Why Express Colostrum Antenatally

Transitioning to motherhood is no small task and you might even find yourself worried about how to start them out right. We worry about feeding a newborn right, that some even go on to commit to pure breastfeeding. Guess what, your body is already clued in on the task at hand! Expressing colostrum antenatally provides a wealth of benefits! We will also discuss the importance of feeding in the first hour after delivery and the techniques to get the colostrum hand expressed if the baby is not latching or is separated from you after birth. 

Colostrum: The Liquid Gold

Colostrum is the product of the first stage of milk production. It is referred to as liquid gold because it provides all the nutrients, minerals, and fluid your newborn needs in the early days. It also contains numerous antibodies that will provide valuable protection against infections, a first passive immunization of sorts.

Your body will produce colostrum antenatally and exclusively for about 2-5 days after birth. It is then followed by “transitional milk” which is a mix of colostrum and more mature milk. By the time transitional milk is expressed, your newborn’s stomach has begun stretching and can now take in more milk at a time.

Why should you express colostrum antenatally? 

To protect your baby from missing out on this liquid gold, new moms are encouraged to breastfeed as soon as possible (within the first hour if possible) to ensure that they encourage the flow and production of colostrum. But did you know that you can already express colostrum antenatally, or even before the baby is born? Some mothers leak colostrum in the weeks leading up to delivery. In such cases, it may be worthwhile collecting and storing the colostrum so the baby has a supply at birth. Don’t worry there isn’t a finite amount of colostrum. Your body just produces more until the baby is born. Deliberately expressing colostrum antenatally (harvesting) apart from collecting what has leaked may also be beneficial in certain circumstances if you: 

• have diabetes as babies can have low blood sugar levels after delivery and need to feed early, frequently and quickly
• have breast hypoplasia (limited breast development) or have had previous breast surgery
• are scheduled for an elective Caesarean section where there might be some delay in initiating breastfeeding.

Or if your baby has:

• cleft lip or palate
• intrauterine growth restriction
• congenital conditions such as Down Syndrome or cardiac complications.

The benefits of antenatal expression include providing a human milk supplement post delivery if the baby has for any reason difficulty with breastfeeding. It also helps establish a full milk supply more quickly hence preventing the need for formula and gets breastfeeding off to a good start. 

When should you start expressing colostrum during pregnancy?

Generally, you may start expressing at 37 weeks of gestation. You can start with three to five minutes of hand expressing each breast alternating, two to three times a day. You should stop expressing immediately if you are having contractions at any time.

Is it safe? 

If you’re concerned that antenatal expression might trigger labour, that won’t be the case. You can check with your OB-GYN to know if you are at risk for early labour. If you feel any uterine cramping while expressing, you need to stop immediately and inform your doctor. 

A DAME (Diabetes and Antenatal Milk Expressing) study revealed that women with diabetes and low-risk pregnancy can safely express breastmilk in late pregnancy without causing harm to the baby.

Who is not advised to harvest colostrum antenatally?

There are cases where antenatal expressing may not be advised for certain women. It is not safe in complicated pregnancies such as a history of antepartum hemorrhage, placenta previa, fetal compromise, and other serious obstetric issues. 

Why should you hand express?

It is recommended to express antenatally by hand rather than use an electric or manual breast pump. Colostrum is produced in quite small quantities, so it’s impractical to use a pump and it may not be as effective. Hand expression is useful, effective, convenient, and free. 

Manual expression for three to five minutes can yield a few drops of colostrum. This may not seem much, but it is enough. A newborn’s first feeding is no more than a teaspoon of colostrum because their stomachs can only hold a few milliliters of milk, and the capacity grows each day. Doing it three times is enough for a feed. With regular stimulation, you’ll be able to express more colostrum. The colostrum can be collected into a spoon or small cup and then drawn into a small syringe for storage. Small sterile syringes 1 ml, 2.5 ml or 3 ml syringes with a bung for a cap are preferred and can be sourced online or in some hospital pharmacies. 

An excellent video on how to hand express can be found here: https://med.stanford.edu/newborns/professional-education/breastfeeding/hand-expressing-milk.html

How to store harvested colostrum? 

You can store the colostrum in the refrigerator in a syringe or in a well-sealed cup in between pumping. You can collect your colostrum 2-3 times on the same day and store it in the same syringe. After expressing from both breasts, place the colostrum in a milk storage bag and label it with your name and date of expression, then store it in the freezer. Please remember to leave some gap in the syringe as liquid expands when frozen. 

To ensure freshness and quality is maintained, seal the storage container properly. Avoid using disposable bags or liners as these are not designed to protect against bacteria and germ growth.

Do not store breast milk in the door of the refrigerator or freezer but close to the back instead. This will help protect the breast milk from temperature changes when opening and closing the door. At room temperature the expressed colostrum can last for up to 4 hours. It can remain in a refrigerator for up to four days. Colostrum in the freezer component of the refrigerator can be stored for 2 weeks and can be stored in a deep freezer for six months. If you’re uncertain about how long your colostrum has been stored, it’s best to dispose of it.

Important reminders

If you don’t have any colostrum expressed antenatally DO NOT PANIC or get anxious. Not being able to collect colostrum is not an indication on how well or poorly you will be able to produce milk or breastfeed after delivery. Sometimes it will take a few days of gentle massage and hand expression to encourage some small droplets to appear. If you feel stressed or frustrated please don’t put excessive pressure on yourself and you can choose to stop. 

…when you go into labour

When transporting your expressed colostrum to the hospital, make sure to place it in an insulated bag. It can remain safe for consumption this way for up to 24 hours. Store it in the fridge/freezer once you get to the hospital. If you and your baby are likely to have difficulties or be separated, one of the containers can be defrosted once you’re close to birth. This is then ready for the first feed, if needed.

…when baby arrives

The first hour after delivery (golden hour) is important for bonding and initiating breastfeeding. Preferably the baby should be kept skin to skin with you if the baby is doing well. Some babies will instinctively reach for the nipple when placed near the breast. The mother can also try encouraging the baby to self latch and nurse by gently rubbing the baby’s nose with the nipple (you can ask for assistance from the midwife). If the baby is not interested yet or needs to be separated from you, you can still try to hand express colostrum to kick start the milk production mechanism. If there isn’t any colostrum in the first hour, do not get anxious and try again after an hour and repeat after a few hours. 

Please refer to the video:
https://med.stanford.edu/newborns/professional-education/breastfeeding/breastfeeding-in-the-first-hour.html

Your baby will need to breastfeed at least 8-12 times everyday. Frequent feedings help stimulate your milk production during the first few weeks. If for any reason, you are separated or unable to breastfeed, your colostrum can be defrosted one container at a time when needed. Try expressing milk eight times in each 24 hours including once at night, until your baby is able to breastfeed.

Being a new mom brings new challenges, but your body is just as equipped to help you out! Unless it is medically advised otherwise, expressing colostrum antenatally allows you to take advantage of the precious source of nutrition that nature has prepared for your little one. 

If you wish to learn more about colostrum harvesting during pregnancy, Dr Pamela Tan would be happy to explain this topic at length with you! Book a no-obligation consultation today, here, or call +65 6254 2878.