title: Randomised trial comparing hand expression with breast pumping for mothers of term newborns feeding poorly.
abstract: OBJECTIVE
  Breast pumping or hand expression may be recommended when newborns latch or suck poorly. A recent trial found worse outcomes among mothers who used a breast pump in the early postpartum period. The objective of this study was to compare bilateral electric breast pumping to hand expression among mothers of healthy term infants feeding poorly at 12-36 h after birth.
  
  
  METHODS
  Randomised controlled trial.
  
  
  METHODS
  Well-baby nursery and postpartum unit.
  
  
  METHODS
  68 mothers of newborns 12-36 h old who were latching or sucking poorly were randomly assigned to either 15 min of bilateral electric pumping or 15 min of hand expression.
  
  
  METHODS
  Milk transfer, maternal pain, breastfeeding confidence and breast milk expression experience (BMEE) immediately after the intervention, and breastfeeding rates at 2 months after birth.
  
  
  RESULTS
  The median volume of expressed milk (range) was 0.5 (0-5) ml for hand expressing mothers and 1 (0-40) ml for pumping mothers (p=0.07). Maternal pain, breastfeeding confidence and BMEE did not differ by intervention. At 2 months, mothers assigned to hand expression were more likely to be breastfeeding (96.1%) than mothers assigned to breast pumping (72.7%) (p=0.02).
  
  
  CONCLUSIONS
  Hand expression in the early postpartum period appears to improve eventual breastfeeding rates at 2 months after birth compared with breast pumping, but further research is needed to confirm this. However, in circumstances where either pumping or hand expression would be appropriate for healthy term infants 12-36 h old feeding poorly, providers should consider recommending hand expression.
authors: Department of Pediatrics, University of California San Francisco, 3333 California Street, San Francisco, CA 94143, USA. flahermanv@peds.ucsf.edu
authors: Valerie J
authors: VJ
authors: Flaherman
authors: Barbara
authors: B
authors: Gay
authors: Cheryl
authors: C
authors: Scott
authors: Andrew
authors: A
authors: Avins
authors: Kathryn A
authors: KA
authors: Lee
authors: Thomas B
authors: TB
authors: Newman
mesh_terms: D000328:Adult; D001294:Attitude to Health; D001724:Birth Weight; D001942:Breast Feeding / Q000523:psychology; D061186:Breast Milk Expression / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000523:psychology; D005247:Feeding Behavior; D005260:Female; D005865:Gestational Age; D006225:Hand; D006801:Humans; D007231:Infant, Newborn; D007774:Lactation; D008297:Male; D008895:Milk, Human / Q000378:metabolism; D009035:Mothers / Q000523:psychology; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000209:etiology; D013396:Suction / Q000295:instrumentation / Q000379:methods; D055815:Young Adult