Hand expressing before birth ‘Colostrum harvesting’

Some women choose to hand express antenatally, to help them learn a new skill, with the added bonus of having some extra milk if they need it when their little one arrives. Many parents have found this extremely helpful and have found it gives them greater confidence in their body’s ability, while also being a benefit in the early postnatal period.  

Women I have supported have used their harvested colostrum for many reasons: if they have to be separated or their little one is unwell, to help flush out jaundice (colostrum is far better at this than formula), and if their little one is sleepy or a reluctant feeder. They don’t always use it in this way, colostrum is an amazing personalised medicine that can be used for many things. It can be used for skin rashes, sticky eyes or sore nipples and even as a bath tonic!  Colostrum contains growth factors and has special immunological properties as well as the perfect balance of micronutrients for your baby. It is designed to be highly concentrated and taken in tiny amounts because a newborn’s stomach is very small. In the breastfeeding world we refer to colostrum as “liquid gold”

Ideally, we prefer it if your baby doesn’t drink this liquid gold from a container in the early days, but takes it straight from the breast. It is, however, very satisfying to have some spare for a ‘just in case’ moment. Knowing how to hand express is also really useful when your ‘milk comes in’ especially if you become engorged and your breasts feel full and heavy. Babies latch much better to a soft breast.

For many years the NHS have been recommending this practice to diabetic women. If you have diabetes or gestational diabetes there is a chance that your baby will be more at risk of having low blood sugar, a condition called hypoglycaemia. Colostrum is great at helping to stabilise this and being able to offer the breast and pre-harvested colostrum can be really helpful. It is also recommended for parents expecting multiples, or babies known to have complications, like a cleft palate or lip, cardiac complications or IUGR (inter uterine growth restrictions). Parents with allergies and those that have had previous breast surgery may also find it beneficial.

Here is a study from 2017 that shows that all women with low risk pregnancies can safely harvest colostrum from 36 weeks.

This is only a suggestion, however, and it is not at all obligatory. If you don’t like the idea of doing so, you really don’t have to. If you do choose to, it’s always good to check with your midwife beforehand. It is not recommended if you’ve previously had a preterm baby, or are at risk of doing so or have placenta praevia.

There is a question mark over the extent to which hand-expressing might release oxytocin.  Oxytocin is the hormone of love, labour and lactation and when released it can stimulate the uterus. For this reason, some say that hand expressing should be avoided. However, it is debatable that it could trigger early labour. Sex is considered safe, for example, while pregnant and so is breastfeeding, and both are likely to produce more oxytocin. However, if you do experience any uterine cramping, you should stop and speak with your midwife.

Here is an article about how parents felt more confident and more able to exclusively breastfeed;

And one about how less likely supplementation was after hand expressing in diabetic women;

A pregnant person will begin to make colostrum from around 16 weeks into their pregnancy, colostrum doesn’t run out, so you needn’t be afraid that you will not have enough when your baby arrives. Colostrum becomes mature milk once your baby is born and you have released your placenta. It is also good to note that the amounts you will be able to harvest will likely be very small. Some find that they do not produce any at all before their baby arrives, and that this is not an indication of their milk making capacity. It is still a really good way to be able to connect with your body and gain confidence in how your breasts work, making it much easier for you when your little one is in your arms.

How to hand express:

Wait until you are at least 36 weeks into your pregnancy and you have had a conversation with your midwife before starting.

1. Find a time and place that you feel relaxed and comfortable. You may want to begin practicing in a warm bath, or play soothing music, light some candles or put some of your favourite essential oils into a burner. Think about the things that make you feel safe and secure, a little like you may think will be helpful during your birth.

2. Wash your hands.

3. Next do some light touch massage around your breasts and nipples, warming them and gently stroking all around the breast tissue. Light stroking motions, small circular movements and very soft kneading. It should be comfortable.

4. Then make a C- shape with your thumb and fingers and cup your breast with your fingers around 2-3 cm from the base of your nipple.

   Imagine your areola as a clock face and place your fingers at 6 o’clock and your thumb at 12 o clock, with the nipple in the middle (remember to still be 2-3cm away from the nipple)

5. Firmly squeeze your thumb and fingers together as if you are trying to get them to meet behind the nipple and areola (the dark circle around your nipple) You could also try pressing back towards your chest wall, then squeeze and release.

   Everyone has their own ‘sweet spot’ and you may like to experiment with moving your fingers a little further back or closer to your nipple. The pressure should be quite firm but it shouldn’t hurt.

   The first time you do this you may see a sparkle, like a piece of glitter, this may then turn into a pearl and progress over the coming days into a tear, before it begins to flow more.

6. You can continue to rhythmically compress and release moving your hands around the clock face, remembering to always have your fingers opposite each other with your nipple in the centre.

7. If you begin to have drops forming, you can collect them using the small syringe or alternatively into a sterilised egg cup or shot glass, before drawing them up in the syringe.

8. Try alternate breasts back and forth, building up to 20 mins 2-3 x a day

Equipment needed for harvesting

• Approximately 30 x 1ml syringes with cap like this; 

• Zip lock freezer bag and a sterilised Tupperware box to store in the fridge

• Sticky labels to write the time of expressing, your name and hospital number

• Everything you collect can then be stored in the syringe, labelled and placed in the Tupperware box. At the end of the day this should be placed in the zip lock bag and put in the freezer.

Please remember to label everything clearly and to have a cool bag ready with an ice block to transport it to the hospital if you are planning to have your baby there.

Here’s an excellent film showing how to hand express;

Further resources:

• https://breastfeeding.support/expressing-colostrum-antenatally/

• https://player.vimeo.com/video/65196007

• https://abm.me.uk/wp-content/uploads/ABM-antenatal-expressing.pdf

• https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/breastfeeding-resources/hand-expression-video/