Expressing colostrum during pregnancy
I am often asked about expressing colostrum during pregnancy (AEC) - either because they have heard it is possible and would like to know more, or because they think it is necessary. Here is as much information as I can give you on AEC.
At 16 - 20 weeks your body starts producing colostrum, due to a hormone called 'prolactin' (pro = for; lact = milk; in = hormone).
Mother Nature was very clever in her design of us humans (despite what some people may tell you, we are not broken!) - during pregnancy, your baby has a 24/7 infusion of nutrients via the placenta - '24hr womb service' if you like ;) - but after they are born the placenta will be removed and they will need to take nutrition in another way.
Enter colostrum - a type of breastmilk that is usually quite thick, clear to yellow (although it can be other colours, including black and brown), and jam-packed full of proteins and oligosaccharides.
Click here to read an article on colostrum.
Some people may notice that they have colostrum as it may start leaking or they may be able to express a few drops. Many mothers who have been breastfeeding an older child when they get pregnant will continue throughout the pregnancy, may notice the change - either the child says that it tastes different or their behaviour at the breast changes. But if you do not notice it, it does not mean that it is not there.
I asked my Facebook followers to share photos of their expressed colostrum - if this was expressed antenatally or in the first 24-48hrs after birth it is quite a lot
I am not too sure when AEC became a 'thing', but I know we discussed it while I was doing my midwifery training in 2012. The study I talk about below started recruiting participants in 2011.
In June 2017 a randomised controlled trial was published on the safety of AEC - since breastfeeding releases oxytocin and oxytocin contracts the uterus during labour, there was a concern that AEC could cause preterm labour. The DAME study asked over 600 mothers who had gestational diabetes to start expressing colostrum BY HAND from 36 weeks* for 5 mins twice a day (intervention group) or not (control group).
The study found that there was no difference in what gestation the babies were born at in the 2 groups. There was also no difference in any adverse events between the 2 groups. In the intervention group, the average total amount expressed was 5mls - that is IN TOTAL, not per day or per session.
*36 weeks was the earliest the study could start from an ethical point of view - no ethics committee would approve a study that may risk mothers birthing earlier than 36 weeks, so we do not know the safety applies to earlier gestations. But keep in mind that many mothers continue to breastfeed older children through pregnancy. They also only looked at those with gestational diabetes as their babies are the most at risk for needing supplemental feeds after birth.
I asked my Facebook followers to share photos of their expressed colostrum - if this was expressed antenatally or in the first 24-48hrs after birth, it is quite a lot
Here are some other considerations:
Antenatal supply is no indication of postnatal supply - if you cannot express anything or very little, it does not mean you will not have a full supply after the baby is born.
There is only meant to be a small amount - drops is considered sufficient
There is a technique to hand expressing (it is not just squeezing the nipple) - click here for a very good video showing the technique
There has been no study on the safety of using a breast pump during pregnancy
The average total expressed, over the days or weeks of the intervention, was 5mls
Another common question is - why does it need to be done?
Often after birth, there can be a concern that the baby is not feeding well, they develop jaundice, or they lose too much weight on day 3. There are many reasons why these issues can happen, and explaining each one could probably be a separate article, but the main risks are - late preterm/early term birth (eg 35 - 38 weeks), intervention* during birth such as epidural, instrumental birth (vacuum or forceps), or emergency caesarean, having a baby that is born below the 10th percentile or above the 90th percentile for weight, or having gestational diabetes.
If these issues occur it might be suggested that the mother starts expressing her milk and feed it to the baby away from the breast (eg with a syringe). But due to the low volume of colostrum (which is perfectly normal), it may be difficult to express out and this may lead to formula being suggested.
*I am in no way saying that these interventions should not occur - but sometimes intervening in birth requires continued intervention to protect breastfeeding.
There has been some suggestion (via research) that giving a baby formula in the first 3 days of their life can increase their risk of developing a cow's milk protein intolerance or allergy later in infancy. Now, this isn't to say that they will definitely develop CMPI/A, it just increases the chances.
Therefore, some parents are quite keen to do what they can to avoid needing to give formula. This is where AEC comes in. If you have some colostrum stored up before the birth you can use it to supplement after the baby is born and increase the chances of either avoiding or delaying the need to give formula.
In regards to the question do you NEED to do it? The simple answer is no - you do not need to do anything that is suggested by a health professional or in a parenting group. If you have gestational diabetes or if you know that you are going to have an elective caesarean or be induced early (although there often is very little warning that this is going to happen), it may be strongly advised, but you still do not NEED to do it.
In a follow-up study to the DAME study mentioned above, mothers who expressed said that they felt more confident about expressing, even if they did not yield much volume, as they had practiced it during pregnancy.
It is important to know that there are some reasons why AEC cannot be done, such as a low-lying placenta. You should discuss AEC with your midwife or doctor first
Feeding the colostrum to the baby
Because it is such a small amount it might not be possible to use a bottle and teat to fed the baby with colostrum (and there is no rule that says that you have to use a bottle and teat if you cannot feed directly from the breast), so syringe or finger feeding will often be advised. Click here for an article on the alternative ways to feed a baby away from the breast
As an aside - one of the World Health Organisation's Ten Steps to Successful Breastfeeding is that mothers should be taught how to express their milk to maintain their supply in case they need to be separated from their baby. Unfortunately, in my experience, hand expressing is often not mentioned, as we rely on electric breast pumps. However, before the 'milk comes in' (which is not the correct terminology since colostrum is milk - it should be 'the milk increases') it may be difficutl to express with a breast pump due to the thickness of the colostrum. Again, here is a good video showing how to hand express. Practicing hand expressing can be a very useful skill - if you find yourself suddenly unable to feed directly it can be a very convenient and quick way to remove milk.
If you want to discuss AEC further, want to learn more about breastfeeding, or midwifery care during pregnancy or after birth, please contact me - 0405 427 998 or info@cherishedparenting.com.au
