Transcript:
Have you tried a haakaa yet? Y’all might be familiar with their best-selling silicone breast pump, but did you know about their silicone colostrum collector set? You can collect store and feed colostrum all from the same kit. They also have a wide range of products, including baby bottles, nipple shields, milk storage sets, baby care kits, and more. Haakaa is a family owned brand that provides parents with safe, natural non-toxic and eco-friendly baby products.
We love how simple and easy to use the haakaa products are. Follow the link in our show notes to see Heather and I demonstrate how to use the haakaa products, including the prenatal colostrum collectors. You might even find a promo code there.
This is Maureen Farrell and Heather ONeal, and this is The Milk Minute. We’re midwives and lactation professionals bringing you the most up-to-date evidence for all things lactation. So you can feel more confident about feeding your baby, body positivity relationships, and mental health. Plus, we laugh a little or a lot along the way.
So join us for another episode. Welcome back to The Milk Minute Podcast, everybody. Hello. We are super pumped to be here and we’re talking about expressing colostrum prenatally, which is something that so many people have asked us about. Is this something we should be doing? Is this standard? I forgot to do it. I’m about to deliver, is it too late? So many questions.
Thank you for taking the time to put this episode together, Heather. Cause I kind of just put it on the to-do list and you were like, why? And then you did it. So thank you. Yeah, no worries. Happy to do it. Happy to dig into topics like this. Always. Yeah. It’s a really frequently asked question and I feel like I usually give people a one-liner and they’re not satisfied.
So hopefully we give you every bit of information we have on this today and you leave this feeling just like really educated. Yeah. Or, you know, informed enough to make a decision that you can feel good about. That’s always our goal. But first instead of a question, oh, I’m going to mix it up a little bit. I love that.
We got an inspirational statement from one of our Facebook group members. Thank you. Yeah. So I’m going to read this to you. Am I going to feel good? You’re going to feel warm and squishy. Yay. Okay. This is from Tina Trickle. So thank you, Tina, for responding to my call for questions for this episode. By the way, if you would like to have your question read, you can join our Patreon at Patreon.com/MilkMinutePodcast. We prioritize all Patrons questions and wins for these episodes.
Tina says, this is more of a revelation I had this week. Breastfeeding journeys, just like breast milk, isn’t a one size fits all, but changes to meet your needs. I think we as new moms put too much pressure on ourselves that if it’s not instantly what was pictured, we’re failing. When in fact you just have to find the plan and tips and tricks that work for you.
Perfect. Tina, we couldn’t have said it better ourselves. Well, I hope everybody takes that to heart today, especially when you meet unexpected challenges and especially when you respond in a way that you would not have imagined.
Exactly. And that goes right in line with what we’re talking about today. Yes. You know, is this something that’s going to work for you? Let’s find out together.
Hey, everybody, Heather here with some good news for you. If you’ve been wanting a lactation consult with me, but you’re not really sure how to go about, I finally can take some insurance. So if you have Blue Cross Blue Shield, Anthem, or Cigna PPO, there’s a very good chance that you can get your visits a hundred percent approved with me.
So if you fill out the short form, it’ll take less than two minutes in the show notes with your insurance information, we’ll know in as little as five hours if you’re approved and then we’ll throw you right on my calendar. And then we get to hang out and guess what? It’s not just one visit. I can see you prenatally.
I can see you before you go back to work. I can see you when you start solid foods. I could see you through weaning. I mean, we got this whole journey covered. So shout out to those insurance companies for valuing this as work, and I’m here for you every step of the way. So click the link in the show notes, to learn more about my private consults and make sure that we can get you what you need.
I look forward to working with ya. Bye.
All right. Prenatal colostrum expression. So let’s first of all, talk about what is it? We’re talking about the what, why, how and when today. So what is prenatal colostrum expression? So this is when you are still pregnant and choose to express some colostrum, which is that first milk and store it in case you need it in the immediate postpartum period.
So first let me say that we do not really develop colostrum until about 18 weeks of gestation. Right. You know, you have something in there a little bit before that, but it’s a little bit more like a, I was joking with my friend the other day who’s a midwife. I was like, it’s like pre Jack, you know, it’s like, it’s not actually stuff.
It’s like a primer. You know, I think of it as like, when you turn the water in your house on after like the pipes have been blown out and you know, it comes out and it’s like, oh, it’s kind of brown. Don’t know what that is. Oh, now there’s air. What’s going on. And then like, after a while, like actual water starts flowing.
And, and that’s what a lot of people are like my nipples are crusty. There is some clear liquid coming out, like what? What’s going on. If it’s clear and your nipples are crusty, that’s like the pre Jack of colostrum. We, yeah, the precursor. It’s kind of like your body is just like throwing some stuff out there trying to put the pieces together, but we’re not, it’s not complete yet.
Right. And if you want to know more about that, we did just do an episode on the life cycle of the breast a few weeks ago and that’s Episode 108. So you can go check that out if you’re like, what is my breast? Why have I never thought about this before? That’s got all the answers there. Awesome. Yeah, that was a fun episode. So I hope you guys like it.
