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Antenatal Expression of Colostrum - La Leche League GB

Mothers start to produce colostrum (early milk) while pregnant. Being able to express colostrum is a useful skill to have. Saving your expressed colostrum may also be beneficial if your baby is likely to need special care after birth.

Why express while pregnant?

Being familiar with your breasts and how they work will give you confidence for after the birth.

• You’ll be able to express a small amount of colostrum onto your nipple if your baby needs encouragement to feed.
• You’ll be able to express colostrum for your baby if he has difficulty feeding or is cared for in the neonatal intensive care or special care baby unit.
• Being able to hand express will help you avoid problems with engorgement and mastitis.

If your baby doesn’t breastfeed well in the first few days, being able to hand express will help you:

• Express your milk if needed.
• Provide your own milk for your baby to prevent or treat conditions such as low blood sugar or jaundice.
• Avoid the need to give infant formula.

Special circumstances

Learning to hand express while pregnant, and collecting and saving the colostrum can be helpful in some special situations, including:

Planned caesarean or induced birth
Consider expressing the day before birth so your milk is available if you and your baby are separated. This will be especially useful if your baby will be born early.

Babies with a cleft lip or palate
This may be diagnosed during pregnancy. Babies with any form of cleft can find it harder to breastfeed. Breastfeeding is particularly important for the first six months as it helps protect these babies against ear and respiratory infections. When the cleft is repaired, your milk helps promote healing and protects your baby against hospital germs.

Mothers with diabetes
In the first 24 hours after birth, babies of diabetic mothers risk developing low blood sugar levels (hypoglycaemia). A baby needs colostrum to  maintain his blood glucose levels. Exclusive breastfeeding has been shown to reduce the risk of a baby developing diabetes later in life.

Mothers with breast abnormalities or who have had breast surgery
Stored colostrum can be helpful if you encounter problems establishing milk production.

Other medical conditions
Some medical conditions may make it harder for you and your baby to establish breastfeeding. Or, if you need to start medications that are incompatible with breastfeeding, your saved colostrum can still be given to your baby.

Talk to your midwife

Some NHS hospital trusts already have policies in place for sharing information on antenatal expression. Your midwife and other members of your antenatal care team may have information to share on breast massage and how to hand express. They should also be able to give you small sterile syringes with identity labels in which to save your colostrum.

Do ask if the hospital has an Infant Feeding Specialist who will be well informed about breastfeeding and a source of support in those early days.

A handy technique

Hand expression is a useful technique to learn even though most mothers find they rarely need to express and store their milk. It is effective, convenient and free. You may also find you can express more milk by combining hand expression with pumping than using just a pump.

When to start expressing

Is it safe?

Don’t worry – following the suggestions to express for a few minutes each day is unlikely to trigger labour. Check with your midwife if you are at risk for early labour. If you experience any uterus cramps when expressing, stop immediately and contact your midwife.

Expressing during pregnancy

1. It helps to be warm and relaxed.
2. You could practise in the bath or shower at first. When you start collecting colostrum, express after a bath or shower.
3. Wash your hands.
4. Massage your breasts to help milk flow.
5. Hand express from one breast. Take care NOT to cause pain or discomfort.
6. You are likely to see small droplets or drips of colostrum appear as you express. Express directly into the container so you save every precious drop. If you’ve been given syringes and find it difficult to collect your colostrum, express into a small clean container (e.g. cup) and draw the colostrum up into the syringe.

You can express up to three times in the same day. If you plan to express again that day, store the syringe in the coldest part of the fridge. This is usually at the back.

Once you’ve expressed for the last time that day, seal the syringe in a bag. Label and date it before placing it in the freezer. The colostrum could be kept in the fridge if you’re going to be induced or have a planned caesarean section within a day or two. Fresh colostrum inhibits the growth of bacteria and can be safely refrigerated for 48 hours.

Why hand express?

Hand expression is the best way to express colostrum. It is simple to learn and gets easier with practice. You’ll only be expressing small amounts so using a pump will be impractical and may not be as effective. You may receive information and a demonstration on hand expression from your midwife.

Our article Hand Expression of Breastmilk also describes an effective method. Antenatally, you’ll only need to express for three to five minutes – just until you have a few drops of colostrum. It may not seem very much, but a baby’s first feed is no more than a teaspoon of colostrum. By expressing up to three times in a day, you can express enough for a feed. With practice and regular stimulation, you’ll be able to express more colostrum.

