Antenatal harvesting of colostrum
by Cordelia Uys, NCT Breastfeeding Counsellor
For many years, women with diabetes or gestational diabetes have been encouraged to ‘harvest’, or collect, their colostrum antenatally. This is because their babies are more likely to be born with low blood sugar and having some stored colostrum ready to give as a top up, in addition to breastfeeding, is an excellent way of stabilising their blood sugar. Colostrum (and breastmilk) are more effective at regulating blood sugars than infant formula.
Health professionals working with diabetic mothers noticed that those who harvested their colostrum antenatally tended to be more successful at establishing breastfeeding. It’s likely that learning how to hand express and having the safety net of a few syringes of colostrum to bring into hospital, helps give a new mother confidence, so she is likely to relax, which tends to make it easier to get breastfeeding off to a good start. Many NHS hospitals now encourage all pregnant women to consider doing some antenatal harvesting of colostrum, in case their baby struggles to latch or is very sleepy.
However, it’s worth pointing out that harvesting colostrum is not obligatory. Some women don’t like the idea, and also, not all women are able to express colostrum before their baby is born: this is in no way a reflection of the amount of milk they will be able to produce postnatally.
By the way, colostrum can’t be collected by pumping, because the volumes are too small.
A study from 2017 showed that for women with low risk pregnancies, antenatal harvesting of colostrum from around 36 weeks is safe:
https://www.thewomens.org.au/news/study-finds-breast-milk-expressing-in-late-pregnancy-safe/
In the case of antenatal harvesting of colostrum, a pregnancy is considered low risk if parents have been told is safe to have sexual intercourse.
There were also a couple of studies done in 2019 showing the women who hand expressed during pregnancy:
Felt more confident they could exclusively breastfeed - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6859991/
Were less likely to supplement with formula after their baby’s birth - https://pubmed.ncbi.nlm.nih.gov/30891743/
Here’s what some new mothers said about their experience of hand expressing:
I decided to try antenatal colostrum harvesting as I wanted to have it available for the baby if there were any problems. It did feel strange at first but quickly became normal, I actually started enjoying it, connecting with my body and preparing for the baby. Fortunately I didn’t need to use what I had collected. But I am still so glad I did this. My milk came in on day 2, which I am sure had something to do with it and also it gave me a confidence, when my breasts were engorged and I needed to do a small amount of hand expressing I already knew what I was doing. I would highly recommend to anyone to kickstart their breastfeeding journey.
Thank you for your advice to hand express antenatally. I did it every day from around 36 weeks and was so glad that I did. It really helped me to build my confidence around breast feeding. More importantly the syringes of colostrum came in very useful when my baby was born. We had a great birth centre birth and first feed but afterwards I lost blood and had to be put on a drip. I wasn’t able to breast feed at the time, but was able to give her the colostrum on the first night. The next night she needed phototherapy for jaundice, and again, I was able to ensure she was well fed and hydrated throughout the night thanks to the syringes of colostrum, without having to use formula. It really helped our breast feeding journey to get off to a good start. I have been recommending it to all my friends who are pregnant.
Some women worry that they will ‘run out’ of colostrum if they express antenatally, but this doesn’t happen, because it’s the birth of your baby, and the delivery of the placenta, that tells your body to start producing mature milk.
It’s not unusual for women to find that the volumes of colostrum they are able to collect decrease temporarily after a couple of days of hand expressing, and then start to come back up again.
Equipment needed to hand express:
Approximately 30 x 1ml syringes, which you can buy online:
Some zip lock freezer bags and a Tupperware that has been sterilised or washed in a dishwasher.
How to hand express – please remember the recommendation is to wait until around 36 week before doing any hand expressing
The first time you try hand expressing, you might find it helpful to have a go immediately after a warm bath or shower.
Wash your hands.
Sit on a comfortable chair in a warm room.
It’s helpful to gently stroke and/or massage your breasts before starting.
