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The effect of pethidine as patient-controlled epidural analgesia (PCEA) on specific biochemical components in breast milk in relation to the timing of secretory activation is not well investigated. The aim of this study was to compare biochemical timing of secretory activation between women who had a vaginal (V) or Caesarean birth with pethidine-PCEA (CBP). Several milk samples were collected daily from 36 mothers (17 V, 19 CBP) for the first 265 h post-partum. Protein and lactose concentrations and Na+ and K+ ion levels were measured. Samples were assigned to three time periods: 0-72, >72-165 and >165-265 h post-partum for statistical analyses. Data were analyzed using linear mixed effect models. In the first 72 h post-partum, the mean difference in lactose concentration was 5 gL−1 higher in group V ( P < 0.05). From >72-165 h post-partum, protein and Na+ concentrations were lower in group V ( P = 0.05, P = 0.02), and K+ levels were higher in group V ( P < 0.001). From >165-265 h post-partum, there were no significant differences between the groups. Biochemically, secretory activation had occurred by 72 h post-partum in both groups. There were greater variations in measured biochemical components observed within group CBP initially. However, by 165 h post-partum, there were no differences in the biochemical components between the groups. This suggests that effects of pethidine-PCEA are diminished by 72 h post-partum and undetected by 165 h. [ABSTRACT FROM AUTHOR]

Background: Whilst it is inconvenient and time-intensive, predominantly (PP) and exclusively pumping (EP) mothers rely on breast expression to provide milk for their infants and to ensure continued milk supply, yet these populations are poorly understood., Methods: We assessed and characterised Western Australian PP mothers ( n = 93) regarding 24 h milk production (MP) and infant milk intake and demographics, perinatal complications and breastfeeding difficulties, the frequencies of which were compared with published general population frequencies. Pumping efficacy and milk flow parameters during a pumping session in PP mothers ( n = 32) were compared with those that pump occasionally (reference group, n = 60)., Results: PP mothers had a higher frequency of pregnancy complications and breastfeeding difficulties than the general population. Exclusive pumping did not impact the 24 h MP and the amount of milk available to the infant. PP mothers had more milk ejections, longer active flow duration and lower milk removal efficacy ratios; however, responsiveness to pump (time to first milk ejection), total flow duration, time to stop pumping, percentage of available milk removed and comfort parameters were not different to the reference group., Conclusions: Despite the reported challenges, when an effective pump is used, predominant or exclusive pumping does not negatively affect the 24 h MP and the amount of milk available to the infant. Increasing awareness of the impacts of perinatal and breastfeeding complications on women may assist health professionals in early identification of mothers at high risk for early cessation of breastfeeding, escalating early postpartum intervention and targeted breastfeeding support.

Background: Maternal breast volume is determined by the quantity of glandular and adipose tissue, and it undergoes significant changes during pregnancy. These changes are intricately linked to the development of glandular tissue, which most likely reflects lactation capacity. Evidence indicates that women with overweight or obesity exhibit larger breast volume compared to those with a normal body mass index (BMI), emphasizing the close relationship between breast volume and maternal adiposity. Hence, we aim to investigate breast volume growth and maternal BMI as potential risk factors for low milk production., Methods: Lactating women (n = 609) from the Perth metropolitan area in Western Australia between 2011 and 2023 were included in the analysis. Twenty-four-hour milk production measurements were conducted using the test weighing method, and milk removal frequencies were recorded. Mothers completed questionnaires regarding demographic, obstetric and infant details. Linear and logistic regression models were used to determine maternal and infant factors associated with milk production., Results: Here we show that increasing maternal age and BMI are associated with low milk production. Moreover, larger pre-pregnancy breast volume and breast growth are associated with both higher BMI and milk production., Conclusions: Women who are older, have an obese BMI and who have minimal pre-pregnancy breast volume and breast growth should be provided with antenatal screening and breastfeeding support as they are more likely to experience low milk production.

Introduction: S. aureus is one of the most prevalent potential pathogenic bacteria found in DHM. Some strains produce heat stable enterotoxins that are able to survive pasteurization. These enterotoxins have been associated with gastritis and potentially necrotizing enterocolitis in preterm infants. The aim of this study is to assess the impact of different storage temperatures on Staphylococcus aureus growth and enterotoxin A and B production in raw and Holder pasteurized donor human milk (DHM). Materials and Methods: Raw and pasteurized DHM were inoculated with enterotoxin A and B producing S. aureus . Samples were incubated at 4°C (10 days), 21°C, and 37°C (18 hours). Bacterial growth and enterotoxin A and B were quantified. Results: S. aureus count increased in pasteurized DHM. Bacterial count decreased in the raw milk when incubated at 21°C and 4°C and slightly increased when incubated at 37°C. Enterotoxins A and B were only detected in pasteurized DHM at 37°C from 9 hours onward. Conclusion: This study showed that raw milk is capable of suppressing S. aureus growth compared to pasteurized DHM. It also provides a measure of assurance of the safety of raw and pasteurized DHM when refrigerated or left at room temperature for a few hours.