Table 3 Studies exploring reasons women express

Dykes & Williams 1999 UK [34]

Longitudinal, phenomenological study

Northern England,

- Explore women’s experience of expressing particularly perception of adequacy of milk supply

- Beliefs re. adequacy of breast milk supply influenced by interplay of feeding management, infant behaviour, lactation physiology and maternal mental health.

Small mono-cultural group

n = 10

1998

Postnatal primiparas recruited face-to-face in hospital, home visits at 6, 8 &12 weeks

Binns et al. 2006 Australia [2]

Longitudinal cohort

Perth, Western Australia

- Explore determinants of breastfeeding

- Early breastfeeding difficulties,

Comparison of similar groups 10 years apart

PIFS I n = 556

- Measure and compare prevalence in expressing

- Engorgement, sore nipples, mastitis

Mainly women who expressed to manage breastfeeding difficulties

1992–93

- Feed to be given by someone else

Public patients only, perhaps not representative

PIFS II n = 587

- To store extra milk

2002–03

- Father to feed

Recruited in hospital in early post-partum period.

- To increase supply

- Feeding/attachment problems

- To get baby to drink from a bottle

- Just to try it out

Labiner-Wolfe et al. 2008 USA [3]

Longitudinal cohort

National study

- Reasons why women express

- to allow someone else to feed

Large sample

n = 3606

- Amount and prevalence of milk expression

- maternal employment

Not nationally representative Participants older, more likely to be educated, white, employed, higher income

2005–2007

- Associated socio-demographic factors

- to have an emergency milk supply

from IFPS II

- no previous breastfeeding experience

- geographic location (Midwest Vs. West)

- embarrassed to breastfeed in public

Buckley 2009 USA [33]

Focus groups

Washington, DC

- Ascertain lactation consultant’s beliefs and experiences re. impact of breast pumps on breastfeeding practice

- Technological birth contributes to technological breastfeeding

Exploration of professional attitudes to change in feeding practice -no previous exploration of this area

n = 12

- Engorgement, plugged ducts, to increase supply, to stimulate the let-down reflex, to pull out inverted nipples.

Small sample size

Lactation consultants

- Return to work

Volunteer participants

Purposeful sampling

- Measuring milk, diminished confidence in ability to provide enough milk

Date of study not indicated

Clemons & Amir 2010 Australia [5]

Cross-sectional

State-wide study, Victoria

- Prevalence of breast milk expression

- Premature baby/sick mother or baby

Large study

n = 903

- Demographic characteristics of women who express, why and how they do it

- Attachment problems/not drinking well

Possible selection bias (members of ABA)

2008

- Women’s experience of using breast pumps

- Advised

Timing of questionnaire, possible recall bias

Online questionnaire sent to Australian Breastfeeding Association (ABA) members who had an email address

- Not enough milk/To store extra milk

- Nipple pain

- Engorged breasts/mastitis

- So someone else can feed baby

- Maternal work

- Just to try it out

- To allow mother to drink alcohol

- Uncomfortable breastfeeding in public

Geraghty et al. 2012 USA [29]

Prospective longitudinal cohort

Cincinnati

- Duration of breast milk feeding

- Planned return to work by 6 months

Prospective design

n = 60

- Describe who commences expressing early

Small study

2004–2007

Recruitment of women who planned to breastfeed for 6 months or more

recruited face to face

Mothers recruited for study knew they were going to be assisted to pump and may have been more likely to be comfortable with this.

Possible introduction of bias as weekly collection of breast milk was initiated at 1 week by research nurse using an electric breast pump