Milk Expression Research Articles

Taxation, Lactation, and Validation: The Symbolic Power of Tax Law to Legitimize Breast Milk Expression

In 2011, the Internal Revenue Service reversed a previous regulation that excluded lactation supplies, including breast pumps, from medical care tax benefits. This policy change was met with joy by some working mothers. Often torn between family needs and workplace duties, these lactating employees struggled with trying to be a “good worker” and a “good mother.” They saw the new tax law as validation of their efforts to express milk at work and legitimation for the accommodations they required. They felt that even an area of law as technical and complex as tax law could recognize their commitment to combining breastfeeding and employment. However, the women recognized that the law only facilitated greater ability to lactate but not more time with their babies, which they greatly wanted. Indeed, this article asks if breast pumps and supplies would even be an issue for many women if the United States provided women with the more extensive maternity leave that workers in other developed countries receive.

Patterns of Breastfeeding Practices among Mothers in Two Urban Cities in Vietnam

INTRODUCTION: Breastfeeding is associated with lower risk of child morbidity and mortality and foster overall child development. However, suboptimal breastfeeding practices have been reported in many countries. This study aims to describe patterns of breastfeeding from birth to 24 months in Vietnam and examine factors associated with the maintenance of breastfeeding at 12 months. MATERIALS AND METHODS: 573 mothers whose infants aged from 12 to 24 months in a multi-centre cross-sectional study were recruited. RESULTS: The prevalence of initiation of breastfeeding within the first hour post-partum was 52.9%, between 1 to 24 hours was 21.9%, after the 24 hours was 25.2% and none not initiated by the 7th day after birth. The prevalence of delayed initiation of breastfeeding was significantly higher in caesarean section than in vaginal births (p=0.0001). Prevalence of infants ever breastfed was 100%; exclusively breastfed at 6 months was 19.7%, continued breastfeeding at 12 months was 92.5%, and continued breastfeeding at 20-24 months was 43.5%. There were 16.4% of mothers had breastfeeding problems. Correctly describing the recommended duration of exclusive breastfeeding and not using a bottle to give expressed milk to the infants were factors associated with the higher prevalence of breastfeeding maintenance for 12 months. CONCLUSION: Early initiation of breastfeeding and exclusive breastfeeding prevalence at 6 months in our study earn rating of “good” and “fair” respectively according to World Health Organization (WHO) recommendation. Improving mothers’ knowledge of exclusive breastfeeding recommendations and educating about breast milk expression may improve the prevalence of breastfeeding maintenance at 12 months.

Acute decrease in mothers' cortisol following nursing and milk expression

The glucocorticoid hormone cortisol is an integral component of signaling pathways related to stress reactivity, energy balance, immune function, and other processes. In animal models, lactation is robustly associated with alterations in glucocorticoid signaling, and limited data suggest that similar changes may occur across human lactation. We asked whether milk letdown/secretion in breastfeeding mothers was associated with changes in cortisol, and whether such effects required presence of an infant. We measured changes in maternal salivary cortisol concentrations before and after nursing, the expression of breastmilk with an electric pump, or control activities. Participants conducted pre-session and post-session sampling (at 30 min) for all conditions, and provided a sample of pumped milk from one session. Both nursing and mechanical expression of breastmilk but not control were associated with equivalent declines in maternal cortisol concentration from pre-session values, indicating an effect of milk letdown on circulating cortisol independent of infant contact. Pre-session maternal salivary cortisol concentration was strongly and positively correlated with cortisol concentration in pumped milk samples, indicating that cortisol ingested by offspring provides a signal of maternal cortisol levels. Self-reported maternal stress was associated with higher pre-session cortisol concentrations, as well as with a larger drop in cortisol following nursing or pumping. These findings demonstrate that milk release—in the presence or absence of a suckling infant—regulates cortisol in mothers, and supports the potential for maternal signaling through breastmilk.

