Antenatal Hand Expressing for mothers with Gestational Diabetes

[crystalmummy]

Hello,

I am now 37 weeks and at a breastfeeding workshop i was told i should antenatally express colostrum and store for baby when i go into labour to help with his blood sugars. They have given me 20ml bottles but each time i go to express i only produce 1 drop from each breast and need to scrape it onto the side of the bottle. I can store in the fridge for 48 hours, so need to get the same bottle and do the same procedure in the evening - again only a couple of drops but the drops I originally scraped into the bottle have disappeared! And sometimes i cannot produce any drops at all and i am starting to get frustrated and anxious in a period of time leading up to labour where i want to be as relaxed as possible :(

Has anybody have experience of this that can share any insight please - i want to do whats best for my baby but can't seem to store much at all?

I have no experience of gestational diabetes so have never heard of this advice, but I know from my own experience that all women are very different in the time, quantity and ease of expressing milk. I have never leaked milk antenatally and I would expect any hand expressing I did would have similar results to the ones you are finding (I am 36 weeks with #3). Expressing can be a soul-destroying process, especially if you feel under pressure to do it and it is not working (my experience was for poor weight gain after birth and it wrecked my first few weeks). My advice would be to give it a go, and if it doesn't work leave it. It sounds like just one of a number of ways to help baby out. Try very hard not to feel guilty about it, which is the hardest thing. Like you said, you need to be relaxed and concentrating on the prospect of labour. It will all work out in the end, it always does.

I am not in the same situation but am leaking colostrum at 36/37 weeks and have had a bit of a go at hand expressing. I only get a few drops too. The lady who did our net antenatal classes suggested keeping colostrum in small medical syringes if we wanted to express antenatally. You can 'suck' the drops straight into the syringe and it is smaller so you feel like you're getting further (iyswim)

Hi crystalmummy, was this advice given by the hospital, a midwife or consultant? Or perhaps NCT workshop? Just wondering (and thinking WTF?) I have GD and have never heard anything about this, though I'm now making a note to ask when I go to clinic on Wednesday!

I was part of a trial for this at Frimley Park Hospital, it helps to avoid induction (expressing produces oxytocin which encourages labour) and gives you colostrum to feed your baby straight after birth if they need top ups or are in SCBU etc. firstly 20ml is huge, I initially expressed 1ml (yes, you read that right) then up to 10ml after a weeks or so. I expressed in to plastic syringes to catch the drops and then labelled and froze them. I expressed every evening in a warm bath from 37 weeks and DH caught the drops from me. We couldn't suck up the drops but filled the syringe from the end the plunger goes in by touching it to my skin just below the drop.

I found being relaxed and warm helped,I massed and pressed my milk ducts with my upper and cupped my boob with the lower hand. If you're struggling with this ask your GD midwife for help. I think you need to see her anyway because 20ml bottles are hopelessly big. If you keep going you may find your supply increases each, day, mine certainly did and the day before I gave birth (at 39 weeks) I produced 20ml and couldn't believe what a difference a couple of weeks made.

Thank you for your replies, yes it does sound strange but both NHS and NCT breastfeeding workshops have recommended that i do this and it does seem to make sense to me - if a little strange.

Thanks, i will enquire about the syringes as i feel that i would feel that i am doing more than what i am with those rather than these big bottles. Tonight i got a whopping 3 drops from one but none all day from the other, one boob is making a good job of it while the other not seeming to play ball at all even after a warm bath. Well i can only keep trying i suppose, but feel a bit more reassured now thank you.

Good luck zoobaby, with your appointment on wednesday :)

Hello! I have been advised to do this too - exact same situation. I am having a c-section and they are concerned that there wont be enough milk if he is having a hypo. Consultant suggested the syringes too...

I am 35 weeks and at my breast feeding class the lady whipped out my boob and started showing me how to hand express there and then!!! ;)

It wasn't loads but there is a definite technique to it.

Not sure i've really added anything of use other than to say that you are not alone! Goodluck xxx

Oh and don't be surprised, most people have one boob that produces more than the other. By nine months my supply on the left, which had never been that great, dropped back so much dd pretty much exclusively fed off the right. In the early days they are more even but I'm 6mo pg now and can express lots of colostrum on the right but just a few drops on the left.

