By Caroline Powell – Cambridge, England

This article contains a real-life story and the specific situation experienced by the author.
In case you consider expressing human milk during pregnancy, please consult your doctor for more information based on your personal history. 

There is no shortage of information regarding pregnancy and birth. Facts, advice and views about motherhood can be overwhelming and unavoidable for women. Guidance can be conflicting and often unsolicited and unhelpful. Yet amidst this cacophony of opinions, I stumbled across one tip whilst pregnant that I feel is, ironically, too useful not to share. Learning about antenatal colostrum harvesting hugely benefited my son’s health and our early bonding. It was the one scrap of information I had never heard of, but it had the most positive influence on my first days as a mother. 

“Antenatal colostrum harvesting” involves collecting hand expressed early human milk (colostrum) in the final weeks of pregnancy. When I was in my second trimester, my close friend’s son ended up in the NICU shortly after birth. My friend had gestational diabetes and her baby developed low blood sugar levels. I was shocked. It reinforced how vulnerable my own baby would be, as I had been an insulin dependent diabetic long before becoming pregnant. Her advice to “Harvest colostrum if you can” combined with my own research and support from my diabetic antenatal team ultimately prevented my son from being referred to the NICU and helped to optimise our bonding despite the challenges we experienced.

I’m now keen to spread the knowledge in the hope that it might help other little babies and their parents secure happy, healthy bonds in their first few days together. 

What is antenatal colostrum harvesting?

Before a mother’s milk “comes in” a few days post-birth, breastfed babies are fed the early milk: colostrum. It is also sometimes referred to as “liquid gold” due to the vast amounts of nutrients and antibodies densely packed into the thick fluid. Mothers only produce a little colostrum to begin with, but the amount steadily increases. The day a newborn baby is born, their stomachs can contain just a few millilitres of milk. The capacity grows a little each day, which is why they need feeding little and often. Only very small quantities of liquid are therefore produced and required with antenatal colostrum harvesting. Every droplet can benefit a baby. Hand expression is necessary because the colostrum is too thick and the quantity too small to successfully pass through a breast pump. Milk is collected and stored in small syringes (1ml, 2.5ml or 5ml) which can be used directly to feed the baby once they are born. Either refrigerate or freeze syringes according to safe milk storage guidelines. [1]

Who could benefit?

According to the National Health Service (NHS) of the United Kingdom [3], antenatal colostrum harvesting may be medically indicated for you and your baby if you:

• have diabetes of any kind
• are expecting twins or triplets
• have breast hypoplasia (limited breast development)
• are taking beta blockers to control high blood pressure
• have had previous breast surgery.

Or if your baby has:

• cleft lip or palate 
• intrauterine growth restriction
• congenital conditions such as Down Syndrome or cardiac complications.

Antenatal colostrum harvesting can also be beneficial in case of planned caesarean or induced birth, if your baby develops jaundice as the colostrum helps to reduce bilirubin levels, or if you have a medical condition that requires you to start medications incompatible with breastfeeding right after birth. [2] 

Antenatal colostrum harvesting is only advised in the third trimester and generally considered safe. Since each situation is different and personal, it is advisable to check with your midwife, obstetrician or other members of your antenatal care team if you’re at risk of early labour before starting hand expressing antenatally, as the hormones stimulated could, in certain cases, cause uterine contractions. [2]  

How was antenatal colostrum harvesting beneficial to me? 

If you have sought medical advice and are considering trying to express human milk ahead of your baby’s birth, these are some of the benefits I experienced.

1.     Avoiding separation from your baby and formula feeding in case of neonatal illness

In my case, the colostrum I had expressed antenatally prevented my son from having to be referred to the NICU. He did develop low blood sugar levels the day after he was born, but a bit of glucose combined with the colostrum I provided managed to stabilise his blood sugars without further intervention, and without him having to be separated from me. We missed out on some early bonding due to a complicated birth, so this was especially important to me. It also meant that he did not need to be given formula. Formula is vital for some mothers and babies, but I was very keen to use my breastmilk exclusively if possible. Being prepared with colostrum allowed me to achieve my wishes and ultimately helped to treat his hypoglycaemia.

