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Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

The World Health Organization recommends exclusive breastfeeding for 6 months and total breastfeeding for at least 2 years. Despite this and multiple interventions promoting breastfeeding, early breastfeeding ...

Although there is a broad knowledge about exclusive breastfeeding among women in Tanzania, exclusive breastfeeding (EBF) remained lower than 50% for about 50 years since her independence in 1961. Previous rese...

In addition to its health and nutritional benefits, breastfeeding can save low-income, food insecure mothers the cost of infant formula so that money can be spent on food and other necessities. Yet breastfeedi...

The International Lactation Consultant Association (ILCA) and the United States Lactation Consultant Association (USLCA) stand firmly in support of the World Health Organization (WHO) and their critical work helping “mothers and children survive and thrive,” particularly during the COVID-19 pandemic. The care plans and policies that are established during COVID-19 for the care of new […]

WHO guidelines recommend breastfeeding for mothers living with HIV adherent to antiretroviral therapy in countries where formula is not accessible. In Canada and the US, guidelines for mothers living with HIV ...

Human milk is the best nutrition for all infants. When the mother’s own milk is not available, the World Health Organization recommends the use of donated human milk and milk banking for neonates born prematur...

Exclusive breastfeeding (EBF) is advocated by the WHO for the first 6 months. In Rwanda, the percentage of infants who are exclusively breastfed decreases from 94% among infants aged 0–1 month to 81% among tho...

Journal of Human Lactation, Ahead of Print.

MARY ANN LIEBERT, INC./GENETIC ENGINEERING NEWS New Rochelle, NY, April 9, 2020–In a new commentary, Alison Stuebe, MD, President of the Academy of Breastfeeding Medicine, addresses the risks and benefits of separating infants from COVID-19-positive mothers following birth. Although multiple public health organizations recommended keeping mothers and infants together, the United States’ Centers for Disease […]

Journal of Human Lactation, Ahead of Print.
Background:During pumping, storage, and pasteurization human milk is exposed to light, which could affect the concentrations of light-sensitive vitamins. Currently, milk banks do not regulate light exposure.Research Aim:The aim of this paper was to determine the influence of light exposure during pumping, storage, and pasteurization on (1) macronutrients, (2) select water-soluble vitamins, and (3) select fat-soluble vitamins.Methods:All 13 participants donated 4 milk samples each. Each sample underwent 1 of 4 treatments: raw and light protected, raw and light exposed, pasteurized and light protected, and pasteurized and light exposed. Samples were analyzed for macronutrients and Vitamins B1, B2, retinol, γ-tocopherol, α-tocopherol, and β-carotene.Results:β-carotene concentrations were not influenced by light exposure. Vitamin B1 was significantly (p < 0.05) affected by light-exposure (M = 0.23, SD = 0.01mg/L) compared to light-protected (M = 0.27, SD = 0.01mg/L) samples. Vitamin B2 concentrations were reduced (p < 0.05) by light-exposure in raw (M = 62.1, SD = 0.61µg/L) and pasteurized (M = 73.7, SD = 0.72µg/L) samples compared to light-protected raw samples (M = 99.7, SD = 0.66µg/L). No other tested nutrients were affected by light exposure.Conclusions:If milk is exposed to excessive amounts of light, Vitamins B1 and B2 concentrations may degrade below the current Adequate Intake recommendations for infants 0–6 months of age, increasing the risk of insufficient vitamin supply to the exclusively human milk-fed infant. Thus, pumped or processed human milk should be protected from light to preserve milk vitamin concentrations.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
Background:Lactational mastitis is a maternal morbidity that affects the wellbeing of women and their babies, including through breastfeeding discontinuation.Research Aim:To systematically review the available global literature on the frequency of lactational mastitis, and to summarize the evidence on risk factors for lactational mastitis. We also describe gaps in the evidence and identify priority areas for future research.Methods:We systematically searched and screened 6 databases and included 26 articles, conducted meta-analysis of disease frequency, and narratively synthesized evidence on risk factors.Results:In 11 (42%) articles researchers reported a measure of disease frequency; 5 (19%) reported risk factors, and 10 (39%) included both. Overall, the quality of studies was low, related to suboptimal measurement of disease frequency, high risk of bias, reverse causality, and incomplete adjustment for confounding. Meta-analysis was based on 3 studies (pooled incidence between birth and Week 25 postpartum: 11.1 episodes per 1,000 breastfeeding weeks; 95% CI [10.2–12.0]); with high heterogeneity across contexts and highest incidence in the first four weeks postpartum. Researchers assessed 42 potential risk factors; nipple damage was the most frequently studied and strongly associated with mastitis. There was a scarcity of studies from low-resource settings.Conclusions:Lactational mastitis is a common condition, but the wide variability in incidence across contexts suggested that a substantial portion of this burden might be preventable. Provision of care to breastfeeding women at risk for or affected by mastitis is currently constrained due to a critical lack of high quality epidemiological evidence about its incidence and risk factors.