But according to research breasts make between 10 and a hundred milliliters of colostrum per day. So 30 milliliters or one ounce per day, which is more than the baby needs. Yeah. I know that sounds small, especially to you guys who are like, I feed my baby like 40 ounces of milk a day.
Colostrum is different, y’all. Yeah, because first of all, when the baby’s first born, their tummies are really tiny. It’s like the size of a marble. So really we always say like one drop of claustrum is equivalent to 30 drops of mature breast milk in a lot of ways. It’s like really condensed. It’s stickier.
It’s just different. It serves a different purpose. Like colostrum is not there to make your baby grow. It’s there to set them up so they can digest. Right. It kind of gets their GI system going. It’s the first thing to colonize them, like their microbiome. Well, one of the first ways it supports their immune system.
Yeah. So it’s, and it gets them to poop. So it stimulates their digestive system and it helps to get that meconium to pass through. Stabilizes blood sugar. It’s got some protein in it, like lots of good protein which kind of helps them with their strength initially. So lots of good stuff there. It’s different milk, but you know, I don’t even know if we should get into this now, but I do have people that have saved colostrum in the beginning.
And then when their baby is six months old, they’re like, can I use this still? The answer is, yes. You can still use it. It’s not like so different that it’s not going to be useful in food. It’s still human food. It’s just a little bit different than your mature milk. Yeah. So why do we do this? And what are the thoughts behind it?
So prenatal or anti-natal as we sometimes call it, breast milk expression is known to decrease the amount of time it takes for your milk to come in. So you can kind of think of this, you know? Cause you might be like, what? No way. But think about this. What if you are still nursing your toddler and then you have a baby, like you’re in labor, but you’re still nursing your toddler.
Do you think that person is going to have a long time for their milk to come in? Probably not, it does switch back to colostrum when you’re pregnant and then you have your baby and you have to go through the same process cause you’re now priming that new baby’s gut, right. But your milk doesn’t take that long to come in because you’re already expressing, so this is not heavily researched.
I will say that. Yeah. So that’s the thought. Yeah. I looked at studies on this actually a couple months ago because somebody in our Facebook group like laid a bold claim about it. And I was like, girlfriend, I got to check that. And there were a couple of studies and some of them supported the theory that this helps your milk come in faster.
And some of them were like meh, didn’t really pan out. So it might do that. And that might be good for you. And that just that chance of it might be enough for you to want to express prenatally. I get the logic though, based on like multi gravas, people that have had multiple kids. Yeah. It’s, it’s just tricky because also like what, what triggers your mature milk is the expulsion of the placenta.
So is repeated expression before then doing much? It’s a little bit hard to say. Right? Another thing that has been thought about it is that it decreases breast engorgement postpartum. I don’t really understand that one. Maybe you can fill me in on what logic you see in that. I don’t. The way that I might be able to see that is that the primary reason.
Okay. So aside from IV fluids, the reason you might experience engorgement is not necessarily because there’s such a big volume of milk, but we’re just not used to the tissue expansion that you’re feeling for the first time when your breasts are emptying and filling and emptying and filling. So, I guess if you did that prenatally and you were like empty fill, empty fill, you would be used to the tissue expansion and you might not feel engorged.
Maybe. I don’t know. That’s a, maybe. That’s going to be a maybe for me too. I mean, I guess I could kind of see it and you know, the best way to prevent primary engorgement is to remove small amounts of milk frequently and just keep it flowing. Right. That’s after birth. Or to like, do your best, not to get six liters of fluid.
Right. Do your best. So that one, that, one’s a big question mark for me, but another thought is that it helps you avoid the need for breast milk substitutes, AKA formula. And this is a yes. In some circumstances, right? Like, and, and hopefully you can go into that for us, but if you need supplementation in the first three to five days postpartum, having expressed colostrum already makes that very convenient.
It makes it convenient. And also it does something for you mentally. I think for people that are planning to exclusively breastfeed, you’re like, look, I’ve already done it. I’ve got it right here. I’m not a quote-unquote failure. I hear this a lot from people. And it is hard to like, hand express a teaspoon of colostrum in the hospital when the nurse comes in and they’re like, we need to supplement.
And peds is like, you have to do it right now. And you’re engorged. Right. Because your baby’s not latching. But that that’s always fine too. So Heather, can you tell us like, why would we need to supplement or what are, what are some things that would put us at a higher risk for supplementation? Well, I think people might individually choose to do this based on their risk factors for having more complications, postpartum that would get in the way of a baby latching or transferring milk.
There are a lot of different situations where it can create a more complicated scenario. So we’ll go through a couple of those scenarios now, and then you can listen and see if you maybe fit into one of these categories to help guide your decision-making about whether or not you would like to express colostrum prenatally.
Okay. Let’s do it. So, number one is you have diabetes. This one gets the majority of the headlines when it comes to prenatal colostrum expression. This has been one of the biggest reasons that babies are supplemented with formula after birth. It’s because they’re hypoglycemic. When you’re diabetic, you have more sugars freely floating through your body, flowing through your placenta.