I had GD and have also heard the advice to express antenatally, although I heard it after DD was born so I never tried! However, I did struggle a bit with the first couple of days getting DD to feed. Actually, DD did have a hypo and I wish I had been a bit better prepared. She ended up having a couple of small formula top ups (I think 10ml) to wake her up, but not interfere with establishing breastfeeding.

The hospital got me trying to express colostrum postnatally, but I had absolutely no luck. Like you, I just got a drop or two, but DD was quite efficient at getting it out when she fed :) the issue was that she was very sleepy and wouldn't wake to feed. This is quite typical for a GD baby - Kellymom has a good page on ways to wake sleepy babies. The midwives also told me to feed her every 3 hours. But, as she got gradually more sleepy, she'd took longer to wake up and dropped off to sleep again without taking a proper feed. So, in hindsight, I'd have tried to feed her more regularly in the first day so that she actually fed often enough. I think the advice is also to feed as soon as possible after birth.

The good news is that after the first few days, she thrived despite the GD and hypo. I don't want to make you more anxious, just back up what one of the other posters said about expressing colostrum being one of a number of things to try :)

I had GD and got told in an nct class to try and express some colostrum

When I told this to my midwife she was very and said it really wasn't necessary and to trust my body.

After birth my colostrum increased 10 fold and I am sitting here typing this wearily breast feeding him now

If you REALLY want to do this then go to boots and buy a 5 or 10 ml syringe, sterilise and when you squeeze a drop out suck it up into the syringe

You should then freeze the syringe and will need to take from freezer to hospital well labeled and ask them to store for you in a fridge

It really stressed me out trying to do this which is the last thing you need in late pregnancy so I'm glad my midwife told me not to

I can understand why you're worried though, I'm not trying to be dismissive.

After birth they will test your baby's blood sugar before the first two feeds and it has to be above 2.6 I believe

My DS was 3.1 both times and wasn't exactly great at feeding initially (now he's a milk monster)

Have a little faith in your body, plus if you need some help the midwife will help you express some colostrum after birth which is much easier because they are more skilled at it and you have more!

This is absolutely a good idea and practice in some trusts (in a rush but baby will have regular blood sugar measurements and you will be compelled to supplement in order to maintain these to a much stronger extent than a woman without GDM. Plus cow's milk early is a diabetes risk so doubly important to avoid. A 1 ml syringe with a flatter more open top (x lots) and 'bungs' are what you need. 0.5ml is fine, you sort of scoop the drops off your nipple, then label (ask for a sheet from your notes?) and freeze. Lots of vids and advice for effective hand expressing on the web, or ask MW. Perhaps find out if a local MW or HV is a lactation consultant? Good luck

I did this as I have pre-existing diabetes. Started at 35 weeks in prep for induction at 38, 3 times a day, mainly hand expressing but also used breast pump (Tomme Tippee hand pump worked best for me). Started with 1ml syringes and ended up with 10 ml full ones by 38 weeks after buidling up. We freezed syringes and I expressed in the 10 minue panic while being shaved for EMCS after 39 hours - that was his first feed!

BUT - it really won't make any difference if he needs a tiny tiny few ml of formula if BM's are low post birth and there are many more important things to worry about, ESP if it just doesn't feel comfortable or is causing stress.

Made NO difference to birth either - induction failed, he just wasn't ready :)

Did you end up having a CS Basically?

I've also been diagnosed with GD (30+5) and am on Metformin + Insulin but there's no diabetic midwife at my hospital currently so I'm having trouble getting this kind of advice, or anything to do with the birth. I had read about expressing for this purpose and also to help induction so I was glad to see this thread.

Should I ask the hospital for syringes or can I just buy them? Would I be able to attach them to a pump or if I use one do I just decant (it doesn't sound like there will be much to decant at first)? And do I take them to the hospital early to keep frozen or just when I go in to be induced?

Any answers gratefully received.

Sorry Basically you answered that. I just wondered what the process was like in terms of induction & leading to EMCS?

Sorry to thread-jack but am feeling a bit panicky and would like to have a clearer idea of what might happen.

I antenatally expressed with both off mine(for other reasons not GD), just drops in syringes is fine - no idea why they gave you bottle I had 1ml syringes. I have a guide on antenatal expression for women with diabetes if you pm me an email.

