Use Of Breast Pumps Research Articles

Informal Human Milk Sharing: A Qualitative Exploration of the Attitudes and Experiences of Mothers.

Little is known about women's participation or likely participation in informal human milk (HM) sharing. The US Food and Drug Administration recommends against feeding infants shared HM acquired directly from individuals or through the Internet. This study explored the experiences of and attitudes toward HM sharing among mothers with experience of HM feeding and breast pump use, regardless of whether or not they had participated in HM sharing. We conducted qualitative, semistructured, in-depth interviews with 41 mothers from 4 counties in upstate New York, asking about their attitudes toward HM sharing. Interviews were transcribed and analyzed inductively. Most women were aware of informal HM sharing and some had personal experience with sharing. Many mothers reported a willingness to provide their own HM if they had extra and their own child had enough. Mothers were less trusting about receiving HM, voicing concerns about the dietary intake or disease status of potential providers. Mothers felt that whether or not they participated in HM sharing would depend on the situation; they were most amenable to sharing with a family member or close friend. A novel finding was the involvement of lactation consultants and midwives, who coordinated HM exchanges for mothers in this sample. Awareness of HM sharing was high in this sample. Depending on the situation, mothers may consider participating in informal HM sharing and they may be facilitated by health professionals. Future research is required to establish the benefits and risks associated with informal HM sharing.

Which breast pump for which mother: an evidence-based approach to individualizing breast pump technology.

The majority of new mothers in the United States use breast pumps in the first four months post-birth in order to achieve their personal human milk feeding goals. Although these mothers seek guidance from health care professionals with respect to the type and use of breast pumps, there are few evidence-based guidelines to guide this professional advice. This paper reviews the evidence to facilitate professional individualization of breast pump recommendations using three categories of literature: the infant as the gold standard to which the pump is compared; the degree of maternal breast pump dependency (e.g., the extent to which the breast pump replaces the infant for milk removal and mammary gland stimulation); and the stage of lactation for which the pump replaces the infant. This review can also serve to inform public and private payers with respect to individualizing breast pump type to mother-dyad characteristics.

Breastmilk Expression and Breast Pump Technology.

More than 80% of mothers express milk at some point during the first 4 months postpartum. Many women rely on breast pumps to establish and maintain lactation particularly when the infant is not able to breastfeed. Proper breast pump fit and use are important to optimize breastmilk supply and prevent injury. As breast pumps continues to evolve and the number of women using them remains a substantial majority, health care professionals need to maintain a thorough understanding of this tool and relevant techniques to help mothers succeed.

Breast pump use amongst mothers of healthy term infants in Melbourne, Australia: A prospective cohort study

Objectivethis paper describes the use of breast pumps amongst a group of mothers of healthy term infants in Melbourne, Australia, between birth and six months post partum. Designa prospective cohort study; data were collected using structured questionnaires. Participants1003 postpartum women who had given birth to healthy infants at term were recruited from three Melbourne maternity hospitals between July 2009 and April 2011. Data were collected by face-to-face interview at recruitment and by telephone interview three and six months later. Findingsat recruitment (24 to 48 hours post partum), 60% (605/1003) of women already had a breast pump. At two weeks post partum expressing was common; 62% (290/466) of women had expressed by this time, with 40% (186/466) doing so several times a day. By six months post partum 83% (754/911) of the women had a breast pump and 40% (288/715) were expressing, although most just occasionally. The most common reasons for any expressing in the first six months were ‘to be able to go out and leave the baby’ (35%; 268/772); milk supply ‘not enough’(27%; 207/772); and having ‘too much’ milk (19%; 147/772). The increasing popularity of expressing breast milk to feed infants is not driven by women returning to the workforce, as only 10% of women (80/772) expressed because they had returned to paid employment. Key conclusions and implications for practicehealth professionals should be aware that in some settings breast pump use is common in the first six months, and this is not always related to maternal workforce participation.

