Learning about antenatal hand expressing, the process of expressing colostrum and how it can benefit you and your breastfeeding journey is an empowering step to take during the end of your pregnancy. Colostrum is also known as the early milk that can start being produced during pregnancy from as early as 16 weeks. Some pregnant mothers may notice crusting around the nipple or colostrum leaking from the nipple, which is normal and natural. Not everyone will notice colostrum production during pregnancy. Not everyone will get colostrum when they try antenatal hand expressing, and one study in Victoria showed that the average amount collected was 5mls in total¹. It can be great to learn about antenatal hand expression in your final trimester of pregnancy; read on for everything you need to know!

What is antenatal hand expressing?

Antenatal hand expressing is the process of manually stimulating and collecting any colostrum that may be present in the breast during the last few weeks of pregnancy and can be commenced by most pregnant mothers from 36 weeks onwards. Mothers are generally encouraged to express up to two-three times per day for approximately five minutes on each breast. 

Eight basic steps for hand expressing: 

1. Wash your hands thoroughly with soap and warm water.
2. Find a private, comfortable, quiet place to sit where you can relax.
3. Gently massage your breasts for a minute or two before expressing to help stimulate oxytocin.
4. Place your thumb and index finger about an inch behind your nipple, keeping your thumb and finger in the same place, and pull them deeper into your breast.
5. Gently squeeze and compress the breast tissue, returning your thumb and finger to the starting position.  Once you get the hang of the technique, repeat it rhythmically.
6. If you see a drop of colostrum on the tip of your nipple, you can scoop this with a clean medicine cup or suction it off with a single-use medical-grade syringe. 
7. Rotate your fingers around the breast and repeat the squeezing motion in different areas to help stimulate milk flow.
8. Switch to the other breast after a few minutes and repeat the process.
9. If you experience uterine pain, contractions or vaginal bleeding at any point, you should stop immediately and contact your care provider if you feel concerned. 

What are the benefits of antenatal hand expression?

Research on antenatal hand expression is limited, but some studies have investigated its potential benefits. Here are six key findings:

1. A 2017 study published in the Journal of Human Lactation found that women who practised antenatal hand expressing had higher milk volumes in the first few days after birth than those who did not¹.
2. Another study published in the same journal in 2012 found that antenatal hand expressing was associated with better breastfeeding outcomes, including higher rates of exclusive breastfeeding and longer breastfeeding duration².
3. A 2018 study published in the International Breastfeeding Journal found that antenatal hand expressing was associated with increased colostrum production³.
4. A 2016 study published in the Journal of Perinatal Education found that women who practised antenatal hand expressing reported feeling more confident about breastfeeding⁴.
5. For women with Gestational Diabetes, a large trial in the UK found that the women in the antenatal expressing group had higher breastfeeding initiation rates than the control group⁵.
6. The trial also found that antenatal expression of colostrum was associated with a lower incidence of hypoglycemia (low blood sugar) in newborns and a lower incidence of neonatal admission to the intensive care unit⁶.
7. Even if you don’t collect any colostrum, practising the technique is hugely valuable as it is one less thing to learn when your baby arrives. 

How do I know antenatal hand expression is right for me? 

Antenatal hand expression is generally considered safe. However, there are specific scenarios where your health provider may provide against this. Any nipple and breast stimulation can have a stimulating effect on the uterus. Situations where hand expressing is advised against can be:

• If you are at risk of preterm labour, your healthcare provider may advise against hand expressing or any kind of breast stimulation, as this can stimulate contractions and increase the risk of premature delivery.
• Vaginal bleeding: If you are experiencing vaginal bleeding during pregnancy, your healthcare provider may advise against hand expressing or other forms of breast stimulation
• There are complications around your placenta, such as placenta previa, accreta and percreta.
• Your pregnancy is complicated, and a planned cesarean is advised

If you are experiencing a more high-risk pregnancy, you can still learn the technique of antenatal hand expressing; you just won't be able to start trying it until your baby is born.

How do I talk to my healthcare provider about antenatal expression? 

In your third trimester, you can ask to discuss antenatal hand expression with your care provider. It is important that your care provider is happy for you to proceed in case you have any complications that could mean hand expressing is inappropriate for your current pregnancy. 

If antenatal hand expressing is right for you, make sure you get a demonstration or have your technique checked. Research shows that women who have  a healthcare professional teach antenatal hand expression have a higher rate of successful expression than women who learn on their own through information sheets or videos. Some care providers will provide you with the necessary equipment, while others may not and you will need to purchase or source independently. Booking a breastfeeding planning session with your local International Board Certified Lactation Consultant (IBCLC) if you want more support with antenatal hand expressing is also a great step to take. 

Equipment, collecting, storing and transporting any expressed colostrum 

Grab some syringes or a premade kit like the Made to Milk Antenatal Colostrum Expressing Kit here, which I love! Everything is conveniently ready to go, with 15 syringes plus caps, labels, a container for the freezer and an education card. Plus, if you use up all of your syringes you can email support@madetomilk.com, and they’ll dispatch you one extra set of syringes, caps & labels FREE of charge*. 

Keep your freshly expressed colostrum in the syringe, with the cap on, in the fridge, add to it over 24 hours and then freeze. If you are only getting small amounts, that is ok too. Once each syringe is filled or you have collected as much as you can within the 24 hours, label the syringe with your full name, date and time it was expressed so that when it comes time to use the colostrum, you will defrost the earliest colostrum first. 