If you think of your areola as the face of a clock, place your thumb on the edge of your areola at 12o’clock and your index finger at 6 o’clock, so that you’re making a C shape around your areola. Make sure your nipple is centred between your thumb and index finger.
Press both your thumb and your index finger straight back towards your ribs. Then squeeze your finger and thumb, slowly and firmly, behind your areola. Imagine you are trying to join your thumb and index finger together. You will probably have to press quite hard. Initially this can be uncomfortable.
Make sure you don’t roll your finger and thumb down towards your nipple as this can cause chaffing of your areola.
You might need to repeat pressing your finger and thumb back towards your ribs and then pressing them together several times before any colostrum appears.
You might also need to try positioning your thumb and index finger a bit closer to your nipple, or a bit further away, before you find the ‘sweet spot’.
Move regularly between breasts, as squeezing on one side tends to encourage colostrum to come out of the other nipple.
Please remember, colostrum comes in tiny drops. At first you might not see more than a bit of glistening on your nipples. But the volumes should increase when you start hand expressing regularly.
If you experience any contractions, stop immediately.
Once there’s enough colostrum to suck up with a syringe, you can start collecting the drops. This process is quite slow and laborious.
You can hand express up to 3 times a day, for up to 20 minutes each time.
Put the syringe in the fridge in a clean Tupperware between sessions.
Once the syringe is full put your syringe (labelled with the date) in the freezer in a zip lock freezer bag. If the syringe isn’t full at the end of the day, you still need to put it in the freezer, and start with a new one the next day.
Here’s an excellent film showing how to hand express:
http://med.stanford.edu/newborns/professional-education/breastfeeding/hand-expressing-milk.html
Here’s a video explaining how to collect the colostrum with the syringe:
https://www.youtube.com/watch?v=4O68uSt2ESg
Taking colostrum into hospital:
The suggestion is to take around 5ml to 10ml of colostrum into hospital with you in a cool bag with ice packs. Make sure you keep the bag close by. If you give it to hospital staff, you might never see it again.
How to feed your baby the colostrum:
In order to defrost the colostrum, place the syringe in a sealed plastic bag, and place the bag in a bowl of warm water. It should only take a few minutes to defrost.
Put your baby on your lap facing you, with their head where your knees are. Making sure your hands are clean and your baby finger nail is short, put your baby finger, nail side down, in your baby’s mouth, on top of their tongue, more or less up to your first knuckle. You might need to wiggle your finger a bit to encourage your baby to start sucking. When they do, put the syringe with the defrosted colostrum in the corner of their mouth, and push very gently. When they start to suck, they will draw the colostrum in.
Here are a couple of videos showing how to syringe feed:
https://www.youtube.com/watch?v=N-wcjrR_If0
N.B. Even if you have lots of harvested colostrum to give your baby, it is still essential, if at all possible, to start breastfeeding your baby from at least 2 hours after birth, and to continue breastfeeding them very frequently (at least 10 to 12 times in 24 hours) from then on, in order for your breasts to get the message to start mature milk production, and so that your baby is getting the colostrum they need directly from your breasts. Colostrum is all a baby needs in the first 3 to 4 days of their life.
Not many women will be able to harvest this much colostrum before their baby is born.
Links:
https://www.gestationaldiabetes.co.uk/colostrum-harvesting/
https://www.laleche.org.uk/antenatal-expression-of-colostrum/
Video on antenatal hand expressing by NCT Breastfeeding Counsellor Steph Westacott: https://fb.watch/dzanUaaoJJ/
First Droplets is a website set up by the paediatrician Dr Jane Morton: ‘The cornerstone of successful breastfeeding is a plentiful milk supply. We will help mothers go into delivery understanding that milk removal in the first few hours, either by the baby, herself or her partner, is the key for future milk production. Simply put, it’s early milk out, later milk in’: https://firstdroplets.com/team/