Hand Expression of Colostrum or Breastmilk

Hand expression of colostrum or more mature breastmilk can be broken down into two parts:

• Nipple massage and stimulation to increase prolactin levels

• Breast compressions with breast massage to remove milk

Click on link to watch hand expression video:

https://www.canva.com/design/DAG2EcgmHCk/-kuLgx9yrlPFAFqM-RZtPA/watch?utm_content=DAG2EcgmHCk&utm_campaign=designshare&utm_medium=link2&utm_source=uniquelinks&utlId=h0468e272e6

Nipple massage and stimulation should be avoided before 39 weeks of pregnancy because it may trigger uterine contractions, potentially leading to preterm labor. Prolactin levels won't rise until after your baby is born and the placenta is delivered, so any nipple stimulation before birth won't boost prolactin. However, it is crucial to begin nipple massage and stimulation within the first 90 minutes after your baby's birth to support full milk production.

Massaging the breast, while avoiding the areola and nipple, can promote relaxation and improve milk flow during hand expression before your baby is born. This practice of hand expression before birth, known as antenatal expression, prenatal hand expression, or colostrum harvesting, is particularly beneficial for diabetic mothers. Their infants may require supplemental feedings initially until their blood glucose levels stabilize and diabetic mothers tend to have delayed or low milk production. Prenatal hand expression enables the collection of small amounts of colostrum, which can be readily available for supplementation. Current research indicates that beginning prenatal hand expression at 36 weeks gestation does not increase Neonatal Intensive Care Unit (NICU) admissions among diabetic mothers, although it hasn't been studied in the general population. This is significant because diabetic mothers often experience premature births, but it's crucial to ensure that this practice of prenatal expression doesn't lead to preterm births in the general population. Babies born even 3-6 weeks early can face challenges with breastfeeding and overall health outcomes.

It is important that before the birth of their baby, every mother learns how to hand express, when they are able to focus and learn this important skill. But hand expression is most useful and beneficial after the birth of your baby!

It is most important to perform hand expression with nipple stimulation:

• Immediately after your baby's first feeding or within the first 90 minutes after birth, whichever comes first. Keep this colostrum to entice your baby to suckle at the next feeding or to use as supplementation if needed.

• Immediately prior to every feeding or pumping session to start the flow of milk and increase prolactin levels. Colostrum is not collected at this time.

• Immediately after each feeding and/or pumping session until you have acheived full milk production to encourage more milk production. Keep this colostrum to entice your baby to suckle at the next feeding or to use as supplementation if needed.

• At least 12 times/24 hours in the first week to ten days after birth, even if your baby is not feeding that often, until you achive full milk production. Keep this colostrum to entice your baby to suckle at the next feeding or to use as supplementation if needed.

Collecting colostrum in a small container such as a medicine cup and then tranferring it to capped syringes allows you to easily store it and use as needed. Refer to CDC guidelines for storage: https://www.cdc.gov/breastfeeding/pdf/preparation-of-breast-milk_h.pdf

Insert the syringe into the corner of your baby's mouth to give small amounts to encourage suckling at the breast.