Your baby makes its own insulin. So your baby is reacting to that sugar all the time with super high insulin, then you cut off the source and suddenly we have high insulin and no source of sugar. So the baby’s blood sugar starts to tank. And then that’s in the first 24 hours where you don’t really have any milk yet.
And so this is where we see formula supplementation. Also we do have some research that shows us that diabetic mothers do tend to get their milk in later. So usually milk comes in on day three or four. With diabetes, we can see maybe day four, day five. So there’s just that bigger gap there of time that needs to be covered.
Side note. Often people with diabetes are induced earlier. So they’re between usually 38 and 39 weeks, depending on how things are going. So if you do choose to plan to express milk prenatally, you’re going to want to take that into consideration as far as when you’re going to start.
You don’t want to be like, oh, I’ll start at 38 weeks. And then you go in for your 38 week appointment and your doctor goes, guess what? Don’t leave. Happy birthday. You’re not leaving. And then you’re like, crap. I never did that. So that’s just something to keep in mind. But fun thing is you can do this in labor.
Especially because nipple stimulation encourages labor. And so if, say during your labor, they’re like, what if we start a Pitocin? You’re like, what are my options? And they’re like, oh, nipple stim. Let’s bring you a pump. You could, I would say hand express first, ask for a little syringe and a teaspoon.
And then save whatever you get out. And you’re like hitting two birds with one stone. Okay and what you just said there is really important. Nipple stimulation encourages labor. It does not start labor usually. Okay. Unless you’re like right about to start it anyway. Right. We’ll get back to it, huh? Yeah. Well, we’ll get back to that.
We’ll circle back at the end. Oh God. I hate that. I know. Don’t say that. Oh my gosh. Can I tell you really quick that I heard the other day at a meeting? Lady leaned really far into the camera in the zoom and she said, I really liked what you said there. Let’s double click on that for a minute. What are we doing?
And then she said it three more times. Like it was her new business term that she just wanted to try out and I was like, it’s not working. Reel it in. Let’s double click on that, Maureen. Number two, this is the second scenario where you might want to consider this. You know that you’re O blood type and your baby might be anything other than O. So you don’t know what your baby’s blood type is until after they’re born.
But if you are O, and your partner is A or B or AB, you know that there’s a chance that your baby is not going to have O blood type. If they do not have O, and they are A, or AB, or whatever your partner is then your baby is at higher risk of jaundice because you have an ABO blood incompatibility. Can I tell you something about this?
I have had several instances where this has happened for, for clients, and I feel like the first thing peds jumps to is like, oh, you’re not feeding enough and their jaundice is getting worse when it’s literally just a blood type issue and it’s not their fault. And I’m just like, what if we just checked that?
What, right. What if we just considered that that’s actually pretty common and it doesn’t always cause a problem, but sometimes it causes really terrible jaundice. Right. And so the whole thing about jaundice is that, and I could talk about jaundice an entire episode. Maybe we should. I definitely will.
Okay. I am actually a little bit obsessed with jaundice. In the future and it’s going on my list of PhD, topic recommendations. So jaundice inherently makes your baby very sleepy. So the more jaundice they are, the more sleepy they are, the less likely they will be able to sustain alertness for a feeding to complete a feeding and the thought by peds and by, I guess, you know, logic is that if you’re not having any input, so you’re not feeding, you’re not going to have any output like pooping.
And the way we get rid of jaundice is by pooping it out. So our liver converts it into a form that we can excrete and we excrete it in our poop. Bilirubin just goes straight out the tube. Right. But the weird thing about it is if the baby doesn’t have enough volume and they don’t poop, they can actually send it back upstream and re unconjugate in the liver and send it back into the tissues and eventually into the brain.
Which is called kernicterus which is very rare. And the thing is too, sometimes even in the, you know, best case, or we just have so much milk or so much formula jaundice just doesn’t get better quickly. And so while that’s often the first thing we jump to is like, let’s increase the volume of feeds, it doesn’t always just like solve the problem. Right.
So, you know, the other issue is part of the way they treat it is with ultraviolet light. So that’s when the babies are on the little glow worm blankets, and they’ve got the glow worm light on top of them. And tiny little sunglasses. And their sunglasses, and they got to keep the diaper on to protect the balls on the balls I’d always say.
But it interrupts breastfeeding because they’re like, okay, we need baby to get a lot of volume quickly, but also do not remove the baby from the bilirubin lights. So you can’t feed them. But you can, you need to remove them, remove the eye shields to do eye care. Most places have Bili blankets. Well we do Bili blankets now with the light on top, but there’s a lot.
Depending on your provider and the way they educate, sometimes people feel scared. Oh yeah. When they get educated on this, like you have to keep your baby in there. You have to do formula. Right? Like a lot of this is just, I’m going to do my best to maintain my breastfeeding relationship and my sanity and get this baby under the lights as much as possible.
And if we need to stay longer, we’ll gladly stay longer. Yeah. I mean, I really like when we can have the Bili blanket come out and be on while breastfeeding and then they can go back and it’s just a tough situation. And there are some creative solutions. There are lots of different ways that we can fix this and help our babies.
