Exploring the views and experiences of women with diabetes in pregnancy in Australia who have been advised to express breast milk antenatally, and implications for clinical practice

Background: The Diabetes and Antenatal Milk Expressing (DAME) randomised controlled trial (RCT) was conducted in 2011–2015, at six sites in Melbourne, Australia to explore the effect of advising women with diabetes in pregnancy to express breast milk from 36 weeks gestation. The DAME study found no evidence of harm, and that infants whose mothers were randomised to express in pregnancy were more likely to be exclusively breast milk fed during the hospital stay. The total median amount of breast milk women expressed antenatally was 5 mLs and mean number of times of expressing was 22. We have identified very limited literature describing women's experiences of expressing in pregnancy, yet that is an important consideration if midwives plan to advise women to do so.

Objective: To explore the experience of antenatal expressing for women allocated to the antenatal expressing group in the DAME trial.

Methods: In this two-arm RCT 635 low-risk women were randomised at 36 to 37 weeks gestation to usual care (not expressing, n = 316), or to twice daily hand expressing for 10 minutes until birth (n = 319). Data on women's experiences of expressing was collected by telephone interview at 1–2 and 12 weeks and by semi-structured interviews with ten women who were advised to express. Thematic analysis identified key themes.

Results: Emerging themes include feeling empowered, time and technique, watching the milk, and complexity of health and life.

Implications for midwifery education, practice and policy: Given this relatively new practice of antenatal expressing is being advised widely, it is important that midwives understand the outcomes and consider the range of experiences of women who have the lived experience of antenatal expressing, especially the women for whom the perceived goal of ‘getting enough milk for their baby’ is not achieved. This will assist midwives with giving evidence-based advice during pregnancy.