Most American mothers who produce human milk (HM) now pump in place of some or all feeding at the breast, and most American infants are now fed pumped HM. We aimed to investigate mothers’ perceptions of, attitudes toward, and practices for pumping and providing pumped HM. Results related to pumping are reported here. We conducted in-depth, semi-structured interviews among a diverse sample of 20 mothers who pumped, following each from pregnancy through infant HM-feeding cessation up to 1 year postpartum. Data were analyzed using thematic analysis with Atlas.ti. Mothers’ reasons for pumping changed over time and reflected their needs and desires (e.g. latch difficulty, return to work, and increasing their milk supply). Mothers reported that pump type and quality were important to pumping success, and that pumping was time-consuming, costly, and unpleasant compared to feeding at the breast. Regardless of how often mothers pumped, most felt pumping was necessary to meet their infant HM-feeding goals and was a welcome means of sharing with other caregivers the bonding opportunity and tasks they associated with feeding infants. Mothers interpreted output from pumping sessions to understand their ability to provide enough milk to meet their infants’ needs. Mothers’ reasons for pumping may signal constraints to infant HM-feeding that may be addressed with policy changes. Mothers’ attitudes and perceptions toward pumping indicate that, while pumping fills important and welcome roles for many mothers, the reality of its practice may make it an unacceptable or infeasible substitute for some.

As pumping has become more prevalent among American women, pumped human milk (HM) is on the rise in their infants’ diets in place of some or all feeding at the breast. We aimed to fill a gap in knowledge about mothers’ motivations, practices and perceptions related to pumping and about mothers’ and other caregivers’ motivations, practices and perceptions related to feeding pumped HM. Results related to providing pumped HM are reported here, and results related to pumping are reported elsewhere. We conducted in-depth, semi-structured interviews among a diverse sample of mothers whose infants were fed pumped HM (n = 20), following each up to 1 year postpartum. Data were analyzed using thematic analysis with Atlas.ti. Nearly all mothers felt bottles were necessary to meet infant HM-feeding goals. Nearly all pumped HM was fed by other caregivers because mothers typically preferred and prioritized feeding at the breast for convenience and maintaining their milk supply. Infants were bottle-fed HM for several reasons that changed over time, such as mother’s absence, latch difficulty, or desire to share the burden and bonding of feeding. Feeding practices differed between feeds from bottles vs. at the breast; some infants were bottle-fed on schedules but fed at the breast on demand. Mothers’ methods for storing, transporting, and preparing HM varied substantially and included practices associated with loss of nutrients and microbial contamination. Mothers’ reasons for bottle-feeding HM may affect how much their infants are bottle-fed. Consumption of pumped HM may not provide the same benefits to infants as feeding at the breast. These findings highlight important avenues for future research into the relationships between bottle-feeding HM and infant health, growth, and developmental outcomes.

Background: Mothers commonly cite an inadequate milk ''supply'' as a reason for stopping human milk feeding. Further, pumping may affect mothers' understanding of their milk production. We aimed to characterize the questions mothers ask each other online related to the adequacy of the milk they pumped and provided to their infants. Materials and Methods: We conducted a secondary analysis of 543 posts containing questions related to pumping on an online discussion forum. These posts were provided by an open cohort of *25,000 women between 1 month before due date and 4.5 months postpartum. We used thematic analysis with Atlas.ti to analyze the posts. Results: Mothers commonly asked how many ounces they should be pumping and inquired about strategies to increase their pump output. They also wondered how many ounces or bottles of pumped milk they should provide to their infants or store for future use. Finally, mothers reported the inadequacy of the milk they were pumping or providing to their infants as potential reasons for stopping human milk feeding. Conclusion:Our findings suggest that mothers may benefit from additional guidance from health care providers on the limitations of using pumps to draw conclusions about their milk production, the current evidence related to the use of herbal galactagogues, and the importance of responsive infant feeding. These findings also highlight the need for future research into how pumping or using herbal galactagogues may affect mothers' actual or perceived milk production and how styles for providing pumped milk compare to styles for feeding directly at the breast.

Despite U.S. mothers’ wide adoption of pumps and bottles to provide human milk (HM) to their infants, mothers lack comprehensive, evidence-based guidelines for these practices. Thus, some women use online sources to seek information from each other. We aimed to characterize the information women sought online about pumping. We used data provided by ~25,000 women in an open cohort within a discussion forum about parenting. We examined 543 posts containing questions about providing pumped HM cross-sectionally and longitudinally in three time intervals: prenatal, 0 through 1.5 months postpartum, and 1.5 to 4.5 months postpartum. We used thematic analysis with Atlas.ti to analyze the content of posts. During pregnancy, women commonly asked questions about how and where to obtain pumps, both out-of-pocket and through insurance policies. Between 0–1.5 months postpartum, many mothers asked about how to handle pumped HM to ensure its safety as fed. Between 1.5–4.5 months postpartum, mothers sought strategies to overcome constraints to pumping both at home and at work and also asked about stopping pumping and providing their milk. Women’s questions related to ensuring the safety of pumped HM represent information women need from health professionals, while their questions related to obtaining pumps suggest that women may benefit from clearer guidelines from their insurance providers. The difficulties women face at home and at work identify avenues through which families and employers can support women to meet their goals for providing HM.

INTRODUCTION: The postpartum visit provides an important opportunity for women to discuss contraceptive options with their provider, but as many as 40% of women do not seek postpartum care. There are limited data on postpartum visit attendance and contraceptive use among women who receive group prenatal care. We studied the postpartum visit attendance and contraceptive use among women in our CenteringPregnancy® program. METHODS: We conducted a retrospective chart review of 90 CenteringPregnancy® participants who delivered their babies between June 2017 and June 2018 at an urban university hospital. We sent an online survey to the 58 participants who were between 3 and 6 months postpartum during the data collection period to ask about their current contraceptive use. This work was approved by Thomas Jefferson University's Institutional Review Board. RESULTS: Of the 90 participants, 88% (79) attended their individual postpartum visit in the first 90 days after delivery. Thirty-one surveys were completed between 3 and 6 months postpartum; 77% (24) reported using a contraceptive method. Of those, 54% (13) reported using a long-acting reversible contraceptive, and 88% (21) were happy with their contraceptive method. Of the 25 participants who reported being sexually active, 84% (21) reported contraceptive use. CONCLUSION: In our population, CenteringPregnancy® increased attendance at the postpartum visit. The additional contact time and structured educational content in CenteringPregnancy® create more opportunities for providers to counsel women about contraceptive options and may lead to increased uptake of long-acting reversible contraceptives compared to traditional prenatal care.