Prenatal Colostrum Expression: An Underused Superpower

08/15/2024

Let’s talk about the *pure magic* that is human colostrum and why you should consider prenatal colostrum harvesting!

Prenatal colostrum expression refers to the practice of manually expressing and collecting colostrum during pregnancy. This is usually done by hand, but can also be done with a pump.

Colostrum is the first form of milk produced by the mammary glands during pregnancy, and is available for baby immediately after birth. It is the ideal first food for babies, as it lines the gut with protective components and helps them pass their first stool (meconium).

Why is colostrum important for babies?
Colostrum, often referred to as “liquid gold” because of its golden color and valuable nutrients, is incredibly rich even in just a single drop. Every drop of colostrum contains:

Antibodies (Immunoglobulins): Colostrum is extremely high in antibodies, especially IgA, which protect the newborn by coating the intestinal tract and preventing the absorption of pathogens. This is crucial for building the baby’s immune system.
Growth Factors: It contains growth factors such as insulin-like growth factors (IGF-1) and epidermal growth factor (EGF) which help in the development and healing of tissues, and the maturation of the gut.
Leukocytes: These are white blood cells that help fight infection and disease by producing protective white cells and initiating immune responses.
Proteins: High levels of protein in colostrum support the growth and development of newborns. It’s also rich in albumin and lactoferrin, which helps in iron absorption and antimicrobial protection.
Vitamins and Minerals: Colostrum is a rich source of vitamins A, B12, and E, which are vital for health, growth, and development. It also contains minerals like zinc, which supports the immune system.
Prebiotics: It contains oligosaccharides that act as prebiotics, promoting the growth of healthy bacteria in the gut.
Enzymes: Various enzymes in colostrum aid in digestion and metabolism.
Hormones: It also contains hormones that help regulate physiological processes in the newborn.
Each drop of colostrum is densely packed with these components, making it incredibly nutritious and beneficial for a newborn’s early days of life, aiding in immune support, growth, and development.

Why collect colostrum prenatally?
As an IBCLC, there are a few reasons why I recommend nearly all of my clients consider prenatal colostrum expression:

Skill-Building
First and foremost, hand expression is a vital skill that every lactating parent should learn. It is useful from pregnancy through weaning, with countless applications: expressing colostrum, expressing mature milk, relieving engorgement, bailing you out if you forget your pump at home, increasing milk supply, and more. Regardless of whether or how much colostrum you are able to express during pregnancy, practicing the skill of hand expression is valuable!

Awareness
Secondly, many parents I work with have no idea that their body is already making colostrum while pregnant. Knowing that their body is producing this vital, nutritious food for their baby before baby even arrives is critical. Why? Because it gives parents confidence to know that they do not have to wait until their “milk comes in” or transitions to feed their baby. The good stuff is already there, ready and waiting. Expressing and seeing it on a spoon in front of them makes it that much more real!

Avoiding Unnecessary Supplementation
Third: expressing colostrum means that a parent already has their baby’s first feed in hand, ready to go if they need it. While most parents have the goal, the plan, and the desire to latch baby and nurse immediately after birth, there are a number of variables that may cause interference. The birthing parent and/or baby may need medical attention that requires separation, or latching may be difficult or painful. Parents who take my prenatal class know that a painful latch is usually an ineffective one, meaning baby isn’t transferring well. In any of these cases, offering expressed colostrum (whether prenatally harvested, or on the spot) is the ideal next step.

In many cases that I witness, baby’s latch looks fine and feels fine, but the suspected input isn’t translating to output (pees and poops). Sometimes baby will pass stool within the first 24 hours, but then is slow to poop on Day 2, when we would typically expect to see two stools. This is commonly when hospital staff will recommend “a little bit of formula”, especially if there are concerns for jaundice or blood sugar. In these cases, expressed colostrum is the optimal first intervention for baby.

1 in 5 babies whose parents plan to nurse receive formula in the first 48 hours, and I suspect many of those cases could be avoided if parents were empowered to express and feed their colostrum instead.

How do I harvest & store colostrum?
So glad you asked!

Before trying prenatal hand expression, I recommend consulting with your primary healthcare provider to discuss any relevant risk factors. In general, if you are not on pelvic rest and have a low-risk pregnancy, you are likely a good candidate for prenatal hand expression after 36 weeks gestation.

When you’re ready, you’ll need something to express into and something to store the colostrum in. There are a number of options, including:

- hand expressing into a clean spoon, and storing in a 1ml syringe
- hand expressing directly into a collector vial

Then, get set up & relaxed in a comfortable spot and follow these steps (or watch the video below):
https://youtu.be/3CyVvFcL1MY

Steps for Hand Expression
Massage Your Breasts/Chest: Gently massage your breasts in a circular motion, working from the outer areas toward the nipple. This helps stimulate a letdown and encourage colostrum to move.
Position Your Fingers: Place your thumb and forefinger about 1 to 2 inches on either side of the nipple, forming a “C” shape with your hand.
Compress Your Breast: Gently press your thumb and forefinger back toward your chest wall and then squeeze them together without sliding your fingers over the skin. Avoid squeezing the nipple directly, as this can cause pain and damage.
Release and Repeat: Release the pressure and then repeat the compression rhythmically. It might take a few minutes for the colostrum to appear, and it might just be drops – that’s great!
Switch to the Other Side: Once you have expressed what you can from one side, repeat steps 2-4 on the other side.

Troubleshooting
Some people are able to successfully express colostrum on the first try, and others aren’t – try not to be discouraged! If you have a strong desire to harvest prenatally, consider booking a prenatal lactation consultation to get expert help.

It can take some practice to figure out the unique method of stimulation that works for your body. Many people find it helpful to take a warm shower or apply a warm compress beforehand, to listen to a guided meditation, or do something that relaxes them.

Hand expression should never be painful. If you experience any discomfort, reach out to an IBCLC for assistance. It is not uncommon for pregnant folks to experience mild uterine cramping with hand expression. If this occurs, pause, and try again at a later time, especially if you are not yet at 40 weeks gestation.

Colostrum Storage
Once you have collected your colostrum, you should transfer it to the fridge within 3-4 hours. It can stay there for several days while you add to it, and then move it to the freezer in a ziploc bag once you have a full syringe/container. Colostrum storage guidelines are the same as mature milk:

When you go into labor, you can take your colostrum with you to the place where you are giving birth. Many hospitals and birth centers have mini-fridges in the room, but I recommend putting your colostrum in a cooler bag with an ice pack, which will buy you 12-24 hours.

Feeding Baby
Once baby has arrived (hooray!), most parents have a desire to engage in Golden Hour practices: skin-to-skin, allowing baby to do the breast/chest crawl, and the first latch. This should take priority whenever possible!

In an ideal scenario, baby latches effectively and painlessly, and there is no need for the colostrum you brought. If at any point, however, there is any concern over baby’s feeding or well-being, the colostrum can be your first line of defense. You can easily feed baby via syringe (allowing them to suck on your finger, and depressing the syringe in the corner of their mouth) or using a spoon. Your care team should be able to help you with this if needed.

Remember that baby’s feedings on Day 1-2 are 5-10ml! A small amount goes a long way.

Final Thoughts
Practicing hand expression prenatally is a skill that I recommend to nearly all my clients, since it has a wide range of benefits. You deserve to understand and be familiar with how your body is working hard to produce extraordinary food for your baby, and to trust your body’s ability to nourish and nurture your baby. Being empowered with this knowledge before baby arrives is a gift I wish for every expecting parent!

– Jill Mailing, IBCLC