Breastfeeding—antenatal expression of colostrum
There are several reasons why a baby may experience difficulties with feeding or maintaining their blood sugar levels after birth and; therefore, may require supplementary feeds.
These include infants:
- whose mother experienced diabetes in pregnancy
- with a cleft lip and/or palate identified during pregnancy
- with congenital conditions such as Down syndrome or cardiac complications
- diagnosed with intrauterine growth restriction
- who are born prematurely.
There are also reasons why women may need to consider supplementing their baby’s feeds.
These include women:
- who have experienced previous low milk supply
- who have a breast hypoplasia (limited breast development)
- with polycystic ovarian disease
- who have had previous breast surgery
- with multiple sclerosis.
What is colostrum and why is it important?
- Colostrum is a fluid which is produced by the breast from about the twentieth week of pregnancy and during the first few days after the birth of your baby.
- Colostrum is easily digested and; therefore, the ideal first food for your baby.
- Its appearance may vary from dark yellow to clear and can be quite thick and sticky.
- Colostrum provides perfect nutrition specifically for your newborn baby. It has a much higher proportion of proteins than mature milk; many of these are immunoglobulins which help boost your baby’s immunity.
- There are also fat-soluble vitamins and some minerals as well as a relatively high salt content which assists in protecting your baby from dehydration in the early days.
- Colostrum is low in volume but high in energy and helps with the early passage of meconium (the baby’s first bowel motion) which in turn assists in preventing jaundice (yellow skin colour).
Why should I consider antenatal expressing?
- Human milk is the recommended food for all babies, but especially for babies with additional health requirements (see list above).
- Expressing and storing colostrum before birth, may decrease the risk of your baby requiring or being given infant formula after birth.
- Expressing can assist in the promotion of successful, exclusive breastfeeding for you and your baby.
When can I start expressing?
Please discuss this with your midwife, lactation consultant or doctor prior to commencing expressing for individual advice. Generally, you:
- can commence expressing at 36 weeks gestation
- can begin with three to five minutes of expressing on each breast; two to three times a day
- 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.
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 Breastfeeding Support Service on 07 3163 8847.
A freezer is available in the Milk Room (located on level 3, Salmon Building) to store your frozen colostrum, if required. You can access this freezer by calling the nutrition assistants on 0434 316 229 between 8 am and 6 pm every day to:
- Have your colostrum placed in the freezer during pregnancy or on admission to hospital (you will take your expressed colostrum to the milk room personally)
- Arrange for your frozen colostrum to be collected (or delivered) during your hospital stay (your partner or support person can collect for you).
How to hand express and store colostrum
- Always wash your hands before expressing.
- We suggest expressing after a bath or shower as the heat may assist the flow of colostrum. You may also wish to apply a warm compress to your breasts.
- Sit in an upright position, leaning slightly forward.
- Start with a gentle breast massage, stroking from the back of your breast towards the nipple to facilitate the let-down reflex.
- Gently press your finger and thumb pads (not your fingertips) back toward the chest wall into the breast tissue, then press then together, and hold for a few seconds.
- Your fingers should be well back from your nipple, on the outside of your areola and should not tug or drag on your nipple.
- Do not squeeze or pinch your nipple.
- Repeat this process in a rhythm, similar to that of a baby sucking at the breast.
- When colostrum is pearling up or dripping easily, it is time to collect the colostrum either into a clean container, such as a medicine cup, or directly into the syringes provided for this purpose.
- When milk ceases to flow, rotate the position of your fingers 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 syringe in the fridge between uses.
- At the end of the collecting day, the colostrum can be frozen—place the syringe into a zip-lock back before putting into the freezer.
- Label the syringe and bag (separately) with a sticker detailing the date and time of the first expression collected.
- The frozen colostrum can be stored for three months in the freezer or six to 12 months in the deep 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.
Storing expressed breast milk for home use
* Australian Dietary Guidelines for Children and Adolescents - table. Copyright Commonwealth of Australia reproduced by permission.
What happens after the birth of my baby?
- You will be encouraged to have skin to skin contact with your baby in the first one to two hours following birth, including caesarean births, if possible.
- Breastfeeding is encouraged and should be unrestricted.
- If your baby is experiencing difficulties or is uninterested in breastfeeding at this time you will be encouraged (and assisted if necessary) to express some colostrum to give to your baby. You may also use any colostrum you have brought into hospital with you.
- Should your baby continue to experience challenges with feeding at the breast or their blood glucose levels become an issue, your baby’s paediatrician will advise you on further treatment and feeding.
- Australian Breastfeeding Association (2012) Breastfeeding information- special situations.
- Ballarat Health Services (2010). The Antenatal Expression of Colostrum Catalogue No 731074
- Cairns Health Service (2005). Clinical Care Policy ‘Antenatal Hand Expression of Colostrum for mothers with diabetes and other mothers whose babies are likely to have feeding difficulties'
- Cox (2010). An ethical dilemma: should recommending antenatal expressing and storage of colostrum continue? Breastfeeding Review 18(3) 5-7
- Forster et al (2011). Diabetes and antenatal milk expressing: A pilot project to inform development of a randomised control trial. Midwifery 27(2)209-214
- Pindarra Private Hospital, Ramsay Health Care (2011). Antenatal expression of colostrum –patient information
- Singh et al (2009) effect of antenatal expression of Breast milk at Term in Reducing Breast Feeding Failures. MAIFI 65:131-133
Mater acknowledges consumer consultation in the development of this patient information.
Last modified 21/4/2016.