When you go into labour

Take your stored colostrum with you to the hospital in a cool bag. The hospital can arrange to keep your colostrum frozen, possibly in the special care baby unit. Make sure you or your birth partner makes a note of where it is stored and that details are in your notes.

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

Your baby will need to breastfeed at least 8-12 times in 24 hours. If, for any reason, you are separated or unable to breastfeed your colostrum can be defrosted if needed, one container at a time to avoid waste. Your colostrum can also be used if your baby needs supplements.

The first few days

Frequent breastfeeding and keeping your baby close by will help establish your milk supply and get breastfeeding off to a good start. If you and your baby are separated, express milk eight times in each 24 hours including at least once at night, until your baby is able to breastfeed. Expressing as well as breastfeeding is important if your baby isn’t feeding well, or needs supplements for any reason. This will help establish milk production and provide milk for your baby’s next feed if needed. For any problems, seek skilled help from an LLL Leader – check our website for details.

Written by Karen Butler, Sue Upstone & mothers of La Leche League GB.

Updated February 2022

Further Reading
Beginning Breastfeeding
Caesarean Birth and Breastfeeding
Comfortable Breastfeeding
Diabetes and Breastfeeding
Hand Expression of Breastmilk
Is My Baby Getting Enough Milk?
Jaundice in the Healthy Newborn
My Baby Won’t Breastfeed
Sleepy Baby – Why and what to do

LLLI Stories
Cleft Lip & Palate Breastfeeding
Books
The Womanly Art of Breastfeeding LLLI. London: Pinter & Martin, 2010
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, Tx: Hale Publishing, 2010.

References

Cox, S. An ethical dilemma: should recommending antenatal expressing and storing of colostrum continue? Breastfeeding Review 2006; 14(3):11-6.
Cox, S. Expressing and storing colostrum antenatally for use in the newborn period. Breastfeeding Review 2006; 14(3):11-6.
Oscroft, R. Antenatal expression of colostrum. Pract Midwife 2001;4 (4): 32-5.
Forster, D. et al. Diabetes and Antenatal Milk Expressing (DAME). Lancet, 2017; 389 (10085): 2204-2213.

This information is available to buy in printed form from the LLLGB Shop

Antenatal (prenatal) colostrum expression

Patient information leaflet * .

Colostrum is a fatty, nutrient-rich substance that is excellent for nourishing and protecting your baby from infections during the first days of life. It is especially rich in immunological factors that promote the growth and development of the infant's immune system and protect it from allergies and various diseases. Colostrum also helps the newborn eliminate meconium (original feces), which helps prevent jaundice.

This first milk begins to be produced at 16-20 weeks of gestation. Some women notice leakage of milk during pregnancy, while others may not. In both cases, this is normal and does not affect a woman's ability to breastfeed successfully.

The importance of exclusive breastfeeding for all newborns has been proven in many studies. Some babies may have difficulty breastfeeding as well as blood sugar regulation in the first few days after birth. By hand expressing and preserving colostrum during pregnancy, your baby will be able to get your milk despite the difficulties. Research data show that colostrum is able to stabilize blood sugar levels in newborns significantly better than formula.

You can start expressing colostrum from the 36th week of pregnancy, although if you notice milk leakage earlier, you can collect it in a sterile syringe. You can discuss this with your midwife or other healthcare provider. They can provide you with tools and guidance to start collecting colostrum.

Benefits of collecting colostrum during pregnancy.

If women start harvesting colostrum during pregnancy, studies show that they:

- gain more confidence in how their breasts work even before the baby is born  reach “full production” of milk faster

- increase their confidence that they will be able to breastfeed their baby manual pumping skills.

Most women can express during pregnancy, although there are several groups of mothers and children for whom antenatal colostrum expression may be particularly beneficial:

- Infants at risk for hypoglycaemia or possible difficulty sucking

- Children of mothers with diabetes mellitus

- Very small and low birth weight children

- when it is known during pregnancy that the baby will need special care in the neonatal unit

- Twins or triplets.

There are also women who, due to their common medical or gynecological history, will find it difficult to exclusively breastfeed their babies. Others suffer from certain diseases, such as multiple sclerosis, for which breastfeeding is very beneficial:

- any form of diabetes

- polycystic ovary syndrome

- breast hypoplasia

- previous breast surgery

planned caesarean section

In mothers with diabetes and allergies, as well as a family history of dairy intolerance, inflammatory bowel disease or diabetes, children may also have these diseases more often if they are fed artificial protein-based formulas from the first days of life cow's milk.

