Antenatal Hand Expression

This leaflet aims to give you information about antenatal expression of colostrum – early breastmilk (also called human milk).

It covers information including:

• What antenatal expression is
• Advantages of expressing
• Situations in which expressing is not recommended
• How to hand express
• How to collect and store colostrum

What is antenatal hand expression?

Antenatal expressing means expressing your colostrum in the final few weeks of your pregnancy before your baby arrives.

Colostrum is the first stage/form of breastmilk.. You start to produce colostrum from around 16 weeks of pregnancy. Colostrum contains everything your baby needs to protect and nourish them in their first few days of life, including proteins, fats and infection-fighting antibodies, and it will help stabilise your baby’s blood glucose (sugar) levels.

Colostrum is normally produced in very small quantities and your newborn only needs small amounts in the first day or two. .

Antenatal expressing can be safely done from 36 weeks of pregnancy unless you have risk factors which for premature labour. You might find it useful to talk to your community midwife or the infant feeding team, who can provide you with guidance on how to get started and what equipment you need.

Why might it be useful to express colostrum while pregnant?

There are many reasons why expressing colostrum before your baby’s birth in pregnancy can be useful. Research has shown that when pregnant women and people, or others preparing to lactate do express milk antenatally they:

• Gain more understanding about how the body prepares for nourishing a newborn baby
• Have increased confidence with establishing feeding Have increased confidence in the skill of hand expressing, which is a useful tool for infant feeding

Whilst hand expressing is a great skill to learn for many expectant parents, it is particularly useful for those who have been told that their baby is at an increased risk of having a low blood sugar in the first few hours after birth or that there may be a feeding difficulty. Reasons for this could include:

• Diabetes in pregnancy (pre-existing and gestational)
• Taking beta blocker medication, e.g. Labetalol or Bisoprolol
• Babies who are known in pregnancy to need care on the neonatal unit after birth
• Babies who are known in pregnancy to be small or “growth restricted"
• Babies who are known in pregnancy to have a cleft lip/palate or other congenital anomalies

Multiple births, e.g. twins, triplets. If these or similar reasons are identified during your pregnancy your midwife will be able to provide you with an expressing pack containing the equipment you need to express, if your pregnancy is low risk but you wish to express please ensure that you are using sterile syringes to collect any colostrum in.

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

If no risk factors for premature labour have been identified during your pregnancy, then there is no evidence that daily hand expression of colostrum can trigger labour.

However, if you have any of the following conditions, antenatal expressing is not advised:

• An increased chance of or history of premature labour
• A short cervix
• A cervical suture
• A multiple pregnancy before 36/40
• Any bleeding in pregnancy
• A low lying placenta

Your midwife will be able to advise if it is safe for you to express your colostrum in pregnancy or if it is not advised and the reasons why.

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

How do I hand expression?

Before you start

• Wash your hand thoroughly prior to expressing.
• Ensure that you have a sterile container for collecting colostrum; a sterile syringe may be the most appropriate due to the small amounts of colostrum expected.
• Many people find that a warm, private, relaxing environment helps to facilitate oxytocin release, the hormone needed to help release colostrum.
• Gently massage all around your breasts for a few minutes prior to expressing. Warm flannels or the warm water from a shower/bath beforehand can help.

Technique for hand expressing

• Position your thumb and fingers in a ‘C’ shape at the milk ducts.
• To locate the milk ducts, either starting as far back on the breast as comfortable or from the base of the nipple, gently ‘walk’ your thumb and fingers until you feel a difference in texture of the breast. This is usually about 2-3cm from the base of the nipple.
• To express, gently compress and release, compress and release and repeat until your colostrum begins to show. If you are finding that you are not getting any colostum you can you move your fingers forwards or backwards slightly to see if that makes a difference. To begin with colostrum will appear like little beads on the nipple.
• Avoid sliding your fingers over the skin as this can cause damage.
• Collect your beads of colostrum in a sterile syringe. You may find it easier for a partner to assist with this.
• Often you will find that you express just one or two drops at a time, this is really normal and will be great practice for after your baby arrives. Each drop of colostrum contains around 3 million antibodies.
• You can rotate the thumb and forefinger position to express the other areas in your breast.

