Written by: Karen Miles, IBCLC
Clinically reviewed by: Laura Serke, RD, CSPCC, LD, IBCLC
The following article is part two in our series on the topic of antenatal hand expression. If you haven’t already read part one, click here for “Thinking of Adding Colostrum Collection to Your Prenatal To-Do List? Here’s What to Consider First.”
Want to learn more about the growing trend of prenatally expressing breast milk? Before you begin, get your obstetrician or midwife’s clearance to do so, as prenatal expression is not appropriate for all pregnancies. Once you have the green light from your provider, read these steps to collect milk prenatally and have it available at your delivery:
First, gather these supplies:
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Optional: a heating pad or a clean, warm wet washcloth to apply to the breasts for a few minutes prior to hand expression, to encourage milk flow. (Instead of or in addition to this, you could focus on light massage of the breasts – but not of the nipple – to encourage milk flow.)
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A clean spoon or a small cup (a medicine cup is a great size when collecting small amounts prenatally). If doing both hand expression and holding of the collection device by yourself at the same time feels awkward, consider involving your partner or a trusted support person in the process if you’d like. One of you can focus on hand expression, and the other can hold the spoon or cup underneath for collection.
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Oral syringes or vials (“colostrum collector”) with caps to store the milk. Institute of the Advancement of Breastfeeding & Lactation Education (IABLE) has a Antenatal Hand Expression tip sheet that recommends “Small syringes, approximately 1-3ml, to draw up the drops. The drops can be stored in the syringes.” Look for syringes at your local pharmacy, a medical supply store, or online using the search words “colostrum collector kit” or “colostrum collector”.
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Labels and a permanent marker. If you purchase a colostrum collector kit, then it will likely come with labels, too. If not, purchase some blank mailing labels. Attach to each syringe a label with these details written on it: your full name, your date of birth (for identification purposes if you take the colostrum to the hospital), and the date and time of milk collection for that syringe.
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A container such as a Ziplock freezer bag to store all the filled syringes or vials in.
Second, practice these steps to antenatal hand expression:
Read the steps to prenatal hand expression here:
IABLE Antenatal Hand Expression tip sheet: IABLE: Antenatal Hand Expression
Remember also, washing hands first is always important as you are preparing food for your baby. So before hand expressing each time, wash hands well with soap and water. Or if soap and water are not available, use alcohol-based hand sanitizer.
See pictures of the steps to hand expression on page two of this:
- The Centers for Disease Control and Prevention (CDC) Hand Expression tip sheet - English version: Hand-Expression-Handout-IYCF-E
- The CDC’s Hand Expression tip sheet - Spanish version: Extracción de leche a mano
Please note: Page one of both of these CDC tip sheets mentions a breast pump, but a breast pump should only be used postpartum, not prenatally. Keep in mind, also, that later postpartum you may find a larger cup or bowl to hand-express milk easier to use, versus using a smaller cup or spoon for the small amounts collected prenatally and in the first week postpartum. Otherwise, the essential steps to hand expression, as pictured on page two, are the same prenatally and postpartum.
Watch hand expression in action here:
- Droplet website: firstdroplets.com/downloads/ (click on #5: “Hand Expression” link). Then, select your preferred language for the video.
- Global Health Media website: How to Express Breastmilk - Video - Global Health Media Project
Please note: The above two videos appear to have postpartum women doing the hand expression, and are likely well beyond the colostrum period. Keep in mind that when postpartum, women typically experience more milk output than prenatally due to the milk-making hormones that kick into gear after delivering the placenta.
Third, check with your hospital/birthing center for accessibility to the milk:
My colleague Laura Serke, RD, CSPCC, LD, IBCLC, who works in a Level III NICU as a dietitian and lactation consultant, and who also works for Milkify Medical in client support, shared with me some words of wisdom for anyone thinking about packing their colostrum in their go bag:
“As more families arrive at hospitals or birthing centers with frozen colostrum they've collected during pregnancy, healthcare teams are adapting workflows around labeling, storage, and handling. Bringing previously collected colostrum is becoming more common, but parents should ask their birth facility about specific policies ahead of time.
If you plan to bring frozen colostrum to the hospital, transport it in an insulated cooler with frozen gel packs and as little empty space as possible. This is a great task for a support person. They can monitor the cooler during transport to ensure the colostrum remains frozen and coordinate with hospital staff upon arrival for proper storage and labelling of the milk. Knowing your hospital’s milk storage practices in advance can help avoid unnecessary stress during labor.”
Note: A great time to ask about all of this is during a prenatal tour of the hospital maternity unit, or birthing center, where you intend to deliver. Your obstetrician or midwife may also be familiar with the facility’s policies.
Gave it a try, but didn’t see much, if any, breast milk output for your time invested prenatally?
Remember: newborns have very small stomachs and need very little per feeding. So don’t sweat it. Your milk output (or lack thereof) now, prenatally, is not a predictor of your postpartum future.
A few words of caution for postpartum lactation life:
After your baby is born, don’t use prenatally stored colostrum as a substitute for frequent breastfeeding (and/or pumping). Frequent removal of milk is critical to maintaining a plentiful milk supply postpartum as your milk supply shifts from being primarily hormonally driven after the delivery of your placenta to primarily milk-removal driven (source).
Serke agrees: “Frequent breastfeeding, effective milk transfer, and skin-to-skin contact remain the foundation for establishing a milk supply after birth.”
Think of any milk you collect prenatally as a bonus that may come in handy, if your postpartum healthcare team recommends your baby receive a little supplementation with your own milk and if you don’t have enough milk pumped postpartum for a feeding or top-off.
Keep in mind these freezer storage guidelines for your precious colostrum collection:
Don’t squirrel away any prenatally expressed milk for too long! Sure, the CDC says that frozen breast milk can be stored six months (optimally) or up to a year maximum. However, since prenatally expressed milk is essentially colostrum, feeding it to your baby in the early days after birth is most ideal. Like colostrum, it has properties that can help your baby’s digestion, and give your sweet newborn an immune system boost.
Karen Miles is an International Board Certified Lactation Consultant (IBCLC) and Lactation Content Specialist with Milkify.
Laura Serke is a Registered Dietitian and an International Board Certified Lactation Consultant (IBCLC) with Milkify.
This article is for informational purposes only and is not intended to diagnose, treat, or be a substitute for medical advice. Please consult with your healthcare provider for any questions you may have related to your own health, or your baby’s health.
