For many mums, thinking about how they are going to feel their baby is something considered once the baby arrives, with the birthing and arrival the focus.

Being prepared for breastfeeding is important and antenatal expressing is a popular and beneficial process to give many mums a head start on breastfeeding.

When done safely and with guidance from the health professionals, mums can get experience in expressing ahead of the baby arriving and understand the process of expressing colostrum to help with the baby’s growth.

Breastfeeding can uncover many challenges, and our lactation consultant Rene Sandeman has put together some helpful tips for how to antenatal express and how you can generate a stash of colostrum ready for your bub.

Breast milk is considered the gold standard when feeding you baby, and both WHO (World Health Organisation) and the NHMRC (National Health and Medical Research Council)  recommend breastfeeding exclusively until 6 months and then alongside family foods for at least one to two years and beyond.

When should you start collecting colostrum?

You can start collecting colostrum from around 36 to 37 weeks of pregnancy, provided your healthcare provider approves.

How much colostrum does a newborn need?

A newborn typically needs a small amount of colostrum, reflecting their tiny stomach capacity. On the first day, they usually consume about 5-7 ml per feeding, which amounts to roughly a teaspoon. This amount gradually increases over the first few days. By the third day, a newborn may consume around 15-30 ml per feeding.

Colostrum is nutrient-dense and packed with antibodies, making even small amounts highly beneficial for the newborn's immune system and overall health (AAP Publications).

How much colostrum should I express before birth?

The amount of colostrum you can express varies widely among individuals, and even small amounts can be beneficial for your baby. You can aim to express colostrum 1-2 times a day, with sessions lasting about 3 to 5 minutes per breast.

The expressed colostrum can be stored in sterile syringes or containers, labeled with the date, and kept in the freezer until needed. (La Leche League International) (Pregnancy, Birth and Baby) (BabyCenter).

How long does colostrum last in the freezer?

Colostrum, can be safely stored in the freezer for a significant period when following proper storage guidelines. According to scientific and healthcare sources, colostrum can be stored in a standard refrigerator freezer (at -18°C) for up to 6 months, with some sources suggesting it can last up to 12 months for best quality and nutrient retention (hegen.us) (What to Expect) (Mommy Labor Nurse). However, it is recommended to use it within the first 6 months to ensure optimal nutritional benefits, as prolonged storage may diminish some vitamins, particularly vitamin C.

Proper storage techniques are crucial to maintaining the quality of frozen colostrum. It should be stored in sterile, airtight containers, such as breast milk storage bags or BPA-free plastic bottles, and kept at the back of the freezer where the temperature is most stable. Labelling each container with the date of expression helps in keeping track of the storage duration (hegen.us) (What to Expect).

Thawing frozen colostrum should be done safely to preserve its nutrients. The best method is to thaw it in the refrigerator overnight or by holding the container under warm running water. Microwaving or boiling colostrum is not recommended as it can cause uneven heating and destroy some of its beneficial properties (What to Expect) (Mommy Labor Nurse).

These guidelines ensure that colostrum remains a safe and potent source of nutrition and immune support for your newborn even after being stored for extended periods.

Can antenatal expression help you prepare for breastfeeding?

Antenatal expressing can be beneficial to help prevent the use of formula unnecessarily and to get your body started on the road to breastfeeding.

Medical conditions this process can assist include:

• Women with diabetes type 1 or gestational diabetes whose babies may be susceptible to reduced blood sugars or increased risk of being admitted to the special care nursery
• Women who have had breast augmentation or reduction where there may not have been sufficient breast tissue or where the nerves may have been affected.
• Babies who have been diagnosed with cleft lip and cleft palate and may find breastfeeding difficult
• Women with polycystic ovarian syndrome
• Babies who may struggle to feed due to cardiac or neurological issues who also may need to spend time in the special care nursery

Important things to note about antenatal expressing before you commence

• You should consult with your primary care provider before antenatal expressing to be sure there are no risk factors 
• It should only be done after 36-week gestation
• It should only be done by hand. A pump should never be used during pregnancy
• Don't be discouraged and feel you won't be able to breastfeed if you are unable to express any colostrum out. This is not an indicator of how well you will be able to supply milk to your baby
• Seek help and support for further education from an experienced breastfeeding professional such as an IBCLC
• You should stop expressing immediately and advise you primary pregnancy care provider if you experience any painful contractions

How to Express Colostrum | Step By Step

Expressing colostrum can be a straightforward process with the right technique. Here’s a step-by-step guide:

Step-by-Step Guide to Expressing Colostrum

Step 1: Preparation

• Hygiene: Wash your hands thoroughly with soap and water to maintain cleanliness.
• Warmth and Relaxation: Apply a warm compress to your breasts or take a warm shower to stimulate milk flow. Find a comfortable and quiet place to relax.

Step 2: Positioning

• Hold a Sterile Container: Use a small cup, or spoon to collect the colostrum.
• Hand Position: Place your thumb and fingers in a C-shape around the breast, about 1-2 inches from the base of the nipple, near the edge of the areola.

Step 3: Stimulation

• Massage: Gently massage your breast in a circular motion to encourage the flow of colostrum.
• Compress and Release: Press your thumb and fingers together gently towards the chest wall, then compress towards the nipple without sliding your fingers. Release and repeat. You should see drops of colostrum appear.

Step 4: Collection

• Collect Drops: Allow the colostrum to drop into the sterile container. Be patient, as colostrum is thick and may come out slowly.
• Rotate Around the Areola: Move your fingers around the areola to express from different milk ducts.

Step 5: Storage

• Store Properly: Once collected, draw the colostrum into a sterile syringe or small container. Label it with the date and store it in the freezer at -18°C (0°F) or colder.
• Thawing: When needed, thaw the colostrum in the refrigerator or warm water before use. Do not microwave or boil.

Tips

• Frequency: Aim to express for 5 minutes per breast, 1-2 times a day if possible.
• Consultation: Always consult with a healthcare provider before beginning antenatal expression.

References

• Breastfeeding Network: Detailed information on expressing and storing colostrum (Mommy Labor Nurse).
• La Leche League: Comprehensive guidelines on hand expression techniques (What to Expect).
• Mayo Clinic: General breastfeeding and colostrum collection advice (What to Expect).

By following these steps, you can effectively express and store colostrum to ensure your newborn has access to this vital first nourishment.

Some other tips:

• You can start doing it after 36 weeks and after you have discussed any concerns or risk with your primary pregnancy care provider
• Wash your hands well and find a clean, wide-rimmed container to collect any drips into. 
• You may get nothing, a few drops or more however this is not an indicator of how good your supply will be or your ability to feed your baby so please don't be discouraged if you cannot get anything
• Expressing after a warm shower may be helpful, and a gentle massage beforehand can also be useful
• Hand express twice a day, usually once in the morning and once in the evening works well
• Continue doing it for 5 mins each side and then stop
• You can collect anything you get out into a syringe (which you can buy from the chemist or obtain from your health care provider) and use one syringe per day. Put the morning amount in the fridge and you can add the evening amount to it once it has also been cooled. 
• Label it with the date, and freeze it ready to take in with you when you go to the hospital 
• Once again, STOP if you feel any pain or contractions and advise your health care provider

If you would like to find out more about antenatal expressing or breastfeeding, we welcome you to get in contact with our international board-certified lactation consultant Rene Sandeman.

Find out more about Rene's Sandeman and her Lactation Consulting IBCLC Breastfeeding Support, via her blog and website.