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Does Warming the Breasts Affect the Amount of Breastmilk Production?

DOI:10.1089/bfm.2011.0142
Authors:
Feride Yigit at Hasan Kalyoncu University
Feride Yigit
Zerrin Cigdem at Hasan Kalyoncu University
Zerrin Cigdem
Ebru Temizsoy at Zeynep Kamil Women's and Children's Disease Training and Research Hospital
Ebru Temizsoy
Melek Ersoy Cingi
Melek Ersoy Cingi
Melek Ersoy Cingi
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Abstract

Background and objective: Increasing the amount of breastmilk is vital for both the nursing mother and child. Warming up breasts before using electrical pumps to pump out breastmilk may help to increase the amount of breastmilk, especially in the mothers of babies who are being nursed in the neonatal intensive care unit. Subjects and methods: Thirty-nine mothers whose babies had been admitted to the neonatal intensive care unit were analyzed. A breast compress that was warmed up in a microwave oven for 1 minute at 180 W was applied to one of the breasts for 20 minutes, and both breasts were sucked by an electrical breast pump for 15 minutes. The amount of breastmilk after each procedure was recorded. Results: The amount of breastmilk that was obtained from warmed breasts was significantly higher than that obtained from nonwarmed breasts (maximum, 47.02 ± 23.01 mL vs. 33.15 ± 19.98 mL) (p=0.000). Conclusion: Warming up breasts by a breast compress is easy and affordable, and this procedure increases the amount of breastmilk, thus facilitating infant nutrition and recovery especially in the neonatal intensive care unit.
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Does Warming the Breasts Affect the Amount
of Breastmilk Production?
Feride Yig˘it,
1
Zerrin C¸ig˘dem,
1
Ebru Temizsoy,
2
Melek Ersoy Cingi,
1
O
¨zlem Korel,
1
Egemen Yıldırım,
2
and Fahri Ovalı
2
Abstract
Background and Objective: Increasing the amount of breastmilk is vital for both the nursing mother and child.
Warming up breasts before using electrical pumps to pump out breastmilk may help to increase the amount of
breastmilk, especially in the mothers of babies who are being nursed in the neonatal intensive care unit.
Subjects and Methods: Thirty-nine mothers whose babies had been admitted to the neonatal intensive care unit
were analyzed. A breast compress that was warmed up in a microwave oven for 1 minute at 180 W was applied
to one of the breasts for 20 minutes, and both breasts were sucked by an electrical breast pump for 15 minutes.
The amount of breastmilk after each procedure was recorded.
Results: The amount of breastmilk that was obtained from warmed breasts was significantly higher than that
obtained from nonwarmed breasts (maximum, 47.02 –23.01 mL vs. 33.15 –19.98 mL) ( p=0.000).
Conclusion: Warming up breasts by a breast compress is easy and affordable, and this procedure increases the
amount of breastmilk, thus facilitating infant nutrition and recovery especially in the neonatal intensive care
unit.
Background and Objectives
Human milk is a unique nutrient designed for the needs
of the baby, especially in the first 6 months of life, and is
fully compatible with the gastrointestinal system of the baby.
Therapeutic warming of tissues is known to increase the local
blood flow, local metabolism, and excretion of local waste
products and to facilitate tissue nutrition and renewal and
phagocytosis.
1
Warming the breasts also facilitates the action
of the oxytocin reflex. Newton and Newton
2
showed long ago
that application of cold to breasts inhibits the let-down reflex,
whereas heat application could facilitate this reflex. Cold
therapy is also useful in the management of breast engorge-
ment due to overproduction of milk.
3
Our aim was to inves-
tigate the effect of warming of breasts of mothers whose
babies were being nursed in the neonatal intensive care unit
(NICU), who were unable to directly breastfeed their babies
and who were using an electrical breast pump.
Subjects and Methods
The study was carried out at the NICU of Zeynep Kamil
Maternity and Children’s Training and Research Hospital,
Istanbul, Turkey. Forty mothers whose babies were being
treated at the NICU and who were using an electrical breast
pump to obtain their breastmilk were included. One of the
mothers had to leave the study before completion, so the
study was completed with 39 mothers. The following criteria
were used for inclusion in the study: No history of breast
operation, the baby was unable to suck, and the baby was less
than 21 days old.
When the mother was included in the study, one of her
breasts were randomized to the warming or control group by
using a computerized randomization program. In this way, the
right breasts of some women and the left breasts of others were
warmed. This study was not blinded. In the study group, a
breast compress made from gel (mainly a hot pack manu-
factured in the form of a single bra cup) that was warmed up in
the microwave oven for 1 minute at 180 W was applied to the
breast for 20 minutes. The temperature of the breast compress
was measured before applying it to the mother. The maximum
temperature of the compress was 40.5C, which was quite
tolerable for the mothers. If it was more than 40.5C, the breast
compress was discarded, and another pad was heated. After-
wards, both breasts were pumped by an electrical breast pump
for 15 minutes simultaneously. The amount of breastmilk ob-
tained from the breasts was recorded. This procedure was re-
peated twice a day at the same daily interval for 3 days.
1
School of Nursing, Maltepe University, Istanbul, Turkey.
2
Neonatal Intensive Care Unit, Zeynep Kamil Maternity and Children’s Training and Research Hospital, Istanbul, Turkey.
BREASTFEEDING MEDICINE
Volume 7, Number 6, 2012
ªMary Ann Liebert, Inc.
DOI: 10.1089/bfm.2011.0142
487
Informed consent was obtained from all mothers before
recruitment. The study was approved by the Institutional
Board.
Results were analyzed with SPSS version 12.0 software for
mean, median, and ttest at the 95% confidence interval and a
significance of 0.05.
Results
A warm breast compress was applied to 20 left and 19 right
breasts. The mean age of the mothers was 30.8 –5.4 years.
Regarding education, 53.8% had graduated from primary
school, whereas 30.8% were high school and 19.3% were
university graduates; two mothers (5.1%) were illiterate. Of
the babies, 64.1% were born by cesarean section, and 66.7% of
them were boys. Their mean birth weight was
1,984.87 –749.16 g. The main reason for their admission to the
NICU was prematurity (79.5%). Of the mothers, 76.9% had
antenatal follow-up. During the study period, the breasts
were pumped twice a day for 3 days (i.e., six times). In all six
times, the amount of breastmilk obtained from the breasts that
were warmed up was significantly higher than that obtained
from nonwarmed breasts ( p=0.000) (Table 1).
Discussion
Our results show that warming up breasts before using an
electrical breast pump is associated with a significant increase
in the amount of breastmilk. The reason is unclear, but it may
be through the dilation of milk channels and preventing the
obstruction of these channels, rather than improving the
amount of breastmilk produced. Warming may also stimulate
the oxytocin reflex. Our literature search did not reveal any
similar studies. Ramsay et al.
4
have showed ultra-
sonographically that under normal circumstances, the
amount of breastmilk is equal from both breasts. This implies
that the significant difference we have observed in our study
is due to the increase in the amount of extracted breastmilk by
warming up the breast. With the use of high-resolution ul-
trasonography, the diameter of the ducts in the breasts and
the flow rate of human milk in these ducts may be deter-
mined, and the amount of ejected milk may be calculated.
5
However, this is a stressful method for the lactating woman,
and by using electric breast pumps, the flow rates of milk may
be determined without using ultrasonography in order to
identify the amount of milk ejection.
6
Because we did not
have the appropriate equipment, we were unable to use high-
resolution ultrasonography and determine the flow rates of
milk ejection. Nonetheless, we measured the amount of ex-
pressed milk from the breasts, which showed the beneficial
effect of breast warming. A similar study by using ultraso-
nography and electrical breast pumps may also be contem-
plated.
Premature babies and others who are in the NICU are in
need of breastmilk perhaps more than other babies because
breastmilk has many properties that are important for sick
babies. Therefore, increasing the amount of breastmilk and
nursing the babies with more breastmilk as long as they
are able to receive it will facilitate their recovery and early
discharge from the hospital. Early recovery and early dis-
charge have innumerable benefits, medically, ethically, and
financially.
Conclusion
Warming up breasts is associated with a significant in-
crease in the amount of breastmilk.
Disclosure Statement
No competing financial interests exist.
References
1. Barret KE, Barman SM, Boitano S, et al. Immunity, infec-
tion and inflammation. In: Ganong’s Review of Medical
Physiology,23
rd
ed. McGraw-Hill, Lange, New York, 2010,
pp. 63–78.
2. Newton N, Newton M. Postpartum engorgement in the
breast. Am J Obstet Gynecol 1951;61:664–667.
3. Sandberg CA. Cold therapy for breast engorgement in new
mothers who are breastfeeding [Masters of Arts Nursing
degree]. College of St. Catherine, St. Paul, MN, 1998.
4. Ramsay DT, Kent JC, Owens AR, et al. Ultrasound imaging of
milk ejection in the breast of lactating women. Pediatrics
2004;113:361–367.
5. Geddes DT. The use of ultrasound to identify milk ejection in
women—tips and pitfalls. Int Breastfeed J 2009;4:5.
6. Ramsay DT, Mitoulas LR, Kent JC, et al. Milk flow rates can
be used to identify and investigate milk ejection in women
expressing breastmilk using an electric breast pump. Breast-
feed Med 2006;1:14–23.
Address correspondence to:
Fahri Ovalı, M.D.
Neonatal Intensive Care Unit
Zeynep Kamil Maternity and Children’s Training
and Research Hospital
U
¨sku
¨dar, 34662, Istanbul, Turkey
E-mail: fovali@yahoo.com
Table 1. Mean Amounts of Breastmilk in Warmed
and Nonwarmed Breasts
Amount of breastmilk (mean –SD) (mL)
Attempt
Warmed
breasts (n=39)
Nonwarmed
breasts (n=39) tp
1 (Day 1) 30.28 –25.04 20.64 –20.42 6.60 0.000
2 (Day 1) 28.07 –20.76 16.89 –15.75 7.44 0.000
3 (Day 2) 44.10 –32.56 33.00 –28.59 7.65 0.000
4 (Day 2) 39.69 –25.45 27.30 –20.20 8.02 0.000
5 (Day 3) 47.02 –23.01 33.15 –19.98 8.06 0.000
6 (Day 3) 45.07 –21.75 32.05 –19.68 8.85 0.000
488 YIG
˘IT ET AL.
... Lactamo, to our knowledge, is the first device of its kind, facilitating breast massage with the capacity to apply both variable pressure and desired temperature at the same time. Traditional approaches such as massage and applying heat or cold at the breast are considered beneficial strategies for managing common breastfeeding problems [5,8,[10][11][12][13][14][15][16]. There are a range of devices on the market for the purpose of warm/cold therapy. ...
... For some women, frequency of use was determined by the occurrence of a breastfeeding concern (e.g., engorgement), where increased application occurred until the problem had dissipated. The majority of women used Lactamo at room temperature, while this was beneficial for massage and compression, using the device at the recommended temperature for specific concerns (e.g., warmth before and during feeding for blocked ducts, and cold after feeding for breast engorgement) may have more effectively managed lactation problems [11,14,24,25]. Women in this study tried Lactamo before, during, and after breastfeeding/expressing often without a clear understanding of the evidence of when it should be used warmed or cooled -depending on their symptoms. ...
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Ultrasound Imaging of Milk Ejection in the Breast of Lactating Women
Article
Currently, the methods for assessing milk ejection in women include serial sampling of plasma oxytocin and measurement of intraductal pressure, both of which are invasive and may induce stress. We hypothesized that milk ejection would cause an increase in milk-duct diameter that could be observed noninvasively with ultrasound, and this could be used to investigate the physiology of milk ejection in women. One milk duct was scanned in the unsuckled breast in 2 groups of mothers: group BB (n = 21) for the beginning of a breastfeed and group EB (n = 24) for the entire breastfeed. A duct also was monitored for a 5-minute period on 2 separate days in the absence of factors that may induce milk ejection in group EB to provide a baseline duct diameter. Milk intake at a breastfeed was measured by test weighing. A significant increase in milk-duct diameter was observed when milk ejection was sensed and/or the infant changed its swallowing pattern in both groups. Multiple increases and decreases (mean: 2.5 per breastfeed; standard deviation: 1.5; n = 62) in duct diameter occurred in group EB. Duct diameter remained relatively stable between breastfeeds (coefficient of variation: 1.4%-8.3%). Infant milk intake was positively related to the number of milk ejections (r2 =.365; n = 57). Ultrasound is an objective, noninvasive technique for detecting milk ejection by observing an increase in milk-duct diameter. However, this technique requires an experienced ultrasonographer, adequate imaging time, and surroundings conducive to breastfeeding. Multiple milk ejections were common during breastfeeding, although they were not sensed by mothers. The number of milk ejections influenced the amount of milk the infant consumed.
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Postpartum engorgement of the breast
Article
Postpartum engorgement of the breast is important because it can be extremely painful, because it may predispose to the development of nipple fissures and breast abscesses, and because it is associated with lactation failure. In spite of this the condition has received very little attention from investigators. Waller¹ emphasizes that severe engorgement often leads to lactation failure and believes that it is due to the fact that milk is not released or removed from the breast. Naish² says that “the cause of engorgement is not yet worked out” and feels that the engorged breasts, at any rate at the beginning, are not overfull of milk but of blood; and the reason why the milk present cannot be withdrawn is that the ducts are closed by the raised pressure in the tissues around them. DeLee³ states that the cause of engorgement is popularly believed to be retention of milk, but that the symptoms are due to lymphatic and vascular statis. The purpose of this study is to investigate the part played by milk in the development of engorgement.
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Cold therapy for breast engorgement in new mothers who are breastfeeding [Masters of Arts Nursing degree]. College of St
  • Jan 1998
  • Sandberg
  • Ca
Sandberg CA. Cold therapy for breast engorgement in new mothers who are breastfeeding [Masters of Arts Nursing degree]. College of St. Catherine, St. Paul, MN, 1998.
Immunity, infec-tion and inflammation. In: Ganong's Review of Medical Physiology
  • Jan 2010
  • 63-78
  • Barret Ke Barman
  • Sm
  • S Boitano
Barret KE, Barman SM, Boitano S, et al. Immunity, infec-tion and inflammation. In: Ganong's Review of Medical Physiology, 23 rd ed. McGraw-Hill, Lange, New York, 2010, pp. 63–78.
Immunity, infection and inflammation
  • Jan 2010
  • 63-78
  • K E Barret
  • S M Barman
  • S Boitano
Barret KE, Barman SM, Boitano S, et al. Immunity, infection and inflammation. In: Ganong's Review of Medical Physiology, 23 rd ed. McGraw-Hill, Lange, New York, 2010, pp. 63-78.
Cold therapy for breast engorgement in new mothers who are breastfeeding [Masters of Arts Nursing degree
  • Jan 1998
  • C A Sandberg
Sandberg CA. Cold therapy for breast engorgement in new mothers who are breastfeeding [Masters of Arts Nursing degree]. College of St. Catherine, St. Paul, MN, 1998.