Colostrum, the yellowish ‘first milk’ produced from the second trimester of pregnancy is an antibody rich immune booster and has often been called ‘baby’s first immunisation’. Colostrum helps to activate early immunological responses in your baby’s gut, promoting the development of normal gut flora and preventing the growth of harmful bacteria. It also increases peristalsis, helping the newborn to pass meconium. This reduces the reabsorption of bilirubin and the potential to develop jaundice if bilirubin levels become elevated.
In perfect circumstances, colostrum should be every newborn’s first feed, however there are medical conditions and issues for some mothers and babies that may mean infant formula is offered to newborns. For instance, babies of mothers with diabetes are particularly at risk of hypoglycaemia (low blood sugar) in the first few hours after birth so although colostrum can be useful in this period to stabilize your baby’s blood sugar levels, these babies are often given formula.
One way to see that your baby is less likely to be offered formula in this important newborn period, is to express and store colostrum during the last weeks of pregnancy. Discuss this with your health- care providers and write a post birth plan (see below) so that everyone caring for you knows your wishes – before your baby is offered formula as his first feed.
In the sixties and seventies – mothers were advised to express colostrum during late pregnancy, supposedly to unplug milk ducts and increase the production of colostrum. There was also evidence that women who expressed during pregnancy were more confident with breastfeeding but despite this, advice about antenatal expressing was abandoned, possibly due to concerns that nipple stimulation could cause early labor. However, recent studies including a study of women who breastfed through pregnancy( Moscone and Moore 1993), show that uterine contractions will only occur following the up-regulation of oxytocin binding sites in the uterus, when your body is ready to begin labor. This means that nipple stimulation won’t induce labor unless you are at term. However, if you have a history of premature labor, prenatal expressing may be contra-indicated and if any cramps do occur while you are expressing colostrum, stop and discuss this with your health professional.
To express colostrum:
- You will need – 1 and 3ml syringes ( from a pharmacy) and plastic ziplock bags to store your syringes in the freezer
- Start hand expressing once daily at 36 weeks (unless otherwise advised by your health carer. For instance if you are being induced earlier for medical reasons or if you are in premature labor and are expected to birth your baby). You can build up to expressing 2 to 3 times a day.
- It’s best to express after your shower when your breasts are warm and your hands are clean. Otherwise wash your hands and warm your breasts with a heat pack before expressing.
- Gently massage your breasts towards the nipple to stimulate the ‘let down’ reflex.
- Compress your breasts with thumb and fingers above and below the areola (the dark skin around the nipple), pressing back towards the chest wall, not squeezing towards the nipple. Try to mimic the rhythm of a baby sucking – the action is ‘press, compress, release’. As the flow slows, move your fingers around to express different ducts.
- Express for about 3 to 5 minutes each side – as flow stops on one side, swap to the other breast, repeat so each breast is expressed twice in a session.
- As colostrum drops appear, collect these in a syringe. If you have a good flow, you can express into a clean medicine glass or spoon (wash in hot soapy water, rinse and dry) and draw the colostrum up into a syringe. Store the expressed colostrum in the fridge between each expressing if you are using the same syringe next time.
- Use a new syringe each day, store syringes in a ziplock bag in the freezer and label with your name and the date. Colostrum can be stored in the freezer for 3 months and in a deep freeze for up to 6 months.
- Stop expressing if cramps occur
Most importantly, write a post birth plan that includes uninterrupted skin to skin cuddles as soon after birth as possible, delayed weighing, delayed bathing so baby keeps his amniotic smell longer (and don’t wash your own chest the first day so baby follows this amniotic smell back to the breast and latches more easily), and advise (pop a notice on your baby’s cot if he is in a nursery) “Colostrum in freezer for baby if needed.”
Liz’s story of expressing colostrum to nourish her newborn
In preparation for the birth of our son a year ago I hand expressed from 32 weeks gestation. When we went into hospital I took in the expressed 150 mls. This was lucky as he weighed 4.6 kilograms and had low blood glucose levels. He breast fed and then needed top ups. Instead of giving him formula the staff were able to give him my expressed breast milk. I wanted the best for him and if I hadnt had enough expressed breast milk formula would have had to bridge the gap. I was told by one of the staff that they would have to give him formula as they were getting low in my milk and his blood glucose levels were borderline. I was a little worried and expressed a few mls and then tried on him on the breast. He breast fed really well from both sides and continued to do so and has not stopped breast feeding since. He’s been a real champion and I am so proud of him.
When I’m holding my baby boy in my arms I feel so content and in love and love the hormonal changes that occur. It’s such a lovely content feeling. I love it when we look at each other when he’s feeding and he smiles. Pure bliss.
Liz is a fan of Boobie Bikkies too!
I love breast feeding my little boy. At Christmas time we went to see my husband’s family which is a little stressful. I was worried about the effect of the stress on my supply. I purchased a box of Boobie Bikkies and took them with me and they worked perfectly. I was so thrilled as was my son.
