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      Which Breast Pump for Which Mother: An Evidenced-Based Approach to Individualizing Breast Pump Technology

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          Abstract

          The majority of new mothers in the United States use breast pumps in the first four months post-birth in order to achieve their personal human milk feeding goals. Although these mothers seek guidance from health care professionals with respect to the type and use of breast pumps, there are few evidence-based guidelines to guide this professional advice. This paper reviews the evidence to facilitate professional individualization of breast pump recommendations using three categories of literature: the infant as the gold standard to which the pump is compared; the degree of maternal breast pump dependency (e.g., the extent to which the breast pump replaces the infant for milk removal and mammary gland stimulation); and the stage of lactation for which the pump replaces the infant. This review can also serve to inform public and private payers with respect to individualizing breast pump type to mother-dyad characteristics.

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          Most cited references79

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          Delayed onset of lactogenesis among first-time mothers is related to maternal obesity and factors associated with ineffective breastfeeding.

          Delayed onset of lactogenesis (OL) is most common in primiparas and increases the risk of excess neonatal weight loss, formula supplementation, and early weaning. We examined variables associated with delayed OL among first-time mothers who delivered at term and initiated breastfeeding (n = 431). We conducted in-person interviews during pregnancy and at days 0, 3, and 7 postpartum and extracted obstetric and newborn information from medical records. We defined OL as delayed if it occurred after 72 h and used chi-square analysis to examine its association with potential risk factors across 6 dimensions: 1) prenatal characteristics, 2) maternal anthropometric characteristics, 3) labor and delivery experience, 4) newborn characteristics, 5) maternal postpartum factors, and 6) infant feeding variables. We examined independent associations by using multivariable logistic regression analysis. Median OL was 68.9 h postpartum; 44% of mothers experienced delayed OL. We observed significant bivariate associations between delayed OL and variables in all 6 dimensions (P or =30 y, body mass index in the overweight or obese range, birth weight >3600 g, absence of nipple discomfort between 0-3 d postpartum, and infant failing to "breastfeed well" > or =2 times in the first 24 h. Postpartum edema was significant in an alternate model excluding body mass index (P < 0.05). The risk factors for delayed OL are multidimensional. Public health and obstetric and maternity care interventions are needed to address what has become an alarmingly common problem among primiparas.
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            Studies in human lactation: milk volumes in lactating women during the onset of lactation and full lactation.

            After validation of test-weighing procedures milk volumes produced by 13 multiparous Caucasian women were followed longitudinally through the first year of lactation. All practiced exclusive breast-feeding for at least 5 mo. Milk transfer to the infant was low on days 1 and 2 and increased rapidly to 498 +/- 129 g/d (means +/- SD) on day 5 and then more slowly to 753 +/- 89 g/d during months 3-5. There was a characteristic milk volume for each mother-infant pair that was significantly related neither to milk yield on days 4-6 nor to birth weight. It was, however, strongly related to infant weight at 1 mo, suggesting that infant and/or maternal factors coming into play during the first month of life are strong determinants of subsequent milk transfer to the infant.
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              Anatomy of the lactating human breast redefined with ultrasound imaging.

              The aim of this study was to use ultrasound imaging to re-investigate the anatomy of the lactating breast. The breasts of 21 fully lactating women (1-6 months post partum) were scanned using an ACUSON XP10 (5-10 MHz linear array probe). The number of main ducts was measured, ductal morphology was determined, and the distribution of glandular and adipose tissue was recorded. Milk ducts appeared as hypoechoic tubular structures with echogenic walls that often contained echoes. Ducts were easily compressed and did not display typical sinuses. All ducts branched within the areolar radius, the first branch occurring 8.0 +/- 5.5 mm from the nipple. Duct diameter was 1.9 +/- 0.6 mm, 2.0 +/- 90.7 mm and the number of main ducts was 9.6 +/- 2.9, 9.2 +/- 2.9, for left and right breast, respectively. Milk ducts are superficial, easily compressible and echoes within the duct represent fat globules in breastmilk. The low number and size of the ducts, the rapid branching under the areola and the absence of sinuses suggest that ducts transport breastmilk, rather than store it. The distribution of adipose and glandular tissue showed wide variation between women but not between breasts within women. The proportion of glandular and fat tissue and the number and size of ducts were not related to milk production. This study highlights inconsistencies in anatomical literature that impact on breast physiology, breastfeeding management and ultrasound assessment.
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                Author and article information

                Journal
                8501884
                5061
                J Perinatol
                J Perinatol
                Journal of perinatology : official journal of the California Perinatal Association
                0743-8346
                1476-5543
                15 December 2015
                25 February 2016
                July 2016
                25 August 2016
                : 36
                : 7
                : 493-499
                Affiliations
                [1 ]Department of Pediatrics, Section of Neonatology, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL
                [2 ]Department of Women, Children and Family Nursing, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL
                Author notes
                Corresponding Author: Paula P. Meier, PhD, RN, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, Paula_Meier@ 123456rush.edu , Phone: 708-307-7496, Fax: 312-942-4370
                Article
                NIHMS743721
                10.1038/jp.2016.14
                4920726
                26914013
                f6793408-2b69-499e-8852-cb509e58162b

                Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use: http://www.nature.com/authors/editorial_policies/license.html#terms

                History
                Categories
                Article

                Pediatrics
                milk expression,breast pump,breast pump dependency,stages of lactation,lactation initiation

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