EFEKTIVITAS PIJAT OKSITOSIN TERHADAP PENGELUARAN ASI PADA IBU POST PARTUM DI WILAYAH KERJA PUSKESMAS KARYA PENGGAWA TAHUN 2021

Breast milk is a source of life for children which is very important in the first life of a child. Expression of breast milk can be accelerated by non-pharmacological action, namely through oxytocin massage. The purpose of this study was to determine the effectiveness of oxytocin massage on breastfeeding in Post Partum mothers at Public Health Center Karya Penggawa, Pesisir Barat Regency in 2021.The design of this study used True Experimental with a Randomize Control Trial (RCT) research design. The samples in this study were 30 respondents, 15 control groups and 15 intervention groups with purposive sampling. The instruments used were the observation sheet and SOP. The statistical test used the Chi Square test. The results obtained indicate that oxytocin massage has an effect on breastfeeding. Mothers who received oxytocin massage were 3.2 times more likely to express breast milk than mothers who received warm water compresses. Those who received oxytocin massage had an intensity of expressing breastmilk faster than those who did not. Mothers should pay more attention to the need for breast milk for their children and how to facilitate the release of breast milk as well as family support, especially husbands, which are very much needed.

Learning from mothers' success in breastfeeding maintenance: coping strategies and cues to action.

This study aimed to gain insight from mothers who were successful in breastfeeding maintenance to develop interventions for promoting breastfeeding maintenance. Following the phenomenological framework, this qualitative study recruited mothers who had maintained breastfeeding for at least 4 months for in-depth interviews. A total of 30 in-depth interviews were completed. We found that almost all participants had experienced an initial adjustment period. During this period, a social support network, personal perseverance in "trying" breastfeeding and "pumping," and adjusting expectations for breastfeeding to relieve themselves from the pressure of exclusive breastfeeding were important coping strategies. All participants then entered a stage of getting more attuned when breastfeeding was easier. During this period, seeking support from the online mother groups, deliberating medication that might affect breastfeeding, adjusting to accommodate breastfeeding and lives, and managing breastfeeding in public were the main strategies. For working mothers, despite workplace and employers' support, proactive adjustment for using the facilities and lactation breaks for breast milk expression was essential for breastfeeding continuation after returning to work. Throughout the whole journey, positive cues identified from their breastfeeding experiences that helped breastfeeding maintenance included enjoying breastfeeding, breastfeeding as a personal achievement, a healthy and thriving child, positive social feedback, bodily response, the convenience of breastfeeding, and breastfeeding as a motherhood commitment. To conclude, while mothers should be mentally prepared for the difficulties of breastfeeding, they should also be encouraged that things will always get easier as they persevere. Adjustments should be made to accommodate lives and other personal needs. Future studies should consider integrating relevant cues into existing psychosocial interventions for promoting breastfeeding maintenance.

SmartLact8: A Bio-Inspired Robotic Breast Pump for Customized and Comfort Milk Expression.

According to the 2018 National Immunization Survey conducted by the Center for Disease Control and Prevention (CDC), 83.9% of the breastfeeding mothers in the United States have used a breast pump at least once. However, the majority of existing products use a vacuum-only mechanism to extract milk. This causes common breast injuries such as nipple soreness, breast-tissue damage, and lactation complications after pumping. The objective of this work was to develop a bio-inspired breast pump prototype, named as SmartLac8, that can mimic infant suckling patterns. The input vacuum pressure pattern and compression forces are inspired from term infants' natural oral suckling dynamics captured in prior clinical experiments. Open-loop input-output data are used to perform system identification for two different pumping stages that facilitates controller design for closed-loop stability and control. A physical breast pump prototype with soft pneumatic actuators and custom piezoelectric sensors was successfully developed, calibrated, and tested in dry lab experiments. Compression and vacuum pressure dynamics were successfully coordinated to mimic the infant's feeding mechanism. Experimental data on sucking frequency and pressure on the breast phantom were consistent with clinical findings.

Maternal immune regulation of lactogenesis

Abstract Breastfeeding has long been associated with health benefits for the infant. Breast milk is composed of essential nutrients and bioactive molecules shaping the growth, and the immune development of the offspring. An optimal development of the mammary gland (MG) during pregnancy is critical to maintaining the beneficial effects of lactation. Nevertheless, how the lactation process is regulated by the immune system remains largely unexplored. Our data reveal that the commitment of mammary epithelial cells into milk-secreting cells is associated with the accumulation of T-bet +lymphoid cells, preferentially localized at the proximity and inside the mammary epithelium. Among mammary T-bet +cells, we characterized an unconventional T cell population exhibiting common features with gut CD8αα +intra-epithelial lymphocytes and deriving from the same thymic progenitor. Such process is associated with thymus involution during pregnancy and specific enrichment in thymic precursor that preferentially migrates into the MG during pregnancy. These cells promote milk production and expression of β-casein, one of the main milk protein, resulting in an increase in newborn weight. This work uncovers a previously unappreciated contribution for the adaptive immune system in mammary gland development and lactation. Decoding the immune regulation of the MG will allow to understand the profound transformation of this compartment as a primary nutritional source for the offspring and may allow to understand how dysregulation of this process could affect the long-term development of newborns. This work was supported in part by intramural funds of NIAID, NIH.

