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Expressing colostrum in pregnancy - particularly for women with diabetes

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HighFibreDiet Thu 23-Jun-11 13:51:18

I notice Mears started a thread about this years ago but I'm not sure if anyone has talked about it recently. I certainly wasn't aware that it could help until my midwife gave me some information. So I thought I'd provide the information here in case it helps anyone else.

Here's the original thread:
www.mumsnet.com/Talk/breast_and_bottle_feeding/84712-antenatal-expressing-of-colostrum-for-freezing-anywhere-else-doing-it/AllOnOnePage

Here is a mishmash of the info my midwife gave me (originally from the Lactation Team at the Royal Hospital for Women, Randwick, NSW, Australia) and some other stuff I've found from the internet for myself. I hope it's useful for other people and not just me:

As well as the normal nutritional and immunological benefits of breastfeeding, it is thought that breastmilk may help prevent diabetes in susceptible children and that the mother's diabetes can improve during lactation. I've given some links to research below.

Diabetes (Type 1, Type 2 or gestational) does not affect your ability to breastfeed your baby but it has been found that in mothers with diabetes there is a 24h delay in the change from colostrum to milk (the milk 'coming in'). Usually it takes about 70-90 hrs after the delivery of your baby, and in mothers with diabetes there is an additional 24h delay. This can affect the glucose levels in the baby.

To reduce the impact of this delay on your breastfeeding, you can begin expressing during pregnancy, from 36 weeks onwards. This will stimulate your milk supply and enable it to come in within the normal time frame. The colostrum expressed can be given to your baby if needed, and reduces the need for the baby to be fed intravenously or receive formula.

The guidelines given to me say you can express both breasts once or twice a day from 36 weeks, for about 5 mins. Don't expect too much; colostrum is low in volume averaging 40 mls/day AFTER birth i.e. will be far less before birth. I got about 5 ml from two sessions today (36+4) but your baby's stomach will be tiny at birth so these amounts are still extremely useful.

After birth the guidelines say to have skin-to-skin contact with baby undisturbed for 30-60 mins and allow baby to nuzzle and feed for as long as baby wants to. Offer both breasts after this feed, express after this feed then feed and express every three hours, especially in the first 12 hours when babies are usually sleepy. If baby not effectively breastfeeding you can offer baby your EBM/colustrum via a spoon, cup or syringe. If you are finding hand expressing ineffective you can use a pump - hospitals should be able to provide double electric pumps or if you are at home, many NCT groups hire them.

All breastfeeding support groups should provide you with guidelines for storing EBM. *Note that many hospitals (in my experience) are set up so the mum expresses and then freezes her milk, and feeds from the oldest milk first. But freezing does change the properties of milk, so it is better to give fresh milk if possible.

Further information:
Study looking at over 100,000 women and whether prolonged lactation had any effect on whether they developed Type 2 diabetes or not. Published 2005.
jama.ama-assn.org/content/294/20/2601.abstract?ijkey=07b92dedffa28f0673a17e1781f02bb64c56c7e2&keytype2=tf_ipsecsha

2007 review article specifically looking at whether breastfeeding after GD reduced the incidence of diabetes in the mum and the baby (includes the above study in the review):
care.diabetesjournals.org/content/30/Supplement_2/S161.full

Link to hand expressing information
www.breastfeeding.com/helpme/helpme_video_hand_expression.html

Kellymom.com links about expressing/pumping
www.kellymom.com/bf/pumping/bf-links-pumps.html

NCT, ABM, La Leche League all have information sheets about expressing, and about storage of expressed breastmilk (EBM)

La Leche League info on colostrum (includes a visual showing how tiny your baby's stomach is):
www.llli.org/faq/colostrum.html

I believe that LLLGB has an information leaflet specifically about diabetes and pregnancy but I haven't seen it so I don't know how up-to-date it is.

www.plus-size-pregnancy.org/gd/gdbfing.htm# Why GD Moms Should Breastfeed: There's loads more information on here but please note that it has not been updated since 2001 so does not include any knowledge from studies done since then, and in particular includes no information about expressing colostrum.

There was a small prospective study done in Melbourne encouraging women with GD to express colostrum from 36 weeks. I don't have access to the journal but the reference is: "Diabetes and antenatal milk expressing: a pilot project to inform the development of a randomised controlled trial" Della A. Forster, Kerri McEgan, Rachael Ford, Anita Moorhead, Gillian Opie, Susan Walker, Cath McNamara, Midwifery, Volume 27, Issue 2, Pages 209-214. Strangely enough, although the findings appear positive, the authors still suggest that women with GD should not be encouraged routinely to express their colustrum until there has been rigorous evaluation of the safety and efficacy of the practice. I wish there were such rigorous evaluation of practices in general regarding GD, as much of the approach seems to be scaremongering and little seems to be evidence based. But of course that's only my opinion!

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