2018 Volume 32 Issue 1 Pages 15-26
Purpose
This study explores the care related to milk expression that promotes breast milk production, as the first step in developing an educational program for obstetric nurses to promote early postpartum breast milk production in mothers of preterm infants.
Methods
Five reviewers conducted a search of published manuscripts using the following databases: PubMed, CINAHL Plus with Full Text, and Ichushi Web Ver. 5 of the Japan Medical Abstracts Society. They also included manuscripts used in a literature review of breast milk expression published by Cochrane Library. The titles, abstracts and main texts of these manuscripts were used as references to extract manuscripts that included the amount of breast milk produced by mothers of preterm infants as their outcome. Two reviewers evaluated and reached agreement on the quality of each manuscript using the Cochrane Handbook for Systematic Reviews of Interventions (5.1.0), Risk of Bias Assessment Tool for Nonrandomized Studies and the GRADE Handbook. They organized the research objectives, methods and results of each manuscript to identify care related to milk expression to promote breast milk production in mothers of preterm infants.
Results
Meeting the inclusion criteria were 35 articles: 24 interventional and 11 observational studies. There was low-quality evidence from the randomized controlled trials for example, insufficient information about random sequence generation, allocation concealment and blinding. Also, sample size had not been calculated in most of manuscripts. There was low-quality evidence from the nonrandomized controlled trials for example, insufficient consideration of confounding variable. Evidence considered applicable in nursing practice was obtained from the observational studies. Useful methods of care related to milk expression that promoted breast milk production were: starting breast milk expression within one hour of delivery if possible, guaranteeing at least seven breast milk expression sessions and at least 100 minutes of breast milk expression per day, fully explaining both hand and electric breast pumping and adding at least six sessions of hand breast pumping to electric breast pumping per day until mothers entered stage II of milk production, and were performing kangaroo care.
Conclusion
Building on the findings from this review the next phase is to document mothers' actual breast expression experience and interview obstetric nurses to build an accurate data-base of about breast milk expression among mothers of preterm infants in Japan. The aim is to deepen understanding of the actual situation of support for breastfeeding among mothers of preterm infants and to develop an educational program that enables nurses working on obstetric wards to provide care related to milk expression that promotes adequate breast milk production.
