Antenatal Expression of Colostrum

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Published: 15 September 2021

Antenatal breast expression (ABE) is defined by the Australian Breastfeeding Association (2017) as ‘the hand expression and collection of colostrum during pregnancy’.

Historically, ABE has been used to help prepare the breasts for postnatal breastfeeding. Today, however, its main value is the storage of colostrum in order to prevent neonatal hypoglycaemia or hasten the production of lactogenesis (Chapman et al. 2013).

Why Express Colostrum Antenatally?

colostrum in cup

From about the 16th week of pregnancy, the breasts begin to make colostrum. During the third trimester, it’s possible to collect and freeze small amounts, which can then be given to the baby soon after birth. This can be especially valuable for babies who:

  • Have a mother with diabetes
  • Have a cleft lip or palate
  • Are diagnosed as being large or small for their gestational age
  • Have a congenital condition such as Down syndrome or a heart condition
  • Have a mother who has breast abnormalities, or who has had breast surgery
  • Have a mother who is taking beta-blockers to control high blood pressure
  • Are twins or triplets.

(Rogers 2021)

The Australian Breastfeeding Association (2017) also makes the point that early availability of colostrum can help to prevent or treat conditions such as hypoglycaemia in the infants of mothers with diabetes. It can also help a mother avoid the need to bottle-feed with formula immediately after birth.

An additional and often overlooked benefit of ABE is that it provides a new mother with the opportunity to practice expressing before her baby is born. This can be especially valuable if mother and baby need to be separated at birth, for example, in the case of premature delivery.

Contraindications and Complications

One of the greatest concerns about antenatal breast expression is the risk of triggering premature labour, although, in the view of the La Leche League (2021), this is very unlikely. Opinions differ, however, on whether expressing colostrum antenatally is likely to induce labour, as the hormone oxytocin can be released when expressing, causing the uterus to contract. For these reasons, women may be advised not to collect colostrum if:

  • A cervical suture is in place
  • There is a history of previous premature labour
  • There is a history of antepartum haemorrhage or placenta praevia
  • There have been contractions, vaginal bleeding, or premature rupture of the membranes during the current pregnancy
  • There have been signs of fetal compromise.

(Rogers 2021; Australian Breastfeeding Association 2017)

Diabetes: A Special Case for Colostrum Collection

Infants born to mothers with diabetes during pregnancy are at increased risk of hypoglycaemia. If the infant’s blood glucose is low in the immediate postnatal period and the mother cannot provide enough breast milk, then formula milk may need to be given.

Antenatal breast expression can help to avoid this. However, Forster et al. (2011) make the point that there is still limited evidence for this practice, including its impact on labour and birth.

In order to address these concerns, a large randomised controlled trial known as the Diabetes and Antenatal Milk Expressing (DAME) study was conducted between 2011 and 2015 (Australian Breastfeeding Association 2017).

During the DAME study, pregnant women were taught how to hand express colostrum and encouraged to express twice daily for up to 10 minutes, from 36 weeks gestation until delivery. They were also instructed to stop if there was any sign of uterine activity, vaginal blood loss, decreased fetal movement or hypoglycaemia (Australian Breastfeeding Association 2017).

The study found that for women having their first baby, the increased availability of colostrum meant that their babies were more likely to be exclusively breastfed during their first 24 hours of life. Furthermore, it also showed that women with diabetes and a low-risk pregnancy can safely express breastmilk in late pregnancy without causing harm to their babies (Australian Breastfeeding Association 2017).

Brisbane and Giglia (2013) also consider this practice to be valuable, not only because of the increased availability of colostrum for the baby but also because the experience of expressing can help mothers to become more familiar with their breasts and give them a greater sense of confidence and security.

Should Midwives Teach Antenatal Breast Expression?

practicing hand breast expression
Rogers (2021) recommends that women should be taught to express by hand rather than using an electric or manual breast pump.

Although midwives may recommend colostrum expression to mothers, relatively few have been trained to teach this technique antenatally. As a result, the advice given to women has been shown to vary widely (Chapman et al. 2013).

Rogers (2021) recommends that women should be taught to express by hand rather than using an electric or manual breast pump, as colostrum is produced in such small quantities it can easily stick to the pump parts, wasting valuable drops of milk.

To ensure expression is as easy as possible, the patient should be relaxed in a warm, comfortable environment. They should begin by gently massaging their breast to encourage the flow of milk. The amount of colostrum expressed can vary from just a few drops to a millilitre at a time, and this should be carefully stored in a suitable container such as an empty syringe, labelled with the time and date and then frozen until needed (Rogers 2021).

Conclusion

Antenatal breast expression has yet to be fully accepted, with further large-scale, credible randomised controlled trials needed to confirm beyond doubt the safety and efficacy of this practice. Chapman, Pincombe and Harris (2013) also recommend that a comprehensive survey is conducted to explore the prevalence of ABE and how midwives currently approach this topic with patients in their care.

To date, much of the research available has focused on the safety of this technique from the mother’s point of view, yet, Casey et al. (2019) make the point that there is still no independent association between expressing colostrum antenatally and rates of neonatal hypoglycaemia, or median blood glucose levels. That said, ABE may have more general benefits to the newborn such as reduced formula consumption in hospital.

Despite the current range of conflicting views, studies conducted by Foudil-Bey et al. (2021) seem to suggest an increasing interest in the safety, efficacy and acceptability of antenatal expression of colostrum. However, they also call for further studies that are heterogeneous with variable research questions, outcomes, study designs and methodology.


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