Right. But the main point here for this episode is that jaundice babies often do need a little bit of supplementation, cause they’re just so sleepy. So having a little bit of extra colostrum on hand already to maybe either A entice them to wake up a little bit and be like, oh, I remember what I’m supposed to be doing here at the breast.
And then suckling themselves on the nipple or to legitimately replace that feeding and then you just have to pump. And that way you get ahead of it so formula doesn’t feel like this looming scary thing. It’s like, we’re good. We’re already ahead of it. It’s not a big deal. And I would say particularly if your other babies were jaundiced and this is not your first baby, this is a really good thing to think about.
For sure. So the third scenario is that you are RH negative. So you’re either O negative, A negative B negative AB negative, something like that. And you’re going to know this because you will be given a RhoGAM shot in pregnancy and postpartum. So even if you’re not like totally connecting the dots on blood type, if you get that extra shot at 28 weeks, you have a negative blood type.
And if your partner’s negative, you don’t really need to worry about it. But if your partner’s positive, guess what. You could have a positive baby, same kinda deal with the blood type. So that’s that scenario. Same issues with jaundice as listed above. What’s your blood type? I am O positive. Oh, me too.
Besties. Besties. We’re the most basic bitches there are, O+. It is kind of the basic bitch blood type. And by the way mom who’s O, and a baby who’s B is the most likely to be jaundice. So if your partner’s B, and you are O, that’s the biggest risk. O to B, or if your partner’s AB. B and AB, right? Yeah. So the fourth scenario is kind of a smorgasbord, but it’s if you have hypertension, preeclampsia, epilepsy, or another chronic condition of pregnancy, that’s going to put your baby at higher risk for complications postpartum and possibly a NICU stay.
Yeah. And I’m going to say like, if, so, any instance where your doctor is talking about inducing for your health or inducing for baby’s health, like something where we’re going to have a medically managed labor, possibly not at the time it would have naturally happened. If there are real concerns about your, you know, you can just ask, like, is there a possibility my baby’s going to be in the NICU?
You know, do I have higher risks of medical complications postpartum? And it’s not like you’re going to run out of time to do this. If they’re like, yes and we need to induce you now, you can be like, cool, can you bring me a pump? Right. I’m just going to start expressing colostrum. Right. And you know, the colostrum is pretty sticky and not a lot of volume.
So if you’re not getting anything in the pump, you might actually be better off hand expressing for the first few days or so. And maybe the first day, at least. I actually, my favorite thing to do is to hand express in the haakaa. Because I don’t know about y’all, but I like spray in 10 different directions when I’m hand expressing.
And I’m like holding a little cup and hand expressing. I’m like it’s all missing, but I suctioned the haakaa on and then I like, hold it on with one hand. And then the other, I do the hand expression, like movements with the haakaa on, and then it all goes in the haakaa. Nice. It’s so nice. Hot tip. Heck yeah. Hot tips from Mo over here. Hot tips from Mo. It’s a PDF.
She’s going to link in the, I’m kidding.
So if this is so great and so helpful to keep babies out of NICU and keep them from being supplemented with formula and all that stuff, blah, blah, blah. Why are we not recommending this prenatally as a standard practice? Because when we express milk, we end up in this lovely oxytocin feedback loop. And guess what oxytocin does? It contracts the uterus! And lots of other things.
Yes, but that’s really why we’re cautious because we don’t want to start labor too early. Let me just say, we used to be like, nobody should do this because nipple stimulation always causes labor, but it’s not, it’s not like really accurate. That’s actually very inaccurate.
It’s not really accurate at all. But say you like have been having trouble with preterm labor or you’ve had miscarriages or you’ve had like a late loss or something. In the past, you know, you probably don’t want to do anything then to increase your chances of preterm labor or early labor. So that can be something where situationally your healthcare provider might have you be more or less cautious.
Mostly in my experience as a provider, I have seen this cause contractions, but not labor. And sometimes that’s really exhausting and it can be mentally exhausting. Cause you think labor starting, but also just like if you have 10 hours of contractions that do nothing, you’re tired. Yeah. Yeah. And you know, Braxton Hicks, aren’t a bad thing.
No. Sometimes they are when they’re very annoying and they last for 15 weeks. If you can’t sleep. If you can’t sleep. But the whole purpose of Braxton Hicks and contracting randomly without dilating your cervix is to tone up your uterus because it’s a muscle. It would be like trying to run a marathon without ever having run a day in your life.
So your uterus has to work out a little bit in order to get ready for the big day. So when you do your nipple stim and you get a milk ejection reflex, it’s squeezing your breast muscles. When you have an orgasm, like when you’re having sex, it squeezes your pelvic floor muscles. And when you finally get a Labor cascade of hormones with oxytocin involved, you are getting your uterus squeezed.
So oxytocin is a squeezy hormone. Yeah. Squeezy, but it doesn’t always cause cervical dilation. No. And, and, you know, we just want to make sure with this that before you do it, you do have that conversation with your healthcare provider, because all of you guys have different bodies, different health statuses, different situations, right?
