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Antenatal hand expression

What is antenatal hand expression?

Also known as ’colostrum harvesting’, this means collecting colostrum in the final few weeks of pregnancy. It can be stored and given to your baby once it arrives.

What is colostrum?

Colostrum is a thick, rich, breast milk substance which is perfectly designed to protect and nourish your baby in the first few days of their life, until your full milk ‘comes in’ at around day 3.  Every drop boosts your baby’s immune system, provides them with the energy they need, and protects against allergy and disease.

Why should I express colostrum?

Some newborn babies may experience difficulties with breast feeding or maintaining their blood sugar levels in the first few days after birth.  Other mothers may not want to breastfeed their baby long-term but would like them to receive the protection and nourishment of colostrum.  By hand expressing and storing colostrum in pregnancy, you can have a supply of this milk ready to give your baby once they arrive.

Most women can hand express in pregnancy but there are certain groups of mothers and babies for whom antenatal expression of colostrum may be particularly beneficial:

  • Babies at risk of low blood sugars
  • Babies of mothers with diabetes
  • Very small or growth restricted babies
  • Babies of mothers taking beta blocker medication e.g. Labetalol
  • Babies with a cleft lip/palate
  • Babies with chromosomal differences such as Down’s syndrome
  • Babies who are known in pregnancy to need care in the Neonatal Unit
  • Twins or triplets

Some women have medical conditions which may make breastfeeding more challenging, and they may wish to consider antenatal hand expression.

  • Any form of Diabetes
  • Polycystic ovary syndrome
  • Breast hypoplasia (breasts which have not fully developed during puberty)
  • Previous breast surgery
  • Planned caesarean section

How do I hand express my colostrum in pregnancy?

Most women can express colostrum from 36 weeks pregnant, however if you are leaking before this time you can collect your colostrum in a sterile syringe.  You may find it useful to talk to your Community Midwife; Diabetes Midwife or Infant Feeding Midwife. They can give you some equipment and guidance to get you started.

Preparation

  • Wash your hands thoroughly prior to hand expressing.
  • Have a sterile container for collecting milk, e.g. cup, bottle, wide-necked container or syringe (might be more useful for collecting small amounts of colostrum to ensure that as little as possible is lost).

Create the right atmosphere

You should find a warm, private and relaxing environment.

You can gently massage all areas of your breasts for a few minutes prior to expressing (see diagram below for suggested techniques), being careful to avoid sliding your fingers along the breast as this can cause skin damage.

Some women find putting warm flannels to the breasts (or warm water whilst in bath or shower) before expressing can help.

antenatal hand expression - diagram showing how to move fingertips in circular movements

Move fingertips in gentle circular movements

Antenatal hand expression  - diagram showing how to gently roll closed fist over the breast towards the nipple
Gently roll closed fist over the breast towards the nipple

Technique

  • Cup your breast and make a ‘C’ shape with your thumb and forefinger.
  • Place your thumb and finger on opposite sides of the nipple, 3-4cm apart, or where the texture of the breast tissue feels different.
  • Without sliding your fingers over the skin, gently squeeze your thumb and finger together.  This shouldn’t hurt. Release the pressure and squeeze again and again, building up a rhythm.
  • You may only see a few drops at first.  The more you practice, the more colostrum will start to appear.
  • Once the flow of colostrum has slowed down, rotate your fingers round to try a different part of the breast.  When you have tried all parts of one breast, repeat the process on the other breast.
  • Expressing from both breasts at the same time, whether by hand or pump, is said to increase milk volume and reduce the time taken.  Pause for 30-60 seconds when the milk flow slows down to allow the ducts to refill.

Antenatal hand expression diagram showing milk ducts

Collect your beads of colostrum in a sterile syringe or if larger amounts, a sterile cup with a lid.  You may find it easier for your partner or family member to assist with this.

Label each syringe with your name, date of birth and date and time of expressing.

Colostrum can vary in colour from dark orange/brown, yellow/green to pale/clear.  Do not worry if your colostrum changes colour and consistency over a few expressing sessions. This is normal.

Be reassured that colostrum does not ‘run out’. You will continue to produce colostrum until your milk ‘comes in’ (about 3 days after your baby has been born).

You can express as often as you feel comfortable to do so.

