Protocol for RCT: Effectiveness of Traditional Breast Stimulations as Adjuvant Techniques to Breast Milk Expression on Lactational and Maternal Outcomes

Background: Mothers of infants who are dependent on expressed breast milk often find difficulty to express adequate quantity of breast milk to ensure exclusive breast feeding to their babies and it has become a major stress factor among these mothers. Many cost-effective adjuvant techniques are proved to be very useful in improving the quantity and quality of expressed breast milk. Objective: To determine the effect of two traditional breast stimulation techniques such as warm compress and breast massage as adjuvant to breast milk expression on maternal and lactational outcomes. Methodology: A hospital-based cross over trial will be considered to compare the effects of two interventions such as breast massage and warm compress, adjuvant to breast milk expression method (breast pump) on lactational outcomes (Quantity and quality of expressed breast milk) and maternal outcomes (Nipple pain, anxiety and experience of breast milk expression). The setting of the study will be selected tertiary level hospital of New Delhi. Approval from Institutional the Ethical approval is obtained from Institutional Ethical Committee, DMIMS (DMIMS (DU)/IEC/2017-18/6979) and also from the institutional ethical committee of armed forces medical services hospital of New Delhi where the study will be conducted. The data collected will be entered to an electronic data sheet and analysis will be done using SPSS. Expected Results: There will be a positive impact of interventions on locational outcomes such as quantity of expressed breast milk and quality of expressed breast milk. There will be a positive impact of interventions on maternal outcomes such as nipple pain. Anxiety and breast milk expression experience. This nurse led interventions will be made as a part of hospital policy to provide routine care to the mothers who are expressing breast milk in hospital settings. Conclusion: Conclusion will be drawn after the analysis of data collected from the predetermined sample size. The findings of the study will be published in an open access peer reviewed journal.

A cross-sectional study of lactation room quality and Dutch working mothers’ satisfaction, perceived ease of, and perceived support for breast milk expression at work

Background The challenge of combining professional work and breastfeeding is a key reason why women choose not to breastfeed or to stop breastfeeding early. We posited that having access to a high-quality lactation room at the workplace could influence working mothers’ satisfaction and perceptions related to expressing breast milk at work, which could have important longer term consequences for the duration of breastfeeding. Specifically, we aimed to (1) develop a checklist for assessing the quality of lactation rooms and (2) explore how lactation room quality affects lactating mothers’ satisfaction and perceptions. Drawing on social ecological insights, we hypothesized that the quality of lactation rooms (operationalized as any space used for expressing milk at work) would be positively related to mothers’ satisfaction with the room, perceived ease of, and perceived support for milk expression at work. Methods We conducted two studies. In Study 1 we developed a lactation room quality checklist (LRQC) and assessed its reliability twice, using samples of 33 lactation rooms (Study 1a) and 31 lactation rooms (Study 1b). Data were collected in the Northern part of the Netherlands (between December 2016 and April 2017). Study 2 comprised a cross-sectional survey of 511 lactating mothers, working in a variety of Dutch organizations. The mothers were recruited through the Facebook page of a popular Dutch breastfeeding website. They completed online questionnaires containing the LRQC and measures aimed at assessing their satisfaction and perceptions related to milk expression at work (in June and July 2017). Results The LRQC was deemed reliable and easy to apply in practice. As predicted, we found that objectively assessed higher-quality lactation rooms were associated with increased levels of satisfaction with the lactation rooms, perceived ease of milk expression at work, and perceived support from supervisors and co-workers for expressing milk in the workplace. Conclusions The availability of a high-quality lactation room could influence mothers’ decisions regarding breast milk expression at work and the commencement and/or continuation of breastfeeding. Future studies should explore whether and how lactation room quality affects breastfeeding choices, and which aspects are most important to include in lactation rooms.

Implementing an education program for nurse-midwives focused on early essential care for breast milk expression among mothers of preterm infants

Background Although breastfeeding guidelines for infants admitted to the neonatal intensive care unit (NICU) have been introduced in Japan, these guidelines have not been reflected in practice. To improve this situation, it is important for nurses and nurse-midwives to acquire knowledge of appropriate care. This study examined changes in nurse-midwives’ knowledge, attitude, and implementation of appropriate care after implementing an education program focused on early essential care for breast milk expression among mothers of preterm infants. Methods This pre- and post-intervention study using a single group was conducted from June 2018 to May 2019 and enrolled 36 nurse-midwives in one perinatal medical center. The education program content included nurses’ roles in early essential care for milk expression and the necessary care to promoting breast milk production among mothers of preterm infants. The nurse-midwives’ knowledge and attitude on care were investigated 3 months before (pre-1), just before (pre-2), just after (post-1), and 3 months after (post-2) the program. The nurse-midwives’ care implementation was investigated at pre-1, pre-2, and post-2. During this time, 11 mothers (before: 7, after: 4) reported the status of milk expression for 10 days after birth. Results The mean knowledge scores of the nurse-midwives at post-1 and post-2 were significantly higher than that at pre-2 (post-1: p < 0.001, post-2: p < 0.001). The attitude on care scores at post-1 and post-2 were significantly higher than that at pre-2 (post-1: p < 0.001, post-2: p = 0.010). The care implementation score at post-2 was significantly higher than that at pre-2 in eight items (e.g., Q7 Explain about the effect of initiating milk expression early and assist mothers in it). However, the education program did not cause any changes in the mothers’ initiation and frequency of milk expression, and breast milk volume after birth. Conclusions The significant increases in the knowledge, attitude on care, and care implementation scores of the nurse-midwives suggest the beneficial effects of the education program. The small number of mothers in the survey on the practice of breast milk expression limited the full determination of the benefits of the education program for nurse-midwives.

