Antenatal Colostrum Expression (ACE) involves gently hand-expressing and collecting colostrum, the early milk, in the final weeks of pregnancy. This practice prepares for potential feeding challenges after birth by creating a ready supply of this nutrient-dense substance. Although ACE is generally considered safe for most people, it requires a careful discussion with your obstetrician or midwife before you begin. The decision to express colostrum while pregnant must be personalized, based on your medical history and the specific circumstances of your pregnancy.
Medical Screening and Safety Concerns
The primary safety concern with expressing colostrum before birth relates to stimulating uterine contractions. Nipple stimulation naturally causes the release of oxytocin, the hormone responsible for triggering labor. Since a surge in oxytocin can cause the uterus to contract, healthcare providers must screen for factors that could increase the risk of preterm labor.
Antenatal expression is contraindicated if you have:
- A history of preterm labor.
- A diagnosed short cervix or a cervical suture in place.
- Recent vaginal bleeding during the second or third trimester.
- A condition like placenta previa.
Those carrying multiples are also often advised against this practice due to the potential for earlier delivery, unless directed otherwise by a specialist.
For those without these risk factors, expression should only begin once 36 to 37 weeks of gestation is reached. This timing ensures the pregnancy is considered full-term or late-term, significantly minimizing concern about stimulating premature birth. If you experience cramping, contractions, or bleeding while expressing, stop immediately and contact your healthcare provider.
Why Antenatal Expression is Recommended
Antenatal colostrum expression is recommended to ensure the newborn has an immediate supply of milk available. Colostrum is rich in antibodies, proteins, and growth factors, and it stabilizes a newborn’s blood sugar levels. A small frozen reserve can prevent the need for formula supplementation in the first hours or days of life.
ACE is commonly recommended if the mother has diabetes (gestational, Type 1, or Type 2). Babies born to mothers with diabetes are at a higher risk of experiencing hypoglycemia, or dangerously low blood sugar, shortly after birth. Providing expressed colostrum immediately helps manage glucose levels and avoids complications.
Expression is also suggested in several scenarios where initial feeding may be complicated:
- The baby has a diagnosed condition, such as a cleft lip or palate, Down Syndrome, or certain cardiac issues.
- A planned Cesarean section or other complication makes a short separation or a Neonatal Intensive Care Unit (NICU) stay likely.
- The parent has flat or inverted nipples, or a history of low milk supply in a previous pregnancy, and needs to practice the technique.
Practical Guidance for Expression and Storage
Hand expression is the preferred method for collecting colostrum during pregnancy, rather than using a mechanical pump. Colostrum is thick and produced in very small volumes, making it difficult for a mechanical pump to collect effectively. Pump parts can also absorb the small amount collected, resulting in unnecessary waste.
Expression Technique
To begin, be relaxed and warm, perhaps expressing after a shower or bath, and wash your hands thoroughly. Place your thumb and index finger in a C-shape around the areola, a few centimeters back from the nipple base. Gently press straight back toward the chest wall, then compress the tissue behind the nipple and roll your fingers forward, avoiding any sliding motion on the skin.
Timing and Collection
Aim to express for short sessions, starting with 3 to 5 minutes per breast, two or three times each day. As your technique improves, you can increase the duration to up to 10 minutes per session. The small drops of colostrum should be collected directly into a sterile, small-volume syringe (typically 1 to 5 milliliters), which your healthcare provider may supply.
Storage Guidelines
Colostrum collected within a 24-hour period can be combined into the same syringe, storing it in the refrigerator between expressions. Before freezing, the syringe must be carefully labeled with the date and time of the first expression. Frozen colostrum can be stored for up to six months and should be transported to the hospital in a clearly labeled bag with an ice pack.