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Table 2 Studies exploring methods of expressing

From: Prevalence and outcomes of breast milk expressing in women with healthy term infants: a systematic review

Author, year, country Design Location, participants, year of study and recruitment Study aims and outcome measures Results Strengths/Limitations
Binns et al. 2006 Australia [2] Longitudinal Perth, Western Australia - Explore determinants of breastfeeding - Approx. 60% (n = 1143) using manual pumps in both studies Large study
PIFS I n = 556 - Measure and compare prevalence of expressing 1992-93 and 2002-03 - Use of electric pumps increased by 31% in 10 years Comparison of similar groups 10 years apart
1992–93    Actual figures not given
PIFS II n = 587    Public patients only, perhaps not representative
Recruited in hospital in early post-partum period    
Labiner-Wolfe et al. 2008 USA [3] Longitudinal National study - Reasons why women express - Birth to 1.5 -4.5 months Large sample size
n = 4606 - Amount and prevalence of milk expression 80% (105/1302) battery or electric 44% (573/1302) manual pump 14% (18/1302) hand 3 mailed questionnaires seeking information re. feeding in previous fortnight - recall bias unlikely
2005-2007 IFPS II - Associated socio-demographic factors - Previous 3 months to 6.5-9.5 months Detailed information re. methods of expression over time
Mail survey 2, 5 and 7 months postpartum   73% (39/529) battery or electric) 33% (18/529) manual pump 13% (69/529) hand Not nationally representative, older, more educated, more likely to be white, employed, higher income, less likely to smoke. More likely to breastfeed and for longer
Ohyama et al 2010 Japan [31] Sequential crossover Yokohama, Kanagawa - Comparison of effectiveness and comfort of manual and electric breast expression in first 48 hours after birth - Manual expressing associated with greater milk volume: net milk yield per woman 2 ml. Limited other exploration of this area
n = 11   - Manual expression 2 ml (median; range: 0-12.6 ml.) Small study
2003-2004   - Electric expression 0.6 ml. (0-7.2 ml.) (P < 0.05). Infant gestation and health status not indicated
Mothers of infants admitted to neonatal intensive care recruited in hospital soon after birth   - Manual pump associated with more reports of pain  
Flaherman et al 2012 USA [32] RCT San Francisco & Sacramento, California Comparison of hand and electric expression measured; - At 2 months mothers assigned to hand expressing were more likely to be breastfeeding (97%, 47/48) than mothers assigned to breast pumping (73%,35/48) (RR:1.32, 95% CI 1.01,1.73) Limited other exploration of this area, no previous studies linking type of expressing to breastfeeding outcomes
n = 68 - Milk transfer   Thorough discussion
2007-2009 - Breast pain   Small study, final outcome assessment based on 48 participants
Recruited12-36 hours after birth - Breastfeeding confidence   Possible bias- recruited infants experiencing feeding difficulty
  - Breast milk expression experience   No control group
  - Breastfeeding rates at 2 months   
Becker et al. 2011 UK [30] Systematic review International - Assessment and review of randomised and quasi randomised trials comparing methods of milk expression any time after birth and crossover trials commencing at least 28 days after birth - More milk with relaxation tape Systematic review
   n = 642 women from 23 studies   - No difference in mean vol. with simultaneous or sequential pumping, or between manual and electric pumps studied Most studies specifically related to the care of the pre-term infant