Re: “Education and Experiences of Antenatal Breast Milk Expression: A Systematic Review” by Sobik et al.

Breastfeeding MedicineAhead of Print Re: “Education and Experiences of Antenatal Breast Milk Expression: A Systematic Review” by Sobik et al.Diane L. Spatz and Nina JunterealDiane L. SpatzAddress correspondence to: Diane L. Spatz, PhD, RN-BC, FAAN, University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19104, USA E-mail Address: spatz@nursing.upenn.eduhttps://orcid.org/0000-0001-7316-6616Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.Center for Pediatric Nursing Research & Evidence-Based Practice, Children's Hospital of Philadelphia, Pennsylvania, USA.Search for more papers by this author and Nina JunterealDepartment of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.Search for more papers by this authorPublished Online:8 May 2023https://doi.org/10.1089/bfm.2023.0058AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Re: “Education and Experiences of Antenatal Breast Milk Expression: A Systematic Review” by Sobik et al.." Breastfeeding Medicine, , pp. FiguresReferencesRelatedDetails Volume 0Issue 0 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Diane L. Spatz and Nina Juntereal.Re: “Education and Experiences of Antenatal Breast Milk Expression: A Systematic Review” by Sobik et al..Breastfeeding Medicine.ahead of printhttp://doi.org/10.1089/bfm.2023.0058Online Ahead of Print:May 8, 2023PDF download

Facility-based care for moderately low birthweight infants in India, Malawi, and Tanzania.

Globally, increasing rates of facility-based childbirth enable early intervention for small vulnerable newborns. We describe health system-level inputs, current feeding, and discharge practices for moderately low birthweight (MLBW) infants (1500-<2500g) in resource-constrained settings. The Low Birthweight Infant Feeding Exploration study is a mixed methods observational study in 12 secondary- and tertiary-level facilities in India, Malawi, and Tanzania. We analyzed data from baseline facility assessments and a prospective cohort of 148 MLBW infants from birth to discharge. Anthropometric measuring equipment (e.g., head circumference tapes, length boards), key medications (e.g., surfactant, parenteral nutrition), milk expression tools, and human milk alternatives (e.g., donor milk, formula) were not universally available. MLBW infants were preterm appropriate-for-gestational age (38.5%), preterm large-for-gestational age (3.4%), preterm small-for-gestational age (SGA) (11.5%), and term SGA (46.6%). The median length of stay was 3.1 days (IQR: 1.5, 5.7); 32.4% of infants were NICU-admitted and 67.6% were separated from mothers at least once. Exclusive breastfeeding was high (93.2%). Generalized group lactation support was provided; 81.8% of mother-infant dyads received at least one session and 56.1% had 2+ sessions. At the time of discharge, 5.1% of infants weighed >10% less than their birthweight; 18.8% of infants were discharged with weights below facility-specific policy [1800g in India, 1500g in Malawi, and 2000g in Tanzania]. Based on descriptive analysis, we found constraints in health system inputs which have the potential to hinder high quality care for MLBW infants. Targeted LBW-specific lactation support, discharge at appropriate weight, and access to feeding alternatives would position MLBW for successful feeding and growth post-discharge.

Human milk expression technologies: an evaluation of efficacy and comfort of hands-free, in-bra, breastmilk collection pump set

Human milk expression technologies: an evaluation of efficacy and comfort of hands-free, in-bra, breastmilk collection pump set

Dietary omega-3 fatty acid deficiency from pre-pregnancy to lactation affects expression of genes involved in hippocampal neurogenesis of the offspring

