Table 3.

Studies exploring reasons women express

Author, year, country	Design	Location, participants, year of study and recruitment	Study aims and outcome measures	Results	Strengths/Limitations
Dykes & Williams 1999 UK [34]	Longitudinal, phenomenological study	Northern England,	- Explore women’s experience of expressing particularly perception of adequacy of milk supply	- Beliefs re. adequacy of breast milk supply influenced by interplay of feeding management, infant behaviour, lactation physiology and maternal mental health.	Small mono-cultural group
		n = 10
		1998
		Postnatal primiparas recruited face-to-face in hospital, home visits at 6, 8 &12 weeks
Binns et al. 2006 Australia [2]	Longitudinal cohort	Perth, Western Australia	- Explore determinants of breastfeeding	- Early breastfeeding difficulties,	Comparison of similar groups 10 years apart
		PIFS I n = 556	- Measure and compare prevalence in expressing	- Engorgement, sore nipples, mastitis	Mainly women who expressed to manage breastfeeding difficulties
		1992–93		- Feed to be given by someone else	Public patients only, perhaps not representative
		PIFS II n = 587		- To store extra milk
		2002–03		- Father to feed
		Recruited in hospital in early post-partum period.		- To increase supply
				- Feeding/attachment problems
				- To get baby to drink from a bottle
				- Just to try it out
Labiner-Wolfe et al. 2008 USA [3]	Longitudinal cohort	National study	- Reasons why women express	- to allow someone else to feed	Large sample
		n = 3606	- Amount and prevalence of milk expression	- maternal employment	Not nationally representative Participants older, more likely to be educated, white, employed, higher income
		2005–2007	- Associated socio-demographic factors	- to have an emergency milk supply
		from IFPS II		- no previous breastfeeding experience
				- geographic location (Midwest Vs. West)
				- embarrassed to breastfeed in public
Buckley 2009 USA [33]	Focus groups	Washington, DC	- Ascertain lactation consultant’s beliefs and experiences re. impact of breast pumps on breastfeeding practice	- Technological birth contributes to technological breastfeeding	Exploration of professional attitudes to change in feeding practice -no previous exploration of this area
		n = 12		- Engorgement, plugged ducts, to increase supply, to stimulate the let-down reflex, to pull out inverted nipples.	Small sample size
		Lactation consultants		- Return to work	Volunteer participants
		Purposeful sampling		- Measuring milk, diminished confidence in ability to provide enough milk	Date of study not indicated
Clemons & Amir 2010 Australia [5]	Cross-sectional	State-wide study, Victoria	- Prevalence of breast milk expression	- Premature baby/sick mother or baby	Large study
		n = 903	- Demographic characteristics of women who express, why and how they do it	- Attachment problems/not drinking well	Possible selection bias (members of ABA)
		2008	- Women’s experience of using breast pumps	- Advised	Timing of questionnaire, possible recall bias
		Online questionnaire sent to Australian Breastfeeding Association (ABA) members who had an email address		- Not enough milk/To store extra milk
				- Nipple pain
				- Engorged breasts/mastitis
				- So someone else can feed baby
				- Maternal work
				- Just to try it out
				- To allow mother to drink alcohol
				- Uncomfortable breastfeeding in public
Geraghty et al. 2012 USA [29]	Prospective longitudinal cohort	Cincinnati	- Duration of breast milk feeding	- Planned return to work by 6 months	Prospective design
		n = 60	- Describe who commences expressing early		Small study
		2004–2007			Recruitment of women who planned to breastfeed for 6 months or more
		recruited face to face			Mothers recruited for study knew they were going to be assisted to pump and may have been more likely to be comfortable with this.
					Possible introduction of bias as weekly collection of breast milk was initiated at 1 week by research nurse using an electric breast pump