Liz Volker lives in ACT, Australia
805 comments
Stefanie
Pinky,
There is currently a trial called the DAME trial being conducted in Melbourne at all 3 tertiary maternity hospitals, as well as 3 level 2 hospitals investigating this exact practice. At this stage, this practice is not routinely being advised to women as there is no evidence to support it as a safe practice for diabetic mothers. The randomised controlled trial has a number of safety mechanisms in place, including frequent CTG monitoring. This large study will look at any adverse and positive maternal and neonatal outcomes extensively. It is the first trial in the world looking at this practice, and while you are quite correct that it is something that has been advised to women in the past as it has obvious benefits, its safety has never been established. As such, I believe it would be unwise to recommend this practice until the results of this trial are released.
Stefanie
Research midwife
http://www.latrobe.edu.au/jlc/research/breastfeeding/dame
Liz
I’m interested to know if this trial has been completed and what the results were?
Belinda
The DAME newsletter mentions that the results of the trial by mid-2016 and will be publishing the results as soon as possible after that.
Anon
It’s now early 2016 and I see that Stephanie’s comment about the DAME trial was made in late 2014. The trial’s still ongoing. I’m a pregnant diabetic woman attending RWH in Melbourne, and I find the situation confusing – before the trial was begun, women were sometimes advised to express colostrum; once it is completed and if safety is established, maybe we will be advised to do so again, but in the meantime we are being explicitly advised NOT to do so! We are not just being told that there’s no evidence either way yet – we’re being told not to do it.
It doesn’t seem that expressing is any more dangerous than it was before, so I find this confusing and somewhat frustrating. Perhaps there is already known evidence _against_ expressing, but if so I don’t know, because doctors no longer feel free to discuss it due to DAME. When I ask about expressing colostrum at the hospital, doctors and midwives look uncomfortable, say “we don’t advise that at this hospital” and move on, and I think it’s because there has been an official policy made that they are not to recommend this in any way until the trial is complete.
I feel, unfortunately, that because my pregnancy happened to occur during the DAME trial rather than before or after it, that I’ve been caught in some political crossfire and am being denied information as a result. I would much prefer it if, until the trial results were in, doctors were free to give me their honest clinical opinion and if I could hear both currently known pros and cons rather than silence.
Danielle
I wish I had found this before my beautiful girl was born in April.
I tried for three weeks to contact the lactation consultant at the hospital where I delivered, I had diabetes and was trying to avoid formula.
Needless to say we didn’t avoid formula and that set up the cascade to failed breast feeding.
Lyndal
Thanks for the info, I have just started expressing today and collected 4.5mls in my first attempt. I have diabetes and baby is expected to be 4.2kg at 36 weeks so. I’m being induced in 2 days and want to collect as much Colostrum as I can before baby arrives.
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Mum of two (soon to be three) boys
I hand expressed for my second child from 32 weeks. I went into hospital with about 150 ml and it was great – My 3.8 kg baby was satisfied after each breast feed with the top ups. I felt like a champion even though i didn’t breast feed past the four week mark.
My little boy has hardly been sick with colds – he is now 18 months old. His older brother, who did not get colostrum, was not breast fed past three weeks, is more susceptible to tonsillitis and longer bouts of colds and flu. He is now 3 years old. If my older boy is sick, my younger boy doesn’t necessarily catch the same thing, or if he does will only have it for a day. They share a bedroom, toys, occasionally drinks when I can’t get to my younger boy quick enough.
I am pregnant with my third, and have started hand expressing this week. I have had no complications with any of my pregnancies, (although i did have a terrible delivery with my first, and now require cesareans) nor did I mention my expressing to my OB’s. When i went into hospital with my expressed colostrum with my second, the nurse was shocked at how much I had with me and thought it was great. My husband stayed overnights with us and he was able to be involved in the top ups, heating it up and gently feeding the milk to our boy.
Because he was a cesarean baby, it was nice to know I had some control around feeding my boy, in case surgery interrupted my milk (I had surgery to stop hemorrhaging after my first son, which I think impacted my milk as I lost 1.5lt of blood and was in recovery for longer than my planned cesarean, so lots of separation despite being ‘natural’ delivery).
My medically indicated cesareans are out of my control, but the feeding and attempted breast feeding I could control. We had a very calm, sleepy baby who was well fed while we waited for my milk to come in. I wish mothers could get an answer soon on if this practice is right for them, especially first time mums and those with diabetes as mentioned in the posts above.
I see my OB this week so I might find out his thoughts on it, and post back again after discussing with him!
All the best to expecting mums and thanks for the information on this page – was handy to refer back to it again 🙂
Doreen
We advocate expressing for diabetic women from 36 weeks at our hospital – Cairns, Qld
Jenna
hv
Jenna
I have just had my midwife teach me how to hand express and I am 36 weeks today. My impression is that it is a common practice here in Canberra. I am from Scotland and there it is certainly not recommended by midwives/hospital, or at least it wasn’t 3 years ago.
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