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Antenatal expression of colostrum

When it’s expected that your baby may have feeding problems or could possibly need extra calories after birth, you may be asked to express breastmilk in late pregnancy. Your baby will then have a small supply of breast milk ready if needed
at birth, and infant formula might be able to be avoided. Babies who receive only breastmilk while in hospital are more likely to breastfeed longer.

Reasons it may help your baby if you express in late pregnancy include babies:

  • whose mother has diabetes in pregnancy
  • with congenital conditions such as down syndrome or heart problems
  • with a cleft lip and/or palate who are smaller than expected 
  • who are born early.

There are also reasons why women may have difficulty with producing enough milk for their baby’s feeds.

These include women:

  • who have had low milk supply in the past
  • who have problems with breast growth
  • with polycystic ovarian disease
  • who have had breast surgery in the past
  • with multiple sclerosis
  • who have had medical assistance to conceive.

What is colostrum and why is it important?

  • Colostrum is a fluid which is produced by the breasts from about the 20th week of pregnancy and during the first few days after the birth of your baby.
  • Colostrum may look dark yellow to clear; it can also be quite thick and sticky.
  • Colostrum is easily digested and the best first food for your baby.
  • Colostrum is specially made for your newborn baby. It is very high in protein that helps protect your baby from illness. There are also vitamins, minerals and salts which help protect your baby from dehydration in the early days.
  • Colostrum is made in small amounts but is high in energy, helping baby to pass the first bowel motion. This also helps prevent jaundice after birth.

Why should I consider antenatal expressing?

  • Human milk is the recommended food for all babies, but especially for babies with extra health needs.
  • Expressing and storing colostrum before birth, may decrease the risk of your baby being given infant formula after birth. 
  • Expressing can assist in the promotion of successful, exclusive breastfeeding for you and your baby.
  • Exclusive breastfeeding promotes growth of good gut bacteria.

When can I start expressing?

Please discuss this with your midwife, lactation consultant or doctor for individual advice prior to commencing expressing. Generally you may commence expressing at 36 weeks gestation. Begin with three to five minutes of hand expressing on each breast; two to three times a day. You should stop expressing immediately if you are having contractions at any time.

Do not express if:

  • you have a history of, or are currently experiencing, threatened or actual preterm labour
  • you have a history of, or are currently experiencing, cervical incompetence
  • you have had a suture put in your cervix to prevent preterm labour
  • you have a history of bleeding through pregnancy or placenta praevia (your placenta is near to, or covering, your cervix)
  • your doctor has advised against expressing.

Expressing must be comfortable; seek assistance from a health professional if you experience any discomfort. If you require additional assistance or support, please contact Mater’s Mothers Parenting Support Centre on 07 3163 2229.

Expressing and collecting colostrum

For details on how to hand express, refer to Mater’s information on expressing breast milk

Collecting and storing your colostrum

  • Wash hands prior to expressing
  • Colostrum may be as little as a couple of drops to be drawn up into the syringe provided for this purpose.
  • If colostrum is pearling up or dripping easily, collect the colostrum either into a clean container, such as a medicine cup then draw up or collect directly into the syringe.
  • When milk ceases to flow, rotate the position of your forefinger and thumb around the areola (imagine a clock face) and repeat the expressing process.
  • Swap to the other breast when the flow slows down or after two to three minutes.
  • Use each breast twice during each expressing session.
  • Colostrum can be collected two to three times each day in the same syringe. You will need to store the capped syringe in the fridge between uses.
  • Make sure each syringe is no more than ¾ full as milk expands when frozen. 
  • Label the syringe and bag (separately) with a computer generated sticker detailing the date and time of the first expression collected and also initialled by you to confirm correct identification.       
  • The refrigerated colostrum will need to be frozen within 24hours of expressing; place the capped syringe into a zip-lock bag before putting into the freezer. 
  • The frozen colostrum can be stored for three months in the freezer or six to 12 months in a chest freezer (see storage guidelines below).

Your colostrum will remain frozen until the time comes for your baby’s birth at which time the containers can be brought to hospital labelled with the mothers’ name, hospital record number, date and time the colostrum was expressed.

Ask your antenatal midwife to supply you with hospital labels, expressing syringes and caps. 

Checklist for bringing your frozen colostrum into hospital

  • Each syringe or container has a cap and is labelled correctly as above. 
  • Place containers in a snap lock plastic bag.
  • Wrap (e.g. in clean tea towel), and place with ice bricks in a hard cooler (e.g. esky) avoiding air gaps
  • When arriving at Mater reception, let staff know you have milk to put into our birth Suite freezer. Volume expressed will vary a great deal from a couple of mL or more. Most babies will need no more than 20 mL for the first 24 hours. 
  • After your baby is born, your frozen colostrum will go with you and your baby
  • If you need to keep some colostrum frozen after your baby is born, it is preferred you organise to send it home. Otherwise arrange for it to be removed from the Birth Suite freezer before you are discharged home.

If you don’t intend to keep your colostrum frozen, it will need to be used within: 

  • 72hours (3 days) if fresh and refrigerated. 
  • 4 hours if not refrigerated, or is defrosted in your cooler bag. 
  • 24 hours if defrosted in the ward fridge
  • Once your colostrum is defrosted, it cannot be re-frozen.

 

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What happens after the birth of my baby?

  • You will be encouraged to place your undressed baby on your bare chest straight after birth including caesarean births  then continue to keep baby skin to skin when you are moved up to your ward bed.  If you are not able to cuddle skin to skin, your support person may help with this.

  • Keeping baby warm and against your skin is very important to help baby conserve energy. In the first few days, small samples of blood may be taken from your baby’s heel to check the blood glucose levels.

  • Breastfeeding should be offered frequently; you may be encouraged to wake your baby to breastfeed every 3 hours in the first few days if your baby is sleepy or needing extra energy.

  • If your baby’s blood test shows that their glucose level is low they will need some extra milk; you will be encouraged to feed more frequently. You may also be encouraged to offer your expressed colostrum and to continue hand expressing and commence using a breast pump.

  • If your baby continues to experience challenges with breastfeeding, talk to your midwife or attend a breastfeeding clinic for support. If blood glucose levels are not improving, your baby’s paediatrician will advise you on further treatment and feeding. This may include oral glucose gel, a drip in baby’s hand to give glucose or introducing formula feeds. 

Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: PI-CLN-430095
Last modified 02/6/2020.
Consumers were consulted in the development of this patient information.
Last consumer engagement date: 27/2/2020
For further translated health information, you can visit healthtranslations.vic.gov.au/ supported by the Victorian Department of Health and Human Services that offers a range of patient information in multiple languages.
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