Authors (including presenting author) :
Chan, HTI(1), Ma, GYG(1)
Affiliation :
Obstetrics and Gynaecology, Queen Mary Hospital
Introduction :
. WHO and UNICEF recommended babies should be exclusively breastfed for at least 6 months. Unfortunately, many women cannot sustain breastfeeding, either exclusive or partial, in Hong Kong Chinese women. Perception of insufficient milk supply was the main reason stated for breastfeeding cessation and giving supplementation to baby. Loke and Chan (2013) pointed out that maternal breastfeeding confidence and newborn breastfeeding behavior were strong predictors of breastfeeding duration as well as exclusivity. Therefore, some health professionals stated suggesting antenatal breast expression and storage of colostrum to offer to neonate, in order to overcome maternal breast anomalies or hormonal insufficiencies, and to avoid any formula supplementation to neonate. A pilot study by Forster and her colleagues (2011) investigated the effect of antenatal breast expression on babies of insulin dependent diabetes women in Australia. The results surprisingly revealed that the special care baby unit admission rate was higher in antenatal breast expression group than the control group. But the study also reflected the high blood glucose threshold of 2.6 mmol/L and large variation of time that when the glucose test was done post birth were the limitation in this study. Another Indian study explored the effect of antenatal breast expression at term in reducing breastfeed failure, concluded daily expression reduced the time for establishing full breastfeeding. It was explained that 'full lactation' was achieved without formula 'top up' and baby did not cry for 2 hours and passed urine at least 6 times per day. However, the aims and objectives, justifications of research method, terminologies were not clear in this published study. Midwives and IBCLC midwives may be faced with an ongoing dilemma as it is well documented that surges of oxytocin occurs with every let-down at the commencement and duration of breastfeed and nipple stimulation Outcomes of uterine contraction or preterm labor therefore become the concerns. A study related to tandem nursing was carried out by Moscone and Moore (1993). 57 pregnancy women continued to breastfeed through out their gestation, 7% of women experienced contraction associated with breastfeeding and all babies were born healthy and appropriate to gestational age.
Objectives :
To investigate the effect of antenatal breast expression (ABE) of colostrum, a pilot study is conducted to determine the feasibly, safety and efficacy to develop a future randomized trial. To assess the effect of ABE on maternal breastfeeding confidence and neonatal outcome
Methodology :
Mixed method will be adopted. As this is a pilot study, a small sample size of 30 pregnant women will be recruited. In order to minimize the risk of inducing preterm labor and any obstetric complication, the major inclusion criteria are women need to be over 37 weeks of gestation who plan to breastfeed. To be eligible for the study, women also need to be a primipara and singleton pregnancy, able to read and speak Cantonese, Mandarin or English. Exclusive criteria include history of antepartum hemorrhage, placenta praevia, Group B Streptococcus carrier, any suspicious fetal compromises or abnormities and maternal major diseases or obstetric complication, In order to meet the inclusion criteria in the most effective way, pregnant women will be recruited in Team Midwife-Led Clinic (TMLC). Part of the low risk clients have their antenatal check up at TMLC by midwives. Eligible clients whose gestation is over 37 weeks will be invited to participate in this study. Once consents are obtained, women will be taught to perform breast expression by certified lactation consultant. Oral and written instruction will be provided on how to hand express the colostrum, safe storage and transportation. Each woman will be encouraged to perform hand expression once a day in first 2 days; twice a day in the third to fifth day and 3 to 4 time s a day afterwards. A diary booklet will be provided to document the date, time and volume of colostrum expressed. Women will be advised of precaution related to expression, such as contraction induced.. As all TMLC client would regular TMLC appointment every week after 38 weeks of gestation, all recruited subjects would be reviewed once weekly by lactation consultant for their ABE progress. Demographic data of participants will be collected. Quantitative data of diary booklet will be analyzed using descriptive statistics, including expression frequency, days of colostrum collection, volume, uterine activity. To assess maternal confidence in breastfeeding, a questionnaire will be given to mother prior to post-partum hospital discharge. The Breastfeeding Self-Efficacy Scale–Short Form (BSES-SF) positively worded, with scores summed to produce a range from 14 to 70; higher scores indicate a higher level of breastfeeding self-efficacy. The BSES-SF questionnaire will also be provided to 30 postnatal mothers without any ABE done as a control comparison. For neonatal outcome, numbers of formula supplementation (both medically and non-medically indicated), babies’ napkin output, percentage of weight loss and special care
Result & Outcome :
Data collection is currently in progress
Co-location with:
