There are many reasons why lactating individuals may have a delay in secretory activation (SA), including high BMI, premature delivery, cesarean birth, stress, breast pump dependency, gestation diabetes, pre-eclampsia, among others. The most common way that researchers have measured the onset of SA is by parental perception, such as breast fullness, change in color of milk, or milk volume.
Why do we need to know about the timing of SA? Knowing whether SA has occurred helps us to understand the possible cause(s) for an individual’s low milk production. For example, when an individual has low production in the second week, it is often unclear if this is due to low glandular tissue or a delay in SA due to medical conditions such as insulin resistance or early postpartum birth control.
Research can help us understand how birth practices and health conditions impact SA, but we need to understand the best way to measure SA.
The study for this week is a review of the different milk biomarkers used to measure SA. The researchers reviewed 40 studies that compared milk biomarkers of SA in pump dependent mothers of preterm infants with healthy term mothers and identified 6 articles that met their criteria for inclusion.
The 4 primary milk biomarkers indicating SA include sodium (Na), lactose, citrate, and total protein. Most studies were small, and the studies collected milk at different time periods and at different frequencies. Some of the studies used 1-2 biomarkers, while others used all 4. Despite the different methodologies, there were some consistent findings. See the question for details!
Madison Hendry
Expressing milk within the first hour makes a difference vs expressing after the first hour birth or 6 hrs after birth
IABLE
The Parker studies from 2012 and 2015 indicated that expressing milk in the first hour made a difference in milk volume later. However, those were not large enough studies, nor were they randomized controlled trials. They repeated their work in a randomized controlled trial in 2020 and demonstrated that pumping in the first hour is NOT what makes the difference in producing sufficient breast milk. They found that pumping within the first 6 hours was important AND pumping frequently was the key to success. We need to be stressing frequency, and not stressing the importance of pumping in the first hour.
I have found that people stress that they ‘ruined’ their chances of making enough milk if they don’t pump in the first hour, so it is important to not perpetuate this disproven theory.
However, I would add that expressing milk in the first few hours for premature infants is important to provide colostrum for oral immune therapy.
Dorothy Macias
Thank you for this information. I have seen the challenges that the nurses have when recovering a mom, let’s say with severe PIH,and then needing to start a pump baby going to NICU. I see that it’s a struggle and challenge even after 6 hours have passed to get a pump started. I really have encouraged the nurses to try to teach hand expression prior to delivery so that can be done immediately after delivery. It works for a little while then goes off by the way side. Lactation consultants are way under staffed and at times we don’t get to them until the next day. I do stress the frequency, day and night, and not to skip night time feedings. There has to be a different approach.