Effects of three methods of breast milk expression on breastfeeding initiation, breast milk extraction and proportion of exclusive breastfeeding—an open label, randomized controlled trial

Background Direct breastfeeding has multiple health benefits. However, in certain circumstances direct breastfeeding is not possible immediately after delivery, yet provision of infants with their mother’s milk is important. There is insufficient evidence regarding an effective method of breast milk expression in the absence of an infant's suction. Therefore, we undertook a trial to investigate the effects of different methods of breast milk expression on breastfeeding initiation, efficacy of breast milk extraction, and on the rate of exclusive breastfeeding at 6 months. Methods The participants of mother-infant dyads separated immediately after birth for at least 6 hrs were recruited and randomly assigned (1:1:1) into three groups: (1) hand expression of breast milk; (2) sequential and (3) simultaneous electrical breast pumping. The two primary outcome measures were the time required for initiation of breastfeeding and the milk volume expressed in a 10-minute session (direct breastfeeding in hand expression group) at 3 days and at 6 weeks; a secondary outcome was the proportion of exclusive breastfeeding at 4 and 6 months. The data were analysed according to intention-to-treat. Results Between 2018 and 2019, we recruited 226 participants, of whom 154 were randomized. The median time (in hours) of breastfeeding initiation of the sequential (46.5, 95% CI 36.1-50.5) and simultaneous (45.6, 95% CI 34.2-53.0) breast pumping groups did not differ from those of hand expression group (46.7, 95% CI 40.8-50.0) (p=1.000). At 3 days the breast milk volume (10 min per breast) through simultaneous pumping (13.1±10.9 ml), but not sequential pumping (16.7±11.6 ml) (p=0.560), was significantly less than hand expression (23.8±26.2 ml through direct sucking) (p=0.007). At 6 weeks the breast milk volume through sequential pumping (64.7±51.0 ml), but not simultaneous pumping (71.6±50.8 ml) (p=0.670), was significantly less than hand expression (89.8±67.3 ml through direct sucking) (p=0.035). The breast milk volume obtained through sequential breast pumping was 37.9 ml less than that obtained by those of simultaneous pumping (p<0.001). The rate of exclusive breastfeeding at 4 months was 21.0%, and at 6 months 10.6%, and did not differ between the three methods of breast milk expression. Conclusions Hand expression, sequential breast pumping, or simultaneous breast pumping in absence of immediate infant suction after birth did not show differences on the time required to initiate breastfeeding, or on the rate of exclusive breastfeeding at 4 and 6 months. Trial registration This trial was registered with www.chictr.org.cn (ChiCTR1800018193) on 4 September 2018.

Implementing an education program for nurse-midwives focused on early essential care for breast milk expression among mothers of preterm infants

BackgroundAlthough breastfeeding guidelines for infants admitted to the neonatal intensive care unit (NICU) have been introduced in Japan, these guidelines have not been reflected in practice. To improve this situation, it is important for nurses and nurse-midwives to acquire knowledge of appropriate care. This study examined changes in the knowledge of appropriate care of nurse-midwives after implementing an educational program focused on early essential care for breast milk expression among mothers of preterm infants. MethodsThis before-after study using a single group enrolled 36 nurse-midwives in one perinatal medical center. The educational program content included nurses’ roles in early essential care for milk expression and the necessary care to promoting breast milk production among mothers of preterm infants. The nurse-midwives' knowledge and attitude on care were investigated three months before (pre-1), just before (pre-2), just after (post-1), and three months after (post-2) the program. The nurse-midwives’ care implementation was investigated at pre-1, pre-2, and post-2. During this time, 11 mothers (before: 7, after: 4) reported the status of milk expression for 10 days after birth. ResultsThe mean knowledge scores of the nurse-midwives at post-1 and post-2 were significantly higher than that at pre-2 (post-1: p < 0.001, post-2: p < 0.001). The attitude on care scores at post-1 and post-2 were significantly higher than that at pre-2 (post-1: p < 0.001, post-2: p = 0.010). The care implementation score at post-2 was significantly higher than that at pre-2 in eight items (e.g., Q7 Explain about the effect of initiating milk expression early and assist mothers in it). However, the educational program did not cause any changes in the mothers’ initiation and frequency of milk expression, and breast milk volume after birth. ConclusionsThe significant increases in the knowledge, attitude on care, and care implementation scores of the nurse-midwives suggest the beneficial effects of the educational program. Further detailed examination of the effects of the program on nurses and nurse-midwives, and identification of methods to reduce barriers to the practice of best evidence in the clinical setting are warranted to improve mothers’ status of milk expression.

