Colostrum harvesting before birth is a method that allows small amounts of colostrum to be collected during pregnancy, which, after the birth of the baby, can be given if necessary. This avoids the use of formula milk when supplementing is necessary.

History of colostrum harvesting

Although this may seem to be a fairly recent method, it is not. Until the late seventies and eighties, all women were encouraged to collect colostrum in the final stages of their pregnancy. Historically, the manipulation of the breasts during pregnancy was even suggested by several authors. (1)

Llewellyn-Jones (1972) stated that: “every day the nipples should be gently stroked and stretched for two minutes from the onset of pregnancy. This manipulation should be done to keep the mammary ducts of the breast open”. Then, only eleven years later, he clarified: “There is some doubt about the value of breast expressing; some physicians believe there is no value in opening the mammary ducts, but it has the advantage of giving the woman confidence in touching and handling her breasts, and gaining a more intimate knowledge about her body.”

Unfounded concerns

When talking about colostrum harvesting during pregnancy, for some people, alarm bells can go off, as they may think that this could endanger the pregnancy or that it could be the cause of premature birth due to the release of oxytocin that, in theory, could be produced. However, this is an assumption without any scientific evidence.

Oxytocin is released not only through sucking at the nipple but also in many other daily, everyday situations such as eating, cuddling, and sexual intercourse, and pregnant women are not warned or forbidden from these activities.

Scientific evidence has shown that breastfeeding and lactating during pregnancy do not pose any risk to the mother, the unborn baby, or the breastfeeding child. Hand-expressing colostrum, which is done once a day, is a far more limited activity than a child breastfeeding several times a day.

Stopping breastfeeding during pregnancy is only recommended when it has been reliably established that painful uterine contractions occur, whether or not accompanied by vaginal bleeding.

When is colostrum harvesting recommended?

Colostrum harvesting during pregnancy can benefit both mother and baby in many circumstances. For example, mothers who don’t want artificial formula milk can have small amounts of colostrum readily available to avoid supplementing the baby with formula. Also, with these small supplies, possible low blood sugar (hypoglycemia) can be avoided, and a weight loss of more than 7-10% can be prevented.

This technique is recommended for pregnant women in the following circumstances:

• Women with type 1 or gestational diabetes

Women with gestational diabetes who don’t breastfeed are at higher risk of developing diabetes later in life. In this way, they can start breastfeeding and avoid the interference that formula milk can cause in their breastfeeding journey.

• Women with breast hypoplasia (insufficient glandular tissue)

Women with breast hypoplasia may have difficulties establishing and achieving exclusive breastfeeding. And during the first few days after birth, babies may experience a greater than expected weight loss. Breast milk expression before the baby is born appears to stimulate the mammary gland for maximal performance.

• Women with PCOS (Polycystic Ovarian Syndrome)

Some women with polycystic ovary syndrome will have difficulties in establishing breastfeeding. As in the case of hypoplasia, making the mammary gland work before birth to achieve maximum performance afterward is crucial when exclusive breastfeeding is desired.

• Scheduled C-section or when there is a risk of separation of mother and baby immediately after birth

In some scheduled C-sections, the mother and baby may be separated for a few hours. Recommendations are always to keep mother and baby in close contact (skin-to-skin) despite a C-section. But if this is not possible and the baby needs to be separated from the mother or be with the father, colostrum can be offered to soothe the baby’s cries.

• IUGR (Intrauterine Growth Restriction)

Babies with intrauterine growth restriction may lose too much weight in the first days after birth because they are too sleepy or inefficient at breastfeeding. Pre-extracted colostrum will help them to slow the usual weight loss after birth.

• Mothers with previous thoracic surgery or mastopexy

In both cases, breast milk supply may be affected. Expressed colostrum can prevent the baby from getting supplementing or from losing weight. In addition, colostrum expressing during pregnancy gives the mother security and knowledge about her breasts.