Postdischarge Breastfeeding Outcomes of Infants With Complex Anomalies That Require Surgery

To examine the duration and exclusivity of breastfeeding and provision of human milk among infants with complex anomalies that require surgery postdischarge from a neonatal intensive care unit (NICU). Prospective cohort study. A tertiary care children's hospital with a fetal diagnostic and treatment center, special delivery unit, and NICU. Mothers who had delivered infants with complex anomalies that require surgery between 2009 and 2012 (N=165). Phone interviews were used for data collection and were analyzed using descriptive statistics methods. The average duration of breastfeeding/provision of human milk was 8 months. The percentage of infants who received human milk at 6 months was 60.1% (n=98/163,; p=.0063) and at 12 months was 34.5% (n=57/165, p=.023). Of infants in this cohort, the percentage of those infants exclusively receiving human milk was 54.3% (n=89/164, p=.0004) at 3 months of age and 35.6% (n=58/163, p<.0001) at age 6 months. Another clinically important finding is that 30.7% of the cohort required gavage feeds postdischarge from the NICU. Even for the most surgically complex infant/mother dyads, breastfeeding outcomes can improve significantly with a strong prenatal lactation program, nursing staff with specific breastfeeding education, and a hospital culture that values and supports breastfeeding and the provision of human milk. These findings support the use of hospital-grade electric breast pumps postdischarge for families of infants with complex anomalies that require surgery, as approximately one third of the cohort went home on tube feeds and their mothers continued to pump their breast milk at home.

What is Breastfeeding?

“Breastfeeding” has typically been considered synonymous with a mother feeding her infant directly at her breast. However, the now ubiquitous use of breast pumps has enabled the separation of human milk (HM) production and consumption. To explore this disconnect, we interviewed a diverse sample of 41 mothers of children aged ~1–3 years. Subjects were asked about (a) dyadic feeding at the breast, (b) maternal HM expression, and (c) infant HM consumption. Interviews were transcribed and themes were identified via iterative open and closed coding using Atlas.ti. Many mothers described HM expression in addition to feeding at the breast: This was done to allow someone else to feed the infant, maintain an adequate HM supply, or build a “stockpile” of HM in preparation for returning to work. This extra “stash” allowed some infants to consume frozen HM after their mother stopped lactating: The disconnect between maternal production and infant consumption of HM indicates that the term “breastfeeding” is no longer appropriate. Definitions of HM production and consumption are in need of revision.

The Use of Technologies to Support Human Milk & Breastfeeding

The application of lactation technologies is not limited to the NICU or the hospital setting. These technologies can be implemented within the home or hospital setting to promote the use of human milk and protect the breastfeeding relationship. Through the use of breast pumps, scales, and nipple shields, women can be supported to achieve their personal breastfeeding and lactation goals.

Board #251 - Program Innovation Experiential Learning at it’s Breast

Objectives The Center for Disease Control (CDC 2011) found <4% of U.S. hospitals provide a full range of support mothers need to be able to breastfeed. The hospital experience can have a strong influence on the mothers’ infant-feeding decisions by implementing practices in labor, delivery, and postpartum care, as well as in hospital discharge planning. As one of 89 facilities participating in NICHQ Best Fed Beginnings Learning Collaborative to improve practices that support breastfeeding, an interdisciplinary team developed an innovative clinical skills education and competency program using high-fidelity simulation, standardized patient interactive scenarios and skills labs to enhance and verify nursing competency in the 4 Baby Friendly Skills Competencies for Maternity Staff: 1) Communicating with pregnant and postpartum women about infant feeding; 2) Observing, assessing, and assisting with breastfeeding; 3) Teaching hand expression and safe storage of milk; and 4) Teaching safe formula preparation and feeding. Additional topics included changing habits of providing formula supplementation beyond medical need, changing reliance on a nursery and shifting care to 24-hour rooming-in, and altering staff responses to feeding challenges. Description A total of 240 RNs and 48 ancillary nursing staff were trained using a ‘bolus approach’ with 37 sessions held over an eight day period. The training included: 1) A skills lab which had reviewed policies, held, open discussion, informational videos (e.g. Stanford breast expression video), breast hand expression task trainer model, hospital equipment (e.g. breast pump), and educational materials (e.g. formula safety and patient education poster), and peer staff surveys; and 2) Scenarios which used standardized patients for a more realistic learning environment. The skills station included a breast milk hand expression trainer (worn by the standardized patient) and allowed staff to practice positioning using a low-fidelity infant simulator, and practice techniques for hand expression of breast milk. The breast model was realistic in shape, texture and warm to the touch and mimics the normal female allowed learners to practice different ways for hand expression of milk and safe milk storage. The life-like breast was able to excrete milk (i.e. formula). The hand expression mimics natural stimulation of breast milk during feeding. RNs were also able to then practice techniques for collecting milk. CME application was submitted and nurses were awarded contact hours. Conclusion Data was collected and analyzed for pre-/post-assessment and evaluations for training, on–unit patient audits, and lactation consultant feedback. Results indicated an improvement in key areas targeted in the training. Significant improvements (p=.000) were seen in RNs ability to: correctly identify frequency mothers should express milk, how to teach hand expression, and reasons to avoid supplements unless medically indicated. The number of RNs increased by 28% that reported teaching BF patients hand expression. Additionally, RNs reported increased confidence to: 1) communicate with patients about infant feeding, 2) observe, assess, and assist with BF, 3) demonstrate teaching, hand expression, use of breast pumps and safe storage of milk, 4) teach safe formula preparation and feeding. Interestingly, areas of significant improvement were areas highlighted in simulation and scenarios in training, particularly using the hand expression breast model. Supporting evidence of impact is provided by medical record data received immediately after training reporting the highest exclusive BF rate recorded- 81% and lowest on record 19% BF babies supplemented with formula. Patient audits support findings, indicating baby-friendly practices are being used.

