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This study investigates the impact of different feeding methods (direct breastfeeding, expressed milk feeding, formula feeding) on the infant microbiota at 6 weeks of age. A total of 217 healthy infants stool samples were collected from Hong Kong between August 2018 and December 2019. Various microbial taxa, including the genera Enterobacter and Raoultella were identified in the expressed breast milk feeding group. The richness and composition of the major bacterial phyla showed similar abundance between direct breastfeeding and expressed breast milk. These findings suggests that these bacteria may have colonized the milk during expression or could be introduced from other external sources. The mode of breastfeeding did not significantly alter microbiota parameters in the infant gut at 6 weeks. [ABSTRACT FROM AUTHOR]

Objectives: To compare the effect of two strategies of breast pumping –power pumping (PP) vs. routine pumping (RP) over one week in mothers of very low birth weight (VLBW) infants with low milk output to improve breastfeeding rates at discharge. Methods: Mothers with low milk output, defined as inability to express sufficient breastmilk to meet the feeding requirements of their infant on or after post-natal day 14, were randomized to receive power pumping vs. routine pumping - once daily for 7 d coupled with routine lactation support and hand expression 3 hourly in both groups. The primary outcome was exclusive breastfeeding at discharge. Results: There was no difference in the two pumping strategies with respect to exclusive breastfeeding rates [61.1% in PP vs. 50% in RP group; (p = 0.477, RR 1.2; 95% CI 0.76 to 2.17)]. Median milk volume pumped in the individual power pumping session on 7th day of intervention was significantly higher than that in the individual routine pumping session on the 7th day (50 mL vs. 27 mL, p = 0.014). The cumulative median milk volume expressed per individual pumping session over the 7 sessions of power pumping was also higher than that with routine pumping (305 mL vs. 213 mL, p = 0.054). Conclusions: In this pilot trial, expressed milk volume was significantly higher after each individual power pumping session compared to routine pumping. However, the exclusive breastfeeding rates at discharge were similar in the two groups. [ABSTRACT FROM AUTHOR]

The article presents an editorial focuses on the resiliency in breastfeeding during times of change, emphasizing its importance for adapting to environmental shifts. Topics include the role of breastfeeding in fostering resilience, the vulnerability and openness inherent in breastfeeding, and the need for ethical and transparent research to understand the complexities of lactation.

It is well recognized by the general public that breastfeeding expends calories. In our clinical practice, a number of postpartum women with a history of or a current eating disorder (ED) report using breastfeeding and/or pumping breast milk to influence their body shape and weight. This appears to be either a form of weight control behavior or, in some cases, a compensation for perceived overeating or binge eating. Breastfeeding and pumping have not generally been identified as maladaptive weight control behaviors, nor have they been a subject of research to date. We suggest that this practice should be investigated to determine how common it is, its potential role in maintaining EDs or contributing to relapse in the postpartum period, and to better understand other potential harms it may cause to both the mother and infant/child. Public significance: Breastfeeding and pumping may be used as maladaptive methods of weight control by women with EDs. This behavior is under‐recognized in clinical practice and has received little research attention. We argue that maladaptive breastfeeding and pumping warrant further investigation, as the behaviors may play an important role in maintaining an ED or in contributing to relapse during the postpartum period and may also indirectly harm the infant/child. [ABSTRACT FROM AUTHOR]

Background: Globally, 10% of all births are preterm. Access to human milk via manual breast expression is required to reduce the incidence of adverse outcomes related to prematurity. However, there is little evidence to recommend optimum timing to commence breast expression in mothers of preterm infants or the most effective method. Research Aims: (1) To test feasibility of recruitment and compliance to the protocol and (2) to determine influence of using hand expressing and breast massage on milk production, engorgement, mastitis, and breastfeeding status at 3 months. Methods: This study was an exploratory parallel two-group, pilot randomized controlled trial. Mothers of preterm infants at a metropolitan maternity hospital in Queensland Australia (N = 31) were randomized to receive either hand expressing and breast massage within the 1st hr of birth or standard care, hand expressing within 6 hr of birth, to determine the influence on milk production, engorgement, mastitis, and breastfeeding status at 3 months. Results: Feasibility targets were not met; however, valuable learning from this trial uncovered barriers facing midwives in the birth suite to commencing expressing in the 1st hr of birth. There was no difference in occurrence of secondary outcomes, although trends support future study. Conclusions: Overall, unpredictability of preterm birth influenced our ability to recruit participants. Important directions for future study design would benefit from incorporating expressing times up to 6 hr with a replicable breast massage. [ABSTRACT FROM AUTHOR]

Wearable pumps have been designed to improve convenience and maximize flexibility whilst pumping and are reported to benefit lactating health professionals when they return to work [...]

Breastfeeding women who pump their milk report that pumping is time-consuming [...]

