Hand expressing colostrum

By Jennifer Clark, IBCLC. Revised December 2021

Research shows the importance of exclusively providing a child with breastmilk and benefits to both the parent and baby. Colostrum, the first milk you produce in pregnancy and in the first few days post birth contains vital immunological properties. It helps to colonise a baby’s gut with healthy bacteria and helps prevent against allergies and disease.

Hand expressing is advised when pregnant or in the early days after birth as colostrum is thick and available in small amounts, it can therefore be lost easily in a breast pump. Some may only be able to express a few drops per session whereas others may achieve a tablespoon or more. At birth a baby only requires very small amounts of milk.

Please note: If there is a risk of preterm birth it is important that you seek advise from your healthcare provider prior to hand expressing in pregnancy.

Reasons to practice hand expressing colostrum

To get familiar with how to hand express ready for the arrival of your baby. You will be supported to breastfeed/chest feed your baby but sometimes it is useful to have expressed milk available while you and your baby are learning.
You or your baby has a medical condition that means baby is more likely to require supplements, for example, diabetes, cleft lip/palate, congenital conditions such as Down’s syndrome or cardiac complications.
In case baby and you are separated for any reason, for example some babies may need special care or parents who have an induction or caesarean birth find it helpful to have expressed colostrum.
Those having twins or triplets (you maybe advised to start expressing earlier than 37 weeks in this case).
A family history of allergy such as cow’s milk protein allergy where it is important to avoid early use of formula supplementation.
If you experience engorgement or mastitis.

How to hand express milk

1. Try this 2-3 times a day for up to 5 minutes per breast after 37 weeks gestation. Express each breast twice during each session if you can. You can express as frequently as you feel comfortable.

2. Wash hands thoroughly.

Hand expressing after a warm bath or shower helps (if not a warm compress) as well as ensuring you are comfortable and relaxed.

3. Massage your breasts to help milk flow, gentle stroking from the back of your breast down to your nipple.

4. Make a C-shape with your thumb and forefingers, press back towards your chest then gently squeeze just behind the areola (a few centimetres back from the nipple), ensure you move your fingers around to stimulate all milk ducts (like moving around the numbers on a clock). At first you may see no colostrum but as you continue to squeeze and practice small droplets will appear on your nipple. If milk does not appear, try moving slightly closer to the nipple or further away until you find a spot that works for you. This colostrum may range from a clear to very yellow liquid. Build up a rhythm to help milk flow. Please note this should not be uncomfortable.

5. Express droplets either into a small sterile cup or use a syringe to suck up each drop from the nipple.

Storing expressed milk

You can use the same syringe 2-3 times a day to collect colostrum. In between sessions this needs to be stored in the fridge. At the end of the day place in a sealed bag and place in the freezer. It’s a good idea to name and date each syringe or bag with a small sticker ready for when your baby arrives. Frozen colostrum can be stored for up to 6 months in the freezer. Once thawed it should be used within 24 hours.

Transporting expressed milk

If you are having your baby in hospital you may want to take the colostrum with you or get your birth partner to bring to the hospital after you have given birth. This needs to be transported in a sealed bag with ice packs. Breast milk can be carried in a cool bag with ice packs for up to 24 hours.
Unless you know you are going to require colostrum it may be wise to keep some at home and not take it all in to hospital.