EXPRESSION OF BREAST MILK AS THE WAY OF MAINTENANCE OF LACTATION

The necessity of maintenance of breast feeding of a child in the first months of his life causes the need for development of preventive measures and plugged duct treatment. Results of use of electric breast pumps by mothers under impossibility of breast feeding by a physiological way are presented. It is shown that modern breast pumps, optimally imitating a peristaltic sucking of a child, allow to reduce time for expression, and also to make it painless and comfortable. It supports mothers' desire of long breast feeding, providing, thus, formation of a child health.

Breastfeeding interventions in Kansas: A qualitative process evaluation of program goals and objectives

Across the state of Kansas, eighteen public health departments received funding through the 2011 Breastfeeding Grant Initiative to start a breastfeeding intervention. The main objective of this study was to evaluate the progress toward program goals and objectives. This study was a process evaluation. Qualitative data were collected from recipient health departments at two time-points during the program year. Structured, open-ended questions were asked through telephone interviews. This study examined: (1) progress toward program goals and objectives, (2) problems encountered during implementation, and (3) evaluation measures employed to assess program impact. All health departments reported making significant progress toward program goals and objectives and reported successful collaboration with other healthcare providers. The use of breast pumps, educational classes, and professional training of staff were reported as providing the best outcome in the promotion of breastfeeding. The majority of respondents did not measure program impact. From a public health perspective, it is important that infants receive breast milk for the first six months of life. It appears that goals and objectives set a priori guided health departments with the administration of their breastfeeding program. Results may be used to enhance and sustain delivery of breastfeeding support programs in Kansas communities.

Maternal and Breast Pump Factors Associated with Breast Pump Problems and Injuries

Benefits of using a breast pump are well documented, but pump-related problems and injuries and the associated risk factors have not been reported. This study aimed to describe breast pump-related problems and injuries and identify factors associated with these problems and injuries. Data were from the Infant Feeding Practices Study II; mothers were recruited from a nationally distributed consumer opinion panel. Mothers were asked about breast pump use, problems, and injuries at infant ages 2, 5, and 7 months. Survival analysis was used to identify factors associated with pump-related problems and injuries. The sample included 1844 mothers. About 62% and 15% of mothers reported pump-related problems and injuries, respectively. The most commonly reported problem was that the pump did not extract enough milk and the most commonly reported injury was sore nipples. Using a battery-operated pump and intending to breastfeed less than 12 months were associated with higher risks of pump-related problems and injury. Learning from a friend to use the pump was associated with lower risk of pump-related problems, and using a manual pump and renting a pump were associated with a higher risk of problems. Our results suggest that problems and injuries associated with breast pump use can happen to mothers of all socioeconomic characteristics. Breastfeeding mothers may reduce their risks of problems and injury by not using battery-operated pumps and may reduce breast pump problems by not using manual pumps and by learning breast pump skills from a person rather than following written or video instructions.