Introduction: At our pediatric institution, lactation consultants completed a quality improvement project exploring ways to support the highest-risk parents in the neonatal intensive care unit: Mothers of outborn infants, who are particularly at risk of lactation problems. Method: We created a structured visitation schedule for these families and tested it over 3 months to see if this schedule increased the milk supply of these mothers. Results: The new schedule was not effective in improving the milk supply. Visits in the first two weeks did not affect the milk supply, but results suggest that later visits showed a trend toward increased supply. External factors may have confounded our results. Conclusion: The lactation team was reassured that the care model in use at baseline supported the parents and their milk supply. [ABSTRACT FROM AUTHOR]

Background: Pumping is a common practice in the United States, but it can be uncomfortable and lead to concerns about milk supply. The fit of the flange, or breast shield, used while pumping can contribute to or alleviate these problems. Flanges are available in a wide variety of sizes, and there are inconsistencies in guidance provided by healthcare providers and pump manufacturers for parents choosing a size. There have been no studies comparing different methods of sizing in terms of comfort and milk output., Research Aims: The aim of this research was to examine differences in milk output and comfort using two methods of flange sizing., Method: A within-subject cross-over design with a convenience sample of parents exclusively feeding their own human milk was used to compare comfort and milk yield between using smaller-fit and standard-fit flanges. Participants pumped for 1 week with each set of flanges and recorded milk output and comfort outcome measures. Data were collected on participant demographics, nipple measurements, and flange sizes used., Results: When compared to the newer small-size fitting, participants using the standard fit flanges had significantly less milk output (mean difference = -15.0 g, 95% CI [-25.0, -5.0], d  = -0.51, p  = 0.004) and less comfort (mean difference = -1.2, 95% CI [-1.6, -0.91], d  = -1.23, p  < 0.001)., Conclusion: Flange fitting is a process that should be individualized to the patient and may require a trial of one or more sizes during a pumping session. Smaller sizes determined using this individualized process and starting with nipple tip measurement may be used without compromising milk output or comfort., Competing Interests: Disclosures and Conflicts of InterestThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Jeanette Mesite Frem is the owner of Babies in Common, a private lactation practice and educational provider, through which she has received payment for courses educating healthcare professionals about flange fitting methods and the Flange FITSTM Guide as described in this manuscript.

Breast pumping practices have scope for improvement. Breast milk weight measurement can be used to evaluate milk flow pattern dynamics during breast pumping. To determine inter-individual differences in milk flow patterns and their practical implications based on high milk flow rate period (HFP) data among Japanese women expressing breast milk using an electric pump. This cross-sectional, observational study analysed data from 19 women (33.0 ± 3.9 years) nursing 1–6-month-old infants and with previous breast milk expression experience. Breast milk was weighed continuously during a 15-min single-breast electric pumping session. The HFP features and flow rate time (≥0.1 g/s) were analysed to determine each individual's milk flow pattern. The total expressed breast milk was 69.8 ± 42.5 g with a maximum individual flow rate of 0.5 ± 0.2 g/s. The breast milk yielded during the HFPs was 43.1 (34.4–81.3) g, accounting for 82.5 % (69.9–89.5 %) of the total expressed breast milk. HFP occurred 0–3 times during the 15-min session. Multiple discrete and continuous milk flow patterns were observed. Among those with discrete HFP, the HFP interval was 221 (68–371) s. Breast milk fat content changes and subjective residual milk measurements implied sufficient milk removal. A strong positive correlation was noted between HFP length and total breast milk expression volume. Individual differences in milk flow patterns were observed among the women using HFP. Milk flow patterns were consistent with previous reports. Milk flow pattern data can be used to guide individualised lactation support. [ABSTRACT FROM AUTHOR]

Background: Mothers of preterm infants born between 26- and 35-weeks' gestation often report challenges with maintaining a pumping schedule and experience perceptions of low milk supply, both of which may contribute to early termination of breastfeeding within the first few weeks. Purpose: The purpose of this study was to assess the relationship between the amount of expressed milk volumes in the first 2 weeks after delivery and infant's continuing to receive mother's milk at hospital discharge. These results were part of a larger study that examined multiple maternal variables that may impact the amount of milk volumes and continuation of breastfeeding in the preterm infant admitted to the NICU. Methods: Mothers of infants (N = 37) in the NICU were recruited for this correlational, longitudinal study. Data was collected at 24–48 hours post-delivery, at 2 weeks, at 4 weeks from mothers participating in the study and from infant chart reviews. Results/Outcomes: Mothers who reported higher expressed milk volumes at 3 days post-delivery had consistently higher volumes of expressed breast milk and a higher percentage of continued breastfeeding at hospital discharge. There was no statistically significant relationship between breastfeeding self-efficacy scores, socio-demographic variables, or pumping frequency and the percentage of infants receiving breast milk at hospital discharge. Overall, 76.4% of the infants enrolled in the study were receiving 100% of their intake with fortified mother's milk at hospital discharge. Discussion/Implications for Practice: The use of a breast pump log in the first 2 weeks to monitor milk volumes may assist in predicting mothers who are at risk of lower milk supply and early discontinuation of breastfeeding. [ABSTRACT FROM AUTHOR]

