Here's What to Consider First
Written by: Karen Miles, IBCLC
Clinically reviewed by: Laura Serke, RD, CSPCC, LD, IBCLC
The following article is part one in a two-part series on the topic of antenatal hand expression. To read part two, click here for “Equipment & Steps to Hand-Express Breast Milk While Pregnant”.
If you’re expecting, you may have seen some images of ambitious mothers on TikTok and YouTube with mounds of colostrum syringes stockpiled in their freezers – while still pregnant! “I am already behind” may be your next thought.
Don’t panic. Collecting breast milk prenatally, also known as “antenatal hand expression” or “colostrum harvesting,” isn’t recommended for everyone. The amount of colostrum produced prenatally is not typically a large volume, despite the images you may be seeing on social media. Prenatally, most people collect a very small amount of breast milk each time, and some may produce nothing at all while pregnant. The practice has its benefits and potential drawbacks. Let’s take a look.
What is colostrum harvesting (aka “antenatal hand expression”)?
Definition:
This funny term may sound like farming. In a way it is because it involves gathering and preparing food (breast milk), but in this case the hands are the tools. The practice involves an expectant parent collecting colostrum by hand expression of the milk, beginning a few weeks before the baby’s due date.
Purpose:
The main goal in doing so is preparation in case the baby needs a little supplementation beyond direct breastfeeding or postpartum-pumped milk. Some hospitals and birthing centers do not have donor breast milk from screened donors on hand if supplementation is needed, and even if they do, a mother’s own milk is always prioritized first.
Besides the assurance that a freezer with some prenatally-expressed colostrum can bring, learning how to hand express milk before delivery can help expectant parents feel more comfortable and confident hand-expressing breast milk postpartum. It’s one less thing to learn in the busyness of early postpartum life.
Why is antenatal hand expression often valuable, even if only a small amount of breast milk is produced during pregnancy?
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, likes to share with her patients, “A few milliliters of colostrum may seem insignificant, but it can provide a meaningful boost in nutrition for a newborn. Newborn stomach capacity is measured in teaspoons, not ounces.” After more than 15 years of working with newborns, Serke has learned, “Feeding plans rarely unfold exactly as expected. Having a small amount of colostrum available can provide flexibility during those first hours and days while feeding is being established.”
If someone already owns a breast pump with all the bells and whistles, why bother with hand expression while pregnant?
First, hand expression is a lot more gentle on prenatal breast tissue (and less vigorous) than pumping. Second, hand expression is typically easier to draw out small amounts of thick colostrum. Third and most importantly, a rise in the hormone oxytocin caused by nipple stimulation during pumping could stimulate the uterus too much – resulting in possible labor contractions. Hand expression can also simulate the uterus, but with stable pregnancies is generally less of a concern. So definitely hold off on any breast pump use until after delivery!
Are there any safety precautions for antenatal hand expression?
Depending on which medical journal or medical website you are reading, advice is variable for how early to think about starting to collect colostrum prenatally. But in general, most healthcare providers advise collecting milk no earlier than 36 or 37 weeks gestation. Earlier than that could increase the risk of spurring on premature labor.
Serke shares that antenatal expression should not be done during any pregnancy where there are “contraindications to labor” or where there exists “any condition where spontaneous labor would be undesirable.” (“Contraindications” being a fancy term for any factors that make something medically inadvisable and potentially harmful.)
So be sure to check with your obstetrician or midwife for clearance before giving prenatal hand expression a go. And if your provider gives you the green light, ask for more specifics:
- how many times per day to hand express and
- how long each hand expression session should be.
Serke says when it comes to prenatal hand expression of milk, most providers recommend “one to two times a day, and up to five minutes per breast” to those who qualify for it. This allows parents before delivery to get comfortable with and accustomed to the sensation of hand expression, as well as placement of the hands and collection container.
Who is often advised to prenatally hand express milk, and why?
Certain maternal and infant conditions are associated with an increased risk of feeding or milk production difficulties after birth. In such instances, it is particularly important to discuss with the healthcare team during pregnancy the topics of antenatal hand expression and lactation support.
