Original Article

Journal of Perinatology (2009) 29, 757–764; doi:10.1038/jp.2009.87; published online 2 July 2009

Combining hand techniques with electric pumping increases milk production in mothers of preterm infants

J Morton1, J Y Hall1, R J Wong1, L Thairu1, W E Benitz1 and W D Rhine1

1Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA

Correspondence: Dr J Morton, Department of Pediatrics, Stanford University School of Medicine, 401 Burgess Drive, Suite C, Menlo Park, CA 94025, USA. E-mail: janemorton@sbcglobal.net

Received 10 December 2008; Revised 5 April 2009; Accepted 12 April 2009; Published online 2 July 2009.





Pump-dependent mothers of preterm infants commonly experience insufficient production. We observed additional milk could be expressed following pumping using hand techniques. We explored the effect on production of hand expression of colostrum and hands-on pumping (HOP) of mature milk.

Study Design:


A total of 67 mothers of infants <31 weeks gestation were enrolled and instructed on pumping, hand expression of colostrum and HOP. Expression records for 8 weeks and medical records were used to assess production variables.



Seventy-eight percent of the mothers completed the study. Mean daily volumes (MDV) rose to 820ml per day by week 8 and 955ml per day in mothers who hand expressed >5 per day in the first 3 days. Week 2 and/or week 8 MDV related to hand expression (P<0.005), maternal age, gestational age, pumping frequency, duration, longest interval between pumpings and HOP (P<0.003). Mothers taught HOP increased MDV (48%) despite pumping less.



Mothers of preterm infants may avoid insufficient production by combining hand techniques with pumping.


hand expression; insufficient milk production; breastmilk; breastfeeding; lactation; preterm infants