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The main objective of this analytical overview is to assess the validity of maternal perception of the onset of lactation (OL) as an indicator of lactogenesis stage II (LS-II). Prospective studies that assessed OL and/or LS-II [based on test-weighing milk volume (MV) and/or breast milk biomarkers (BMB)] were identified. OL is a clearly defined and easily identified event across cultures, with the overwhelming majority of women being able to report when they experience it. Mean OL ranges from 50 to 73 h postpartum across studies and from 1 to 148 h postpartum within studies. The wide range detected within samples is fully consistent with the wide within sample LS-II variability as determined by BMB or MV. Studies have identified similar risk factors for delayed LS-II, such as labor and delivery stress, primiparity and insulin-dependent diabetes mellitus, regardless of marker used (i.e., OL, MV or BMB). The correlation between OL and MV (r = -0.60) is of similar magnitude to that between OL and BMB (r = 0.50) and that between BMB and MV (r = 0.47-0.69). In conclusion, OL is a valid clinical indicator of LS-II. This has public health relevance because studies have identified delayed OL (i.e., >72 h postpartum) as a risk factor for shorter breastfeeding duration and for greater infant weight loss by d 3 postpartum. Multidisciplinary studies are needed to standardize the definition of OL and to confirm its validity in different sociocultural contexts.

Objective: Women at risk for delayed onset of lactation are often advised to pump their breasts before lactogenesis stage II to hasten the timing of this process. The effectiveness of this clinical practice has not been previously evaluated. This study investigates the effects of breast pumping before the onset of lactation on early milk transfer and subsequent breastfeeding duration among women giving birth by cesarean delivery., Methodology: Sixty women were randomly assigned to either the pumping group (n = 30), which used a double electric breast pump for six 10- to 15-minute sessions from 24 to 72 hours postpartum, or to the control group (n = 30), which held the pump to their breasts without suction for the same amount of time. Milk transfer was assessed by test weighing infants before and after 3 breastfeeding sessions daily. Test weight data were fitted to a second-order polynomial curve, to predict milk transfer over time., Results: Breast pumping between 24 and 72 hours after cesarean delivery did not improve milk transfer. Participants in the pumping group tended to have lower milk transfer than did controls. Primiparae in the pumping group breastfed for ~5 months less than their counterparts in the control group; however, this difference was not statistically significant., Conclusions: Breast pumping did not improve milk transfer during the first 72 hours postpartum and may negatively affect breastfeeding duration among primiparous women. lactation, lactogenesis, breast milk, breast pumping, milk expression, breastfeeding, cesarean delivery.

Test weighing is the "gold standard" for documenting lactogenesis stage II. However, this method is impractical for use in population studies. Maternal perception of the timing of the onset of lactation may be a useful proxy for lactogenesis stage II. This study seeks to validate maternal perception of the onset of lactation as a marker of lactogenesis stage II. Women (n = 60) were recruited after cesarean delivery. Beginning at 24 h postpartum (pp), the onset of lactation was assessed 3 times daily by both test weighing and maternal perception. Delayed onset of lactation was defined as follows: 1) milk transfer < 9.2 g/feeding at 60 h pp and 2) maternal perception >/= 72 h pp. Misclassification analyses were conducted. Multivariate logistic regression, bivariate analyses and Cox survival analyses were used to evaluate the determinants and consequences of delayed onset of lactation, using both definitions. The sensitivity and specificity of delayed maternal perception as an indicator of delayed lactogenesis were 71.4 and 79.3%, respectively. Four risk factors for low milk transfer were significant (P: < 0.05) or nearly significant (P:

This longitudinal study evaluated the impact of the timing of maternal perception of the onset of lactation on breastfeeding duration. Breastfeeding mothers who delivered a full-term infant were interviewed daily from day 1 postpartum until the onset of lactation. Women were recontacted to determine the duration of any breastfeeding at 6.7 months postpartum, and if necessary, at 16.2 months postpartum. Cox survival multivariate analyses indicated that among women planning to breastfeed for at least 6 months, those with onset of lactation < 72 hours postpartum were likely to breastfeed longer than their counterparts with a delayed onset of lactation. Median breastfeeding durations were 11.7 months and 3.4 months, respectively (p < 0.00001). Among women who intended to breastfeed for less than 6 months, the timing of the onset of lactation did not influence breastfeeding duration. All analyses controlled for body build, delivery method, employment status, education, parity, and maternal age. These findings suggest that a delayed onset of lactation is likely to be associated with a shorter breastfeeding duration. This relationship, however, was modified by the mother's intended breastfeeding duration.

Objective: To identify infant feeding, socioeconomic, demographic, and delivery-related factors that affect women's self-reported timing of the onset of lactation., Design: Longitudinal survey of women from day 1 postpartum until self-reported onset of lactation. Subjects were interviewed in person on day 1 postpartum, then surveyed daily by telephone regarding infant feeding method, breast symptoms, and perception of whether the onset of lactation had occurred. Medical records were reviewed., Subjects/setting: Data were collected from 192 women after they gave birth to a healthy, term singleton., Statistical Analyses Performed: chi 2 Analyses were used to identify variables associated with delayed onset of lactation (onset of lactation > or = 72 hours postpartum). Multivariate logistic regression was used to identify the independent association of each significant variable with delayed onset of lactation., Results: Risk factors for delayed onset of lactation included white/Hispanic ethnicity, heavy/obese body build, delivery of offspring by unscheduled cesarean delivery, vaginal delivery with prolonged stage 2 labor, infant birth weight less than 8 lb, and exclusive formula-feeding before the onset of lactation., Applications/conclusions: Women who are at risk for delayed onset of lactation need additional breast-feeding support during the first week postpartum. During their hospitalization, these women should be instructed about the normal lactation process and the possibility that onset of lactation may occur later than 72 hours postpartum. Frequent nursing should be recommended, as delayed onset of lactation was associated with the lack of infant suckling.