Breastfeeding is such a beautiful journey. Sometimes moms have to (or want to) express for different reasons, whether they want to pump exclusively or because they have a premature and/or neonatal intensive care unit (NICU) baby, because they or their babies may have any medical conditions that are cause for concern regarding feeding or the milk production, or even because they’re expecting twins or a higher number of multiples. Their choice is valid, and they deserve the correct information and guidelines.
There are certain ways to express colostrum vs mature milk and it’s important that it’s stored in the safest way possible. Especially if it’s for a more vulnerable baby.
What is colostrum?
Colostrum is the first milk that a mother produces, it’s usually clear or yellow in color and thick and sticky in consistency. Your body will produce very small amounts of colostrum at first, but that’s nothing to worry about, these small amounts of colostrum in the first few days of your baby’s life is more than enough colostrum for a newborn’s tiny stomach. Although your baby will only receive it in very small quantities for a very small amount of time, it has an incredibly important job to do, and it offers your baby so many benefits. It’s not called liquid gold for nothing.
Why is colostrum important?
Colostrum is not only the optimal nutrition for a brand-new baby, but it has a very important protective job. Colostrum helps to coat the gut linings of a newborn baby to help prevent bad bacteria, infections and viruses from entering the baby’s immune system.
In the first few weeks of life, babies have little to no immunity against all those bad bugs out there. That’s why breastmilk, especially colostrum plays a very important and protective role. Your baby will receive both active and passive immunity by means of your breastmilk to protect them against infections and illnesses.
If your baby is a premature baby, your body will produce colostrum that is higher in protein to support the development of the premature newborn, it will be higher in the enzyme called lysozyme which helps fight to off bad bacteria and helps to protect your baby from infections, and it will also be lower in lactose, as premature babies find it more difficult to digest lactose. Colostrum truly offers your baby the best possible start to life.
Your body will start producing colostrum around 16 weeks of pregnancy. You may or may not notice leaking, which is no indication of whether you’re going to have milk for your baby once they’re born. Some women leak and others never leak, both are perfectly normal.
Your body will continue to produce colostrum for the first few days after birth while it slowly transitions into mature breastmilk, which is triggered by the delivery of the placenta.
You will usually produce colostrum for the first 3-5 days before your breastmilk starts transitioning to mature breastmilk. If you’re still producing obvious colostrum in small amounts after 5 days, it probably means you have a delayed onset of mature milk and you should contact an International Board Certified Lactation Consultant (IBCLC) as soon as possible to help assess and support you and your baby.
Why you may need expressed colostrum
There are many different reasons why expressed colostrum may be needed.
– High risk for birth complications
Being high risk for birth complications may call for antenatally expressed colostrum for your baby until you’re able to either directly breastfeed, or to express fresh colostrum for your baby.
Birth complications can include many things such as a caesarean section, separation of the mother and baby, high blood pressure, postpartum hemorrhage, birth injury in either the mother or the baby, and many other complications.
– Expected health conditions in either mother or baby
It may be that either the mother or the baby is known to have certain health conditions that may make immediate expression or breastfeeding difficult or even impossible.
Health conditions can include gestational diabetes, cleft of the lip and/or palate, neurological conditions, cardiac complications and many other conditions.
– Expecting your baby to be admitted to the NICU
Many times, especially if the baby is very premature, they will often be unable to breastfeed and will need expressed colostrum. Most of the time, mothers of premature or NICU babies have cesarean sections or emergency cesarean sections due to a range of complications in either the mother or the baby. Many of these conditions can interrupt breastfeeding or expressing colostrum right after birth.
– High risk for a true low milk supply
If a mother is known to be at risk of a true low milk supply, colostrum harvested at the end of pregnancy may help offer more of the mother’s own milk to supplement the baby at birth.
Risk factors for a true low milk supply can include things like underdeveloped glandular tissue, PCOS, thyroid conditions, the use of medication that can suppress or lower the milk supply, previous breast surgery and many other conditions.
– The mother choosing to exclusively pump
Some mothers choose to exclusively pump for their babies for many different reasons. Harvesting colostrum before birth may help ensure that the baby will have enough milk while the mother builds up her milk supply. It will also ensure that the mother has some back up when needed.
Mothers who choose to pump exclusively will also need to express colostrum very frequently to be able to feed their babies and to build up their milk supplies. Just like with exclusive breastfeeding, the frequent removal of milk is very important to establish and maintain the needed milk supply.
The best expressing and collection methods
Whether you express by hand or by pump, and whether you’re expressing colostrum or mature milk, you will have to express frequently, as frequently as a baby would breastfeed, if you’re not directly breastfeeding. This helps to build up a healthy milk supply for your baby.
Expressing 8-12 times or more in a 24 period is recommended. Studies have previously shown that babies feeding less than 8 times, or mothers expressing less than 8 times in a 24-hour period resulted in a reduced milk supply.
Try to express for at least 20 minutes per breast at each pumping session. Avoid expressing for top long periods as this can cause damage to your nipples.
If you’re only harvesting colostrum while pregnant, be sure to wait until 36 weeks’ gestation and get medical clearance from your lead maternity provider. Once you have the go ahead, hand expressing twice a day for a few minutes is more than sufficient.
– Expressing colostrum
To express colostrum, the best way is to hand express and catch the colostrum in a spoon, syringe or small cup.
Seeing as colostrum is so thick and low in quantity, a manual or electric pump is often unsuccessful in expressing the colostrum, and even if it does succeed, the colostrum often gets lost in the process.
You will need to ensure good hand hygiene beforehand expression, and make sure whatever you use to collect the colostrum in, is clean, this helps ensure the safest possible milk for your baby, especially for vulnerable babies.
– Mature milk
Once your milk starts maturing and it’s no longer as thick and it becomes more copious, you can either continue to express it by hand or by pump. Some studies have shown that mothers who pumped with a double electric breast pump had a higher milk supply than those who hand expressed.
It’s important to note that some women never respond well to a pump at all and sometimes finances just won’t allow for a pump, and thus making hand expression the only option. It can be done successfully but you’ll need to hand express with the correct technique and you’ll have to hand express as often and for as long as you would with a pump.
Storage guidelines for colostrum
The best place to store colostrum is in a 1-3 ml syringe and then storing it in plastic bags such as Ziplock bags. Your healthcare provider may be able to supply you with sterile syringes. Make sure you label the syringes with the date that you expressed the colostrum. You can freeze the syringes for up to 6-12 months in the freezer.
If you’ve been expressing colostrum during pregnancy, you may need to transport it to the hospital when you give birth. You can take the syringes of frozen colostrum into the hospital using ice packs in an insulated bag. Some hospitals may have a freezer available for you to store the colostrum in.
It’s a good idea to mention to the staff that you have colostrum ready should it be necessary. But remember, direct breastfeeding and freshly expressed colostrum is the best choice when possible.
Important notes on the expressing and storage of colostrum
Never thaw colostrum in the microwave, not only can it cause hot spots that can burn your baby’s mouth, but it can also damage the composition of the colostrum.
The colostrum can be defrosted in a bowl of warm water, under a running warm tap or at room temperature before use.
Antenatal expression, also known as colostrum harvesting, should always be done with the approval and guidance of your health care provider.
Expressing and storing colostrum differs between NICU babies and full-term babies. The NICU may have stricter rules, so be sure to discuss it with them so you can plan or express accordingly.
Always consult and communicate your needs with your child care provider or other healthcare professionals, especially before birth.
You can always consult with an International Board Certified Lactation Consultant (IBCLC) for any support during your expressing or breastfeeding journey.