Maternal n-3 PUFA (omega-3) deficiency can affect brain development in utero and postnatally. Despite the evidence, the impacts of n-3 PUFA deficiency on the expression of neurogenesis genes in the postnatal hippocampus remained elusive. Since postnatal brain development requires PUFAs via breast milk, we examined the fatty acid composition of breast milk and hippocampal expression of neurogenesis genes in n-3 PUFA deficient 21d mice. In addition, the expression of fatty acid desaturases, elongases, free fatty acids signaling receptors, insulin and leptin, and glucose transporters were measured. Among the genes involved in neurogenesis, the expression of brain-specific tenascin-R (TNR) was downregulated to a greater extent (∼31 fold), followed by adenosine A2A receptor (A2AAR), dopamine receptor D2 (DRD2), glial cell line-derived neurotrophic factor (GDNF) expression in the n-3 PUFA deficient hippocampus. Increasing dietary LA to ALA (50:1) elevated the ARA to DHA ratio by ∼8 fold in the n-3 PUFA deficient breast milk, with an overall increase of total n-6/n-3 PUFAs by ∼15:1 (p<0.05) compared to n-3 PUFA sufficient (LA to ALA: 2:1) diet. The n-3 PUFA deficient mice exhibited upregulation of FADS1, FADS2, ELOVL2, ELOVL5, ELOVL6, GPR40, GPR120, LEPR, IGF1 and downregulation of GLUT1, GLUT3, and GLUT4 mRNA expression in hippocampus (p<0.05). Maternal n-3 PUFA deficiency affects the hippocampal expression of key neurogenesis genes in the offspring with concomitant expression of desaturase and elongase genes, suggesting the importance of dietary n-3 PUFA for neurodevelopment.

Infant and Young Child Feeding (IYCF) practices amongst mothers in Hospitals of Mohali district (Punjab, India)

India has achieved significant improvement since 2000, yet there are still areas of alarm, notably with regard to child nutrition. Adequate nutrition during infancy and early childhood is critical to each child’s development of his or her full human potential. The period from birth to two years of age is widely acknowledged as a “critical window” for promoting optimal growth, health, and behavioral development. The present study was conducted on 500 mothers of infant and young children (0-24 months) visiting OPDs of government and private hospitals of district Mohali. The respondents were interviewed using a questionnaire provided by WHO (WHO, 2021). It was found that only a few mothers (n=20) practiced hand expression of breast milk irrespective of the type of hospital visiting. A majority gave pre-lacteal food among those visiting both the private and government hospitals. 89.4 percent (n=447) had ever breastfed their infants while a majority visiting government (52.1%) as well as private (53.3%) hospitals practiced exclusive breastfeeding. Reasons for stopping breastfeeding included medical advice, family advise, perceived decreased milk production or birth of another child. IYCF practices were found to be similar amongst mothers visiting the government and private hospitals. Therefore, breastfeeding counselling at antenatal clinics and peer support for exclusive breast feeding as per WHO recommendations should be included as part of breast-feeding promotional programs both in private as well as government hospitals, dispensaries and clinics.

Maternal perceptions of human milk expression output: An experimental design using photographs of milk

BackgroundThe widespread use of breast pumps in the United States is a recent phenomenon that is reshaping how individuals understand and perceive lactation. In the 1990s, adequacy of milk supply was primarily measured indirectly by infant weight gain and/or diapers; now >95% of all lactating persons in the United States use breast pumps and are seeing their milk regularly. How seeing milk impacts the perception of lactation sufficiency is an important area of research.Research aim/question: To understand personal and intersubjective influences of seeing expressed human milk on perceptions of milk supply among participants who express milk for their infants. MethodsWe surveyed 805 lactating participants from the United States about their pumping practices using an online survey. Participants described pumping practices, milk output, and beliefs. They were then randomized to view one of three photographs of expressed milk (<2 oz, 4 oz, >6oz) and asked to imagine they had just pumped that amount and provide a written response; this created 4 exposure groups (2 increase and 2 decrease) and a control group (no difference). ResultsParticipants randomized to a higher volume reported more positive feelings and used the terms “good”, “great”, and “accomplished” to describe emotional responses to output. Participants randomized to lower milk volumes reported more feelings of “bad” or “depressed.” A subset of participants reported feeling “annoyed” about small volumes of milk. ConclusionsParticipants in this study were very conscious of the volume of milk pumped each session; both increases and decreases were associated with emotional responses that could contribute to decisions about pumping practices, perceived milk supply, and lactation duration.