But here’s, what’s straight from the La Leche League website. They say, “Expression of colostrum has not been shown to trigger labor contractions if the pregnancy is otherwise stable. In fact, nipple stimulation is not especially effective in starting or enhancing labor contractions.” Interesting. I feel like I see it work in labor all the time.
Yeah, but that’s but with a primip? I guess I don’t use it. I mean, usually primips, just get on the train and slowly go. It’s usually with multips where I’m like, what happened to your labor? Yeah, because their uterus is a little floppy here. They’ve been Braxton Hicks seen for a while and that’s when it’s like, go get your toddler and see if they’ll nurse and see if we can’t get you in a better pattern, but it’s not the end all be all.
And especially not at 33 weeks or 34 weeks or 35 weeks. So the cool thing about your uterus is that it actually develops more oxytocin receptors the further along in pregnancy you go. So if you are 24 weeks, you have very few oxytocin receptors. So you could have all the orgasms in the world and you could do all the nipple stimuli in the world and your uterus would just be like, that’s nice.
And you might not feel the contractions. The interesting thing is I feel like people’s awareness of this is really different, right? Like some people, you know, cause theoretically like anytime your baby nurses, you could have uterine contractions, even postpartum, but again, like you lose those receptors as time goes on.
Not all of them, but a lot of them. But man, some people will be like, yeah, I still feel it at like a year postpartum. And I don’t know what kind of interesting nerves you have in your body. That’s very strange. That’s also probably not studied. Yeah. But here’s what makes me mad about it. Tell me. Because we went through this big phase where doctors were like, you absolutely cannot breastfeed.
We still have this happen where they’re like, you need to wean your toddler now that you’re pregnant so you don’t miscarry. You need to wean your toddler so you don’t go into early labor. Even with someone who has no history of preterm labor. We hear this all the time from the people in our Facebook group.
And it is just ridiculous because that same doctor is not telling you to refrain from having sex with your partner. True that. Because we can’t let our husbands go without sex. Cause they got a penis; they got a penis. They like, well, you have to continue doing your wifely duties, but definitely stop breastfeeding your toddler.
You know, it, it doesn’t make any sense. Now if your doctor is like putting you on pelvic rest, no sex, nothing in the vagina and recommending not breastfeeding because you are definitely worried about preterm labor, that’s a, that makes sense. Yeah. And that’s why we’re like have that conversation with your doctor.
You might disagree with your doctor at the end of it, but have your conversation, like, make sure you ask all the questions. Why do they think that? What are the risks? Are those risks applicable to you specifically? Right. And, you know, I looked up a lot of research on this and I actually found a great research paper that compiled studies on this topic, and they actually put together results from 20 different really good studies.
Love when they do that. Thanks for doing our work for us. Yes. And the majority of these studies, I got a tip of the hat. Yeah. Were from Australia in the last five years. Honestly, I would like to go there someday. The Aussies care. I just feel like I’m going to walk it out in public and just, everyone’s going to be breastfeeding.
Yeah. That’s how we imagine it. Is that how it is? Australians tell us. Toilets flush backwards. Everybody’s breastfeeding. There’s some kangaroo. You know, the Dingoes ate their babies. I’m kidding. Okay. Well it did happened one time? Well, that was one time. Okay. So in these studies that they looked at all 20 of them, there was a wide range of suggestions, of course, for how the milk should be expressed.
So hand expression versus pump versus nipple rolling versus nipple stretching as well as when to start, like how many weeks you are. How often you do it? Do you do it once a day, three times a day, five times a day? All over the map. Sure. And also for how long? Do you do it for 10 minutes? 15 minutes. Like there’s no standard on how much..
Yeah. With every possible, you know, protocol and they were like, just pick one, have fun. Yeah. Yeah. I mean, some of them in there were actually pretty grueling and I was like, this sounds stressful. I would never recommend that to somebody. And that’s one of the reasons I don’t recommend it to people is this is a stressful thing for a lot of people.
And we’re going to get to your opinions at the end. I had a feeling that we were going to differ on this and I’m excited about it. Okay. So here were some of the findings. So number one, parents felt a sense of confidence and ownership of their breastfeeding experience after performing prenatal, breastfeeding milk expression.
That’s cool. Yeah. So in the survey, obviously there were some studies that included surveys and the parents were like, yeah, actually this made me feel really confident that not only can I do it, but that like I’ve already taken active steps towards doing that. I guess it always makes me wonder then, like people who didn’t get really anything expressing, like, did they just feel like they couldn’t breastfeed and decided not to?
I feel, I don’t know. I feel like if people are actively doing it, they probably are going to be the kind of people that would ask a second question. I guess but like how many people come to you and they’re like, I tried to express colostrum and nothing came out! Not that many people. So many people tell me that.
I have more people that are like, I don’t leak. Am I going to be able to breastfeed? And I’m like, yes. Okay. So number two findings is the most value. And this is coming from the most valuable study, which was a random controlled trial of over 600 diabetic mothers. And the study found no evidence that prenatal breast milk expression was unsafe for newborns.
So this is speaking directly to the concern that prenatal milk expression causes preterm birth and NICU admissions. So they found none of that, which was excellent. And that’s a pretty decent size grouping like 600 people with diabetic mothers that clearly have more risk. Right.
