Effects of three methods of breast milk expression on breastfeeding initiation, breast milk extraction and proportion of exclusive breastfeeding—an open label, randomized controlled trial

Abstract Background Direct breastfeeding has multiple health benefits. However, in certain circumstances direct breastfeeding is not possible immediately after delivery, yet provision of infants with their mother’s milk is important. There is insufficient evidence regarding an effective method of breast milk expression in the absence of an infant's suction. Therefore, we undertook a trial to investigate the effects of different methods of breast milk expression on breastfeeding initiation, efficacy of breast milk extraction, and on the rate of exclusive breastfeeding at 6 months. Methods The participants of mother-infant dyads separated immediately after birth for at least 6 hrs were recruited and randomly assigned (1:1:1) into three groups: (1) hand expression of breast milk; (2) sequential and (3) simultaneous electrical breast pumping. The two primary outcome measures were the time required for initiation of breastfeeding and the milk volume expressed in a 10-minute session (direct breastfeeding in hand expression group) at 3 days and at 6 weeks; a secondary outcome was the proportion of exclusive breastfeeding at 4 and 6 months. The data were analysed according to intention-to-treat. Results Between 2018 and 2019, we recruited 226 participants, of whom 154 were randomized. The median time (in hours) of breastfeeding initiation of the sequential (46.5, 95% CI 36.1-50.5) and simultaneous (45.6, 95% CI 34.2-53.0) breast pumping groups did not differ from those of hand expression group (46.7, 95% CI 40.8-50.0) (p=1.000). At 3 days the breast milk volume (10 min per breast) through simultaneous pumping (13.1±10.9 ml), but not sequential pumping (16.7±11.6 ml) (p=0.560), was significantly less than hand expression (23.8±26.2 ml through direct sucking) (p=0.007). At 6 weeks the breast milk volume through sequential pumping (64.7±51.0 ml), but not simultaneous pumping (71.6±50.8 ml) (p=0.670), was significantly less than hand expression (89.8±67.3 ml through direct sucking) (p=0.035). The breast milk volume obtained through sequential breast pumping was 37.9 ml less than that obtained by those of simultaneous pumping (p<0.001). The rate of exclusive breastfeeding at 4 months was 21.0%, and at 6 months 10.6%, and did not differ between the three methods of breast milk expression. Conclusions Hand expression, sequential breast pumping, or simultaneous breast pumping in absence of immediate infant suction after birth did not show differences on the time required to initiate breastfeeding, or on the rate of exclusive breastfeeding at 4 and 6 months. Trial registration This trial was registered with www.chictr.org.cn (ChiCTR1800018193) on 4 September 2018.

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