August continues to be focused on the breastfeeding dyad as recognition of World Breastfeeding Week, National Breastfeeding Month and Black Breastfeeding Week continues. Doulas play a key role in supporting parents who are planning to breastfeed.  The information we share prenatally, the help we offer immediately after birth and the resources and assistance we provide through the early weeks of parenting and feeding a newborn are invaluable.  Both birth and postpartum doulas can support a family in achieving their breastfeeding goals.

Sometimes, immediately after birth, a parent is not able to feed their baby at the breast.  In some situations, a baby needs additional care in the neonatal intensive care unit or special care nursery.  A baby may be separated from the birth parent and even if the baby is stable, the parent may need some recovery time before joining the baby.  Other circumstances affecting the birthing parent may mean that the baby is not able to nurse in the first hours.  This delayed first nursing session may be even more likely with premature babies who require more care.

Two studies, “Effect of early breastmilk expression on milk volume and timing of lactogenesis stage II among mothers of very low birth weight infants: a pilot study” and “Association of timing of initiation of breastmilk expression on milk volume and timing of lactogenesis stage II among mothers of very low-birth-weight infants” examines the topic of sufficient milk supply for the parents of these babies.  The importance of breastmilk for low birth weight babies in reducing morbidity is recognized, but the breastfeeding parent often has difficulty in establishing supply especially when the opportunity to nurse or pump does not occur promptly after birth.

Doulas should be aware of these studies because there are some benefits that can be applied to their clients who birth premature infants and there could be as yet unobserved benefits to parents of full-term babies too.  The researchers in one study were looking at whether initiating milk expression within six hour hours of birth impacted mature milk volume increasing sooner and more overall milk at various points after birth.  In the other study, they examined whether initiating milk expression within one hour after birth increased overall supply when parents were separated from their babies.

© Ginna Wall

The results of the initial study indicated that the most benefit was received when milk expression initially occurred within the first hour after birth.After analysis, the findings of the second study suggest initiation of milk expression prior to six hours following delivery may not be associated with an increased milk volume during the first seven days, at three weeks, and six weeks or with an earlier lactogenesis stage II compared with initiation of milk expression after 6 hours following delivery unless the parent initiates milk expression within the first hour following delivery.

Parents had more milk at every evaluation point observed in both studies when initial milk expression was started within an hour after birth.  This time period is when doulas are still in attendance supporting the new parent and could easily help them to initiate a pumping or hand expression session to remove milk if they are unable to feed their baby.  While the study was done on people who gave birth to a premature infant, there very well may be similar benefits for full term dyads.

© Ginna Wall

Doulas can discuss prenatally the parent’s desire to breastfeed and let them know that there may be long term benefits to removing milk by hand or pump within the first hour if they are unable to nurse their newborn.  The doula can share that this study was done with premature babies but there may be a positive impact for full term babies as well.  Families can include their request to express milk if not with their baby in their birth plan and the doula can help the parents to facilitate this action if necessary.

Birth and postpartum doulas can play an integral role in helping families to succeed in their breastfeeding goals.  When parents are separated from their babies, doulas can continue to set the nursing relationship up for success by helping families to express milk shortly after birth.  Do you feel that this information might be something you will want to mention to the families you work with?


Parker, L. A., Sullivan, S., Krueger, C., Kelechi, T., & Mueller, M. (2012). Effect of early breast milk expression on milk volume and timing of lactogenesis stage II among mothers of very low birth weight infants: a pilot study. Journal of Perinatology, 32(3), 205.

Parker, L. A., Sullivan, S., Krueger, C., & Mueller, M. (2015). Association of Timing of Initiation of Breastmilk Expression on Milk Volume and Timing of Lactogenesis Stage II Among Mothers of Very Low-Birth-Weight Infants. Breastfeeding Medicine, 10(2), 84–91.