Antenatal Hand Expressing

What is Hand Expressing?

Hand expressing means using your hands to remove (express) milk, or colostrum, from your breasts. It is a very useful skill to have and can be used after the birth of your baby to:

• Express colostrum. Colostrum is your first milk. Colostrum is produced in small amounts, but it is perfectly designed for your baby in their first days of life. If your baby is a little sleepy, you can use expressed colostrum to encourage your baby to feed. Expressed colostrum can be given via syringe or cup if your baby is not able to latch to your breast in the early hours or days after birth.
• Express a small amount of breast milk to soften your breasts if they feel full. This can help with breast discomfort and will make it easier for your baby to latch to your breast.
• Manage symptoms of blocked milk ducts and mastitis. It is important you talk to your midwife or maternity support worker if you notice any pain or redness in your breasts.
• Boost your milk supply. This may be suggested as part of a feeding plan.

Why might it be useful to try hand expressing during pregnancy?

Hand expressing in pregnancy can be a great way to prepare for breastfeeding. It can help with your confidence with expressing after birth. However, if you would prefer not to hand express, this is ok. Hand expressing is not vital to successful breastfeeding.

When you start hand expressing you may not see any colostrum at first. Please do not worry! This is normal and does not mean you will not be able to breastfeed your baby after birth.

We recommend you start hand expressing during pregnancy if you or your baby have any risk factors that might cause a delay to establishing breastfeeding (see list below). When the establishment of breastfeeding is delayed in the early hours or days after birth, hand expressing is a great way to stimulate your milk production. Hand expressing antenatally will help you express quickly and effectively after birth to minimise any delay.

Risk factors in pregnancy that may lead to slower establishment of breastfeeding include:

• Planned Caesarean birth.
• Induction of labour.
• Some medical conditions such as hypothyroidism and diabetes.
• A history of breast surgery.
• Poly Cystic Ovary Syndrome.

Collecting or ‘harvesting’ your colostrum can also be valuable in some situations. These include:

• If your baby is at risk of having a low blood sugar level (hypoglycaemia) after birth. This could be due to certain medicines you are taking or if you are diabetic.
• If your baby is at risk of having difficulty feeding. This could be if they have a cleft lip or palate, or if they have a congenital condition such as Down’s syndrome or a heart complication.
• If you are expecting twins or triplets.
• If your baby is expected to spend time on the neonatal unit after birth.

When should I start expressing in pregnancy?

For most people antenatal expressing is safe to start from 36-37 weeks of pregnancy. Your midwife will advise you when it is safe for you to start hand expressing. Hand expressing releases a hormone called Oxytocin. Oxytocin helps you release breastmilk. Oxytocin also causes the muscles in your uterus (womb) to contract. Hand expressing has not been shown to start contractions if you are not at risk of premature (before 37 weeks of pregnancy) labour.

If you would like to hand express or collect your colostrum in pregnancy, it is good to start by hand expressing for a few minutes, once a day and then increase to 2-3 times a day, as you get closer to your due date. Colostrum does not ‘run out’, so hand expressing in pregnancy will not mean you have less colostrum when your baby is born.

How do I hand express?

Hand expressing is the same whether you are expressing in pregnancy or after your baby is born.

Before you begin to hand express, try some of the things below to encourage the release of hormones that promote the flow of colostrum or milk:

• Get in to a comfortable and relaxed position. This could be a warm bath or a comfortable chair.
• Think about, or talk to your baby.
• Gently massage your breasts for a few minutes by stroking or making circular motions with your fingertips. Avoid sliding your fingers along your skin as this can cause soreness.
• Gently roll your nipple between your thumb and first finger.

When you are ready to begin hand expressing:

• Wash your hands.
• Make a ‘c-shape’ with your thumb and fingers.
• Place the c-shape approximately 2-3cm from the base of your nipple.
• Gently squeeze your breast by bringing your thumb and fingers together and then release. Repeat this action of squeezing and releasing. Avoid sliding your fingers along your skin as this may become sore.
• It will take time for any colostrum or milk to appear. If no droplets of colostrum are seen after a few minutes of expressing, you could try some additional breast massage and nipple rolling or try repositioning your thumb and fingers forwards or backwards a little to find the right spot for you. Remember if you are expressing antenatally, you may not see any colostrum at all, and this is not a reflection of how much milk you will produce for your baby after birth.
• Repeat on both breasts, rotating your thumb and finger to different sections of your breasts if this feels comfortable.
• If droplets of colostrum or milk appear, these can be collected into a small sterile syringe. If expressing larger volumes after birth, milk can be collected into a sterile cup, pot or bottle. Ask your midwife or support worker to provide you with these.

Watch a video about hand expressing

How do I store colostrum expressed antenatally?

• If you hand express more than once in 24 hours, any colostrum collected can be added to the same syringe. The syringe should be stored in the fridge between hand expressing.
• At the end of each 24-hour period, the colostrum should be put into a freezer for storage.
• Label the syringe using one of the hospital labels with your name on. With a pen, add the date and time that you expressed the colostrum.
• Place the syringe(s) into a clear bag (this should also be labelled with your name and date of birth) and place in the freezer.
• Only bring your colostrum into hospital if your baby is at risk of developing a low blood sugar level after birth. It is important you put your labelled syringes of colostrum into a cool bag with ice packs to keep it as cold as possible. When you get to the hospital, give your colostrum to the ward staff as soon as possible so it can be put into a hospital freezer without delay.
• Hand expressing in pregnancy will mean you have more confidence hand expressing when your baby is born. If your baby needs your colostrum, you will have the skills needed to hand express quickly and easily.

If you want more support and information?

If you have any questions about the information in this leaflet, please speak to your midwife or maternity support worker.

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