Antenatal expression of colostrum

Antenatal expressing of colostrum is the hand expression and collection of colostrum during pregnancy. Expressed colostrum is collected and frozen and used to feed a baby after birth, if required.

Colostrum

From about the 16th week of pregnancy, a mother’s breasts begin to make colostrum. Australia’s National Health and Medical Research Council (NHMRC) recommends babies be exclusively breastfed (that is receive nothing but the mother’s breastmilk) for around the first 6 months of a baby’s life. This includes receiving only colostrum in the early days after birth. The NHMRC then recommends breastfeeding continues alongside family foods for one year or for as long as the mother and child desire1.

Why express colostrum antenatally?

For various reasons, some babies may require more fluids/nutrition in the early postnatal period than they can get directly from the mother. If extra breastmilk (from the mother or via a breastmilk bank) is not available, these babies may have to be given formula in the early postnatal period. If a mother is aware of this possibility during pregnancy, she may choose to express her colostrum antenatally. In this way, if her baby needs extra fluids/nutrition, he can be given her colostrum rather than anything else and exclusive breastfeeding can be achieved.

Potential reasons for the antenatal expression of colostrum include:

Before expressing colostrum antenatally it is important to discuss this with your midwife or obstetrician.

Some potential reasons for expressing colostrum antenatally include if a mother has:

  • Diabetes. A baby born to a mother who has diabetes during pregnancy is at risk of low blood sugar after birth. Receiving extra colostrum at this time can help a baby’s blood sugar level to stabilise.
  • Conditions which may make it hard for a baby to breastfeed well, at least in the early postnatal period. For example babies diagnosed antenatally with cleft lip and/or palate, or a neurological or cardiac condition. Babies with these conditions may not be able to breastfeed well and so a mother will need to express her milk to be able to give it to her baby. Expressing colostrum antenatally can mean she has extra on hand if needed. It also gives her practice at expressing before her baby is born.
  • A family history of cows’ milk protein sensitivity. A genetically predisposed baby who receives formula in the early postnatal period may have an increased risk of developing this condition2.

The DAME study

A large randomised, controlled trial, the DAME (Diabetes and Antenatal Milk Expressing)

study was done to find out whether it was safe to advise women with diabetes in pregnancy to express breastmilk in late pregnancy. The study results showed that women with diabetes and a low-risk pregnancy can safely express breastmilk in late pregnancy without causing harm to their babies3.

Antenatal expressing was not studied in, and may not be safe in, pregnancies with complications that may lead to uterine contractions: including (but not limited to): a history of antepartum haemorrage or placenta praevia, previous classic, undocumented or multiple caesarean scars, any suspicion of fetal compromise or any abnormal tests of foetal wellbeing or serious maternal, mental, obstetric or medical issues.

In the DAME study, pregnant women were taught how to hand express colostrum and encouraged to express twice daily, for no more than 10 minutes, from 36 weeks until being admitted to hospital to give birth. They stopped expressing colostrum if there was excessive uterine activity, vaginal blood loss, decreased fetal movements or signs of hypoglycaemia.

In the DAME study, the median* number of times women expressed before birth was 20 times and the median amount of colostrum expressed was 5 mL total. Some women were unable to express any colostrum.

*The median is the middle number in a set of numbers — half the numbers lie above it and half below it.

The DAME study showed that for women having their first baby, there was an increased chance that their babies would be exclusively breastmilk fed in the first 24 hours of life, if expressed colostrum was available. This increased chance was not seen in women having a subsequent baby.

Also, having expressed colostrum antenatally, tended to increase the chance of babies being exclusively breastmilk fed until discharge from hospital, but the result was not statistically significant.

The DAME study showed that women with diabetes and a low risk pregnancy can safely express breastmilk in late pregnancy without causing harm to their babies and, for some first-time mothers, their babies will be less likely to receive formula in the first 24 hours of life.

Nonetheless, if you are considering expressing colostrum antenatally discuss this with your obstetrician or midwife.

There is wide variation in the amount of colostrum different women express antenatally

It is important to be aware that there is wide variation in amount of colostrum different women can express antenatally. There’s no evidence to suggest that a woman who can express a tiny amount of colostrum antenatally is at risk of low milk supply, or vice versa. The median amount of colostrum mother’s expressed in the DAME study was 5 mL in total.

Apart from expressing colostrum antenatally, there is still a lot women can do to minimise the risk of early formula supplementation and get breastfeeding off to the best start possible. See ABA’s ‘My breastfeeding plan’ article for more information.

For further information about the storage of your expressed colostrum see:

expressing and storing breastmilk

Breastfeeding: expressing and storing breastmilk booklet

Breastfeeding: Expressing and Storing Breastmilk covers all aspects of expressing and storage of breastmilk including hand/pump expressing, when to hire/buy a pump, long term milk expression, and correct storage and handling of breastmilk.

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To see a video of a mother expressing colostrum see:

References:

1. National Health and Medical Research Council 2012, Infant feeding guidelines: Summary. Canberra, ACT: National Health and Medical Research Council.

2. Cox SG 2006, Expressing and storing colostrum antenatally for use in the newborn period. Breastfeeding Review 14(3): 11–16.

3. Forster DA, Moorhead AM, Jacobs SE, Davis PG, Walker SP, McEgan KM, Opie GF, Donath SM, Gold L, McNamara C, Aylward A, Ford R, Amir LH 2017, Advising women with diabetes in pregnancy to express breastmilk in late pregnancy (Diabetes and Antenatal Milk Expressing [DAME]): a multicentre, unblinded, randomised controlled trial. The Lancet, 389(10085): 2204-2213.

© Australian Breastfeeding Association June 2017

 The information on this website does not replace advice from your health care providers.

 

Last reviewed: 
Jun 2017