Effect of antenatal milk expression education on lactation outcomes in birthing people with pre-pregnancy body mass index ≥25: protocol for a randomized, controlled trial

BackgroundBirthing people with pre-pregnancy body mass indices (BMIs) ≥ 25 kg/m2, particularly those without prior breastfeeding experience, are at increased risk for suboptimal lactation outcomes. Antenatal milk expression (AME) may be one way to counteract the negative effects of early infant formula supplementation common in this population.MethodsThis ongoing, randomized controlled trial in the United States evaluates the efficacy of a telelactation-delivered AME education intervention versus an attention control condition on lactation outcomes to 1 year postpartum among 280 nulliparous-to-primiparous, non-diabetic birthing people with pre-pregnancy BMI ≥ 25 kg/m2. The assigned study treatment is delivered via four weekly online video consultations between gestational weeks 37–40. Participants assigned to AME meet with study personnel and a lactation consultant to learn and practice AME. Instructions are provided for home practice of AME between study visits. Control group participants view videos on infant care/development at study visits. Participants complete emailed surveys at enrollment (340/7–366/7 gestational weeks) and 2 weeks, 6 weeks, 12 weeks, 6 months, and 12 months postpartum. Surveys assess lactation and infant feeding practices; breastfeeding self-efficacy, attitudes, and satisfaction; perception of insufficient milk; onset of lactogenesis-II; lactation support and problems; and reasons for breastfeeding cessation. Surveys also assess factors associated with lactation outcomes, including demographic characteristics, health problems, birth trauma, racial discrimination, and weight stigma. Health information and infant feeding data are abstracted from the pregnancy and birth center electronic health record. Milk samples are collected from the intervention group at each study visit and from both groups at each postpartum follow-up for future analyses. Qualitative interviews are conducted at 6 weeks postpartum to understand AME experiences. Primary outcomes of interest are breastfeeding exclusivity and breastfeeding self-efficacy scores at 2 weeks postpartum. Outcomes will be examined longitudinally with generalized linear mixed-effects modeling.DiscussionThis is the first adequately powered trial evaluating the effectiveness of AME among U.S. birthing people and within a non-diabetic population with pre-pregnancy BMI ≥ 25 kg/m2. This study will also provide the first evidence of acceptability and effectiveness of telelactation-delivered AME.Trial registrationClinicalTrials.gov: NCT04258709.

Effectiveness of lactation cookies on human milk production rates: a randomized controlled trial

BackgroundExpensive lactation cookies (LCs) are marketed as milk boosters; however, their effectiveness remains unknown. ObjectivesThe objective of this study was to evaluate the effectiveness of the 1-mo daily intake of LCs on changes in objective and subjective milk production and breastfeeding self-efficacy. MethodsThis is a 1-mo, randomized controlled trial among 18–45-y-old exclusively lactating parents of healthy, term, 2-mo-old infants living in the United States from March to December 2021. Participants (n = 176) were randomly assigned to eat daily 56.5 g of either LCs with “galactagogues” (oatmeal, brewer’s yeast, flax seeds, and fenugreek) or conventional cookies containing similar weight, calories, and presentation but lacking galactagogues. The primary outcome was baseline-to-1-mo changes in human milk production rate (HMPR), measured with a validated milk expression protocol. Secondary outcomes included changes in perceived insufficient milk (PIM) and lactation self-efficacy scores. ResultsAmong 176 randomly assigned participants (age: 31.3 ± 5.8 y; 71.0% self-identified as White, 15.3% Hispanic/Latin, 6.3% Black, and 4.0% Asian), 90 participants (51.1%) completed endline HMPR measures and 129 (73.3%) completed secondary outcomes. Imputed models showed a mean increase in HMPR of 5.8 ± 15.7 mL/h in control participants and 5.5 ± 17.6 mL/h in the LC participants after 1 mo of daily intake of the cookie. No significant differences were observed with adjusted linear mixed models on the multiply imputed data comparing baseline-to-endline changes in HMPR, PIM, or breastfeeding self-efficacy: mean (SE) difference-in-differences for HMPR, −0.33 (4.97), P = 0.948; PIM scores (range: 5–50), −0.52 (1.83), P = 0.775; and self-efficacy scores (range: 14–70), 0.31 (2.23), P = 0.888, respectively. ConclusionsThis study found no evidence for the effect of consuming LCs on HMPR, PIM, or breastfeeding self-efficacy in exclusively breastfeeding parents with an overall adequate perceived milk supply. Recommendations to consume LCs for increasing objective or subjective milk supply may deliver false hope and unnecessary financial costs at a vulnerable time.Trial registration number: This trial was registered at clinicaltrials.gov as NCT04805008.

Recommendations for the establishment and operation of a donor human milk bank.

