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Stanford expert discusses breastfeeding techniques

Last year, a Centers for Disease Control and Prevention report (.pdf) showed that only a small percentage of U.S. hospitals provided the necessary support for breastfeeding moms, and its authors argued there was a clear need for better in-hospital support for new moms. Jane Morton, MD, whole-heartedly agrees.

Morton, a clinical professor of pediatrics at Stanford, recently presented a Grand Rounds talk titled "Is Pumping Out of Hand? Game-Changing Research About Breastmilk Expression" at Lucile Packard Children's Hospital. During the presentation, she discussed her work teaching moms how to breastfeed successfully and underscored the need for health-care workers to better educate women about breastfeeding techniques.

Below Morton discusses her research findings related to increasing breastmilk production, nursing premature infants and electric pump vs. hand pumping.

What motivated you to begin researching the effectiveness of breastfeeding techniques?

Years ago, when I first began private practice, I had one after another motivated mothers end up with problems. There were no teachers or mavens to learn from. So it became a personal quest - one with many rewards.

Why have hand expression techniques been an under-utilized skill among new mothers?

In many medical arenas, there’s been a drift away from bedside hands-on evaluation towards reliance on technical devices. When a $1,500 pump is pushed into the room, a new mother would assume this is state-of-the- art technology. Often, the most available care provider is inexperienced and uncomfortable teaching techniques that involve touching the breast. Odd, since the same staff member may feel comfortable with obstetrical manipulations.

Your research (subscription required) shows there are significant differences in milk production between electric pumping and hand expression. What factors contribute to increased milk production when mothers use hand expression techniques?

When a baby removes milk, the infant uses a combination of suction and the stripping action of the jaw and tongue. Suction alone is less effective at removing more viscous milk such as colostrum, or fat-rich breast milk.  In comparison, the massaging action used with hands-on pumping and hand expression, the two manual techniques demonstrated in our research, is much more effective.

You strongly encourage new moms to begin hand expression within the first three days after delivery. Why is this window of time critical to overall milk production?

Our hypothesis is that the early, frequent and effective removal of small aliquots of colostrum stimulates the breast (programs it, if you will) to recruit the number of alveolar (milk factory) units needed for future production. Think of any mammalian species and how important it is for each of the littermates to suckle right after birth.

About one in eight babies U.S. are born prematurely. To help these infants survive, many are given fortified breast milk to help them quickly gain weight. What has your research shown about how hand expression can positively alter the protein, fat and lactose content of breastmilk and potentially be a better alternative than fortified milk?

We have shown (subscription required) that combining manual techniques with pump suction enables not just greater output, but also the expression of milk with a higher fat content. Presumably this is because milk expression is more effective, as fat content increases with greater emptying. The protein and sugar values were consistent with reported norms. We don’t know how this will effect healthy growth, but with a caloric value averaging 26 calories per ounce we expect there will be benefits.

The first few months of motherhood can be difficult, and it's often a challenge to get the hang of breastfeeding and using an electric pump effectively. How do you respond to new moms who say it's just too overwhelming to have to learn how to hand-express on top of this?

There are new studies since ours suggesting hand expression may be better than electric pumping in the first three days. The American Academy of Pediatrics, the World health Organization, and many other reputable organizations recommend every new mother learn hand expression.

Hand expression is easy to learn and probably a more effective way to express colostrum. We have developed several video resources to help new mothers getting started with breastfeeding. You can watch them here.  There are many benefits of knowing how to express milk from the breast without the use of expensive or cumbersome pumps. This video demonstrates how easily hand expression can be taught to mothers.

Previously: Breastfeeding: “Not only a lifestyle choice,” More breastfeeding support needed in hospitalsVictory for nursing moms: IRS now says breastfeeding is a medical expense, Surgeon general calls for more breastfeeding support and Breastfeeding called a “secret weapon to save billions of dollars”
Photo by Judy Ann Warren

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