Hand Expression Across 30 Countries: A Scoping Review of Utilization, Outcomes, and Patient and Health Care Provider...

Hand expression (HE) of breast milk enables milk collection at any stage of lactation. Its use is widely recommended for breastfeeding mothers. However, evidence surrounding utilization, outcomes, and experiences using HE is limited.

This scoping review aims to broadly examine the literature describing patient and health care provider experiences, utilization, and clinical outcomes of HE of breast milk.

We conducted systematic searches in MEDLINE, Embase, Web of Science, Scielo, and DialNet. We included both primary research and quality improvement reports. Four reviewers screened all papers for eligibility, read the full text of included studies, and extracted data.

Of the 620 reports identified, 118 studies from 30 countries met eligibility criteria. Studies found high rates of familiarity with HE but variable rates of use. Most women expressed favorable views and experiences with HE. Multiple successful methods of teaching HE to lactating women and health care professionals were described. Many studies report teaching HE within wider interventions, such as antenatal milk expression programs and initiatives to increase breastfeeding among preterm infants. Most reports of breastfeeding outcomes, breast milk volume, and constituents gave mixed results, although HE in the first days postpartum was often associated with improved outcomes. No studies were found testing the use of HE for particular breast conditions such as mastitis or hyperlactation.

While HE is generally favorably experienced by women and health care providers and may improve breastfeeding outcomes, further research is needed on HE as a primary exposure to better apply it in clinical lactation management.