In Europe, an increasing number of human milk banks (HMBs) collect donor human milk to feed preterm infants when their mother's milk is not available or not enough. Moreover, donor milk is a bridge to breastfeeding, with positive clinical and psychological advantages for both mother and infant. Italy, with 41 HMBs actively operating in 2022, has the highest number of HMBs in Europe. The process of human milk donation is complex, so activity of HMBs must be regulated according to well-established rules. The present recommendations have been prepared as a tool to standardize the organization, management, and procedures of HMBs operating in Italy and to determine the minimal essential requirements to establish new HMBs. This article covers all the aspects of human milk donation and human milk banking, including general recommendations, donor recruitment and screening, expression, handling and storage of donor human milk, milk screening, and milk treatment (pasteurization). A pragmatic approach was taken to drafting the recommendations. Items for which there was consensus or robust published evidence on which to base recommendations were included. When there were differences that could not be resolved by reference to published research, a statement of explanation based on the expert opinion of the authors (all members of the Italian Association of Human Milk Banks) was included. Implementation of these recommendations can contribute to promotion of breastfeeding.

Leveraging mHealth and a milk expression frequency biomarker during postpartum to prolong lactation among parents of critically ill infants: a pilot study.

To assess the feasibility and potential benefits of personalized biomarker-based text messages in prolonging lactation among parents of critically ill infants. Thirty-six participants were randomized to receive either daily texts with Mother's Own Milk (MOM) sodium levels or standard care. Surveys at months 1 and 3 assessed whether infants were receiving exclusive MOM feeding, any MOM feeding, and whether the parent was still lactating. Kaplan-Meier and log-rank tests were used for time-to-event analysis within and between intervention and control groups. Participants were predominantly on Medicaid (72%), delivered infants <1500 g, and by c-section (56%). Kaplan-Meier probabilities at month 3 suggest prolonged MOM feeding (63% [0.95CI, 0.43-0.91] vs. 41% [0.95CI, 0.21-0.67]) and lactation (63% [0.95CI, 0.42-0.95] vs. 37% [0.95CI, 0.18-0.76]) in the enhanced group compared to the control group. Personalized biomarker-based text messages are feasible and may prolong lactation and MOM feeding among parents of critically ill infants.

A single bout of breast milk expression does not increase resting metabolic rate.

Breastfeeding women have elevated resting metabolic rate (RMR); however, whether a single bout of lactation increases RMR is unknown. This study aimed to determine if a single bout of lactation acutely increased RMR. Twenty-two lactating women (age: 31 ± 0.9year, body mass index: 27.3 ± 1.2kg/m2 ) were recruited. RMR was assessed at baseline and at 1- and 2-h following breast milk expression. RMR was unchanged in lactating women following a single bout of lactation (baseline: 1437 ± 39; 1h: 1425 ± 37 2h: 1440 ± 31 kcal/day) (p> .05). RMR was not correlated to daily milk produced (r= 0.05, p> .05), but was correlated to body mass (r= 0.74, p< .001), fat-free mass (kg) (r= 0.61, p< .01), and fat mass (kg) (r= 0.71, p< .01). RMR in lactating women appears to be more related to body mass or composition in the postpartum period rather than lactation.

Human milk expression in the first year postpartum among persons with low incomes.

Expressing milk (i.e., human milk) is common in the USA, but practices are unknown among families in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). This study of a WIC population explores the practice of and reasons for expressing milk in the first year postpartum. We analysed data from a longitudinal study to examine milk expression at 1, 3, 5, 7, 9, 11, and 13 months postpartum among breastfeeding persons enrolled in WIC with term singletons. We cross-sectionally analysed the weighted prevalence of milk expression at each survey month and report reasons for milk expression in the first 7 months. Among the study participants who reported feeding human milk at Month 1, 70.4% expressed milk in the first 13 months postpartum. The prevalence of milk expression was 56.8% at Month 1 and decreased to 13.9% at Month 13 among those feeding any human milk that month. Reasons for expressing milk changed over time; in the first month, increasing milk supply, relieving engorgement, and having an emergency supply of milk were common. In later months, having a supply of milk available so that someone else could feed their infant was common. Clinicians, health educators, WIC staff, and others working with WIC families can promote optimal expressed milk feeding and storage practices. Extra attention and support may be especially important in the first months postpartum when milk expression is common. Support for persons who are expressing milk can be tailored for reasons of milk expression.

456 - Speed up: addressing barriers to early expression of breast milk in medically fragile mothers of preterm very low birthweight infants

456 - Speed up: addressing barriers to early expression of breast milk in medically fragile mothers of preterm very low birthweight infants