Antenatal Hand Expression

→ Find our NEW infographic here! ←

Antenatal hand expression is removing colostrum from your breasts before your baby is born. There is growing awareness that this technique can support lactation early postpartum. Colostrum that is hand-expressed and stored at the end of pregnancy can be used to supplement newborns who need extra calories early postpartum. More studies are needed to identify the risks and benefits of this technique and to identify populations that may benefit from using it. If you plan to use this technique, speak with your obstetrical physician or midwife to ensure that it is safe for you and your baby.

What are the possible benefits of antenatal hand expression?

• • Storing colostrum to use if your baby needs supplementation after birth. The colostrum expressed during pregnancy can be brought to the hospital and given to your newborn if the hospital staff recommends supplementation because of the need for extra calories. The most common reason for newborns to need supplementation is low blood sugar, particularly if the mother or birthing parent has a history of diabetes or gestational diabetes. Premature babies and babies that are very small or very large are also at risk of having low blood sugar in the hours after birth.
• • Antenatal hand expression can help you learn a valuable skill in case you need to hand express your colostrum or milk after your baby is born for one or more of the following reasons:

• • → Expressing colostrum early on if you and your baby are separated. Hand expression often works better than a breast pump at removing colostrum.
  • → Expressing colostrum after feeds to promote an increase in milk production. It takes longer for milk production to rapidly increase in some people, such as those with gestational diabetes, cesarean birth, pre-eclampsia, and other medical conditions.
  • → Feeling engorged with a need to remove a small amount of milk for comfort or to help latch.

When should I start antenatal hand expression, how often, and how much?

Always check with your obstetrical physician or midwife prior to starting antenatal hand expression to ensure this technique is safe for you and your unborn baby. Generally, this can be started at or after 36 weeks, and performed no more than twice a day, for no longer than 10 minutes each time. Skipping a day or deciding not to continue is fine, and it is OK to stop if it causes you any distress. Do not worry if you don’t get much colostrum. Many people express very little colostrum each time, often none or a few drops, and it does not predict how much milk you will make after your baby is born. You should not use a breast pump to collect milk while you are still pregnant.

How do I hand express?

Check out this UNICEF video on how to hand express. This video discusses hand expression after delivery, but the technique is similar when expressing milk before your baby is born. Another helpful video can be found at firstdroplets.com.

If you are expressing colostrum solely to learn the skill, you do not have to collect what you get, but if you’d like to collect it to potentially give your baby, below are the steps:

• • Collect the supplies needed to hand express. These include:

• • → A heating pad or other means of warmth, to help promote colostrum flow prior to hand expressing.
  • → A small bowl, plate, or cup to express the colostrum into.
  • → Small syringes, approximately 1-3ml, to draw up the drops. The drops can be stored in the syringes.
  • → A container, such as a zip lock bag, for storage of the syringes containing with colostrum.

• • Get ready: find a comfortable place to sit, apply heat to your breasts for a few minutes, and take a moment to relax and clear your mind before starting.
• • Massage: Gently touch your breasts before hand expression. Tickling or light petting of the breasts can help to increase colostrum flow. Avoid nipple stimulation, which can increase the chances of uterine contractions.
• • Hand express:

• • → Make a C-shape with your hand and cup your breast a few inches away from your nipple.
  • → Compress the breast tissue with your thumb and index finger (make sure you are not pressing on the nipple and are on the breast tissue) and then release. Allow droplets of colostrum to collect in your small container.
  • → After a few minutes repeating a and b, rotate your hand so that you are expressing a different region of the breast. You will learn with practice what positions for your fingers work best for you.
  • → Use a small syringe to collect the colostrum. You may want to use a periodontal syringe to collect very small drops.
  • → Label the syringe with your name and the date and time of colostrum expression.
  • → Freeze the labeled syringe if you do not anticipate using the colostrum in the next 3 days.

What if I cannot express any colostrum?

Many women have difficulty expressing drops of milk during pregnancy. This does not predict anything about your milk production after birth.

Will I use up my colostrum if I do this, so there isn’t any in my breast once my baby is born?

During pregnancy, your hormones maintain continued production of colostrum and prevent transition to full milk production. More colostrum will be produced right after birth. The shifts in your hormones that occur after birth gradually trigger full milk production.