It is especially important for mothers with diabetes to completely avoid the use of artificial formulas, or at least not to use them until the baby is 6 months old.

Women with gestational diabetes are less likely to develop the disease after childbirth if they are breastfeeding.

Women with diabetes should monitor their blood sugar levels especially if they express colostrum before giving birth. They may need to adjust their insulin doses and change their diet.

Are there women who should not express colostrum during pregnancy?

There is no scientific evidence that daily hand expression of colostrum activates labor in women who are not at risk for preterm birth.

However, we would advise some women not to actively express colostrum until a sufficient pregnancy is reached: multiple births before 36/40 weeks

- women with cervical sutures to prevent preterm labor

If you feel uterine contractions during pumping, you should stop the procedure. If contractions continue, contact your midwife.

How can I express colostrum during pregnancy?

Preparation.

To prevent cross-infection, please:

- wash your hands thoroughly before pumping

- wash your breasts no more than once a day (avoid using detergents that can irritate or dry out the skin on the nipples, causing soreness ).

Prepare a sterile milk collection container, such as a cup, bottle, wide-mouth container, or syringe (may be best for collecting small amounts of colostrum with minimal wastage). Activation of the release of OXYTOCIN (milk ejection reflex) can facilitate the outflow of milk. Find a quiet, secluded place where you can relax properly. You can gently massage your entire breast before pumping (you can see some of the massage techniques in the picture), be careful not to slide your fingers over the breast, as this can damage the skin. You can gently roll the nipple between your index and thumb. Some women find it helpful to put a warm diaper (soaked in warm water) over their breasts before pumping.

Make gentle circular motions with your fingertips.

Gently roll your clenched fist towards the nipple.

Locate the milk ducts.

Place your thumb on top of your chest with your index finger opposite it underneath. Both fingers are placed as far away from the base of the nipple as you can comfortably do. Gently “walk” your fingers along the chest until you find structures that feel different to the touch.

This means that you have felt the milk ducts (usually they are located 2-3 cm from the nipple).

Expression positions.

It can help if you lean forward slightly. Place your thumb and forefinger in the place where you found changes in the tissue of the gland. The thumb should be at 12 o'clock and the index finger at 6 o'clock, as shown in the picture (your hand is in a C-shape), covering the chest.

Pumping .

Without moving the thumb and forefinger, gently press the chest towards the chest (if the chest is large, it should be lifted first). Without releasing the pressure, roll your fingers towards each other to draw the milk out of the ducts. After that, you should reduce the pressure to allow the ducts to refill with milk. At first, you will be able to get only a few drops, but with practice, the amount of colostrum will increase. You can move your hand in a circle, changing the position of your thumb and forefinger, or change your hand, if necessary, to express milk from the entire breast. Collect drops of your colostrum in a sterile syringe or capped cup if more. You may find it easier to deal with this if your husband or other family members help you. Write your name, date of delivery, time and date of pumping on each syringe. Colostrum is usually produced in small amounts, so don't expect to be able to express a lot right away, although you might get lucky! You can make just 1 or 2 servings, but don't despair...every drop counts, and the more often you pump, the more likely you are to increase your milk production. Hand pumping is generally more effective than using a manual or electric breast pump.

Colostrum can vary greatly in color from dark orange/brown, yellow/green to pale/clear. Don't worry if your colostrum changes color or consistency after a few pumps. This is fine. Rest assured, the colostrum has not "run out". You continue to produce colostrum until the milk "comes in" (about 3 days after your baby is born). You can pump as often as is comfortable for you.

What if colostrum is not produced?

Don't panic! For some mothers, pumping is not easy. Keep trying, it may take a few days for you to see the first drops of colostrum. If you're ready to continue, try to pump every day. Remember that it is not necessary to pump during pregnancy, however, if you do, it can be very beneficial. Be sure that when your baby is born, you will definitely be able to get colostrum.

Expression Assistance Manual:

- try pumping after a hot bath or shower

- put warm diapers on your chest to improve circulation

- relax!

- Gently massage your breasts before pumping

- Have your baby's ultrasound scan handy

What do you need?

You can ask your midwife for some sterile syringes for your first colostrum. Then you can buy them at a pharmacy or online. 1ml syringes work best.

How much colostrum should be collected?

As many as you want and can. Remember that a newborn's stomach is the size of a small balloon.

Colostrum storage.

In addition to preparing colostrum for your baby, there are other benefits to expressing your first milk. Many women feel more relaxed and secure knowing they have an "extra reserve" of colostrum in case their newborn needs it.