Where's the Lactation Consultant? Increasing Exclusive Breastfeeding Rates by Empowering L&D Nurses

<h2>Childbearing Poster Presentation</h2><h3>Purpose for the Program</h3> Breastfeeding is widely recognized as the ideal method of feeding infants. An objective of Healthy People 2010 was for 75% of infants to be exclusively breastfed upon hospital discharge. Currently, breastfeeding rates in the United States have not met this goal. Baylor University Medical Center (BUMC) implemented a program that focused on increasing exclusive breastfeeding rates (EBRs). <h3>Proposed Change</h3> There has been a significant increase in BUMC's EBR because of nurse and patient education, nurses' hands‐on assistance with breastfeeding initiation, and the labor and delivery (L&D) nurses role as bedside breastfeeding advocates. <h3>Implementation, Outcomes, and Evaluation</h3> An International, Board Certified, Lactation Consultant (IBCLC) at BUMC championed a project that filled the gap in lactation support, which is given to patients throughout the Women's and Children's service line, by creating <i>the crew</i>. The crew consists of nurses that underwent training and were committed to serving their individual unit's needs regarding breastfeeding. The L&D crew is addressing barriers to breastfeeding on our unit and is implementing changes to overcome these challenges. In particular, we re‐purposed a patient breastfeeding education sheet used by the lactation department. By adding the breastfeeding education sheet to our electronic system, it prints with the chart and is readily accessible to staff. Also, crew members are assessing attitudes and comfort levels of L&D nurses regarding lactation support by using an online survey. Once survey results are analyzed, in‐services and staff education will be implemented that focuses on topics such as hand expression of colostrum and spoon‐feeding, skin‐to‐skin contact, breastfeeding in the operating room, use of breast pumps, and breast milk storage. Implementation of the crew in L&D has already made an impact on our EBR, increasing the rates from 41% to 72%. Follow‐up from the online surveys will hopefully further increase the EBR rate. <h3>Implications for Nursing Practice</h3> Increasing the EBR is a Baylor Healthcare System goal, prompted by Medicaid reimbursement policies, The Joint Commission quality measurement tools, and the Baby Friendly designation that BUMC is working to achieve. This innovative project will increase the EBR at our institution by empowering BUMC nurses to be champions of excellent care of women and newborns. By exclusively breastfeeding, our patients will take part in one of the most highly effective preventative measures a mother can take to protect the health of her infant and herself.

Expression of Breast milk-an update

Breast feeding by sucking is the norm. However sometimes expression is the only way by which breast milk can be given to babies. There are many situations when expressing breast milk is useful and necessary to enable a mother to initiate or to continue breast feeding. Hand or breast pump are used to express breast milk. Hand expression is the most preferred method. There are some mechanical pumps though pumps cause discomfort and are usually ineffective. The Marmet technique of expressing breast milk with hand is a fabulous alternative to using a breast pump. Until recently hand expression of breast milk has been as underutilized skill. However, there are many benefits of knowing how to express milk from the breast without the use of expensive and cumbersome breast pumps. Expressed breast milk can be feed by spoon, cup and nasogastric tube. It is essential to collect and store breast milk properly to prevent the risk of bacterial overgrowth. Feeding with breast milk is quite safe if done properly. It is important for every woman to learn to express the milk. Certainly all health workers who take care for breastfeeding mothers should be able to teach the way of expression of breast milk. DOI: http://dx.doi.org/10.3329/jssmc.v4i2.14422 J Shaheed Suhrawardy Med Coll, 2012;4(2):62-64

Examining the Use and Outcomes of a New Hospital-Grade Breast Pump in Exclusively Pumping NICU Mothers

