Results From a Pilot Randomized Trial of Antenatal Breast Milk Expression Among Healthy, First-Time Mothers

Abstract

To examine the relationship between antenatal milk expression (AME) and breastfeeding outcomes in a sample of first-time mothers in the United States. Limited research, mostly among diabetic women outside the United States, has indicated that hand expression, collection, and storage of breast milk during pregnancy (i.e., AME) is a safe, potentially effective intervention to improve short-term breastfeeding exclusivity. This was a pilot randomized, controlled trial of a structured AME intervention versus an education control. Participants were recruited from a single hospital-based midwife practice in the northeastern United States. We recruited and randomized 45 low-risk, nulliparous women who were at 34–36 6/7 weeks of gestation to the AME intervention or weekly breastfeeding handouts beginning at 37 weeks. The AME intervention involved technique demonstration from a lactation consultant, reinforcement at weekly visits, and daily home practice for 10 min. Follow-up data were collected during the postpartum hospitalization, at 1–2-weeks postpartum and at 3–4 months postpartum, on breastfeeding self-efficacy (Breastfeeding Self-Efficacy Scale-SF, BSES-SF; higher score indicative of greater self-efficacy), perceived insufficient milk volume (H & H Lactation Scale; higher score indicative of greater confidence in breast milk sufficiency), proportion of breast milk feeds, formula use, and maternal qualitative experiences with AME. Between-group differences in quantitative outcomes were examined with chi-square and independent-sample t tests. At baseline, AME participants were more likely to be employed (p = .03) and had slightly higher BSES-SF scores than controls (Ms = 53.2 vs. 47.1, respectively, p = .04). There were no other between-group differences in demographics or pregnancy–birth characteristics. AME participants scored slightly higher on the BSES-SF at 3 months compared with the control group (Ms = 65.0 vs. 59.3, respectively, p = .04), with trends toward higher scores on the BSES-SF and H & H Lactation Scale in the intervention group at all time points. There were no between-group differences in formula use or proportion of breast milk feeds. Women reported that AME increased their commitment and confidence to breastfeed. AME is a feasible intervention that may increase breastfeeding confidence among first-time mothers. Additional research with a powered sample is indicated.