So the third thing that was found was that more babies were exclusively breastfeeding and upon discharge from the hospital. Cool. And number four was more babies exclusively breastfed until six months of life. That’s great. So I like that. I think it sounds pretty good.
So. When? We’ll get, well, we’ll get back to you and you, and my opinion at that. So when do we collect it? So, like I said, there’s no official recommendation on this. Definitely after 18 weeks, right?
Like, don’t be doing this before 18 weeks. It doesn’t make sense to start before the third trimester. No, I don’t think so either. I don’t want any prejack. No, no, no. Or prestress. So, because there’s no official recommendation, I personally, and Maureen can say her recommendation after, but I think it makes sense to start around 35, 36 weeks.
Yeah. And just do a little bit at a time only if it’s not stressful for you. I think after a shower where you let hot water hit your breast directly, and then you can massage them and then hand express when you get out of the shower. Yeah. I think that is the easiest time to do it. And I don’t really see a reason to collect more than three to five ounces total.
Yeah. Especially, you know, one of my big things is that we store it in one ounce or less increments. Do we? Because there’s, I exactly, that’s what I said too. I’m like, we need to be storing this. I actually said 5 CCs. Yeah. Well, I like the one out syringes where you can like choose your own adventure there but knowing that we’re only going to be feeding like five to 10 milliliters at once.
And depending what you’re using it for, you might just be using it to wake the baby up and get them a little additional volume, but not replacing a whole feeding. You might be finger feeding for just a second and then putting them on the breast. So like 5 CCs is perfect. So actually maybe it makes more sense to do some in 5 CCs, like one in 10 CC, maybe one in a one ounce.
But like, if y’all are freezing a five ounce bottle of this, it’s not the way. It’s not the way. Right, because keep in mind, you’re just using this to get over a hump until your milk comes in. If we’re freezing it, then when we thaw it, we have 24 hours to use it, right. And a newborn is not going to drink five ounces.
Right. And then of course, most of the time everything’s completely fine postpartum. Like most babies don’t need anything and you might not even need it. So you don’t want to go to all that effort of hand expressing and storing a ton of milk if your baby is latching and transferring milk fine. Which I assume they will be, probably, probably.
And the other thing that I just wanted to say is if your baby is requiring more than three to five ounces of supplement on day three or four of life, I would really hope that you’d be able to pump milk by then, or if your baby’s in the NICU and super sick, they would qualify for donor milk until your milk came in.
That’s a situation where it’s like listen, you, you did everything you could. We’re like we’re at a crossroads and it’s fine. We cannot predict everything. No.
So let’s go into the how. Okay. Okay. So again, there’s no official recommendation on exactly how to do this or how to store it. So a practical guide to expressing colostrum, we’re going to make sure everything is clean, clean, clean.
Extra clean, because if you are using this for a medically unwell baby, which means jaundice makes them medically unwell. Hypoglycemia, low blood sugar makes them medically unwell. Any reason they’re in the NICU. All of that, honestly, we are, we should not be supplementing with formula for healthy term babies.
So if we’re supplementing with colostrum instead of formula, then they probably need all that extra care we can give them. So we want you to wash well and sterilize all of your collection items before use. So when you’re using a syringe and by the way, you can sterilize the syringes, just like anything else.
You can actually pull the plunger out of the syringe and put a cap on the end and literally drip the milk into the butt of the syringe, which I kind like to do because it’s less transfer. But if that’s like too much, you can easily express into a medicine cup that’s sterilized and then suck it up with the syringe.
Yep. And then once you have those syringes, you can keep them in the freezer for up to six months, or you can keep them in the fridge for four days. So if you’re going in for an induction tomorrow and you just wanted to get a couple syringes, just put them in the fridge because you’re going to probably hopefully use them in the next four days.
But if they’re in the freezer, You can actually, here’s my hot tip. You can get your Ceres Chiller that you should definitely get, and we’ll put a link in the show notes for you for that one. You can actually put the syringes, the frozen ones in the internal chamber with ice around it. So you don’t have to worry about messing with refrigeration for the next 24 hours.
Okay. So that’s my hot tip. If you live close to the hospital and you’re not sure when baby’s coming out or maybe you’re getting admitted just for like observation for a while, you can have your partner go and get it the day after if you need it. Hopefully. Yeah. And you know, you can ask like, do, are there fridges in the room?
Do you have ice packs I can use? If I bring colostrum, can you store it safely? Things like that. Right. So that’s probably the easiest way how to do it.
But now I’m really curious. Can we just have chat about why and what we think? Yeah. I would love to hear what you think first. Okay. So I have to preface this with saying that this question and this activity for my clients has seemed like for most people, it is caused more stress than benefit.
Now I primarily work with people who have really healthy pregnancies, really healthy births, really healthy babies, and they simply don’t need this. But I also tend to work with people who overthink things and over worry. And so I get a lot of like, oh, I tried to hand express and nothing came out. Am I going to make milk?
