Dr. Jane Morton, MD is a plenary speaker at the upcoming 2015 ILCA Conference, 22-25 July in Washington, DC, USA. Her plenary address will be Updates on Game-Changing Research about Breast Milk Expression: Early Hand Expression and Hands-On Pumping. Dr. Morton will also present during a breakout session on Prevention, Availability and Sustainability: What Baby-Friendly Bedside Care for Low- and High-Risk Infants Must Offer.
Dr. Morton was recently interviewed by Marie Hemming, IBCLC, a member of the International Lactation Consultant Association® (ILCA®) Medialert Team.
MH: In September 2011, your overview of pumping appeared in an article entitled Is Pumping Out of Hand. Many of us working with new mothers get the impression that all mothers want to have a breast pump and health care practitioners want to give them one. Why do you think that has gotten a little out of hand, so to speak?
JM: Pumps (used most effectively) are a vital part of lactation support. The high number of mothers discharged from the hospital with their babies and pumps is most often twofold, sending mothers home who will not produce enough milk to feed their babies, and sending babies home who risk not getting enough breast milk.
We need to ask ourselves why this is and how we can leverage the time spent in the hospital to prevent problems. Commonly, in medicine, rather than thinking preventatively, we offer episodic, problem-oriented care, waiting for excessive weight loss, excessive jaundice, etc. before more urgent measures are taken. The question that needs to be addressed is how can we better prevent these problems?
MH: Breast pumps are not particularly convenient, given the need for sterilization, perhaps a source of electricity, and the unwieldy size and weight. Hand expression seems so much simpler. How do you think we can guide mothers prenatally to teach them that hand expression is almost mandatory postpartum?
JM: From Picasso to Steve Jobs, artists and inventors have found that keeping things simple is worth striving for. Building simplicity, repetition, and logic into a didactic setting is key. Learning prenatally the benefits of hand expression gives expectant mothers the answer to many typical “what if” concerns and preparation for whatever the outcome may be. Unlike a machine, a mother’s touch is quite natural and does not suggest a problem or medicalize milk expression.
MH: What are the benefits of hand expression?
JM: Our research and subsequent studies [to be presented at the ILCA15 Conference] suggest hand expression of colostrum increases milk production, onset of lactogenesis, and breastfeeding rates.
MH: What’s the most surprising thing you’ve found in your research on hand expression?
JM: I have been teaching hand expression to mothers from the beginning and referred mothers to IBCLCs if they needed a pump. This research project required the use of a pump, but I found that they were not as effective as hand expression. I went back to the Internal Review Board to change the protocol to incorporate hand expression as part of the tools and [to] add a tally of how frequently milk was hand expressed.
The first surprising thing to me was that the data showed that [there was a] difference [in] milk production, depended[ing] upon how often milk expression happened in the first three days. The second surprise was how very simple it is to express colostrum in the first hour after birth and how much more difficult it was for the same mother to express colostrum later.
A new study I just reviewed will be coming out in Academy of Breastfeeding Medicine in a couple of months, and the results show precisely that the timing of the expression of colostrum is much more important than we thought. That first hour after birth we have known is very critical to the success of breastfeeding, and, again, this reiterates the significance of hand expression of colostrum in the first hour.
MH: Do you have a teaching method you prefer to use to teach hand expression, and how long does it take?
JM: The World Health Organization, the American Academy of Pediatrics, and other well recognized supporters of breastfeeding recommend every mother learn hand expression prior to discharge, for a myriad of reasons. How long it takes and how easy it is to teach will, of course, vary from one mother to the next. When the oxytocin level is highest (within the first hour after delivery), colostrum is quite easy to express; mothers are delighted to see their milk, and research supports this may be a critical window of time to maximize the benefits [of expressing]. In fact, hand expression and helping a baby latch work well together.
At the [ILCA15] Conference, we [will] discuss ways of integrating this into our practice, [while] respecting the constraints of time, skills, and resources. The more frequently hand expression is used, the easier it becomes, the earlier milk comes in, and the more milk mothers make. Mothers who use hand expression can make up to 80% more milk. Teaching hand expression needs to be incorporated into the first hour following birth to maximize the benefit.
MH: What kind of clinical guidelines need to be in place so that all mothers can receive timely teaching of hand expression prenatally and following the birth of their babies?
JM: In my mind, the question is not whether mothers need to learn this, but how often they may need to practice this technique prior to discharge. We certainly don’t have all the answers and, at the conference, I [will] share how some hospitals are managing this.
MH: Have you considered incorporating the teaching of hand expression into the Baby-Friendly Hospital initiative (BFHI)?
JM: Given the increasing number of dyads at risk for preventable complications of breastfeeding, I think a stronger case for this will become clear. With more randomized clinical trials addressing outcome measures, we would have a stronger case to recommend just this.
At the [ILCA15] conference, [I] will discuss why Baby-Friendly care, as wonderful as it is, may fall short of providing truly preventative care to all dyads.
Dr. Jane Morton, MD is a Professor of Pediatrics at Stanford University School of Medicine. Her particular interest is preventing breastfeeding problems by training new mothers, their partners, and their providers simple, doable but critical steps from the first day, no matter what the challenges may be.
Marie Hemming, IBCLC is the mom of three breastfed children (now 21, 17, and 16 years of age). She developed and taught a 20-hour breastfeeding class at the Florida School of Traditional Midwifery. She is currently volunteering as an IBCLC and lay community counselor at Birthline of San Diego, serving families living in poverty.
