Expressing colostrum before your baby arrives

For various reasons, some babies may require more fluids or nutrition in the early postnatal period than they can get directly from their mother. Your midwife or obstetrician could recommend antenatal expressing of colostrum, which will be frozen and used to feed your baby after birth, if required.

Let’s look at the benefits and the potential reasons you might be required to express colostrum whilst pregnant, whether it’s safe, and finally, the amount you would expect to express antenatally, according to the Australian Breastfeeding Association.

Expressing colostrum before your baby arrives

Antenatal expressing of colostrum is the hand expression and collection of colostrum during pregnancy. You might not be aware, but from about the 16th week of pregnancy, a woman’s breasts begin to make colostrum.

The benefits of antenatal expressing

Australia’s National Health and Medical Research Council (NHMRC) and the World Health Organisation (WHO) recommends babies be exclusively breastfed for around the first six months of life, and then to continue breastfeeding alongside family foods for one year, or for as long as the mum and child would like to.

This also includes only receiving colostrum in the early days after birth. If there is a possibility that the baby will require more fluids/nutrition during this period than what she can provide herself, she might choose to be prepared with a supply of expressed colostrum rather giving her baby formula.

The potential reasons you might be required to express colostrum

Remember to discuss this first with your midwife or obstetrician before proceeding. You may be advised to express if you have:

• Diabetes. A baby born to a mother with diabetes during pregnancy is at risk of low blood sugar after birth. Receiving colostrum can help to stabilise a baby’s blood sugar levels.
• Conditions which may make it difficult for a baby to breastfeed well. Babies diagnosed via prenatal screening with cleft lip and/or palate, or a neurological or cardiac condition. If a baby is unable to breastfeed well, a mother will need to express to be able to feed her baby. Expressing antenatally would have given her the practice at pumping, and will ensure she has an extra supply on hand if necessary.
• A family history of cows’ milk protein sensitivity. A baby who is genetically predisposed to this condition is more at risk of developing it if they’re given cows’ milk-based formula.

Is it safe to express during pregnancy?

The results from a large study called the Diabetes and Antenatal Milk Expressing (DAME; read more here) showed that women with diabetes and a low-risk pregnancy can safely express breastmilk in late pregnancy without causing harm to their babies.

Antenatal expressing was not studied in, and may not be safe in, pregnancies with complications that can lead to uterine contractions. Complications can include (but are not limited to): a history of antepartum haemorrage or placenta praevia; previous classic, undocumented or multiple caesarean scars; any suspicion of fetal compromise or any abnormal tests of foetal wellbeing; or serious maternal, mental, medical, or obstretic issues.

How much can you expect to express antenatally?

There is a wide variation in the amount of colostrum different women express. The median amount mothers expressed in the study (mentioned above) was 5ml in total. There is no evidence to suggest that a woman who expresses a tiny amount of colostrum will go on to have a low milk supply, and the same goes for expressing larger amounts.

Apart from antenatal expressing, to further minimise the risk of early formula supplementation, you could create a breastfeeding plan to get breastfeeding off to the best possible start.