An Integrative Review of Exclusive Breast Milk Expression

A growing number of families are using exclusive breastmilk expression to feed their newborns. They need accurate information and support from their providers.

The purpose of this integrative review was to explore the prevalence, characteristics, practices, and outcomes of families who fed exclusively expressed breastmilk to their infants. The electronic databases of CINAHL, Scopus, PubMed, Web of Science, and article reference lists for articles on expressing human milk for infants were searched. Results were filtered to glean published studies between 2012 and 2022, academic journals, human studies, and English language journals while excluding secondary reviews and expert opinions. Both authors screened records within Covidence systematic review management software. Selected studies were evaluated for quality of evidence using the Johns Hopkins Research Evidence Appraisal Tool.

Twenty-seven studies were included in this review. Most families who exclusively expressed originally planned to directly breastfeed their newborns and only began pumping after encountering problems. The most frequently recurring theme was that advice from health care personnel was inconsistent. Women described a knowledge deficit and received more help with exclusive expression from informal social media groups than their providers. Prevalence of exclusive breastmilk expression is highest in Asian countries and in the neonatal intensive care unit environment. These women had a shorter duration of human milk feeding and higher likelihood of cessation compared with women who both fed expressed milk and directly breastfed.

Only recently have breastfeeding researchers begun distinguishing the type of milk (human milk or artificial formula) from the feeding method in their publications. This approach allows clinicians to provide better guidance on the outcomes of each feeding method. As clinicians, we can help families by encouraging them and providing consistently accurate information. Solely feeding expressed human milk is a valid option when the lactating person is unable or unwilling to directly breastfeed.