To determine whether exclusively pumping mothers of preterm infants could achieve full milk production while using the Ameda Platinum breast pump the first 14 days postpartum. Twenty-six mothers who delivered infants between 26 and 32 weeks' gestation at 2 Intermountain Healthcare hospitals completed the study. Mothers could not take milk-enhancing or milk-reducing substances, feed directly at the breast, have had breast surgery, or use any other breast pump during the study. Nonexperimental, descriptive study. Mothers were instructed to use the Ameda Platinum breast pump exclusively 8 times daily, for 14 days. They recorded milk volumes, suction pressures, cycle speeds, and time spent pumping. A "Performance Questionnaire" was completed at the end of the study with questions about the ease of use, preferred speed and suction settings, and overall performance of the pump. Full milk production was defined as 700 mL/d. Speed and suction settings, as well as average pumping session length, were analyzed in relation to categories of maximum milk volumes expressed. The average maximum daily milk volume for all mothers was 817 mL/d. Sixteen mothers produced milk volumes more than 700 mL/d and 9 of these mothers were able to express more than 1000 mL/d. Those with daily milk production more than 700 mL/d used lower suction pressure settings to stimulate the milk ejection reflex and to empty the breast. These higher-producing mothers also chose ending speeds of 50 to 60 cycles per minute, similar to the nutritive sucking pattern of a healthy newborn. Mothers producing less than 500 mL/d used higher suction pressures, faster ending cycle speeds, and longer pumping times. Suction pressures varied widely among all of the mothers and were influenced by the mothers' nipple or breast sensitivity, which varied from mother to mother and day to day. Mothers reported liking separate controls for speed and suction and used them to achieve maximum comfort and milk volume. The Ameda Platinum breast pump is an effective hospital-grade pump for exclusively pumping mothers to establish full milk production by 14 days postpartum. Separate control of speed and suction allows mothers a wide range of options to achieve greater comfort and multiple milk ejections, both of which contribute to optimal milk expression.

A Mother With Glandular Hypoplasia and a Late Preterm Infant

This case study presents a maternal-infant dyad, both of whom bring risk factors to the breastfeeding relationship. The mother had true glandular hypoplasia that was not detected in the antenatal period or during her hospital stay. In addition, the infant was a late preterm infant, bringing the risks of poor feeding behavior and ineffective removal of milk from the breast as well as limited body reserves. Through the use of breastfeeding technology, including test weights, use of a hospital grade double electric breast pump and use of a nipple shield, in addition to a pharmacologic intervention, in which Domperidone was administered, this mother was able to maximize her milk yield and the infant was able to receive human milk for 6 months. This case report highlights the need for a thorough assessment of the breasts as well as the breastfeeding process in all breastfeeding dyads.

Sources of Education About Breastfeeding and Breast Pump Use: What Effect do they Have on Breastfeeding Duration? An Analysis of the Infant Feeding Practices Survey II

To examine the association between breastfeeding duration and sources of education about breastfeeding and breast pumps. We analyzed data from the Infant Feeding Practices Survey II (n = 2,586), a national longitudinal consumer-based study. We used χ(2) and ANOVA to contrast categorical and continuous variables, respectively, and logistic regression to model the association between breastfeeding duration and sources of education about breastfeeding and breast pump use. In unadjusted results, multiple sources of breastfeeding and breast pump education were significantly associated with breastfeeding duration. However, in multivariable logistic regression models, there was a negative association between longer breastfeeding duration and receiving breast pump education from a physician/physician assistant (OR 0.58, 95% CI 0.36-0.93); and a positive association between longer breastfeeding duration and receiving breastfeeding education from classes/support group (OR: 1.85, 95% CI: 1.24-2.76) and receiving breast pump education from friends/relatives (OR: 1.70, 95% CI: 1.13-2.55). Although healthcare providers such as physicians and nurses have regular contact with women, the only statistically significant association between breastfeeding and breast pump education from healthcare providers and longer breastfeeding duration was a negative one. This likely reflects time and resource limitations of clinical practice, but may also indicate a need for more consistent training for healthcare providers who provide breastfeeding and breast pump education. Social supports, such as education from classes/support groups and friends/relatives demonstrated positive associations with longer breastfeeding duration. This emphasizes the importance of fostering a positive sphere of influence around breastfeeding women. Future work should also investigate alternative levers of action, such as policies affecting insurance coverage of breast pumps.

The quiet revolution: breastfeeding transformed with the use of breast pumps.

A quiet revolution has been taking place in the feeding of US infants in the form of women using electric breast pumps. This revolution in milk expression may be a boon for both mothers and infants if more infants are fed human milk or if they receive human milk for a longer period. Milk expression may also be problematic for mothers, and it may be particularly problematic for infants if they are fed too much, fed milk of an inappropriate composition, or fed milk that is contaminated. As a result, the time has come to determine the prevalence of exclusive and periodic breast milk expression and the consequences of these behaviors for the health of mothers and their infants.

