Expressing Colostrum Before Birth: The Complete Australian Guide

Antenatal expressing is frequently suggested when there is a reasonable chance your baby may need extra milk in the first 24 hours, or that your milk may take a little longer to come in. That commonly includes:

• Gestational diabetes or pre-existing diabetes, because these babies are at higher risk of low blood sugar in the first day.
• A planned caesarean birth.
• A baby measuring small for dates.
• Polycystic ovary syndrome, previous breast surgery or hypoplastic breast tissue.
• A previous experience of delayed milk supply or difficult early feeding.
• Twins, though this needs specific obstetric sign-off first.

Plenty of women with none of these do it simply because they want a small buffer and the confidence of having practised. That is a perfectly good reason.

This is the section most articles skim over, and it is the one that matters most. Nipple stimulation releases oxytocin, the same hormone involved in labour contractions. In a healthy term pregnancy that is not a concern, which is what the DAME trial demonstrated. In some situations it is.

Do not begin antenatal expressing without specific obstetric clearance if any of the following apply:

• You have a history of preterm labour, or you are currently at risk of preterm birth.
• You have a cervical suture (cerclage) or a diagnosis of cervical insufficiency.
• You are expecting twins or more.
• You have placenta praevia, or you have had bleeding during this pregnancy.
• You are being monitored for a pregnancy complication, or your baby’s growth is being closely watched.
• Your obstetrician or midwife has advised against it, for any reason.

Stop expressing and contact your maternity unit if you experience regular or painful contractions during or after a session, any vaginal bleeding, fluid loss, or a change in your baby’s usual movements. Occasional tightenings are common in late pregnancy. A pattern that continues after you stop is not something to sit on.

Colostrum is thick and comes in small volumes, which is precisely why hands work better than a pump. A pump is designed to move liquid through tubing. Most of your colostrum would be left behind in the equipment.

Before you start

• Wash your hands.
• Try after a warm shower or bath. Warmth and relaxation both help.
• Sit somewhere comfortable, leaning slightly forward. Rushing works against you here.
• Massage your breast gently for a minute or so, working from the chest wall towards the nipple.
• Have your collection syringe uncapped and within reach.

The technique

• Place your thumb above your nipple and your first two fingers below it, forming a C shape, roughly two to three centimetres back from the base of the nipple. You should be on breast tissue, not on the nipple itself.
• Press straight back towards your chest wall. Do not slide your fingers along the skin.
• Gently compress your thumb and fingers together, then release. Press, compress, release. Find a rhythm rather than squeezing hard.
• Squeezing or pinching the nipple will not work and will make you sore. If it hurts, adjust your position.
• It can take several minutes of this before anything appears. That is completely normal, particularly the first few times.
• When drops appear, catch them directly in the syringe, or collect them on a clean teaspoon and draw them up.
• Rotate your hand position around the breast like a clock face to reach different areas.
• Swap sides when the flow slows. Most women do a few minutes on each side, then swap back.

How often

The DAME protocol was ten minutes, twice a day, from 36 weeks until birth. Once or twice daily for five to ten minutes per session is a sensible general pattern. Consistency matters more than duration, and this should not become another thing you are failing at. Missing days is fine.

Drops. Genuinely, drops.

This is the single biggest source of unnecessary distress around antenatal expressing, so it is worth being blunt about it. Many women collect nothing at all for the first several sessions. Many go on to collect 0.2ml to 1ml per session. Some collect a few millilitres. All of these are normal.

A newborn’s first feeds are measured in teaspoons, not bottles. A collection of one or two millilitres is a meaningful amount of milk for a baby that size, not a disappointing one.

Here is the part that matters most: how much colostrum you collect before birth does not predict your milk supply afterwards. It is not a test. Women who collect nothing antenatally go on to breastfeed successfully all the time. The Edith Cowan review made this point explicitly, and it is worth repeating to yourself if the syringe looks emptier than you hoped.

Most women notice volumes increase over the weeks as they practise. If you are collecting more each week, that is your technique improving as much as anything else.

Colostrum is famously described as liquid gold, and often it is: thick, sticky and a deep golden yellow, coloured by beta-carotene.

It can also be:

• Pale yellow or cream, which is very common.
• Clear or almost watery, which is also normal and does not mean it is low quality.
• Orange-tinged, usually reflecting a high carotenoid content.
• Slightly pink, brown or rust-coloured. This is usually a small amount of blood from tiny capillaries, sometimes called rusty pipe syndrome. It is generally harmless and settles on its own, but mention it to your midwife so it can be checked.

The colour will also vary between sessions and between breasts. None of this tells you anything reliable about how nourishing your colostrum is.

What to collect it in

Small sterile syringes, usually 1ml or 2ml, are the standard. Many Australian hospitals and midwifery clinics will give you a colostrum collection pack, so ask at your next appointment before buying anything. Purpose-made antenatal collection kits are also available through pharmacies.

Labelling

• Write your full name and the date on every syringe.
• If you are told to include your hospital record number, add that too.
• Cap the syringe and place it in a sealed bag, which most collection packs include.

Freezing

• Freeze each syringe as soon as you have finished the session.
• You can add to a syringe across the same day if you keep it in the fridge between sessions, then freeze it at the end of the day. Do not add fresh warm colostrum directly to already frozen colostrum.
• Standard Australian guidance for expressed breastmilk is up to three months in a freezer section with its own separate door, and six to twelve months in a deep freezer held at minus 18 degrees or below. Many hospitals apply a shorter window to antenatally collected colostrum, so follow the timeframe your hospital gives you.
• Store syringes at the back of the freezer, not in the door, where the temperature fluctuates every time it is opened.

Taking it to hospital

• Transport it frozen, in an insulated cooler bag with ice bricks.
• Hand it to your midwife on arrival so it goes straight into the ward freezer.
• Tell them at admission that you have brought antenatal colostrum, and make sure it is written in your notes and on your feeding plan. This is the step most commonly missed.
• If you have a planned caesarean, arrange this in advance so it is not being sorted out on the day.

For the full picture on breastmilk storage once your supply is established, including containers, thawing and how to organise a stash without wasting any, see our guide to how much breast milk to store in the freezer and how to build a stash.

• Starting without checking first. A two-minute conversation at your next appointment covers whether it is appropriate for your pregnancy.
• Reaching for a pump. Colostrum is thick and scarce. Most of it will be lost in the flanges and tubing. Hands are better.
• Squeezing the nipple. Compression needs to happen back on the breast tissue, not on the nipple. Nipple squeezing produces nothing and causes soreness.
• Judging yourself on volume. The amount you collect is not a preview of your supply.
• Forgetting to label. Unlabelled milk cannot be safely given to your baby in a hospital setting.
• Leaving it in the car. Frozen colostrum needs a cooler bag, not a handbag in an Australian summer.
• Not telling the ward. Colostrum that stays in the cooler bag while your baby is given formula helps nobody.

Contact your maternity care team promptly if you experience:

• Regular or painful contractions during or after expressing, particularly if they continue once you stop.
• Any vaginal bleeding or fluid loss.
• A change in your baby’s usual pattern of movement.
• Nipple pain, cracking or bleeding from expressing.
• Blood in your colostrum that does not settle after a few days.

The Australian Breastfeeding Association helpline is free and open 24 hours a day on 1800 686 268, and their counsellors can help with technique before your baby arrives, not just after.

This article is general information and does not replace individual advice from your midwife, obstetrician or lactation consultant.