In perfect circumstances, colostrum (that yellowish, antibody-rich ‘first milk’ produced from the second trimester of pregnancy) should be every newborn’s first feed.
Often called baby’s ‘first immunisation’, colostrum aids in the activation of early immunological responses in the infant’s gut, promoting the development of normal gut flora and preventing the growth of harmful bacteria. It also increases peristalsis, helping your newborn pass meconium. This reduces the reabsorption of bilirubin and the potential to develop jaundice if bilirubin levels become elevated.
Unfortunately, though, there are a number of medical conditions and issues with either (or both) mother and baby that may mean infant formula is offered as a first feed. For example, babies of mothers with diabetes are particularly at risk of hypoglycaemia (low blood sugar) in the first few hours after birth, so although colostrum can be useful to help stabilise your baby’s blood sugar levels, the baby will often be given formula.
One way to see that your baby is less likely to be offered formula in this important newborn period is to express and store colostrum during the last weeks of pregnancy. It’s important to check and discuss this with your healthcare providers, and to write a post-birth plan so everyone caring for you knows your wishes – even before your baby is offered a first feed.
Fairly recently – in the 1960s and 70s – mothers were advised to express colostrum during late pregnancy, supposedly to unplug milk ducts and increase the production of colostrum. There was also evidence that women who expressed during pregnancy were more confident with breastfeeding after the birth.
Despite this, advice about antenatal expressing was abandoned, possibly due to concerns that nipple stimulation could cause early labor. But recent research – including a study of women who breastfed through pregnancy – shows that uterine contractions will only occur following the up-regulation of oxytocin binding sites in the uterus, when your body is ready to begin labor. This means that nipple stimulation won’t induce labor unless you’re already at term. However, if you have a history of premature labor, prenatal expressing may be contra-indicated; if any cramps do occur while you’re expressing, stop and discuss this with your health professional.
How to express colostrum
To start expressing, you’ll need 1ml and 3ml syringes, which can be bought from a pharmacy. You’ll also need plastic ziplock bags to store your syringes in the freezer
- Start hand expressing once daily at 36 weeks (unless otherwise advised by your health carer – for instance, if you’re being induced earlier for medical reasons, or if you’re in premature labor and are expected to birth your baby). You can build up to expressing two or three times a day.
- It’s best to express after your shower when your breasts are warm and your hands are clean. Otherwise, wash your hands and warm your breasts with a heat pack before expressing.
- Gently massage your breasts towards the nipple to stimulate the ‘let down’ reflex.
- Compress your breasts with your thumb and fingers above and below the areola (the dark skin around the nipple), pressing back towards the chest wall, not squeezing towards the nipple. Try to mimic the rhythm of a baby sucking - the action is ‘press, compress, release’. As the flow slows, move your fingers around to express different ducts.
- Express for about three to five minutes each side. As flow stops on one side, swap to the other breast. Repeat so each breast is expressed twice in a session.
- As colostrum drops appear, collect these in a syringe. If you have a good flow, you can express into a clean medicine glass or spoon (wash in hot soapy water, rinse and dry), then draw the colostrum up into a syringe.
- Store the expressed colostrum in the fridge between each expressing session if you’re using the same syringe next time.
- You can keep the expressed colostrum in the syringe If you’re using a new syringe each day. Storing syringes in a ziplock bag in the freezer, and label each one with your name and the date expressed. Colostrum can be stored in the freezer for three months, and in a deep freeze for up to six months.
- Stop expressing if cramps occur.
If you do express, remember to take the syringes with you when you go to hospital to have your baby, and make sure it gets put in a freezer nearby. Write a post-birth plan that includes uninterrupted skin to skin cuddles as soon after birth as possible; also include delayed weighing and delayed bathing, so baby keeps his amniotic smell longer (also don’t wash your own chest the first day, so your baby can follow this amniotic smell back to the breast more easily). Lastly, advise “Colostrum in freezer for baby if needed.”
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