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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 encouraged to express breastmilk in late pregnancy. It is recommended babies breastfeed exclusively for approximately the first six months. This helps encourage good health throughout a baby’s first year of life, reduces baby’s risk of infection and reduces the risk of the mother developing breast cancer (World Health Organisation, 2022, National Health and Medical Research Council, 2018). 

Reasons where antenatal expressing and storing milk may be of benefit:

  • diabetes in pregnancy where the baby needs blood sugar monitoring
  • babies with a known congenital abnormality or a planned early delivery

There are also reasons why mothers may have difficulty with producing enough milk for their baby’s feeds. These include mothers:

  • 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.

What is colostrum and why is it important?

  • Colostrum is a fluid produced by the breasts during pregnancy, and the first few days after birth.
  • Colostrum may look dark yellow to clear in colour and is thick and sticky.
  • Colostrum is easily digested and the best first food for your baby.
  • Colostrum contains many protective substances that help build baby’s immune system.
  • Colostrum is made in small amounts but is high in energy, helping baby to pass their 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 normal development of the baby’s digestive system including 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.

The amount of colostrum expressed will vary, it may take a few attempts before you get a drop!

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 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.
  • 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/container. You will need to store the capped collection container in the fridge between uses.
  • If you are using a syringe for collection, make sure it is no more than ¾ full as milk expands when frozen. • Label the syringe and snap-lock storage bag (separately) with a sticker detailing your name, medical record number and 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 24 hours of expressing; place the small container or capped syringe into a snap-lock bag before putting into the freezer.
  • The frozen colostrum can be stored for three months in the freezer or 6 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 frozen to hospital labelled with your name, hospital record number, date and time the colostrum was expressed.

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

Checklist for bringing your frozen colostrum into hospital

  • Each syringe or container has a cap and is labelled correctly as detailed previously.
  • 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. Please bring between 5 and 40 ml of expressed colostrum to hospital. If you have more than this, it can be brough from home at a later date if required.
  • Please let staff know you have milk to put into our Level 10 freezer.  
    • Frozen colostrum defrosted in the ward fridge will need to be used within 24 hours. 
    • Once your colostrum is defrosted, it cannot be re-frozen.

Unused colostrum while in hospital

  • Please remember to take your frozen colostrum home on discharge.
  • If your frozen colostrum passes expiry times and/or you leave hospital without your colostrum – your milk will be discarded, as we have limited facilities to store it.

  • If this is not your wish, please arrange a family member or friend to take your colostrum home prior to discharge

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 your 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 your baby warm and against your skin is very important to help your baby conserve energy and begin to establish early feeding behaviors such as bobbing/nuzzling and licking your breast/chest area. 

  •  Breastfeeding is encouraged and should be unrestricted. We may suggest waking your baby to feed if there is a medical need. 

  • Babies who require blood sugar monitoring may need to be breastfed more frequently to maintain normal blood sugar levels. Having frozen colostrum available can help. We encourage you to continue expressing at this time.

  • We encourage all mothers to seek breastfeeding assistance from the midwife caring for them. There are also daily breastfeeding classes run by the lactation consultants available to all. If your baby is in the nursery, lactation consultants can help support expressing and breastfeeding should your baby be able.

 References

World Health Organisation, 2022, ‘Breastfeeding’, WHO, [Online] Available at: https://www.who.int/health-topics/breastfeeding

National Health and Medical Research Council, 2018, ‘Supporting women to breastfeed’, NHMRC, [Online] Available at https://www.nhmrc.gov.au/about-us/news-centre/supporting-women-breastfeed

Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: PI-CLN-430095
Last modified 23/9/2022.
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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