What do I do if I don’t get any colostrum?

Don’t panic! For some mothers it is not easy to express.  Keep trying as it may take a few days before you see a bead of colostrum. If you’re happy to continue then keep trying every day. Remember it is not necessary to express whilst you are pregnant but it is useful if you do. Be reassured that you will be able to express once your baby is born.

Colostrum is normally produced in quite small quantities so don’t expect to get great amounts initially, unless you are very fortunate!  You may only manage a bead or two but don’t give in… every drop counts and the more often you express the more likely your supply will increase.

Tips to help expressing:

  • Try expressing after a warm bath or shower
  • Hold warm flannels on your breasts to increase circulation
  • Relax!
  • Massage your breasts gently before expressing
  • Have a scan image of your baby close by

What do I need?

You can ask your Community Midwife or Diabetes Midwife for a starter pack to get started. More syringes can be bought in pharmacies or online. 1 ml syringes are best initially as you will probably get small amounts.

How much should I collect?

Collect as much as you would like to and are able to. Bear in mind that a newborn baby’s tummy is the size of a small marble at birth.

Storage of antenatal colostrum

There is benefit to the process of expressing colostrum, regardless of whether you choose to store it for the arrival of your baby, or choose to discard it. However, many women find satisfaction and security in knowing that they have a ‘back up’ supply of colostrum in case their baby needs it.

Place the syringe in which you have collected colostrum back into its wrapper, and put into a sealable plastic bag (e.g. sandwich or freezer bag). Chill or freeze straight away.

PLACE MAXIMUM TIME
Fresh breastmilk Always store in a sealed container
Room Can be kept at room temperature for up to 6 hours
Fridge: 5-8°C Can be kept at the back of a fridge for up to 3 days
Fridge: 0-4°C Can be kept at the back of a fridge for up to 5 days
Ice compartment Can be stored in an ice compartment of a fridge for 2 weeks
(if temperature rises above 4°C after 3 days, use within 6 hours or throw away)
Freezer: -18°C or lower Can be stored in a deep freezer for 6 months
Previously frozen breastmilk
Defrosted in fridge Defrost in the fridge for 12 hours.  Use as soon as possible after thawing
Defrosted outside fridge Use immediately

 

Transporting your expressed colostrum

It is best to freeze your colostrum as you collect it at home and bring it into hospital at the time it is needed.

Use a cool bag with an ice pack for transporting it into hospital and ask a midwife to put it in the designated fridge as soon as possible on arrival.  Frozen colostrum must be used within 12 hours of thawing so to avoid wasting colostrum that has thawed but not used, it is best to only bring in a few syringes at a time.

Are there women who shouldn’t express colostrum in pregnancy?

There is no evidence that daily hand expression of colostrum can trigger labour for women who are not known to be at risk of premature labour

However, the following women should be advised to not actively express colostrum until 37 weeks gestation:

  • Women with threatened/actual premature labour
  • Women with a shortened cervix
  • Multiple pregnancy before 36 weeks
  • Women with a cervical suture to protect against premature labour

If you experience any uterine contractions during expressing, you should stop. If these continue, contact your Midwives.

When my baby is born

At birth, you and your baby should be given uninterrupted skin-to-skin contact to initiate breastfeeding as soon as possible (usually within the first 90 mins).  Ideally your baby will breast feed well soon after birth and frequently at the breast so that your expressed colostrum remains unused!

However, some babies may need to be fed regularly (to maintain their blood sugars) or if baby has any difficulties with breastfeeding, you should be offered any on-going support to help solve these difficulties, and you may now want to use some of your stored colostrum.  Ward staff will show you how to give your colostrum to your baby.

You will also be encouraged to continue to express your colostrum regularly, until baby is feeding effectively at the breast, to help establish your breast milk supply and provide the best milk for your baby.

We hope that you will find the process of expressing breast milk in pregnancy a positive one, providing you with reassurance and back-up if establishing breastfeeding is more challenging.  We hope you will have learnt more about how your breasts work and that hand expressing in pregnancy will help you confidently breastfeed your baby!

Useful Contact Numbers

Breastfeeding Midwife                                           01296 315799

Community Midwives Office (SMH)                   01296 316120

Community Midwives Office (WH)                     01494 425172