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Randomised trial comparing hand expression with breast pumping for mothers of term newborns feeding poorly
  1. Valerie J Flaherman1,
  2. Barbara Gay2,
  3. Cheryl Scott3,
  4. Andrew Avins4,
  5. Kathryn A Lee5,
  6. Thomas B Newman1,6
  1. 1Department of Pediatrics, University of California School of Medicine, San Francisco, California, USA
  2. 2University of California San Francisco Medical Center, San Francisco, California, USA
  3. 3Kaiser Permanente South Sacramento Medical Center, Sacramento, California, USA
  4. 4Division of Research, Northern California Kaiser Permanente, Oakland, California, USA
  5. 5Department of Family Health Care Nursing, University of California School of Nursing, San Francisco, California, USA
  6. 6Department of Epidemiology and Biostatistics, University of California School of Medicine, San Francisco, California, USA
  1. Correspondence to Valerie J Flaherman, Department of Pediatrics, University of California San Francisco, 3333 California Street, Box 0503, San Francisco, CA 94143, USA; flahermanv{at}


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.

Design Randomised controlled trial.

Setting Well-baby nursery and postpartum unit.

Patients 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.

Mainoutcome measures 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.

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  • Funding This project was supported by grant number KL2 RR024130 from the National Center for Research Resources and grants number 5 K12 HD052 and 1K23HD059818-01A1 from the National Institute of Children Health and Human Development.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the UCSF Committee on Human Research, the Kaiser Permanente Institutional Review Board and the Stanford University Administrative Panel on Human Subjects in Medical Research.

  • Provenance and peer review Not commissioned; externally peer reviewed.