Liquid Gold and the Art of Hand Expressing Antenatally

 (November 2016c)

As a breastfeeding counsellor I am frequently asked about antenatal hand expressing from a gestation of 37 weeks, regarding both the rationale and technique.



Colostrum is the first milk produced and is present during pregnancy and until the mature milk comes through at around 2-3 days. Colostrum is particularly important in the protection of the newborn as it transitions from being inside the uterus in a sterile environment to being on the outside, exposed to the bacteria present in our environment. Colostrum is high in protein, carbohydrates, vitamins, bacteria- fighting leukocytes as well as a high concentration of the secretory immunoglobulin A (IGA) which acts as a sort of 100% organic vaccine, protecting the vulnerable membranes in the lungs and gastrointestinal system. Furthermore colostrum acts as an antibacterial paint, sealing off the naturally permeable newborn gut. Speaking of the gastrointestinal system, colostrum acts as a laxative to one of the newly birthed parents hazing rituals – meconium.

So it is fair to say that colostrum is a big deal and is the most effective way of stabilising a baby’s blood sugars after birth as he or she moves from a constant supply of energy from the placenta to maintaining their own levels. Some babies may have trouble making this transition:

• Babies of mothers with gestational or pre-existing diabetes
• Intrauterine growth restricted babies
• When mothers have received glucose in labour
• Babies of mothers with pre-eclampsia or pregnancy induced hypertension

For these babies it is even more important that they receive frequent colostrum which not only gives them the energy they need but stimulates an effective supply in the mother when fed directly from the breast or stimulated via hand expression. In mothers with uncontrolled diabetes whether pre-existing or gestational, babies are not only more likely to be born prematurely which brings further challenges, but they are more likely to have difficulties stabilising their blood sugars and suffer low blood glucose levels, known as hypoglycaemia. For this reason it is recommended in most UK Trusts that their blood glucose levels be monitored at various times in the first day and up to 37 hours of age.

So why antenatal hand expression of colostrum?

By having a pre-existing store of colostrum is invaluable for those times when the baby does not latch onto the breast for whatever reason. This may include:

• Separation of mother and baby either due to the mother requiring additional care or the baby needing a stay in SCBU or NICU
• Sleepy babies
• Difficulties with latching on
• Babies with cleft palate and/or cleft lip

So if there is any reason to suspect an increased risk of hypoglycaemia in the baby, by having a store of colostrum, even if difficulties present in latching the baby to the breast, colostrum can be given to the baby to protect against low blood glucose levels as well as passing on all the extremely important benefits outlined above.

It is recommended to hand express colostrum and only move to using a breast pump (manual or electric) once your mature milk has started to come through around day 2 to 3.

Hand Expressing
You will need:

• Small 1ml syringes (You can get these from your midwife or very cheaply online)
• Clean hands!

Begin by preparing the breasts by massaging them – this encourages oxytocin as well as starting to stimulate the breast. For best results do this for at least 5 minutes prior to starting. If you intend to hand express from both breasts then you can massage them both initially


Technique

• Make your thumb and forefinger into a C shape
• Support the breast with your other hand
• Place them on the breast just past the outer edge of the areola
• Gently pull back towards your rib cage
• Squeeze gently as you bring your fingers forwards again releasing the pressure as you come forward
• Repeat and gently build up a rhythm
• Don’t lose contact with the breast
• Don’t drag your fingers over the skin
• You will start to notice the end of the nipple produce very small amounts of colostrum
• As that builds to a ‘raindrop’ draw it up using the syringe
• Continue for about 10-15 minutes or until the flow stops whichever is sooner

You can store your colostrum in the syringes with a bung on it in the fridge for up to a week. You can also freeze it and it will keep for 6 months.

See below for a  variety of information sources about hand expressing and you may find it helpful to search on YouTube for demonstrations using the search terms “hand expressing colostrum”.

https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/video/hand-expression/

http://www.nhs.uk/conditions/pregnancy-and-baby/pages/expressing-storing-breast-milk.aspx

https://www.nct.org.uk/parenting/how-hand-express-breastmilk

www.lalecheleague.org

For more information about Gestational Diabetes see the following links:

https://www.rcog.org.uk/en/patients/patient-leaflets/gestational-diabetes/?gclid=CL3PkoLBsNACFcEy0wodMGMCKw

http://www.nhs.uk/conditions/gestational-diabetes/pages/introduction.aspx

https://www.diabetes.org.uk/gestational