Hospital gave us syringes, we bought breast milk storage bags from Boots and put them in there, labelled bag then into our freezer. bM storage bags sterile before opening. Sterilised breast pup or pot we used after each expressing and sucked up clostrum into syringe from pot. The Tommee Tippee hand pump had little milk powder pots that fit in the bottle - expressing directly into bottle would have meant we got way less!

Despite my induction being long (39 hours) and ending in EMCS, it was the BEST time, and I wouldn't change it for the world! Managed on just G&A but ultimately at 38 weeks my cervix was shut tight and he wasn't coming - 3 pessaries and regular contractions, I hot to half a cm! But I'm so glad I did it - we went in with open eyes! Only you can make the decision re induction / ELCS, based on info at 36 week scan (you Should have this offered) - get as much info sapped before hand.

The NICE guidelines on diabetes in pregnancy were incaluble and really good source of knowledge - can link as on phone but easy to google. They have a long, short, professional and 'lay' version - forewarned and all that!

Sorry for hijack - feel free to PM me if you have any other Q's :)

Also for that first / first few feeds Baby literally only needs a few ml - not the 7oz I had ready :) So if you opt to antenatally express and 'only' take a few ml in that's fine.

Freezer blocks and cool bag too for transporting to hosp, they then stored it on NICU freezer.

Finally - I did feel a bit ick about it initially - actually, I felt like a cow being milked - but glad I stuck with it. Really personal choice and if not for you then really not a prob.

DS was latched on in recovery room and fed from the off despite first feed being from syringe (they won't give a bottle - syringe easier).

He was also sleepy from day 2 onward til day 5, so we had to wake every 2 hours and found that drizzling cold water on his belly if stripping him / changing nappy didn't work woke him. Day 1 he just slept on my boob (which meant I didn't sleep as MW said against hospital policy to show me how to feed laying down...)

Thanks all, i do feel a lot better now - actually i was mistaken they gave me 50ml and 100ml bottles so no wonder i was feeling anxious about it! Quite ridiculous really but i have my midwife appointment on tuesday so will insist on syringes then.

The upside is that i am not on medication for the gestational diabetes they are letting me go to 40 weeks but no longer so hopefully still have time to produce some good amounts in syringes before hand.

Things us women have to do eh? Good luck everyone x

Sorry blonderthanred - so i found out at a breastfeeding workshop - likewise was asked to whip one out and give it a whirl! Unexpected as my midwives (in the specialist diabetes clinic i might add!) did not tell me about this at all - so i feel really on the back foot with it all.

I am hoping to get everything ironed out at my weekly diabetes/midwife clinic on tuesday. So go demanding answers right away then you won't feel as anxious and slightly clueless as i have.

Trust me if i had the syringes i think in the first 2 days i would have gotten 8 drops which would look much more substantial in them.

I was told to hand express and not use a pump - the technique is in the breastfeeding pamphlet they give to you. Then was told for 1st 2 days do it am/pm, 3/4 days do it morning/noon/night then 4 days plus hand express 4 times a day. To start massage your breast then squeeze 20 times then move in a clockwise motion around the breast doing the same action.

I hope that helps :)

Mad how the advice changes depending on area - we were consistently advised to use breast pump from 35-36 ish weeks! Maybe it's something to do with the stimulation and not bringing on early labour / trying to induce labour naturally?

Thanks for all the info - and thanks crystalmummy for starting the thread. I don't feel quite so alone now!

hello, so i thought i would send an update as still having issues. i did get syringes yesterday and expressed into it last night - i felt much more assured as could see a significant amount. however the syringes they gave me have no lid - so how does the milk remain safe?!?!

Tried phoning the midwives this morning as i noticed that the syringe had slipped to the fridge floor - with no lid on and worried about the safety of the milk - they said try using bottles - it is getting beyond a joke now and getting hugely frustrated and now emotional.

How are you guys storing your syringes? Do they have lids?

Panic not - breast milk storage bags from Boots - can be sealed and sterile in freezer in these. Milk will not flow out of syringe due to pressure.

Thank you, 38 weeks today and literally crying over spilt milk!!! Must be having an emotional surge :-/

Thank you, 38 weeks today and literally crying over spilt milk!!! Must be having an emotional surge :-/