Expressing breast milk prior to giving birth

This post was contributed by Diabetes Educator and Registered Nurse/midwife, Jenny van Gemert MNurs GDipMid GDipEd (Facebook and Insta).

When is it beneficial to express breast milk prior to giving birth?

While some women like the security of having colostrum (early breast milk) stored prior to giving birth, it is particularly beneficial for women who have diabetes.

Mothers with all types of diabetes (pre-existing or gestational diabetes) have relatively higher blood glucose (sugar) levels during their pregnancy – even when their diabetes is well treated. This glucose crosses the placenta to the baby. In response, the baby makes more of the hormone, insulin, which lowers the baby’s blood glucose to the perfect level. Over the course of the pregnancy, the baby’s body becomes used to making more insulin.

After delivery, babies born to women with diabetes are at a higher risk of hypoglycaemia (low blood glucose levels). This occurs because these babies continue to produce large amounts of insulin after birth, even though their supply of glucose from their mother, through the placenta, has ceased. This results in an overcorrection of glucose levels, dropping them to potentially unsafe levels.

Rest assured that if you have diabetes, it is standard protocol for your midwife to check your baby’s blood glucose level after birth. If your baby’s blood glucose level is too low, your midwife will encourage you to breastfeed. This initial feed is usually enough to raise the baby’s glucose level. Your midwife will continue checking your baby’s blood glucose level until there are three readings in the appropriate range.

If the initial breastfeed is unsuccessful in maintaining your baby’s blood glucose level, your midwife will seek your permission to give your baby a small amount of formula. At this point, you may prefer to give your baby pre-expressed colostrum. Therefore, expressing breast milk prior to birth allows this option for women who wish to avoid giving their baby formula.

If pre-expressed colostrum or formula does not raise your baby’s blood glucose levels, glucose can be given to your baby – orally or through a drip. However, this is not commonly required.

Is it safe to express?

In 2017, a world-first study about antenatal expressing of colostrum was published in The Lancet – a renowned medical journal. The study found that pregnant diabetic women without complications can safely express breast milk towards the end of their third trimester. You can read more about the study in this article by the Royal Women’s Hospital.

When should I start expressing?

Ideally, you should start expressing between 36–37 weeks of your pregnancy. However, always seek the approval of your obstetrician prior to expressing. In some, albeit rare, cases, nipple stimulation can induce labour. Therefore, it’s important to ensure that your body is ready should this occur.

How do I express?

I recommend watching one of the many excellent online demonstrations, such as this one. 
 
I do recommend hand expressing, rather than using a breast pump. While pumps are excellent for postnatal expressing (when your milk has come in), hand expressing is much more successful for antenatal expressing.

What if I can’t do it?

Initially, keep trying! I recommend that you hand express for at least five minutes per side, every day, for at least a week. Be mindful that it does not always work. However, this does not mean that you won’t be able to breastfeed – there is no evidence to suggest that an inability to express in the antenatal period predicts your ability to breastfeed after birth.

Additionally, keep in mind that there is no set amount of colostrum that you need. The amount collected varies from woman to woman, ranging from 0.5mL to 25mL or more. Any expressed colostrum is considered ‘liquid gold’; therefore, no amount is too small – just do your best.

How do I store the breast milk?

Breast milk can be stored in sterile containers or 1–3mL syringes. If you’re storing the breast milk in a syringe, the syringe can suction the milk up after it is hand-expressed into a sterile container. Once suctioned, a cap should be placed on the syringe. No needle is required in the process. Both sterile containers and syringes can be bought over the counter at the chemist. Alternatively, if you have an appointment with myself or Dr Chris Russell, you can request that I mail these items to you. You can also collect them from the office after your next appointment with Dr Chris Russell.

Once filled, label the syringe or sterile container with your full name, date of birth and the date it was expressed. The breast milk should be frozen, until it’s time to head to the hospital for delivery. The frozen breast milk can be transported to the hospital with an ice brick in a cooler bag. Upon arrival, give your frozen breast milk to your midwife. A small quantity of expressed breast milk will not take long to defrost, and your midwife is well trained in the preparation of expressed milk.

What should I do if I need more help?

If you would like, you can make a 45-minute appointment with me. As a diabetes educator, registered nurse and midwife, I can teach and assist you to express breast milk. These appointments are $90 and can be arranged by calling 9418 8299.