Antenatal breast expression: exploration and extent of teaching practices amongst International Board Certified Lactation Consultant midwives across Australia.

BACKGROUND: Antenatal breast expression (ABE) has been taught in the past as breast preparation. Now some authorities are advising ABE and storage of colostrum for the feeding the newborn in the treatment and/or prevention of hypoglycaemia in the immediate postnatal period (thus avoiding the need for formula supplementation). The actual incidence of ABE teaching amongst International Board Certified Lactation Consultant (IBCLC) Midwives is unknown. Results of this study will provide valuable baseline data for future randomised controlled trials into this practice. RESEARCH QUESTION: What are the teaching practices surrounding ABE and the incidence of this type of teaching by IBCLC Midwives across Australia? METHOD: A descriptive cross-sectional Internet survey containing both quantitative and qualitative questions was sent to Australian IBCLC Midwives. Simple descriptive statistics was used to analyse quantitative data. Content analysis examined qualitative textual data of open-ended questions. FINDINGS: Response rate was 27% (n=347/1269). 93% (n=322) of those responding to the survey had heard of ABE. 60% (n=134) actively teach the practice. Descriptive statistics and content analysis revealed marked differences in teaching practices amongst this specialised group of midwives. CONCLUSION: This study suggested a large proportion of lactation qualified midwife respondents were aware of ABE and some currently teach the skill. However, advice given to women during pregnancy varied substantially.

Antenatal breast expression: a critical review of the literature.

OBJECTIVE: to critically review literature related to the practice of antenatal breast expression (ABE) and the reasons for this practice. METHOD: a critical review of available literature was undertaken by accessing Internet and library resources. Articles were to be documented in English. No restrictions were placed on dates due to the important historical background of this topic. Keywords used to refine the search included antenatal breast expression, colostrum, antenatal breast-feeding education and midwives and International Board Certified Lactation Consultants (IBCLC). FINDINGS: the literature search discovered ABE has been performed historically to prepare breasts for breast-feeding postnatally. It is presently being taught to store colostrum to prevent neonatal hypoglycaemia or hasten production of Lactogenesis 2. Studies relating to nipple stimulation were also critically appraised due to concerns of premature labour. CONCLUSIONS: the safety and efficacy of ABE has yet to be demonstrated. The three studies related to the benefits teaching of this skill were small in size with methodological flaws. Trials related to nipple stimulation were also found to have substantial limitations. The reasons for and physicality of performing ABE vs. nipple stimulation differed markedly. While recent teaching of ABE has been encouraged through available commentaries, case studies and policies (in view of the documented positive effects of early colostrum administration), the benefits of this practice are yet to be substantiated. IMPLICATIONS FOR PRACTICE: large, credible RCTs are needed to confirm efficacy and safety of this technique. A survey exploring the prevalence of ABE practices is also indicated and to explore the information currently provided by midwives to women in their care.