BACKGROUND:
The WHO recommends exclusive breastfeeding for the first 6 months. However, cesarean section (CS) delays lactogenesis II and increases formula supplementation compared with vaginal delivery (VD), leading to early breastfeeding cessation. With CS rates increasing globally, a program for promoting milk production from the day of CS is needed.

OBJECTIVES:
To develop a program for promoting lactogenesis II by initiating early nipple stimulation using a breast pump (BP) on the day of CS.

METHODS:
The program included prenatal breastfeeding education and bilateral 15-minute nipple stimulation using a BP ≥ 4 times per 24 hours, starting within 6 hours after CS. This was in addition to direct breastfeeding and continued until rooming-in on day 2. Outcomes included time to lactogenesis II, milk volumes on days 3 and 5, and program feasibility. Analysis was performed using SPSS. This study was approved by our university IRB.

RESULTS:
Seven mothers (1 primipara, 6 multiparas) aged 34-41 years participated. There was 1 infant admitted to NICU (roomed-in from day 5), 1 emergency CS, and 2 with difficulty in direct breastfeeding. All mothers used the BP ≥ 4 times in the first 24 hours. The time to lactogenesis II was 60.1 ± 11.7 hours, comparable to VD (2023 chart review). The median milk volume was 67.8 g (IQR 46.9) on day 3 and 218 g (IQR 138.5) on day 5. At discharge, 1 mother was exclusively breastfeeding, 2 were predominantly breastfeeding, and 1 who was previously using formula feeding now practiced mixed feeding with high breast milk volume. Mothers and midwives evaluated the program as acceptable and feasible.

CONCLUSIONS:
Nipple stimulation with a BP from the day of CS is feasible and may promote lactogenesis II. Future experimental study designs are warranted.

KEY MESSAGE:
Early BP use after CS may promote lactogenesis II and improve breastfeeding Poster session 2 (Group A)