Hand expressing and storing colostrum in pregnancy

Colostrum (first milk) is produced from around 16 weeks of pregnancy. This continues in pregnancy in preparation for your baby’s birth. This leaflet will support you in expressing colostrum before you give birth, to support your baby in the early hours after they are born.

Colostrum triggers the baby’s immune system, helps to stabilise blood glucose levels and is particularly high in infection fighting properties including antibodies. It also contains vital immunological properties and helps to coat your baby’s gut with healthy bacteria, which helps to protect against allergy and disease. It is produced in small quantities which are the perfect amount for your baby’s stomach.

There is evidence that giving formula can increase your baby’s risk of developing diabetes, asthma and other illnesses. It is better for your baby to receive only your milk in the early weeks. If the unexpected happens and you and your baby are separated, or if your baby has feeding difficulties or health problems, having saved colostrum can be extremely helpful, and you will find it easier to express your milk if you have practised beforehand.

If you are experiencing challenges with breastfeeding at the beginning, you can give your milk to baby through a syringe or cup (it is best to avoid bottles while establishing breastfeeding) so that baby is only getting your milk from the very start.

When to express

If you wish to express colostrum for your baby before they are born, we suggest you start at around 36-37 weeks of pregnancy (unless an individualised plan is in place). If you are in hospital being induced, the process can take some time. This can be a perfect time to hand express, and staff can store your milk safely for you.

If no risk factors for premature labour have been identified during your pregnancy, then there is no evidence that daily hand expression of colostrum can trigger labour.

However, if you have any of the following conditions, antenatal expressing is not advised:

A short cervix
A cervical suture in situ
History of antenatal bleeding in this pregnancy

For some women in pregnancy, stimulating the nipples can cause ‘Braxton Hicks’ (period type cramps), therefore you might experience these painless tightening’s whilst expressing which is normal. However, if these become painful and do not subside once you stop expressing, please telephone the delivery suite for advice (you will find the telephone number on the front of your pregnancy notes).

How to express milk by hand

Start by making sure that your hands are clean and that you have a sterilised container or syringe before you start.
Get comfortable, ensuring you are as relaxed as possible.
To encourage the release of colostrum, you may find having a bath or a warm shower before expressing might help, alternatively, you can apply some warm cloths to the breasts prior to expressing. This will help facilitate Oxytocin, the hormone needed to help release the colostrum.
Use a few minutes of gentle breast massage before expressing. This can be kneading, massage, stroking towards the nipples, or whatever feels comfortable for you. Nipple stimulation is also helpful.
Cup your breast with one hand making a ‘C’ shape with your thumb and the rest of your fingers, about 2-3cm from the base of the nipple.
Gently compress and release your breast in a rhythmical motion. Avoid sliding your fingers over your skin as this may cause damage. Because colostrum is very concentrated, it can be thick and will come out of your breast drop by drop. To begin with, colostrum will appear like little beads on your nipple and may vary in colour, which is very normal.
Collect your droplets of colostrum on a clean cooled sterile teaspoon or in small container (such as a feeding cup) and draw it up in a 1ml sterile syringe (which your Midwife can provide you with). You can collect the droplets directly in the syringe however you may find it easier for a partner to assist with this.
If you cannot see any colostrum, try moving your fingers slightly towards the nipple or further away. Find the spot that works best for you.
Keep your hands in one position until the colostrum stops coming. Then you should rotate your thumb and forefinger position to express the other areas of your breast.
Aim to express from both breasts each session.
If you do not see any colostrum, don’t worry! It can take time to start to be able to express. Play around with the position of your fingers and keep trying regularly.

See the useful videos on how to hand express in the ‘Preparing to Breastfeed’ section of our website.

How often can I express and what do I need?

You can initially express for 3-5 minutes on each breast, increasing to 5-10 minutes once confident and repeat this 2-3 times a day.

The same syringe can be used to collect your colostrum during the 24 hour period, ensuring it is capped and placed in the fridge (stored below 4°C) each time. After 24 hours, the capped syringe should be labelled with your name, hospital number (which can be found on the front of your pregnancy notes) and the date of expression, and placed in a zip lock bag and stored in the freezer. It can be stored for up to six months in a freezer (at a temperature of –18°C or below).

Important safety information

Some colostrum collection syringes have a free-fastening lid which must be removed and disposed of before giving expressed colostrum or milk to your baby. This should ideally happen as soon as the syringe is removed from the fridge.

Always keep syringes and lids away from toddles and children as they can be a choking risk if placed in the mouth

Bringing your milk to hospital

When you attend the hospital to have your baby, we recommend initially only bringing 3-4 syringes of frozen colostrum. It should be transported in a clear box with freezer blocks alongside, with a label on the top clearly stating your name and the contents.

If delivery is not imminent upon your arrival, your frozen colostrum will be stored in the milk freezer on the neonatal unit or postnatal ward until it is required. Alternatively, if your colostrum is likely to be required sooner, it will be stored in the milk fridge either on the neonatal unit or on the postnatal ward. Once your milk has been defrosted it must be used as soon as possible and within 24 hours. To avoid unnecessary wastage and due to minimal storage capacity, it is not recommended you bring in large numbers of syringes therefore it would be preferable to bring your colostrum in over a period of days (if applicable).

Ensure that the midwives caring for you (or the neonatal team if they are caring for your baby) are aware that you have collected your milk antenatally should it be needed by your baby.

If your baby is in special care

Antenatal expression of colostrum can be extremely useful for preterm or unwell babies, in helping them avoid the need for formula supplementation.