• Bring the frozen syringe in a labelled container and ask the hospital staff to freeze this for you. 
• Don’t put the frozen colostrum in the fridge immediately, as this means that any colostrum will be thawed and must be used within 24 hours of thawing. 

• To protect all the nutritional properties in the colostrum, thaw it slowly in the fridge or use warm water in a clean mug, gently swirling the syringe to mix any separated fats. Avoid thawing the colostrum in boiling water or microwaves to preserve the beneficial components. 
• Discard any unused colostrum after 24 hours.
• Tip: Smaller volumes will defrost more quickly; a one ml syringe thaw more quickly than a ten ml syringe. 

*Pay $12 for shipping, have your order number or purchase receipt handy and request the free syringes within six months of your original purchase date. 

Six ways to use your antenatally expressed colostrum after the birth of your baby

Whenever I meet a family who has bought frozen colostrum into the hospital with them, I light up with excitement. It means we have options and a head start if breastfeeding gets tricky. Knowing what to do with your colostrum and how to use it if needed is also important. Here are six common and easy ways to use any expressed colostrum: 

• The Special Care Nursery or Neonatal Intensive Care Unit will want to feed your baby any available colostrum if you and your baby are separated after birth
• Offer colostrum to your baby before breastfeeding if your baby is sleepy or not interested in feeding.
• Offer colostrum after a breastfeed; this is particularly helpful for lower birth weight babies, if you have had gestational diabetes and/or if your baby seems hungry or fussy after breastfeeding.
• Colostrum can be used as a backup plan instead of breastfeeding if your nipples are too sore from breastfeeding; in this case, it is essential to continue expressing to stimulate your milk supply.
• Having a few mls of colostrum to give to your baby during cluster feeding, generally seen on the second and third nights after birth, can help reduce the chances of introducing non-medically indicated infant formula.
• If there is no need to feed the expressed colostrum to your baby, you can add it to their bath water as long as it is within its safe-to-use period (as above). Colostrum has healing and antibacterial properties that can benefit your baby's sensitive skin. 

Continuing hand expressing once baby has arrived

Hand expressing is gentle enough to do regularly until your supply increases, generally around 72 hours post-birth. Hand expressing can be done after each breastfeed to give your baby more colostrum if needed, and it is also a great way to gently support your milk supply increasing by removing milk from the breast (aka supply and demand). Hand expressing is also a helpful tool  during periods of engorgement, when the breasts feel very firm and filled with milk. Hand expressing when you are engorged or full will allow you to soften the breast a little, making latching your baby a little easier. 

Summary

I love promoting antenatal hand expression as there are so many benefits. It can be a really empowering and tangible experience for those who want to prepare for their breastfeeding journey. Hand expressing  can be very helpful after your baby has arrived to either help stimulate your breastmilk (more gently than a breast pump) or to feel some relief when your breasts feel uncomfortably full throughout your breastfeeding journey. 

About Joelleen

Joelleen Winduss Paye is a holistic, Internationally Board Certified Lactation Consultant (IBCLC), endorsed midwife, naturopath, and educator, and is the founder of JWP. Joelleen has supported breastfeeding families for over 13 years and offers a uniquely holistic perspective. Joelleen supports clients face-to-face in Melbourne and consults virtually with clients from around the world. She teaches a live breastfeeding workshop every second month, supporting parents to learn about breastfeeding before their baby arrives. Joelleen also has a Breastfeeding eGuide, and her services are available here. Follow Joelleen @jwp.ibclc for holistic breastfeeding and baby content. 

References

1. McLeish, J., Bick, D., Beake, S., Chang, Y. S., & Tham, K. (2017). Antenatal breast expression in women with diabetes: Outcomes from a retrospective cohort study. Journal of Human Lactation, 33(3), 540-547.
2. Fewtrell, M. S., Loh, K. L., Blake, A., Ridout, A., Hawdon, J., & Williams, J. E. (2012). Randomized, double-blind trial of antenatal expressing and breast milk feeding: Effects on the mother and breastfeeding outcomes. Journal of Human Lactation, 28(2), 161-166. 
3. Nissen, E., Lilja, G., Widström, A. M., & Uvnäs-Moberg, K. (2018). Expression of breast milk in pregnant women. International Breastfeeding Journal, 13(1), 6. 
4. Thomson, G., Dykes, F., McCourt, C., Sandall, J., & Balaam, M. C. (2016). Pregnant women's perceptions and experiences of routine antenatal enquiry for domestic abuse. Journal of Perinatal Education, 25(1), 32-42.
5. Jolly, K., Ingram, L., Khan, K. S., Deeks, J. J., Freemantle, N., & MacArthur, C. (2012). Systematic review of peer support for breastfeeding continuation: Metaregression analysis of the effect of setting, intensity, and timing. BMJ (Clinical research ed.), 344, d8287. 
6. Forster, D. A., McLachlan, H. L., Davey, M. A., Amir, L. H., Gold, L., Small, R., Mortensen, K., & Oats, J. (2017). Antenatal expression of colostrum for improving breastfeeding outcomes. Cochrane Database of Systematic Reviews, 1, CD012008.