Put the syringe you used to collect the colostrum back into the package and place it in an airtight plastic container (such as a lunch box or freezer container). Freeze this serving of colostrum immediately.

Transportation of colostrum.

It is best to freeze the colostrum after you have collected it at home and take it to the hospital when needed. Use a cooler bag with ice when transporting colostrum to the hospital and ask medical staff to place it in a special refrigerator as soon as possible after delivery. Once thawed, colostrum should be used within 12 hours, so to avoid wasting colostrum when it is thawed but not used, it is best to defrost a few syringes for each feed.

When the baby is born

Immediately after birth, continuous skin-to-skin contact between mother and baby should be established as early as possible to encourage initiation of breastfeeding (usually within the first 90 minutes after birth) . Ideally, your baby will suckle well at the breast soon after birth and will latch on frequently, so you won't need the expressed colostrum! However, some babies need regular supplements to keep their blood sugar levels stable, or the baby has some difficulty suckling. In this case, you will be provided with ongoing support to help resolve the difficulties, and in this situation, you can use pre-prepared colostrum. The medical staff will teach you how to feed your newborn with colostrum. You also need to take care to continue expressing colostrum regularly until your baby is able to breastfeed effectively in order to get the milk production back on track and provide the baby with it. We hope you enjoy expressing colostrum during pregnancy, as it will give you extra confidence and an invaluable reserve if you encounter difficulties in establishing breastfeeding. We hope you now know more about how your breasts work and how pumping during pregnancy will help you be more confident when you start breastfeeding your baby!

Useful Contact Numbers Breastfeeding Midwife 01296 315799 Community Midwives Office (SMH) 01296 316120 Community Midwives Office (WH) 01494 425172

patients. If you have any comments or suggestions regarding this booklet, please contact us:

Head of Midwifery Women & Children’s Division Buckinghamshire Healthcare NHS Trust Stoke Mandeville Hospital Mandeville Road Aylesbury Buckinghamshire HP21 8AL

How can I help reduce hospital acquired infections?

Infection control is an important part of the well-being of our patients, which is why we have developed local infection control procedures. Frequent hand washing is an effective way to prevent the spread of infection. We ask you and your visitors to use hand sanitizer, which you can find before entering each room, before and after visiting the patient. In some cases, hands need to be washed in the sink with soap and water instead of just hand sanitizer. The hospital staff will let you know if additional hand sanitization is needed.

www.buckshealthcare.nhs.uk Follow us on Twitter @buckshealthcare

Author: L. Randell

Publication date: December 2016

Reissue date: December 2018

9 Leaflet code: n/a Version00 5002: 1

Translation: Tatyana Mamontova

*Attention! Antenatal (prenatal) expression of colostrum should be carried out only when indicated. If you think you need it, be sure to check with a breastfeeding support leader or lactation consultant beforehand

Colostrum during pregnancy | Medela

Colostrum is sometimes called liquid gold, and not only because of its color. We will tell you why this first food is so important for a newborn baby.

Share this information

Colostrum, the first milk produced at the start of breastfeeding, is the ideal nutrition for a newborn. It is very concentrated and rich in proteins and nutrients, so even in small quantities it saturates the tiny tummy of a newborn for a long time. Colostrum is low in fat and easy to digest, yet provides the baby with all the essential ingredients for an optimal developmental start. And perhaps most importantly, it plays a decisive role in the formation of the baby's immune system.

Colostrum looks thicker and yellower than mature milk. Its composition also differs in accordance with the special needs of the newborn.

Colostrum fights infections

Almost two-thirds of the cells in colostrum are white blood cells, which not only protect the baby's body from infections, but also teach them to fight them themselves. ¹ “White blood cells are very important for the development of immunity. They provide protection and counteract pathogenic microbes,” says Professor Peter Hartmann of the University of Western Australia, a leading lactation expert.

After giving birth, your body no longer protects the baby, and he must confront the new dangers of the world on his own. The white blood cells found in colostrum produce antibodies that can neutralize bacteria and viruses. These antibodies are especially good at dealing with indigestion and diarrhea, which is very important for very young children, whose intestines are not yet fully developed.

