title: Manual expression and electric breast pumping in the first 48 h after delivery.
abstract: BACKGROUND
  Early feeding for preterm infants via the mother's own milk is crucial for lowering morbidity and mortality. Obtaining the mother's milk in the first few days is sometimes difficult; an effective way of mediating this problem has not yet been established. The aim of the present study was therefore to investigate whether breast pumping using a hospital-grade electric pump was more effective in maximizing the available milk volume and more comfortable than manual expression in the first 48 h after birth.
  
  
  METHODS
  A sequential cross-over study was performed in a maternity ward, in a tertiary perinatal center, Japan. Eleven women whose infants were admitted to the neonatal intensive care unit were sequentially allocated to either manual or electric breast expression (Symphony) for their first expression after 6 h following birth. The women then used the other method for the next expression, and continued to alternate between methods until seven sessions had been completed for each method. The time interval between expressions was 3 h. Main outcome measures were volume of milk expressed per session and pain assessment at each expression using the Wong and Baker face-scale.
  
  
  RESULTS
  Net milk yield per woman was 2 mL manually (median; range: 0-12.6 mL) and 0.6 mL (0-7.2 mL) by electric expression (P < 0.05). The frequency of women stating no pain was higher for electric pumping than manual expression (90% vs 36%, respectively; P < 0.05).
  
  
  CONCLUSIONS
  In the early postpartum period, the best way to obtain colostrum is by gentle manual expression. For mothers who feel pain during manual expression, use of the stimulation phase of the Symphony pump may be preferable.
authors.affiliation: Neonatology and Maternity Ward, Kanagawa Children's Medical Center, Minami-ku, Yokohama City, Japan. neoohyama@gmail.com
authors.forename: Makiko
authors.initials: M
authors.lastname: Ohyama
authors.forename: Harumi
authors.initials: H
authors.lastname: Watabe
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Hayasaka
mesh_terms: D000328:Adult; D001942:Breast Feeding; D003126:Colostrum; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000628:therapy*; D007363:Intensive Care Units, Neonatal; D007564:Japan; D008880:Midwifery; D008893:Milk Ejection / Q000502:physiology*; D010147:Pain Measurement; D049590:Postpartum Period / Q000502:physiology*; D055815:Young Adult