• Baby’s congenital pathologies

A baby who is found to have a pathology during pregnancy is very likely to be separated from their mother after birth. If colostrum is extracted beforehand, the baby can be fed optimally from the first moment of life.

• Previous history of hypogalactia

A woman who has had a previous experience of low milk supply may benefit from learning how to stimulate her breast milk supply during pregnancy. At the same time, the continuation of the stimulation of the mammary gland immediately after birth allows breast milk production to be maximized.

Benefits of colostrum harvesting

In addition, when a pregnant woman and mother-to-be is performing colostrum harvesting, she gets many benefits from this practice:

• She will improve self-knowledge of her breasts and how they work.
• She can avoid common fears about her ability to produce breast milk.
• It provides security and confidence that she has the optimal nourishment ready to offer to her baby.
• It stimulates the mammary gland to increase oxytocin receptors and optimize milk production.
• It avoids the delay of (mature) breast milk coming in (lactogenesis II).
• Provides learning about hand expression and breast milk conservation which is useful for the entire breastfeeding journey.

We know that breast milk, and especially colostrum, is the best food a baby can receive, so giving expressed colostrum provides:

• Giving formula milk or glucose solution during the first days can be avoided.
• It avoids the risks associated with formula supplementing during the first days of life.
• In the case of the mother being diabetic, it also reduces the risk of the baby having to get supplementing formula, which can condition the onset of diabetes.
• Giving harvested colostrum can help to avoid a baby’s low blood sugar and dehydration during the first days.

How to do colostrum harvesting

The method of colostrum harvesting during pregnancy is very simple. The mother only needs to hand express colostrum once a day, ideally after a warm, relaxing shower:

• Start by thoroughly washing your hands for at least one minute or after washing your hands in the shower.
• Perform a massage with your hands on both breasts
• Start with the hand expression of breast milk, expressing colostrum from both breasts.
• Colostrum will flow very slowly, drop by drop. It is also possible that the first few times you try this technique, only a few drops of colostrum may come out, or even none at all.
• To harvest the colostrum, it can be collected directly into a tablespoon. You can see how to do it in this video.
• Once colostrum has been expressed from both breasts, collect it with a syringe or similar; you can see how to do this in this video.
• Label each syringe with the date of collection.
• Freeze the colostrum in another container or freezer zip bag to prevent it from absorbing odors from other foods in the freezer.
• If you start to experience contractions or pain in your belly, it is recommended to immediately stop the extraction.

On the day of giving birth, bring the frozen colostrum with you in a freezer bag to the hospital. A freezer bag filled with ice or ice elements can be used. In case of low blood sugar or if the baby has sucking difficulties, offer the harvested colostrum in the same syringe in which it was collected. You only need to hold the syringe between your hands to thaw it, or you can do so with a little warm water.

Depending on each individual situation, the baby should latch onto the breast as early as possible after birth. The baby should be kept in continuous skin-to-skin contact with the mother. The newborn baby should also be encouraged to feed at the breast as frequently as possible, being proactive about breastfeeding during the first days.

 

References:

• (1) Applebaum 1969, Eiger y Olds 1973, Messenger 1982
• https://www.ncbi.nlm.nih.gov/pubmed/20149033
• https://www.ncbi.nlm.nih.gov/pubmed/22333968
• https://www.laleche.org.uk/antenatal-expression-of-colostrum/
• National Health and Medical Research Council 2012, Infant feeding guidelines: Summary. Canberra, ACT: National Health and Medical Research Council.
• Cox SG 2006, Expressing and storing colostrum antenatally for use in the newborn period. Breastfeeding Review 14(3): 11–16.
• Forster DA, Moorhead AM, Jacobs SE, Davis PG, Walker SP, McEgan KM, Opie GF, Donath SM, Gold L, McNamara C, Aylward A, Ford R, Amir LH 2017, Advising women with diabetes in pregnancy to express breastmilk in late pregnancy (Diabetes and Antenatal Milk Expressing [DAME]): a multicentre, unblinded, randomised controlled trial. The Lancet, 389(10085): 2204-2213.