Effects of three methods of breast milk expression on breastfeeding initiation, breast milk extraction and proportion of exclusive breastfeeding—an open label, randomized controlled trial

Background Direct breastfeeding has multiple health benefits. Some mothers need to express their breasts when directly breast feeding is unavailable immediately after delivery. However, there is insufficient evidence regarding an effective method of breast milk expression in the absence of an infant's suction. This trial was designed to investigate the effects of different methods of breast milk expression on breastfeeding initiation, efficacy of breast milk extraction, and on the rate of exclusive breastfeeding at 6 months. Methods The participants of mother-infant dyads separated immediately after birth for at least 6 hrs were recruited and randomly assigned (1:1:1) into three groups: (1) hand expression of breast milk; (2) sequential and (3) simultaneous electrical breast pumping. The two primary outcome measures were the time required for initiation of breastfeeding and the milk volume expressed in a 10-minute session (direct breastfeeding in hand expression group) at 3 days and at 6 weeks; a secondary outcome was the proportion of exclusive breastfeeding at 4 and 6 months. Intention-to-treat data set was used in this analysis. Results Between 2018 and 2019, we recruited 226 participants, of whom 154 were randomized. The median time (in hour) of breastfeeding initiation of sequential (46.5, 95% CI 36.1-50.5) and simultaneous (45.6, 95% CI 34.2-53.0) breast pumping groups did not differ from those of hand expression (46.7, 95% CI 40.8-50.0) (p=1.000). At 3 days the breast volume through simultaneous pumping (13.1±10.9 ml), but not sequential pumping (16.7±11.6 ml) (p=0.560), was significantly less than hand expression (23.8±26.2 ml through direct sucking) (p=0.007). At 6 weeks the breast volume through sequential pumping (64.7±51.0 ml), but not simultaneous pumping (71.6±50.8 ml) (p=0.670), was significantly less than hand expression (89.8±67.3 ml through direct sucking) (p=0.035). The breast milk volume through sequential breast pumping (10 min per breast) was 37.9 ml less than those of simultaneous pumping (p=0.000). The rate of exclusive breastfeeding at 4 months was 21.0%, and at 6 months 10.6%, and did not differ between the three methods of breast milk expression. Conclusions Hand expression, sequential breast pumping, or simultaneous breast pumping in absence of immediate infant suction after birth did not show differences on the time required to initiate breastfeeding, or on the rate of exclusive breastfeeding at 4 and 6 months. Trial registration This trial was registered with www.chictr.org.cn (ChiCTR1800018193) on 4 September 2018.

Effects of three methods of breast milk expression on breastfeeding initiation, breast milk extraction and proportion of exclusive breastfeeding—an open label, randomized controlled trial

Background Direct breastfeeding hasmultiple health benefits. Some mothers need to express their breasts when directly breast feeding is unavailable after delivery . However, there is insufficient evidence regarding an effective method of breast milk expression in the absence of an infant's suction. We aimed to investigate the effects of different methods of breast milk expression on breastfeeding initiation, efficacy of breast milk extraction, and on the rate of exclusive breastfeeding at 6 months. Methods In this open-label, randomized controlled trial, the participants of mother-infant dyads separated immediately after birth for at least 6 hrs were recruited and randomly assigned (1:1:1) into three groups: (1) hand expression of breast milk; (2) sequential electrical breast pumping: and (3) simultaneous electrical breast pumping. The two primary outcome measures were the time required for initiation of breastfeeding and the milk volume expressed in a 10-minute session (direct breastfeeding in hand expression group) at 3 days and at 6 weeks; a secondary outcome was the proportion of exclusive breastfeeding at 4 and 6 months. Analysis was according to intention-to-treat. Results Between 2018 and 2019, we recruited 226 participants, of whom 154 were randomized. The time to breastfeeding initiation showed no difference between the three groups. At 3 days and at 6 weeks, the volume of breast milk produced by 10 minutes of sequential pumping or simultaneous pumping was less than that of hand pumping before direct breastfeeding, while the volume did not differ significantly between the two pumping groups. However, simultaneous breast pumping was more effective than sequential pumping both in volume and saving time in women who had established breastfeeding. The rate of exclusive breastfeeding at 4 months was 21.0%, and at 6 months 10.6%, and did not differ between the three methods of breast milk expression. Conclusions Hand expression, sequential breast pumping, or simultaneous breast pumping in absence of immediate infant suction after birth did not show differences on the time required to initiate breastfeeding, or on the rate of exclusive breastfeeding at 4 and 6 months. Trial registration This trial was registered with www.chictr.org.cn (ChiCTR1800018193) on 4 September 2018.