Overview

We might advise you to hand express breast milk while you are still pregnant. If you express before birth, the milk you will produce is called colostrum.

Colostrum contains everything your baby needs in the first few days including proteins, fats and infection-fighting antibodies. It will help stabilise your baby’s blood glucose (sugar) levels, and help you develop breastfeeding skills that will benefit you and your baby.

You may have been asked to hand express before your baby is born if your baby has a medical condition or if you have diabetes.

This information should answer some of the questions you may have about hand expressing breast milk from 37 weeks of pregnancy. If you have any questions or concerns, please speak to your midwife or the infant feeding team.

Why you might need to hand express before your baby is born

It can take some time to learn how to hand express, so starting from 37 weeks helps you to learn skills before your baby arrives. Hand expressing might allow you to collect a small store of expressed colostrum ready to be given to your baby, and reduce the need for formula milk if your baby has a medical condition. However, we might advise for your baby to have other fluids or formula milk until there is an adequate supply of breast milk. If this happens, a member of staff will discuss your baby’s individual needs and gain consent from you.

If your baby has a medical condition

Your baby may have a medical condition which means they will need to be cared for in the neonatal unit at Evelina London Children’s Hospital. This means your baby may not be able to feed from you. They might be fed in a different way such as through a feeding tube or with medicated fluids. Knowing how to express confidently can help you to maintain your supply of breast milk while waiting for your baby to be ready to start feeding orally (using their mouth).

If you have existing or gestational diabetes

If you have pre-existing diabetes or gestational diabetes that developed in pregnancy, your baby may have some difficulties keeping their blood glucose at the right level.

It's important for your baby to feed soon after birth and at regular intervals, and colostrum can help stabilise your baby’s blood glucose,

We'll check your baby’s blood glucose level regularly. If it is lower than it should be, your baby might need an extra feed. As it can take some time to learn how to breastfeed, it's useful to have expressed breast milk to give them.

We have more information about low blood sugar (hypoglycaemia) and your baby.

General benefits of expressing your breast milk

Your breast milk is specifically produced for your own baby and it is readily available all the times you need it. It will protect your baby from many diseases early and later on in life. Research shows that breast milk reduces the chance of infections, diabetes, obesity and heart disease, and helps with brain development.  As well as helping your child's health, expressing and breast feeding will also help protect you from breast and ovarian cancer and osteoporosis.

The World Health Organisation (WHO) recommends that babies are exclusively breastfed for the first 6 months of their life. After 6 months babies should receive complementary food but you can still breastfeed until you and your baby decide to stop.

Hand expressing during your induction or labour may help to further stimulate your contractions.

How to hand express

Once you are 37 weeks pregnant you can start off by hand expressing twice a day and when you are happy increase up to 4 times a day.

Try to express from each breast at least twice per session. This helps to increase the amount of colostrum available to your baby.

We have step by step guidance to help you hand express.

Expressing colostrum

You begin to produce colostrum during pregnancy and the first few days after birth.

Colostrum is the thick and sticky base product of breast milk, and is produced in small quantities. We only expect you to produce very small amounts at a time, and this can mean less than a millimeter. A newborn baby’s stomach is as big as a marble so they will just need a few millimitres of colostrum to be full and content.

Its colour can range from almost see-through to yellow, but it’s not unusual to also produce green, pink or red colostrum. However, please contact the infant feeding team if you are concerned.

Collecting colostrum

Because you will be expressing a small amount of thick sticky colostrum, a syringe is usually the best way to collect it. Your midwife will give you a supply of syringes and bungs to seal liquid inside the syringe.

You can either take out the plunger and scoop the colostrum into the of the syringe, with a bung on the end to stop it escaping.

Or you can use the syringe to 'suck up' the drops of colostrum. Once you have expressed a few times you may find that you are producing more than the syringe can hold. If this is the case simply use a small sterile container with a lid. You can sterilise it using a home steriliser.

Collect and store every single drop of colostrum you have expressed. Let none of it go to waste.

It can take a few attempts to express any colostrum. Try not to get frustrated, this is very normal.

Storing colostrum

You can store it in the syringe or container you collected it in, as long as it is sterile at the beginning. You can add to the container throughout the day as long as your store it in the fridge in between. Start a new container each day (every 24 hours)

Label each bag or bottle with the date and time and freeze it. Colostrum can be stored in a freezer at a temperature of -18C for up to 6 months.

If you do not have access to a freezer straight away, colostrum can be stored:

• at room temperature for up to 6 hours
• in a fridge at a temperature of 5 to 10C for 3 days
• in a fridge at a temperature of 0 to 4C for 8 days

If you are uncertain of the temperature of your fridge, store the colostrum for up to 3 days.

Transporting colostrum to the hospital

Place the frozen colostrum in a cool bag with frozen packs to help keep the temperature cold.

Once you are in the hospital your milk can be put in the fridge or freezer, labelled with your name, time and date. If the milk is placed in the freezer it can be stored for 6 months.

• You will have 12 hours to use the milk once it is defrosted, as long as it is stored in the fridge.
• If you leave it at room temperature you will need to use it as soon as you can once it is defrosted.
• If you need to defrost it quickly you can place it under warm running water, and then use it immediately.

Your midwife will support you with storing your milk, as well as showing you how to give the colostrum to your baby.

If you cannot express colostrum

Not everyone is able to express any colostrum while they are pregnant. This usually means that the hormones that are maintaining your pregnancy are blocking the hormones that release your colostrum. This is completely normal and does not mean that you will have the same issues when you have had your baby. The main reason we encourage antenatal hand expressing is so that you become confident with the skill rather than having to learn it when you might be busy looking after your baby.

Very occasionally expressing can stimulate mild contractions. If these happen each time you express then you need to stop expressing and contact your midwife for further information.

More information

Please discuss any questions or concerns at your next antenatal appointment. If you do not think you can hand express your colostrum, do not worry. We will help you to do it once your baby is born if and when needed.

There are a series of videos on Global Health Media's website that can help with feeding your baby and hand expressing.