Practices, predictors and consequences of expressed breast milk feeding in healthy full-term infants

Abstract

Breast milk expression is becoming more common in mothers of healthy term infants. Studies examining the effect of expression on breastfeeding duration are limited and their conclusions remain contradictory. A total 2560 mother-infant pairs in Hong Kong were recruited in 2006-07 and 2011-12 and followed up prospectively for 12 months or until the infant was weaned. Across the first 6 months postpartum, rates of exclusive expressed breast milk feeding ranged from 5.1% to 8.0% in 2006–2007 and from 18.0% to 19.8% in 2011–2012. Factors associated with higher rates of exclusive expressed breast milk feeding, include supplementation with infant formula, lack of previous breastfeeding experience, having a planned caesarean section delivery, and returning to work postpartum. Exclusive expressed breast milk feeding was associated with an increased risk of early breastfeeding cessation when compared with direct feeding at the breast. The hazard ratios (HR) ranged from 1.25 (95% CI: 1.04, 1.51) to 1.91 (95% CI: 1.34, 2.73) across the first 6 months. Mothers of healthy term infants should be encouraged and supported to feed directly at the breast, especially early in the postpartum period. Exclusive expressed breast milk feeding should be recommended only when medically necessary and not as a substitute for feeding directly at the breast. Further research is required to explore mothers' reasons for exclusive expressed breast milk feeding and to identify the health outcomes associated with this practice.