Colostrum supports the baby's immune system and intestinal function

Colostrum is especially rich in secretory immunoglobulin A -
is the most important antibody that protects the child from diseases, but not through the circulatory system, but as a protective coating of the mucous membrane of the gastrointestinal tract. ² “The molecules that provide the mother's immune defenses enter the breast with her bloodstream, where they combine and form secretory immunoglobulin A, which is then transferred to the baby along with colostrum,” explains Professor Hartmann. “Secretory immunoglobulin A accumulates on the mucous membranes of the intestines and respiratory system of the child and protects him from diseases that the mother has already had.”

Colostrum also contains many other immunological components and growth factors that stimulate the development of protective mucous membranes in the intestines of the child, and the prebiotics contained in it contribute to the formation of beneficial microflora. ³

Colostrum prevents jaundice

Colostrum not only protects against indigestion, but also has a laxative effect. This helps newborns to empty the intestines frequently, removing from it everything that was digested there in the prenatal state, in the form of meconium - dark and viscous feces.

Frequent stools in newborns also reduce the risk of jaundice. A baby is born with a high level of red blood cells that absorb oxygen from the air. As these cells break down, the liver helps to process them, producing a by-product called bilirubin. If the child's liver is not yet sufficiently formed to process it, bilirubin begins to be deposited in the body, causing jaundice. ⁴ The laxative properties of colostrum help the baby to remove bilirubin from the body along with the stool.

Colostrum contains vitamins and minerals

Carotenoids and vitamin A give colostrum its characteristic yellow color. . ⁷ Babies are usually born with a low supply of vitamin A, ⁸ and colostrum helps to replenish it.

"The first three days are especially important for establishing breastfeeding"

In addition, colostrum is rich in minerals such as magnesium, which is good for the baby's heart and bones, and copper and zinc, which are involved in the development of the immune system. ^9.10 Zinc also contributes to the development of the brain, and there is almost four times more zinc in colostrum than in mature milk, ¹⁰ because the brain of a newborn must develop rapidly.

Colostrum helps your baby grow and develop

Colostrum contains many other ingredients that help your baby grow and develop. The role of some of them is still unknown to scientists.

“Colostrum retains its composition for about 30 hours after the baby is born,” says Professor Hartmann. - It contains quite a lot of proteins, because all the antibodies in its composition are essentially proteins. It is relatively low in lactose [milk sugar] and has a different fat composition than mature milk.”

In addition, colostrum is close in composition to the amniotic fluid that your baby swallowed and excreted while in the womb, making it ideal for adapting to the outside world. ¹¹

Transition from colostrum to mature milk

Breast milk usually begins to arrive two to four days after birth. The breasts become firmer and fuller, and instead of colostrum, transitional milk is excreted, which is whiter in color and creamier in consistency.

“The first three days are especially important for establishing breastfeeding,” says Prof. Hartmann. “If everything is done correctly during this period, lactation is likely to be good, and the baby will be able to grow normally.”

It seems unbelievable now, but in just one year your baby will be able to walk and maybe even talk. Colostrum is produced for only a few days, but makes an invaluable contribution to the development of the baby during the first 12 months, and the resulting benefits remain with him for life.

Want to know more? Read our free e-book Surprising Breast Milk Facts and article What is Transitional Milk?.

Literature

1 Hassiotou F et al. Maternal and infant infections stimulate a rapid leukocyte response in breastmilk. Clin Transl Immunology. 2013;2(4): e 3. - Hassiot F. et al., "Infectious diseases of the mother and child stimulate a rapid leukocyte reaction in breast milk. " Clean Transl Immunology. 2013;2(4):e3.

7 Bates CJ. Vitamin A. Lancet. 1995;345(8941):31-35. — Bates S.J., "Vitamin A". Lancet (Lancet) 1995;345(8941):31-35.

8 World Health Organization. e-Library of Evidence for Nutrition Actions (eLENA) [Internet]. Geneva , Switzerland : WHO ; 2018 [ Accessed : 05/14/2018]. Available from Evidence-based electronic library on WHO nutrition activities ( eLENA ) [Internet]. Geneva, Switzerland: WHO; 2018 [visited 14 May 2018] Article at: [ www.who.int/elena/titles/vitamina_infants/en/ ]

9 Kulski JK, Hartmann PE. Changes in human milk composition during the initiation of lactation. AUST J EXP Biol MED SCI . 1981;59(1):101-114. - Kulsky JK, Hartmann PI, "Changes in the composition of breast milk at the onset of lactation". Aust Zh Exp Biol Med Sai. 1981;59(1):101-114.

10 Casey CE Studies in human lactation: zinc, copper, manganese and chromium in human milk in the first month of lactation. Am J Clin Nutr 1985;41(6):1193-1200.

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