Antenatal expression, or colostrum harvesting, is the practice of gently hand-expressing colostrum, the initial form of breast milk, during the final weeks of pregnancy. This involves collecting the thick, yellowish fluid and storing it for the newborn. Although the body begins colostrum production around the 16th week, expression is typically reserved for late-term gestation. This practice is often recommended by healthcare providers for specific medical needs or embraced by parents seeking a ready supply of the nutrient-dense fluid.
The Value of Antenatal Colostrum
Colostrum is often called “liquid gold” due to its highly concentrated nutritional and immunological composition, perfectly tailored for the newborn. Unlike mature milk, colostrum is low in fat and sugar but high in proteins, antibodies, and white blood cells that help establish the baby’s immune system. This “first milk” is rich in secretory immunoglobulin A (IgA), which coats the lining of the baby’s immature digestive tract, offering protection against bacteria and viruses.
Having a supply banked before birth is beneficial if the baby faces immediate challenges. Infants whose mothers have diabetes, for instance, are at risk of neonatal hypoglycemia (unstable blood sugar levels). Administering harvested colostrum provides a natural source of glucose and nutrients to stabilize blood sugar, potentially reducing the need for formula or intravenous fluids.
A pre-collected supply is also invaluable if the newborn is premature, separated from the mother, or has a condition like a cleft palate that complicates immediate latching and feeding. Colostrum acts as a natural laxative, helping the baby pass meconium, the first tarry stool, which reduces the risk of jaundice. The concentrated nature of colostrum means that even small amounts collected provide substantial benefit in the first days of life.
The practice also empowers parents by teaching hand expression and providing a backup plan, which can increase confidence in establishing successful feeding after birth, especially if there are unexpected delays in mature milk production.
When to Start and Medical Precautions
The primary safety concern is the potential to stimulate uterine contractions and induce premature labor. Nipple stimulation releases oxytocin, the hormone responsible for the milk let-down reflex, which also triggers contractions in the uterus. Therefore, the timing of when to begin expression requires careful medical consideration.
Most healthcare providers advise waiting until approximately 36 to 37 weeks of gestation. Starting at this late stage minimizes the risk of inadvertently triggering labor, as the pregnancy is nearing full term. Consulting with a doctor or midwife before beginning is necessary, as they can assess individual risk factors.
Expression should never be attempted earlier than the recommended window without explicit medical guidance, particularly in high-risk pregnancies.
Contraindications
Antenatal expression may be contraindicated if the mother has:
- A history of preterm labor.
- Bleeding during the current pregnancy.
- Placenta previa.
- A diagnosed short cervix.
Any individual who begins expressing must immediately stop if they experience cramping, pain, or signs of uterine contractions, and contact their healthcare provider. For low-risk pregnancies, studies have shown that expressing colostrum in late pregnancy is safe and does not increase the risk of harm to the baby.
Step-by-Step Guide for Collection and Storage
Once medical clearance is given, manual expression is recommended over using a mechanical pump. Colostrum is thick and produced in very small quantities that pumps cannot effectively collect.
Begin by washing hands thoroughly and finding a warm, relaxed environment to help stimulate flow. Gentle breast massage, stroking from the outer breast toward the nipple for a few minutes, can further encourage the let-down reflex.
To express, place the thumb above and the index finger below the areola, forming a “C” shape about one inch back from the nipple. Press the fingers gently back toward the chest wall, then compress the thumb and forefinger together, repeating in a rhythmic motion. Rotate the hand position around the areola to empty all milk ducts. This process should be done without squeezing the nipple itself, which can cause pain.
Collection is best done using a sterile one-milliliter syringe to draw up drops directly from the nipple, or by expressing into a small container before drawing it up. Express for only three to five minutes on each breast, one to three times per day.
After collection, the syringe must be labeled immediately with the date and time of expression. If collecting multiple times in one day, the syringe can be stored in the refrigerator between sessions. The collected colostrum should be frozen as soon as possible after the final daily expression and can be stored for up to six months. When going to the hospital for birth, the frozen supply must be transported in a cool bag to ensure it remains frozen until hospital storage is available.