Evaluation of an Educational Intervention to Promote Breast Pump Use Among Women With Infants in a Special Care Nursery in Kenya

Development of an educational program for women of special care nursery (SCN) infants in Kenya about the use and cleaning of breast pumps through culturally appropriate teaching tools as well as conduction of an evaluation of change in knowledge, attitudes, beliefs, and practical ability in pump use following the educational intervention. An evaluation of an educational intervention. 40 women with infants in the SCN unable to directly breastfeed. Educational intervention instructing electric or pedal breast pump use and cleaning with a pre- and posttest evaluation. Paired t test scores of the combined practically oriented questions were significantly increased from 1.8 to 4.6 (p<.001) from pre- to posttest scores. Likewise, the practical demonstration of learned pump use skills significantly improved from 0.08 preintervention to 4.8 postintervention ( p<.001). Results of the evaluation indicated the intervention significantly increased women's practical knowledge regarding use and cleaning of the breast pump and accessories. With knowledge of proper use of breast pumps, women will be more likely to successfully utilize pumps to provide adequate milk volumes for SCN infants. A culturally appropriate educational intervention in developing countries appears to be a feasible means of facilitating instruction of breast pump use.

Highlights in this issue

John R Østergaard reports that febrile seizures affect 2–5% of all children between the ages 3–60 months. It is usually benign, but meningitis should be considered especially in infants less than 18 months. Febrile seizures of >30 min duration is one of the most common causes of Status epilepticus in children. EEG abnormalities do not predict recurrence with development of subsequent epilepsia (pp. 771–773). Children admitted due to paediatric head injury were investigated. More than 50% had a history deemed to raise suspicions of abuse but only in 10% of these cases, child abuse could be documented. Björn Tingberg et al. propose use of a standardised protocol (pp. 777–781). See also A Different View by Alan Ashare on concussion in relation to child sports (pp. 774–776). As many as 15% of all children experience at least one episode of syncope before the end of adolescence. Syncope is usually due to autonomic mediated reflexes, cardiogenic or psychogenic mechanisms. The authors, Qingyou Zhang et al. propose the introduction of a diagnostic protocol (pp. 879–884). Ravi Swamy et al. found that infants with antenatal diagnosis of clubfoot are more likely to need surgical correction than infants without antenatal diagnosis. The controversial question is whether it is ethical to terminate pregnancy due to clubfoot (pp. 804–806). Lord Byron was one of the most famous persons with clubfoot. There is a positive trend of increasing breastfeeding. However, there is a risk that the mothers are unable to detect a shortage of breast milk and dehydration. A nationwide study on hospital admissions due to dehydration in exclusively breastfed infants was done in the Netherlands, and is reported in this issue, pp. 807–811. However, the risk seems to be very low. Only 20 cases out of 100 000 breastfed infants were reported. This is a lower incidence than reported from the U.K. Most cases are in the group up to 11-days-old. Rolf AA Pelleboer et al. recommend extending the use of breast pumps at home.

A nationwide study on hospital admissions due to dehydration in exclusively breastfed infants in the Netherlands: its incidence, clinical characteristics, treatment and outcome

To estimate the incidence and clinical characteristics in hospital admissions due to dehydration or undernutrition and their laboratory evaluation and treatment outcome in exclusively breastfed infants. All hospital admissions during the first 3 months of life assessed by the Dutch Paediatric Surveillance Unit (DPSU) between mid 2003 and mid 2005. Nationwide 158 cases reported, correspond to an incidence of 58/y/100,000 breastfed infants; it is lower for severe dehydration at risk for hypernatraemia; 20/y/100,000. Sixty-five per cent of cases were <2 weeks old, their median weight loss was 9.3% and median age at admission 5 days; Serum sodium value was measured in only 12% of all cases. Insufficient volume intake and inadequate growth were most frequently reported (61% and 41%). Lethargy, jaundice or clinical dehydration was scored in 11-25%, seizures or shock in 3%. A breast pump at home was used in only 31%. In the hospital breast pumps were available (82%) as lactation consultants (73%). For treatment 65% was offered formula, in 30% by nasogastric drip. Most admissions lasted up to 3 days, all recovered fully and 33% were breastfed exclusively at discharge. The incidence of severe dehydration in the Netherlands is relatively low. With extended use of breast pumps at home it could be lower. To prevent complications, we recommend applying a reference weight chart, a full clinical examination and more extensive screening of serum sodium and glucose.