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. Some mothers need to express their breasts when directly breast feeding is unavailable immediately after delivery. However, there is insufficient evidence regarding an effective method of breast milk expression in the absence of an infant's suction. This trial was designed 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. Intention-to-treat data set was used in this analysis. Results Between 2018 and 2019, we recruited 226 participants, of whom 154 were randomized. The median time (in hour) of breastfeeding initiation of 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 (46.7, 95% CI 40.8-50.0) (p=1.000). At 3 days the breast volume 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 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 through sequential breast pumping (10 min per breast) was 37.9 ml less than those of simultaneous pumping (p=0.000). 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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