Be reassured that colostrum does not ‘run out’. You will continue to produce colostrum until your milk ‘comes in’ (which is around day 3 after birth, but can differ from person to person).

If you do not get any colostrum, do not worry,not being able to express colostrum during pregnancy does not mean you won’t have milk after the birth. The hormonal changes at and after birth, mean your body will begin producing the right amount of milk for your baby. Remember that it is not necessary to express whilst you are pregnant. Be reassured that you will be able to express once your baby is born, and your midwife will ensure that you are taught to hand express before you are discharged home with your baby.

For further information on hand expressing, there is a picture guide in the Mothers and Others Guide on page 19, which will have been given to you by your community midwife. If you do not have a copy of this guide, please speak to your midwife.

It is a really useful skill to be able to hand express. This is something that you can continue to do after your baby is born, as you need or want to. It is important that antenatally only hand expressing is used, breast pumps should not be used during this period. If you require the use of a breast-pump in the postnatal period your midwife will provide assistance with this.

Storage of antenatal colostrum

If you chose to store the colostrum you have expressed, this needs to be labelled with your name, date of birth, the date and time that the colostrum was expressed. It should be stored in the freezer until you need it. Frozen colostrum needs to be used within 12 hours of complete thawing (and within 24 hours of taking out of the freezer) and should be stored in the fridge.

Expressed milk storage

The following table gives the storage guidelines for storing expressed milk, including colostrum. Please note that in hospital the recommendations for safe storage times are different to in the hospital as stated in the table below.

* If temperature rises above 4 degrees after 3 days, use within 6 hours or throw away.

• NEVER refreeze previously frozen breastmilk.
• Breastmilk can be used cold from the fridge, or can be warmed to body temperature by standing in a container of warm water for a few times.
• Do not us a microwave to warm breastmilk as this can cause 'hot spots' and affect the quality of the milk.

Once my baby is born

At birth when clinically appropriate, you and your baby will be offered uninterrupted skin-to-skin contact. We recommend that skin-to-skin contact lasts for:

• At least an hour,
• Until after the first feed,
• Or, for as long as you want to have skin-to-skin contact for.

If skin-to-skin is unable to be facilitated at birth, this will be supported as soon as clinically appropriate for you and your baby. Skin-to-skin contact is something you can do to help with feeding and bonding throughout the postnatal period.

Ideally your baby will breastfeed soon after birth and responsively at the breast, so that your expressed breastmilk may even remain unused!

Some babies may need to be fed to a specific time frame, in order to maintain their blood sugars. If certain risk factors have been identified in your pregnancy which mean your baby will be on such a feeding pathway, for example if you have diabetes, your community midwife will have discussed these with you in your antenatal appointments. Some babies may have feeding difficulties in the first few days whilst you establish feeding.

In both these circumstances you will be offered on-going support, and you may want to use some of your stored colostrum. Your midwife will be able to show you how to feed your colostrum to your baby and support you with establishing breastfeeding If your baby requires neonatal care and therefore may not be able to establish breastfeeding, your expressed colostrum/milk can be given during mouth care or via a nasogastric tube.

Contacts and further useful information

Rosie Infant Feeding Team

01223 596292 - please be aware this is a voicemail service for non-urgent queries and is monitored Monday-Friday 9am-5pm

Maternity Assessment Line

01223 217217 for urgent concerns during pregnancy

If you want to find out more information about getting infant feeding off to a good start, please book on to the Rosie Hospital’s infant feeding workshop

References / Sources of evidence

• NHS: Expressing and storing breast milk
• ABM: Antenatal expressing of colostrum