Getting a good pump fit is vital, especially when you pump often and the breast-pump part your nipple is drawn into (the nipple tunnel) is composed of rigid plastic, as is true of most pumps. If it is made of soft silicone, which a few pumps are, it may mold more easily to different nipple sizes.

Figure 1

Pump fit affects both nipple comfort and milk flow. When a nipple tunnel is too small, it can lead to pain, skin trauma, and reduced milk flow, because it compresses the nipple during pumping. In pump-dependent families, this can put milk production at risk.

Pump Fit and Nipple Diameter

Pump fit is based on how well your nipples fit into the pump’s nipple tunnel. Pump manufacturers call the pump part with the nipple tunnel by different names (flange, shield, breastshield). Some parents refer to it as the “horn” or “funnel.”

Figure 2

Nipple tunnel diameter varies slightly by brand (Figure 1), with 24 or 25 mm the standard diameter of most pumps. One sign a different size nipple tunnel is needed is pain or discomfort during pumping, even near the pump’s lowest suction setting. Because the left and right nipples may vary in size, some parents get the best results when they use one size on one side and another size on the other side.

If pumping is comfortable with good milk flow, you probably have a good pump fit. If there is discomfort, even on low suction settings, watch your nipples during a pump session and see how they compare with Figures 2a, 2b, and 2c.  

Depending on the pump brand, larger or smaller nipple tunnels may be available for purchase separately.

How Often Are Larger or Smaller Nipple Tunnels Needed?

More often than you might think. In one U.K. study, 36 mothers with babies in the NICU pumped with a standard 25 mm nipple tunnel, and the researchers noted that because they reported discomfort, the opening was too small for 28%. The authors wrote: “If the [opening] is too small, pressure is highest on the nipple tissue, which can cause sore nipples and ineffective drainage.”2

In a U.S. NICU study, a different brand of pump with a 24 mm standard nipple tunnel was used. When both milk flow and comfort were assessed, a much higher percentage of mothers had better results with a larger diameter nipple tunnel. “[W]e found that 51.4%—or about half—of the 35 mothers who served as subjects in the research initially required either the 27 or 30 mm shield in order to achieve optimal, pain-free nipple and areolar movement during milk expression. As lactation progressed, 77.1%—or slightly more than three quarters—of the mothers eventually found they needed these larger shields.”3

Pump Fit Can Change with Regular Pumping.

A 2019 U.S. randomized crossover study compared the effects of nursing, hand expression and pumping on the nipple sizes of 46 lactating women1. The researchers found that unlike direct nursing and hand expression, with pumping, nipple length and diameter increased in size. Two U.S. lactation consultants used an engineer’s template to measure mothers’ nipples before and after pumping and also found that pumping causes nipples to increase in size. They wrote: “Pre- and post-pumping measurements taken with a circle template reveal that nipple size can increase 3 to 4 millimeters.”4 So even if parents are fitted well when they start pumping, it makes sense for them to check their pump fit over time to see if it has changed and whether they need a larger diameter nipple tunnel.

Signs a Larger or Smaller Nipple Tunnel Is Needed

Consider a larger nipple tunnel if:

• You feel discomfort, even on low suction settings.

• Your nipple rubs along the tunnel, despite efforts to center it.

• Your nipple blanches, or turns white.

• Your nipple does not move freely in the nipple tunnel.

• You notice slow milk flow or less milk expressed than expected.

Consider a smaller nipple tunnel if:

• You feel discomfort, even on low suction settings.

• More than about 1/8 inch (3 mm) of the areola is pulled into the nipple tunnel.

• Your nipple bounces in and out of the tunnel.

• You have difficulty maintaining an air seal.

Major breast-pump brands, such as Ameda, Medela, and Spectra offer fit options ranging from 20 mm to 36 mm. Another product that can sometimes help make pumping more comfortable is Pumpin’ Pal, which provides an angled nipple tunnel. Contact a lactation supporter for help in finding the best fit for you. See also the blog post HERE for other reasons pumping might feel uncomfortable.

References

1 Francis, J., & Dickton, D. (2019). Physical analysis of the breast after direct breastfeeding compared with hand or pump expression: A randomized clinical trial. Breastfeeding Medicine, 14(10), 705-711.

2 Jones, E., Dimmock, P. W., & Spencer, S. A. (2001). A randomised controlled trial to compare methods of milk expression after preterm delivery. Archives of Disease in Childhood. Fetal and Neonatal Edition, 85(2), p. F94.

3 Meier, P. (2004). Choosing a correctly-fitted breastshield. Medela Messenger, 21, p. 8.

4 Wilson-Clay, B., & Hoover, K. (2017). The Breastfeeding Atlas (6th ed.). Manchaca, TX: LactNews Press, p. 80-81.

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