This document evaluates the mobility and comfort perception of a hands-free, in-bra breastmilk collection pump set. The study involved 23 lactating mothers who used the pump set for a 15-minute pumping session. The results showed that the pump set was efficient and effective in emptying the breasts, with good comfort ratings. The mothers found the pump set easy to use and liked the hands-free aspect and mobility. Overall, the study supports the use of wearable pumps to allow for flexibility in combining lactation and career goals. [Extracted from the article]

This document discusses a study comparing the efficacy and comfort of traditional breast pumping methods with a new hands-free, in-bra breastmilk collection pump set. The study found that the new pump set resulted in efficient and effective breast emptying without compromising comfort. Participants rated the new pump set as more comfortable and liked the hands-free aspect. These findings suggest that wearable pumps may help breastfeeding women support lactation while balancing personal and career goals. The study was conducted in accordance with ethical guidelines and informed consent was obtained from all participants. [Extracted from the article]

An editorial is presented on the importance of supporting breastfeeding parents in the workforce and the cultural challenge of balancing career and breastfeeding. It highlights the need for research in areas such as the impact of milk expression on milk microflora, the effectiveness of breastfeeding equipment, and the implementation of workplace policies to facilitate breastfeeding.

Objective: To determine the effect of providing antenatal education regarding milk expression to the support person (SP) of mothers of preterm infants on time to initial milk expression following delivery and daily volume of expressed mother's own milk. Methods: Sixty-one mothers delivering infants <35 weeks gestation and their SP were randomized to receive antenatal education regarding milk expression or to receive standard care. Time to initiation of milk expression was determined through self-report and verified through the electronic medical records. Expressed milk volume was measured on days 1-7 and weekly for 3 weeks. Results: No difference in time to first expression or expressed milk volume was found between groups. Posthoc analysis suggests those in the antenatal education group were more likely to express without nursing assistance and expressed more frequently during days 1-5. Conclusions: SP antenatal education may be an important step in supporting lactation in mothers of critically ill infants. Further research is needed to determine whether SP education during both the antenatal and early postpartum periods could improve lactation success. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT04006509.

Introduction: The Baby-Friendly Hospital Initiative has had a positive impact on breastfeeding initiation; however, posthospital exclusive breastfeeding (EBF) rates remain low. We aimed to analyze thoughts and attitudes toward breastfeeding at the postpartum visit among women who deliver at a Baby-Friendly hospital. Methods: Women ≥14 years who delivered a live-born infant at our center were eligible. Participants completed an infant feeding questionnaire at the postpartum visit recording patient and delivery characteristics, antepartum care and infant feeding details, reasons for breastfeeding discontinuation or formula initiation, workplace environment, and cultural beliefs about breastfeeding. Thematic coding via line-by-line analysis of the free responses was performed using NVivo12 by QSR international. Results: Of 263 participants, 110 responded to the open-ended question. Of these, 53 and 46 were negative-toned and positive-toned, respectively. Negative breastfeeding responses related to the mother addressed the need for more support, low milk supply, pressure to breastfeed and feelings of guilt if unsuccessful, maternal health issues, painful breastfeeding, and high time requirements. Negative breastfeeding responses about the baby included concerns about infant health, latching issues, and disinterest. Positive responses focused on the support system, maternal weight loss, health benefits for baby, and mom-baby bonding. Some women (27) commented specifically on pumping. Negative comments noted that pumping led to less milk production, was time consuming, and was too much work. Positive comments about pumping noted that it is a convenient alternative to breastfeeding. Conclusion: Efforts to improve posthospital EBF rates in accordance with national guidelines must acknowledge the complex experience of breastfeeding mothers.

Objective: American women are consistently tasked with breastfeeding, while returning to work, but little research examines how women perceive support in the workplace and their own working outcomes. This study examined the associations among breastfeeding women's perceptions of breastfeeding support in the workplace (i.e., managerial, organizational, co-worker, time, and physical environment), attitudes toward multiple roles, and workplace outcomes (i.e., affective commitment, job satisfaction, and workplace productivity). Materials and Methods: Survey data from 109 mothers who have or are currently breastfeeding/pumping human milk at their workplace were collected and analyzed. Results: Results indicated significant positive relationships among attitudes toward multiple roles and workplace productivity. In addition, perceptions of breastfeeding support were significantly associated with both affective commitment as well as job satisfaction. Finally, our sample of breastfeeding employees returned to work after having a baby primarily for financial reasons, and do not generally feel very supported in the workplace. Conclusions: Overall, organizations can promote more investment and satisfaction in employees by providing explicit communication about breastfeeding-supportive policies to all employees. These findings underscore the importance of organizational breastfeeding support for mothers as well as their coworkers, which ultimately influences the success of the organization as a whole.