Hand Expression and Antenatal Colostrum Harvesting

Hand Expression

What is hand expression?
Hand expression is the technique used to express breastmilk by hand.

Reasons you may hand express after your baby is born
Hand expression of breastmilk is useful skill for all mothers to learn and can be useful in various situations including:

• Your baby is sleepy or reluctant to breastfeed. Expressing small quantities of breastmilk can tempt a baby to feed
• To help clear a blocked duct
• If your breasts become full or engorged and your baby is struggling to latch to the breast
• If you are separated from your baby for example if they are admitted to the Special Care Baby Unit (SCBU/NICU)

How To Hand Express
The UNICEF Hand Expressing Video and the How to Express Breastmilk video from the Global Health Media both provide a useful visual guide to learn the technique of hand expression.

Please note these videos contain some women with a well-established postpartum milk supply and do not represent the small quantities of colostrum (first milk) you may express when you are pregnant or in the first few days after your baby is born.

Antenatal Colostrum Harvesting

What is antenatal colostrum harvesting?
Antenatal colostrum harvesting involves hand expressing your breastmilk in the final few weeks of your pregnancy to build up a store of colostrum before the birth of your baby. This can be given to your baby in the first few days and can avoid the need for formula milk supplementation.

Colostrum is the first stage of breastmilk which is produced from around 16 weeks of pregnancy. Colostrum contains everything your baby needs, including vital immunological properties and helps to colonise your baby’s gut with healthy bacteria that helps protect your baby from infection and disease.

Who can harvest colostrum during pregnancy?
Most women can safely express their colostrum from 36-37 weeks of pregnancy. It is particularly useful for women who have been told their baby is at increased risk of having a low blood sugar in the first few hours after birth and need to regularly feed. Reasons for this may include -

• Women who have diabetes
• Raised blood pressure and taking beta-blocker medication for this (labetalol)
• Multiple pregnancy
• Expecting to give birth to a small baby

​​​​​​​If you have been told your baby is at increased risk of a low blood sugar and their blood sugar will be monitored after birth our leaflet Protecting your baby from a low blood glucose provides more information about what to expect, the signs your baby is well and how to avoid a low blood glucose.

Other women who may benefit from expressing their colostrum during pregnancy include:

• Planning to have an elective c-section or induction of labour
• Have polycystic ovary syndrome (PCOS)
• Raised BMI
• Previous breast surgery
• Expecting a baby with a cleft lip or palette
• Had a previous poor feeding experience
• Expecting a baby with a known congenital condition

Are there women who shouldn’t express colostrum during pregnancy?
​​​​​​​Antenatal colostrum expressing is not currently recommended for women who:

• Have had a cervical suture
• Have a baby that is not in a head down position
• Are planning on flying
• Have a low placenta covering the cervix
• Have experienced a premature rupture of membranes or vaginal bleeding in the third trimester

Please speak to your midwife or obstetrician if you are unsure about whether you can express your colostrum when pregnant.​​​​​​​

Antenatal Colostrum Harvesting Clinic

At Macclesfield Hospital we provide an Antenatal Colostrum Harvesting virtual clinic. The clinic is run by a member of our team who will call you at around 36 weeks pregnant to provide information around hand expressing and talk you through the technique. If you would like to attend this clinic, please ask your midwife at your 34-36 week appointment. They will book you into the clinic and provide you with a hand expression pack.

If you wish to bring colostrum with you to the hospital when you give birth, please only bring a small quantity (1 – 2 syringes) of frozen colostrum. On arrival, please inform a member of our team as soon as possible so we can store this in our freezer.

Our Antenatal Colostrum Harvesting Leaflet will provide you with further information about hand expression during pregnancy including, when and how often to hand express during pregnancy and transporting this to the hospital.

Storage of breastmilk
For detailed information about how to store breastmilk see the Breastfeeding Network Expressing and Storage Breastmilk leaflet.