BOOSTING OXYTOCIN Skin to skin contact prolonged Pumping

BOOSTING OXYTOCIN? • Skin to skin contact - prolonged • Pumping during skin to skin or at the cot side • Massage of breasts • Pictures of baby • Infant's worn clothing to smell • Videos of infant • Noises infant makes

EXPRESSING IN CLOSE PROXIMITY TO THEIR INFANT Mothers achieved significantly higher volumes of milk: • Expressing during or straight after KC compared with expressing beside cot with no KC Mothers still achieved higher volumes of milk • Expressing next to infant in cot compared with expressing away from baby Acuna-Muga et al 2014

COLLECTION AND STORAGE OF EBM (@RWH) • Collect first 30 expressions of colostrum and label them 1 -30 – use in order of expression • 2/3 expressions from the same day may be placed in one container, provided the milk is chilled in the refrigerator before adding to the container – (this may not be same at all hospitals) • Ideally fresh EBM will be used when possible otherwise refrigerated within 4 hours or frozen. • • Only open refrigerator doors minimally Ensure no overcrowding Do not store trays of EBM in front of motors or fans Do not store EBM in the refrigerator door

HOW ELSE TO BOOST MILK SUPPLY? • Double pumping? • Hands on pumping? • Cluster/ power pumping? • Domperidone?

EXPRESSING WITH PUMPS Double pumping • Up to 18% higher milk volume • Milk has higher energy (fat) content • 80% of the milk volume can be removed in the first 8 mins • Milk ejection reflex occurs simultaneously in both breasts • Increased prolactin levels after expression Prime et al 2009 Prime et al 2011

HANDS ON EXPRESSING/PUMPING Combining hands and pump = average of 48% more milk Milk contained twice as much fat Mothers continued to increase their milk production throughout the first eight weeks 1. First, massage both breasts. 2. Double pump, compressing your breasts as much as you can while pumping. Continue until milk flow slows to a trickle. 3. Massage your breasts again, concentrating on any areas that feel full. 4. Finish by either hand expressing or single pumping, whichever yields the most milk. Continue breast compression on each breast, moving back and forth from breast to breast several times until you’ve drained both breasts as fully as possible. Morton et al 2009