Post-publication Peer Review (P3R) is an online forum for ongoingreview peer review. To submit a P3R please go to the article you wish to respond to and click on the link that reads "P3Rs: Submit a Response." Submission of P3Rs are open to all health care professionals and experts in related fields.

Post-publication Peer Reviews to:

ELECTRONIC ARTICLE:
Donna J. Chapman, Sara Young, Ann M. Ferris, and Rafael Pérez-Escamilla
Impact of Breast Pumping on Lactogenesis Stage II After Cesarean Delivery: A Randomized Clinical Trial
Pediatrics 2001; 107: e94 [Abstract] [Full text] [PDF]
*P3Rs: Submit a response to this article

P3Rs published:

[Read P3R] Mechanical pumping, not as effective as the real thing, but still achievable
Elizabeth Jones   (7 November 2001)

Mechanical pumping, not as effective as the real thing, but still achievable 7 November 2001
Top
Elizabeth Jones,
Research Fellow

Send letter to journal:
Re: Mechanical pumping, not as effective as the real thing, but still achievable

elizabethajones{at}yahoo.com Elizabeth Jones

Sir,

Mechanical pumping, not as effective as the real thing, but still achievable.

We were delighted to read the paper by Chapman et al,(1) because it illustrates the importance of developing an evidence base to underpin breastfeeding practice. The authors have demonstrated very clearly that breast pumping does not help mothers establish breast-feeding following a Caesarean section. In fact the practice is counter-productive and should now cease.

We have also studied the impact of breast pumping using a randomised trial(2). Our study was concerned with mothers of sick preterm infants, where manual expression was the only way of establishing lactation. In this study we were able to demonstrate that a combination of breast massage and simultaneous pumping hugely increased the volumes of milk produced and also increased maternal satisfaction. Using these techniques to express their milk, the majority of mothers are able to sustain their milk supply until their babies are strong enough to establish breastfeeding. The breastfeeding rate on discharge is 72%. In order to produce good results in this group it is important to recognise that a breast pump does not suck or pull milk out of the breast. When oxytocin is released the myoepithelial cells contract and as milk fills the available space into the alveoli, intra-mammary pressure rises. Oxytocin then reduces resistance to the outflow of milk from the alveoli, by shortening and widening the ducts, thus allowing the internal pressure of the breast to push milk out. Therefore, the key to a sustainable milk supply can be found in triggering milk ejection. Simultaneous milk expression is the most efficient way to capitalise on the rapid transfer of milk following milk ejection by removing milk as soon as it flows from the alveolar spaces into the ducts. In this way, both the breast and the pump work together facilitating breast emptying. Furthermore, the time needed to express is substantially reduced. Initially milk volume is hormonally driven, and mothers should express frequently in order to ensure the sensitisation of prolactin receptors. However, 30 - 60 hours following delivery maternal milk volume is directly related to the frequency and quality of milk removal. Advice given to mothers regarding milk expression should address the fact that milk volume is directly related to the frequency of removal, the degree of breast emptying and the storage capacity of the breast. Advice must be individually tailored.

By helping mothers adopt good technique (3) it is possible for the vast majority of mothers to establish and sustain lactation, even under the most adverse circumstances.

(1)Chapman D, Young W, Ferris A, Perez-Escamilla R, Impact of Breast Pumping on Lactogenesis Stage II After Cesarean Dlivery: A Randomised Clinical Trial, Pediatrics, 2001:107 (6); e94 (2) Jones E, Dimmock P, Spencer SA, A randomised controlled trial to compare methods of milk expression after preterm delivery, Arch Dis Child Fetal Neotal, 2001:85;F91-F95 (3) Spencer SA, Jones E, Woods A, Breastfeeding - A Multimedia Learning Resource for Healthcare Professionals, www.MatrixMultimedia.co uk

Liz Jones, Neonatal Research Fellow / Neonatal Nurse Andy Spencer, Reader in Paediatric Medicine, Keele University