Antenatal expressing - how much to do?

[notinagreatplace]

I've been advised to do this (as the baby has a cleft lip and probably a cleft palate) - have had a few goes now and am getting the hang of getting the colostrum out. My midwife gave me some tiny syringes (1ml each) but I'm not really sure how much to aim to express?

I will probably use up my remaining syringes (will be 5 in total) before my next appointment on Tuesday and will ask for some more then but I'd find it useful to have some idea of what would be a good amount to aim for.

[Orsono]

When I did this, I expressed around 10ml to cover a first feed, based on what I'd read online about how much a newborn takes. After the birth you can express more for subsequent feeds, the hospital will give you syringes. The advantages of this are that it may well be easier to express as your post-birth hormones kick in, and also you'll be stimulating natural milk production by keeping up with what the baby needs. If you express loads now, the risk might be that you use your stash instead of expressing after the birth, and don't stimulate your supply. I would say the only reason to build up a bigger stock beforehand is if there could be any complications with the birth that might mean you're unable to express afterwards.

[Orsono]

I should have said, I don't have any experience with cleft lips, so that's just based on what I did. Maybe tge midwife can give you specific advice for your situation?

[PoloZolo]

I'm not sure you can 'use it up' before the birth? I think your body just makes more of it until after birth when your hormones change anyway to produce actual milk.

As expressing now will save time for after the baby is born is just express as much as possible antenatally (without stressing about it) because what's the harm? If you are sitting watching TV while doing it then it's no real bother and having a stash in your freezer will be reassuring. Instead of aiming of a particular amount you could always just try and express 1ml per day, or whatever you think is realistic for you.

[Orsono]

PoloZolo, I didn't mean that expressing before the birth would 'use up' the colostrum, it doesn't. I mean that if the OP has lots of expressed milk and uses that in the days after the birth instead of expressing then, she won't be expressing that volume at the time the baby would normally be removing it. There is a risk, I believe, that this could interfere with her supply. Of course, you could do both and keep expressing after the birth as well, but it just seems simpler to me to do it as and when it's needed.

[PoloZolo]

Ah ok Orsono, I see what you mean. Yeah I guess it would be easy not to express enough after the birth to keep the supply up, good point.

Good luck Op, hope all goes well

[notinagreatplace]

Thanks! I definitely plan to continue to express after birth as well but the medical professionals seem really keen on me having some ready for him - I guess because cleft babies can be prone to hearing infections so the more antibodies they get the better.

I had an appointment today but they seem very reluctant to give me a sense of how much would be useful - I think they don't want to put any pressure on, which is nice.. but, actually, expressing is going reasonably well (I just did 3ml in about 30 mins) so I would find it more useful if they just told me what a sensible quantity would be. I guess I'll just keep going and see what I end up with.

[PoloZolo]

I know what you mean about getting an idea about quantities from midwives - I was told a feed is 20ml by one midwife and 5ml by another, such a difference. I can't see a newborn having 20ml in one feed myself since their tummies are the size of a marble as colostrum is maybe more filling than formula.
3ml in 30 mins is amazing antenatally though, & a good confidence boost that you can do it and will know how to express once the baby is here, hopefully will make it so much easier.
Do you know how long you'll have to express for? Do they do cleft palate/lip surgery pretty much straight away or is it only after a few months? I'm sure it will be definitely nice to know you've expressed to give the antibodies to hopefully keep ear infections etc at bay.

[notinagreatplace]

Unfortunately, it takes a few months to operate for cleft so it is unlikely that I'll be able to breastfeed - it's either expressing or formula.

I'm keen that the baby gets a good amount of colostrum for the antibodies and at least a few weeks of breastmilk. I'll take it as it comes but, I think, realistically, exclusively expressing for months and months isn't going to work well and I'll end up mixed feeding.

Colostrum expressing is going really well - I can easily get 4-5ml in a session. At the moment, I'm only doing it once a day but I could obviously increase that and get still more. In many ways, though, I think the benefit is not so much in having a large stash - though I think that will take the pressure off after birth and I won't feel worried that the baby is hungry - as that I'll feel comfortable and able to do it. It wasn't straightforward the first 2-3 times at all and I think it was definitely easier to get used to without a hungry baby screaming at me...

[PoloZolo]

Sounds like the expressing is going really well, & like you say so much easier to get the hang of it now rather than when you have a crying baby in front of you!
I didn't realise it would be so long to have the surgery, I guess the baby will be a little more robust to go through it when it's a tiny bit older too. Definitely agree expressing exclusively would be quite tough long term, I'm sure whatever amount you do will be worth it & good for the baby, good luck with the birth and enjoy the newborn snuggles!

[ZZZZ1111]

Sounds like you're doing amazingly!

We had problems with feeding when my baby was born and I expressed colostrum for a few days. It was really hard and only got the odd drop out here and there even though I was trying every few hours. So it's good you've got some back up even though you'll still be expressing once the baby's born.

You could look into milk donation if you have any leftover?

[Frazzled2207]

I was useless at breastfeeding and expressing so no advice from me but it sounds like you're doing amazingly well. Best of luck with the birth!

[notinagreatplace]

Thanks! Now that I've started, it's pretty hard to stop... if I don't express, I get leakage... Now up to 12ml in 30 mins and I have a slightly ridiculous quantity in the freezer - I suspect way more than I will actually need but I guess that's better than having not enough!

I will ask the midwives what is sensible to do with any left over - I gather it's really good for premature babies and other babies with special needs so, if my hospital will take donations, I might do that. The other thing I've heard suggested is to save it for after my baby's surgeries as a good source of nutrition and antibodies for them then.

[SauvignonPlonker]

I expressed for both my prems; if my memory is correct, about 120-150 MLS/kg of milk is needed.

I expressed every 3-4 hours to establish my supply & used a hospital grade double electric pump. Apparently the overnight express (around 3am) is best for establishing & maintaining a supply.I ended up with a freezer full; unfortunately there was no donor milk bank at the time but there is now. It would keep in a large feeezer for up to 6 months, but less in an ice-box type freezer.

I found it all went to pot once baby came home; it was impossible to express, bottle feed & look after another child. So if you can build up a supply now, all the better.

The only thing I would be aware of: I was told not to express before 36weeks in case it triggered labour. Also try to find out what happens during delivery to the milk - will they have somewhere to store it?

Good luck with everything!

[Toddlerteaplease]

I am a children's nurse and look after post op cleft babies. Have you had much contact with your cleft team? They will visit while you are still in hospital and teach you assisted feeding. And are the best people to advise you. If it's just a lip you may be able to still breastfeed. Lips are generally fixed at about 9-12 weeks and palates at 7-9 months.

[notinagreatplace]

Sauvignon - I think that you're talking more about milk than colostrum, which is much smaller quantities and only for the first couple of days before proper milk comes in.

Toddler - thanks, yes, I have seen the cleft team. They weren't very helpful initially in terms of giving me advice on amounts, though, as I think they didn't want to put me under pressure but I've texted them to say just how much I now have in the freezer and they agree that it's way more than I need and let me know roughly how much to bring with me to the hospital. I've been told that, at my hospital, the lip repair is most likely to be around 4 months (due to waiting times) and palate could be anytime between 6 and 12 months (again, due to waiting times.) I know that they can't tell yet whether it's just lip or lip and palate but my consultant seemed fairly sure that there would be palate issues as well so I'm preparing on that basis.

[Toddlerteaplease]

Which area of the country are you?