Can I breastfeed? Do I need to buy formula? I mean, like. The high anxiety people. So what I, when people ask me this question, I have that conversation with them where I’m like, is this going to help you feel like you’re more in control or cause you more anxiety if it doesn’t work? Because really like, it’s hard to express colostrum.
It’s thick, it’s sticky and not a lot comes out. And it doesn’t feel very rewarding sometimes when you express it and you get 1 milliliter. So that can be really tough to get your like self-esteem around, you know, so I pretty much have that conversation. And then if we decide to move forward with it, it’s not my choice.
You know, it’s never my choice. It’s someone else’s choice their body. If they decide to move forward with it, then I say, okay, let’s set a limit on how much you’re going to do this. So like, You know, why don’t you can do it once a day or whatever, but once you get a couple ounces in the freezer, stop and don’t do it anymore. Because I’ve also had the case where I did not help somebody set limits.
And then I came in there, they had 40 ounces of colostrum in the freezer. Yes. Oh my, it was wild. It was like, they had this whole little box of syringes in the freezer, like chock full. Whoa. And I was like, oh my God, I did not anticipate this happening. First of all, how? I mean, and I think for some people pumping can become like, a bit of an obsessive compulsion.
And I think in that case, that’s kind of what was happening. Like there was an anxiety, pumping made it feel better, the client pumped, and then the anxiety was relieved. Then the anxiety came back, pumping made it feel better, client pumped, you know, and we had to really work and I, I was kind of immediately like, cool, we’re doing a mental health referral.
Right now. Because anyway. That’s actually, thank God you had a physical representation of that OCD, which could have been previously hidden. Absolutely. So anyway, I’m a little cautious of it because I’ve had some experiences like that. And I just don’t work with high-risk people a lot, you know?
And typically if people who with more complex situations come to me for lactation, it’s postpartum. Right. Well, me on the other hand. Hmm. So I’ve been doing a lot of prenatal, breastfeeding consults for people. Awesome. Virtually, which is awesome. Or in person, but they’ve mostly been virtually because their partner can be there and they’re like, cool.
We’re all in our pajamas. And I’m, I mean, I’m not usually, but I could be. And the people that often book a prenatal breastfeeding consult are people that had a shit show happened the first time. Right. And they’re like, this ain’t going to happen to me again, like I’m going to get ahold of this. Smart and that’s smart, or they know they have risk factors.
Like they know they’re going to be induced. They know that this is going to be a C-section. They know that they have jaundice babies. They know that they’re diabetic. And I think that is super smart to actually first of all established care with a lactation consultant beforehand, because the chances of you having a hitch in your giddy up are pretty high and that’s okay.
And that way you don’t have to think about like, who do I call? It’s like, oh no, obviously I call Heather or I call Maureen, or I call whoever the heck. And it’s not a giant leap for you to make that call. So when I’m working with these people, we go over their risk factors. And I talk about scenarios. And I’m like, listen, here’s a scenario that could happen.
And how do you feel about formula supplementation? Yeah. How do you feel about it? What would you like to know about it? This is what it usually looks like. These are conversations that usually happen at this time between providers and, you know, a lot of times that’s all they really needed to hear was like, okay, as long as I know what’s going to happen, I’m mentally prepared for it now and I’m actually not that mad at it.
But then there’s other people that are like, I absolutely 1010% do not want to do formula. It was awful with my first baby. I think it’s the reason I didn’t breastfeed and I’m like, great. How do you feel about prenatal expression of claustrum? And it actually gives them somewhere to put their anxiety much like with the OCD scenario, but in a, not in a situation, in a healthy way, it’s proactive.
And so in general, with my population that I work with, it’s been very positive and helpful. It’s been very helpful. I think we have the same opinion of this. We just have different experiences of it. I think so, too. Because like the conclusion of this is that there are a couple of scenarios where this is probably going to be more useful than other ones.
It’s an individual situation, you know. You should definitely consult about it. You should know what you’re doing, how you’re going to do it, have a solid plan. And then, you know, also decide is this another thing to do that’s going to add stress or is this a productive thing that you can do that’s going to make you feel more prepared and more empowered? Right.
And can I give you my tip on how to prevent people from going crazy? Please. I give them the syringes. That’s a good idea. And I make them ask me for more. I like that. And I don’t tell them I’m limiting them. I just say here, start with this and let me know what you need. Yeah. I don’t have an office right now, so I’m trying to limit the stuff, which like half of my bedroom is full of it right now.
Yep. You’ll get there. I mean, you, you have a one-year-old so like, let’s just give you a minute. So, but yeah, and also, I, I do three milliliter syringes a lot because it looks like they’re getting more. They’re like I have 10 whole syringes and I’m like, sweet. That’s a whole bunch. Yeah. Yeah. I mean, all, all the different syringe sizes, as long as we’re doing like a smaller than an ounce, we’re going to be okay.
Yeah. So that’s my little barrier. If you’re a lactation consultant out there, who’s like, how do I, I definitely don’t want them expressing 40 CCs then just don’t create a barrier to them asking you for more. So I am pro breastfeeding expression. I just also want to say that if you are doing this and you get a contraction, just stop stimulating your nipples until the contraction is over and wait a few minutes. And then or stop completely and be like, hm, yeah, listen to your body.