2.     Facilitating a positive start with breastfeeding

Before embarking upon colostrum harvesting, I researched and spoke to different medical professionals about the process. I was warned to keep my expectations low for how much colostrum I would be able to express. Regardless, I knew it could be worth the effort as any drop could help my baby. With this knowledge, I was only mildly disheartened when my first session of expressing yielded no colostrum. Although it was frustrating, I was determined to persevere. The next session produced a precious droplet and the one after that yielded a few more. I expressed twice a day for half an hour per session, and by the sixth day my husband and I were easily collecting 2mls each time before calling it a day. By the time I was admitted into hospital for my induction, we had stored around 10mls. We could have collected more, had we not run out of syringes. Going into labour knowing that I already had a store of milk and was capable of producing more felt empowering.

Having kickstarted my early milk supply a week before birth, I found that I had an ample flow of colostrum ready when the time came for me to actually breastfeed. I was very fortunate that my son had no issues with latching on or feeding, which allowed me to focus on improving our technique and to enjoy bonding with him. With a week of hand expressing under my belt, I felt that my body was physically well prepared for breastfeeding. Moreover, I had an extra appreciation for the wonderful feeling of breastfeeding and the bond it nurtures in comparison to hand expressing. 

3.     Involving a partner or loved one in feeding

If you have a partner or loved one who would be willing to help, colostrum harvesting can be a great way to get them involved and offer their support.

Colostrum harvesting is undeniably fiddly as the syringes are little and the colostrum can seem stubborn. I was not blessed with good co-ordination or manual dexterity, so my husband stepped in to do the actual hand expression and colostrum collecting. This meant that I could remain relaxed, which helped aid the production of colostrum.

Hand expression is not usually painful for mothers who are already breastfeeding. But as I was not, and my baby had not yet been born, I found the start of each session painful. Having less control enabled me to grit my teeth through each wave of discomfort until it settled, and there was no hesitation from having to mentally prepare for it. This obviously necessitates a level of intimacy that would be uncomfortable for many. That’s fine, too! Expressing is more commonly a solo mission. You may feel more relaxed doing it alone.

4.     Regaining some control in difficult circumstances

My labour was induced and complicated. My vital signs caused concern throughout and my body overreacted to synthetic oxytocin. Towards the end, my son’s heart rate dropped dramatically. I was rushed to the operating theatre for an assisted delivery, but by the time I arrived, the situation had worsened and it was immediately deemed “A category one C-section.” I was being put to sleep for an emergency caesarean. The room sprang into action. There was no time to top up the epidural that had been placed a few hours previously. There was no time to sign consent forms or consult my husband. He and my mum had been unexpectedly shut out of the room without explanation. There was nothing I could do about that. Nothing I could really do about anything. 

I felt completely powerless to help my baby in distress, despite the days of effort and pain I had already put in. During the sudden hurry to obtain my verbal consent for the operation and to anaesthetise me, I managed to remind the midwife: “My colostrum is in the NICU if the baby needs it”. This reassured me that in the likely event we became separated after birth, my baby could be fed with my milk. It was oddly comforting, and I drifted to sleep feeling a calm that was probably inappropriate for the situation.

5.     Aiding recovery post-birth

Whichever way you give birth, you will likely feel sore and tired afterwards – to put it mildly. After the effort of labour and/or surgery and potentially with painkilling/anaesthetic drugs still in your system, you are then responsible for your newborn child. 

Still groggy from three days of labour followed by general anaesthetic and copious morphine, it was difficult to stay awake for the duration of my son’s night feeds by our third night. My husband helped by feeding him with our stored colostrum. This gave me some time to sleep and recover, and he was delighted to gain extra bonding time with our baby.

These benefits led to a healthier and happier start for our family. For us, the effort of antenatal colostrum harvesting was worth its weight in (liquid) gold. To those for whom it is medically indicated: I hope it can be for your families, too.

 

 

Caroline lives in Cambridge, England with her husband and son. She teaches English and leads her faculty in a Secondary School and Sixth Form College. 

References

1. Philippa Pearson-Glaze, Expressing Colostrum Antenatally, Breastfeeding Support, 24 August 2019, https://breastfeeding.support/expressing-colostrum-antenatally/ (accessed 9 September 2020).

2. La Leche League Great Britain, Antenatal Expression of Colostrum, https://www.laleche.org.uk/antenatal-expression-of-colostrum/ (accessed 16 September 2020).

3. NHS Mid Cheshire Hospitals, Antenatal Colostrum Harvesting- Important information for patients, August 2017.