Let’s explore some of these scenarios:
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Mother with diabetes: The Academy of Breastfeeding Medicine’s prenatal protocol notes that prenatal women at 36+ weeks gestation with a history of diabetes, or with current gestational diabetes, may find colostrum harvesting helpful. That way some colostrum is on hand if the baby is hypoglycemic (with low blood sugar) and needs a little supplementation to correct blood sugar levels.
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Past milk production challenges for the parent: If you had trouble with milk production for a past child, a backup stash of liquid gold for the early days postpartum could put your mind at ease. But try to stay optimistic. Every baby and every breastfeeding journey is unique; this journey may be smooth sailing compared to the last. In fact, after experiencing one lactation journey, research shows breast milk output and breast milk transfer could come easier with subsequent babies.
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Certain health conditions for the mother: Do you have a specific health condition (such as preeclampsia) or an anatomical feature (such as a prior breast surgery) that could potentially affect milk production? In such situations, colostrum harvesting could help you feel more equipped postpartum to meet your baby’s feeding needs. Similarly, if your baby has a health diagnosis such as a cleft palate that could impact breastfeeding once born, some colostrum already in the freezer could help you breathe easier as you both adapt to any potential breastfeeding challenges in the early days postpartum.
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Certain health conditions for the baby that could impact feeding, such as Down syndrome or cleft lip and/or palate: Babies with low muscle tone, such as those diagnosed with Down syndrome, may struggle to coordinate suck and swallowing. However, lactation support postpartum may make breastfeeding possible at least partially if not more fully. On the other hand, babies born with a cleft lip or palate may have difficulty making the suction required to breastfeed well or may tire quickly, resulting in long feedings at the breast/chest, but lactation support can also help in such scenarios. In both instances, expressing some milk prenatally might be recommended by the healthcare team, depending on the health of the expectant mother and baby.
- Any parent, with healthcare provider consent: Colostrum in the freezer can bring peace of mind and may prove useful for a variety of reasons. According to the Institute of the Advancement of Breastfeeding & Lactation Education’s (IABLE’s) Antenatal Hand Expression tip sheet, “Premature babies and babies that are very small or very large are also at risk of having low blood sugar in the hours after birth.” (Not just babies of mothers with diabetes.) Colostrum harvested prenatally can then be used instead of formula for supplementation postpartum, if needed.
Why is knowing how to hand-express breast milk a handy tool to have in a postpartum tool belt?
By learning the steps to hand expression of breast milk while pregnant (with or without actually hand expressing prenatally), you will feel more assured of yourself and free up brain space for all the other things you need to learn about postpartum. Plus, knowing how to hand-express milk postpartum can help set yourself up for breastfeeding success in two ways:
1. Postpartum hand expression can help with early postpartum engorgement, and latching during engorgement.
If you are feeling engorged when the “milk fairy” comes to visit a few days postpartum, magically upping your milk volume, knowing how to hand express a little milk can bring some welcome relief to your feelings of fullness, make your areola area (the area around the nipple) less taut, and latching your baby easier.
2. Postpartum hand expression may boost milk production.
One theory of milk production is that the first few weeks immediate postpartum are key for laying down prolactin receptor sites, which the hormone prolactin (the milk production hormone) binds to. The more you express milk in the first few weeks postpartum – either by feeding the baby at the breast, by hand expressing milk, or by pumping it (or all three), the more prolactin receptor sites you may be laying down which could give you an edge on milk production longer term.
And during both early and later postpartum life, if you want or need to boost your milk output, Dr. Jane Morton’s video, “Electric Pump and Hands-On Pumping,” recommends adding a little hand expression immediately after pumping to further empty the breast. This sends a signal to the body to make even more milk.
Still on the fence about whether or not to hand-express milk while pregnant?
Check with your obstetrician or midwife, who are most acquainted with you and your baby’s health history, for guidance on whether antenatal hand expression is right for you.
Interested in learning more on this topic?
Stay tuned for part two in our antenatal hand expression series,
entitled “Equipment & Steps to Hand-Express Breast Milk While Pregnant”.
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.