And if you’re like, wow, that really doesn’t feel good, then maybe this is not for you. Yeah. Or if you get a contraction and it goes away and then you try again and you get a contraction and it goes away, but it’s not bothering you, oh well. Keep doing it. Yep. You know after 37 weeks, by the way, you’re technically term.
So who cares if you’re contracting? It’s all good. Yeah. Oh, I didn’t answer you before, but I usually wait until 36 weeks to start, but especially because I’m a home care provider, I’m like we can’t have babies before 37 weeks. Yeah, I am so like, I know a lot of other states, their home birth, midwifery legislation includes 36 weeks in their scope of practice, but it freaks me out because I’m like a lot of those babies go to the NICU.
Well, I mean, not even like a lot of them, they just usually have issues and they just need to be watched. Just need to be watched closer and you’re not going to be moving in with them. So. Yeah. Anyway. So I usually wait a little longer, unless of course I’m somebody ‘s like doula and we’re in the hospital and we know, you know, now it’s going to happen.
So yeah, if you want to be very conservative and smart about it, you would wait until you’re 37 weeks. You would do it very sterily after a shower without hurting yourself. So no one else should be expressing you other than you. So that’s a best way to prevent injury of your nipples. And then you will stop doing it if you get contractions.
That’s the most conservative way to do it. Yep. All right, guys, I hope that you feel like this episode helped you feel more confident in what decision you’re going to make here. Me too. We want the best for you.
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Yeah. They donate worldwide which I love. Also, they don’t come in plastic bottles. They come in little packages that you mix in your water bottle, and that keeps plastic bottles out of landfills. So if you’re bored with water, check out Liquid IV and use our discount code MILKMINUTE for 25% off and free shipping. That’s Liquid-IV.com and enter promo code MILKMINUTE for 25% off and free shipping.
Do we have somebody to bestow upon an award? We do, and I’m going to do it today, if you don’t mind. Cause I love this gal. She is just such a cool person. So today’s award goes to Linsey Hill and we will put her picture in our Instagram story. So you can go and give her a high five.
Linsey says, “First-time mom. Six months of exclusive breastfeeding next Monday with no plans to stop. None of this would have been possible without listening to every episode of the Milk Minute Podcast during my pregnancy, taking Heather’s breastfeeding class, and the multiple consultations with her. Thanks, Heather and Maureen for making this possible for myself and baby girl.”
And she posted a picture of her nursing on an airplane. So planes, trains and automobiles, you know, we love to take the booby pictures on the go. So send us all of those. And Linsey, we are so proud of you. Absolutely. By the way, time is a black hole and I can’t even believe your baby is six months old. You were just at my office like yesterday, but that’s okay.
They’re all growing up so fast. We’re going to give you the Fabulous Foundation Award. Oh, that’s cute. Yeah. Cause I don’t think I’ve ever met anybody else who has worked on a good breastfeeding foundation in pregnancy like Linsey. Nice. There’s been a few, but she’s definitely one of them. That’s what my dream is for all of you out there so that when you give birth you’re like I know what I’m doing and I’m ready.
Yeah. That, or at least like when something goes wrong, I’ll know it’s wrong and I’ll know who to call. That’s really all you need to know. That’s great, amazing Linsey. So proud of you. Everybody else, so proud of you guys. Thanks for listening to another episode of the Milk Minute Podcast. The way that we change this big system, that’s really not set up to support lactating parents is by educating ourselves and our friends and family.
If you would like to help make this project more sustainable so we can get evidence-based lactation information to more people, you can make a small monetary donation to our Patreon at Patreon.com/MilkMinutePodcast. And for as little as $1 a month, you can get access to behind the scenes content, videos, pictures of us in our crazy bathrobes at our house, little educational videos and even merch and live Q and A’s.
All right, Heather, Heather, wait, before we leave, nobody leave. I forgot to thank a few patrons. Tell me, tell me. Okay, well, first I wanted to thank Joanna from Washington DC. She’s like almost a local. Whoop! And then Alexandra from Omaha. Oh, my God Omaha. Oh my God. Thank you guys so much for supporting the show.
I will always do the accent. Please just keep doing it. It’s fine. We love you. Okay guys, really bye this time. We mean it this time. We mean it bye.
Resources:
Forster DA, Jacobs S, Amir LH, Davis P, Walker SP, McEgan K, et al. Safety and efficacy of antenatal milk expressing for women with diabetes in pregnancy: protocol for a randomized controlled trial. BMJ Open. 2014;4: e006571 https://doi.org/10.1136/bmjopen-2014-006571.
Foudil-Bey, I., Murphy, M. S. Q., Dunn, S., Keely, E. J., & El-Chaâr, D. (2021). Evaluating antenatal breastmilk expression outcomes: a scoping review. International Breastfeeding Journal, 16(1), 1–12. https://doi-org.wvu.idm.oclc.org/10.1186/s13006-021-00371-7
La Leche League- https://www.llli.org/breastfeeding-info/colostrum-prenatal-antenatal-expression/
