Colostrum harvesting in the antenatal period 

What is antenatal hand expressing? 

Antenatal hand expressing is when you gently massage and compress the breast tissue in order to collect your colostrum (first milk) during your pregnancy. 

Colostrum is rich in nutrients and antibodies, it helps kick start your baby’s immune system and helps get feeding off to a good start. You start to produce this in pregnancy and for the first few days after birth before the mature milk comes in. 

Why hand express before birth? 

Learning the skill  of hand expressing before your baby arrives can help build your confidence in the technique. Perhaps you aren’t sure about how you want your breastfeeding journey to be.  Any amount of colostrum that you offer can be beneficial to your baby’s short term and long term health outcomes. 

It may be suggested that you antenatally hand express if 

-you have diabetes (pre existing or gestational)

-you baby is expected to be born small 

-your baby needs extra support after birth, e.g. premature, unwell 

-your baby hasn’t established feeds

When can I start? 

You can learn the skill of hand expressing at any point in pregnancy, but to begin expressing, it's encouraged to start from around 36/37 weeks. 

Is it safe to do so? 

There is a theory that hand expressing may cause uterine contractions. While this is unlikely to happen if you are low risk and your placenta is functioning, it is not recommended if you have a history of threatened pre term labour or issues with your placenta. Individual cases should be discussed with your health care professional. 

Technique- 

Preparation
-Get comfy. Preferably in a warm, quiet room where you can relax undisturbed. Place the container within easy reach.

-You will feel more comfortable if your hands are warm. You may want to warm the breast with a warm cloth. 

-Start to massage your breast, just gentle strokes. You can also roll your nipple between your thumb and finger. 

Finding the right spot

-Make a ‘C’ shape with your thumb and index finger. You will want to use this hand shape to compress the breast. 

-With your other hand, use 2 fingers to measure from the base of the nipple. Your finger will sit 2-3cm from the nipple, keep your fingers in position. This is where your milk ducts are found.

-Above the edge of the finger furthest away from the nipple is where you will press place your ‘C’ shape hand. Place the C shaped hand above and below the fingers before removing them. 

-Your finger and thumb should be opposite each other – if you imagine that your breast is a clock, your thumb would be at 12 o'clock and your finger at 6 o'clock
Expressing

-Gently press your thumb and fingers together, imagine you are making the pads of your finger and thumb meet at the centre of your breast tissue 

-Hold for a few seconds before releasing. 

-Continue to repeat the technique in one spot, be patient, as you get into a rhythm you may start to see colostrum appear. 

-When it’s no longer flowing, rotate your fingers around the breast until you have come full circle.
Key Tips

-Avoid Sliding: Don't slide fingers on skin. 

-Be Rhythmic: A press, compress, release rhythm mimics a baby's suckling. 

-Practice: It gets easier with practice; you may only see small drops. 

-Remember: Antenatal hand expression isn’t about just collecting the colostrum, it’s about learning the skill. 

How long should I do it for? How much shall I collect? 

Initially you can just start off for a few minutes. 

You can then continue to express until the colostrum stops flowing. There isn’t a specific amount that your baby needs. 

Caution: Stop if you feel any uterine tightening/contractions, vaginal bleeding, pain or discomfort. 

Collecting and storage- 

As the colostrum starts to flow, you want to collect it. When using a syringe, always draw the plunger down first to pull the colostrum towards the end, the slowly push up and down until the air gap reduces. When finished, always put the lid on before storing. 

You should then store it in the freezer and keep it frozen until it is needed. Do not place syringes under direct boiling water, this can affect the material of the syringes as well as the quality of your milk. Once you are sure you are going to use them, you can store them in the fridge. they must be used within 24 hours of being defrosted. If chilled in the fridge, warm up by rubbing the syringes in your hand or under a warm running (with lid on) until room temperature. Avoid warming any milk as this can damage the plastic material and will change the properties of your milk. For more information on on expressing and storage times, click the Breastfeeding Network link below. 

FAQ-

What if I don’t see any colostrum? 

It’s important to remember that your body starts to produce colostrum from about 16 weeks, unless you have a specific medical history, it’s unlikely that you won’t produce any colostrum. It just may not be flowing at the time you are trying, and that’s ok! It’s not about collecting as much as possible, the main thing is learn the skill so that you are better equiped to stimulate your breasts post birth if needed. The amount of colostrum you produce doesn't reflect how much milk you are going to make. 

What if I don’t use the syringes immediately after birth? 

You can use them at any point in your feeding journey, just make sure you aren’t using this to necessarily replace feeds alone. 

What if I don’t use them in hospital? 

It’s hard to plan in advance when you might use the syringes, so make sure you freeze them as soon as you have collected the colostrum. When transporting them, keep them in a cooler/freezer bag and store again in the freezer as soon as possible. If this isn’t an option, avoid bringing them with you unless needed.