production potential in pump-dependent mothers.
Supported in part by National Institutes of Health grant M01 RR-00070 from the National Center for Research Resources and by Medela, Inc. We thank P. Hartsell, D. Inguillo, B. Kogut, and B. Piane for their contributions.
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