Hand Expression in Pregnancy

‘Antenatal’ Hand Expression

Colostrum can be collected in small amounts near the end of pregnancy and stored for use after birth.
Having this milk stored can prevent formula supplementation when milk supply has not yet been established. It also allows moms time to learn hand expression techniques.
Onset of milk production after birth (lactogenesis II) likely occurs later in women who have diabetes mellitus.

In 2017 The Lancet published the DAME Study (Diabetes and Antenatal Milk Expressing), which found that there was no harm in advising women with diabetes in pregnancy to express breast milk starting at 36 weeks gestation.
Nipple stimulation theoretically increases release of oxytocin, a hormone that causes uterine contractions in labor, so hand expression in pregnancy should be started near term – between 36-37 weeks.
Your provider may tell you to refrain from colostrum expression in pregnancy if there is concern for preterm birth, contractions or if you have a cervical cerclage (cervical stitch).
Breast pumps should not be used while pregnant due to concern for causing labor.
Overall, antenatal hand expression is a safe method and does not generally increase the chance of labor.

Always wash your hands before expressing milk.
Applying a warm compress to the breast or taking a warm shower can aid the flow of milk.
Place your thumb above the nipple and fingers below the nipple and cup the breast in a ‘C’ configuration.
Press back towards your chest, then compress and release. Repeat this motion in a rhythm.
Rotate the position of your fingers and thumb around the areola to repeat process in different parts of the breast.
Express colostrum from each breast twice during each session and up to 2-3 sessions per day.
The amounts expressed may be very small but over time may increase. Even a teaspoon is helpful in the early days after delivery.
Collect the colostrum into a clean container. It can be helpful to use a clean plastic spoon then transfer to a small syringe (1 or 2ml).
Store in the freezer when syringes are filled. You may store in the fridge until the end of day.
Online resources may help you learn the correct technique (access one such resource here).

Hand expression starting between 36-37 weeks is recommended for all uncomplicated pregnancies. Consider discussing this with your provider.
Antenatal colostrum expression is most recommended for women with babies who may have difficulty with blood sugars or feeding difficulties after birth, including the following:
- Women who have Type I or Type II diabetes mellitus.
- Women who have gestational diabetes.
- Women expecting multiples (twins, triplets).
- Babies with cleft lip and/or palate.
- Babies with congenital conditions such as Down syndrome.
- Babies with intrauterine growth restriction (IUGR).

Bring your labeled syringes of colostrum to the hospital at delivery and ask staff to store in approved freezer.
After thawing, the colostrum should be used within 24 hours.
If it remains frozen, it can be stored for up to six months.
Ideally, after delivery the woman will breastfeed directly or pump (at least 8 times in 24 hours to establish supply) and the early expressed milk will not be needed. This would be considered a great start.