Hands-On Pumping Pumps Up Milk Production

by Amy Spangler
June 11, 2009

Results of a recent study show that hand expression and breast massage combined with breast pumping did a better job of stimulating milk production than breast pumping alone.

Dr. Jane Morton and a research colleague at Stanford University investigated the effect of two methods of milk removal in mothers of infants born at less than 30 weeks’ gestation. The study has been accepted for publication in an upcoming issue of the Journal of Perinatology.

Because breastfeeding is typically delayed for weeks or months in mothers of infants born prematurely, these mothers often rely upon breast pumps to stimulate milk production. To test the theory that frequent and effective milk removal in the first three days after birth is critical to establishing full milk production at two months, mothers participating in the study were taught to hand-express during this period. Once they began to produce larger amounts of milk, they were taught what is described by the researchers as “hands-on pumping”—a technique that combines breast massage, hand expression, and breast pumping.

Study results
Researchers found that mothers who relied solely on breast pumping, and stopped each pumping session when the flow of milk ended, left available milk in the breast. Mothers who combined breast massage with breast pumping, and followed breast pumping with hand expression, removed more of the available milk. Mothers who used hand expression (five times or more each day) in addition to hands-on pumping produced an average of 955 ml per day (approximately 32 ounces) by two months—an amount that would satisfy most healthy, full-term, breastfed 3-month-olds. Moreover, those factors thought to compromise milk production such as advanced maternal age, obesity, cesarean birth, and preterm birth had no impact on long-term milk production in the mothers in the study.

Before these preliminary findings can be applied to a wider population of mothers, more research is needed. While these results are not meant to challenge the importance of breast pumps, they are meant to highlight the effect of combining breast pumping with other techniques as a means for maximizing long-term milk production. Given that insufficient milk is the most common reason mothers give for stopping breastfeeding, any strategy for increasing milk production could have a profound impact on exclusive breastfeeding rates as well as duration rates.

With increasing reliance on gadgets to support continued breastfeeding, it’s encouraging to think that the best strategy for helping mothers make more milk is a no-cost, no-risk, hands-on solution.

Editor’s Note—July 14, 2009
The study has been published. Here is a commentary from Dr. Jane Morton:

Our research suggests that mothers of premature infants should not rely solely on breast pumps to establish and maintain their breast milk supply. These mothers, and most likely all mothers already have a simple, safe and free tool for assisting breast milk production: their own hands. We found that the suction of an electric pump could not reliably remove a significant portion of colostrum and milk, and that massaging and compressing those areas of the breast that felt firm improved milk removal.

In our research, we taught mothers to use their hands to express colostrum (early milk) during the first three postpartum days. Once milk volume increases, they are instructed to use a technique called hands-on-pumping (using both an electric pump and hand techniques synchronously). Mothers of babies born before 30 weeks of gestation who hand-expressed colostrum more than five times a day in addition to pumping and then used hands-on-pumping for eight weeks produced an average of a quart (32 oz) of milk a day and were even able to express less frequently and sleep longer at night at eight weeks postpartum.

It was actually the study mothers who first became aware of the importance of the two skills—hand expression and hands-on pumping. Before we began to tabulate the data, our study mothers kept commenting on how much more milk they were making compared to non-study mothers.  Instead of expressing appreciation for the use of a brand new top-of-the-line electric breast pump and access to lots of instruction and encouragement, their almost unanimous response regarding their experience of being in the study was the value they attached to learning how to use their hands.

This was a wonderful study to be involved in because the results were so clinically relevant.  For too many years I have been relatively unsuccessful helping mothers turn around the distressing problem of having too little milk. The “take home points” of this study are:

1. What happens in the first 3 days is critical to future milk production.
2. There is a risk when mothers are taught to rely solely on breast pumps to establish and maintain their breast milk supply.
3. Even low producing mothers can become high producers—not by expressing more frequently, but by expressing more effectively. This involves learning a simple technique called hands-on-pumping.
4. So-called “risk factors” for insufficient milk production such as preterm birth, obesity, cesarean birth, advanced maternal age, first-time mother, and mother of multiples (twins, triplets or more) seem to be of little consequence when effective expression techniques are utilized.

Our study involved only mothers who delivered prematurely and were most likely to have low milk production. However, there is no reason to think that these techniques would not be just as effective, or even more effective for mothers of near-term or term babies. Late pre-term infants (those born between 34 and 36 weeks of gestation) are at highest risk of feeding problems related to poor milk intake, including jaundice, dehydration, and poor growth.