Extremely Frustrating Convo w/ MW Re Hand Expressing Before Birth

[Sugarcoma]

I've been reading up on hand expressing before birth - it seems to be, at the moment, still fairly uncommon but gaining popularity. From my understanding you express tiny amounts into a syringe and freeze them until baby is born in case your milk doesn't come in straight away.

I'm particularly interested in this because I am diabetic, likely to be induced early and there's a chance that a) it'll take longer for milk to come in and b) baby may have low blood sugar at birth and need some milk asap.

I have just spoken to a midwife at a top private maternity ward because I wanted to see if they had freezer facilities. She was extremely dismissive of the whole idea and just kept repeating that as soon as baby is born and the placenta delivered your body will express colostrum and baby can feed.

This is the opposite of what I've read elsewhere where women have struggled to BF in the first few days.

This is my first pregnancy so I personally don't have a clue - can anyone who's been there weigh in? Is she right? If so why do newborns ever have to be given formula?

Hi sugarcoma,

Sorry to hear you ran into such an obstructive midwife. Sometimes I think Healthcare professionals are difficult when it's a topic they feel a bit embarassed they know nothing about. I think her advice was not great in my opinion!

The midwife that ran my aquanatal class told me about antenatal handexpressing in my first pregnancy. I work in hospitals with babies and have met so many families where the baby got readmitted with dehydration as breastfeeding didn't work out and mum didn't have enough milk. It always seemed so stressful and heartbreaking, so I wanted to avoid that if at all possible. There are 2 issues to get breastfeeding to work, supply and latching - and if I could sort out the first issue, then that meant I'd only have to work on the latch - which seemed a no brainer to me.

So I did a LOT of reading and it basically seems to be a brilliant idea with practically no drawbacks. It is more widely recommended in Australia , and some NHS trusts, for women with diabetes in particular - as the baby's sugar level is more likely to drop when mum has diabetes, so extra milk is more likely to be needed. Nippe stimulation / expressing gives a theoretical risk (miniscule) of bringing on labour, so it's not recommended to do before term (=37 weeks).

I did it from 38 weeks for about 45 mins to 1 hour every other day on average. It was amazing, I started with no milk at all (literally not even a drop after 30 mins trying) and ended up being able to get 2 ounces = 60mls colostrum at a time. In my professional experience, most mum's are only able to express 0.5ml to 2 mls colostrum when they try and do so immediately after birth and for the first 48 hrs or so. So this is a massive advantage in my mind. I didn't have diabetes, I was just trying to make sure breastfeeding was most likely to work - and I think it made a huge difference.

It was great to have in the freezer for the first couple of days so my daughter could be fed by my husband whilst I slept, and so I could express some onto the nipple to get her interested in trying to latch. As I had such a good supply, I didn't end up using much of what I'd frozen antenatally, and I donated it to a donor breastmilk bank instead. Getting her to latch properly was still difficult - I think if I hadn't had a good supply I may well have run into real difficulties and given up breastfeeding altogether.

I wouldn't worry too much about having a freezer at the hospital, yes it would be nice to be able to bring some in to give in the first day that you'd already expressed, but the main point is it induces better supply so when you baby is born your milk is there is good quantities already in your breasts. I'm sure they will have a fridge / freezer on the ward anyhow -babies that go to SCBU all need expressed milk stored somewhere so once you're on the ward I'm sure it would be possible. As I said, having some in your home freezer is incredibly useful for the first few days home from hospitals.

Here's some info leaflets I found:
www.dvh.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=165903
www.meht.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=2420
www.rcht.nhs.uk/DocumentsLibrary/RoyalCornwallHospitalsTrust/Clinical/MidwiferyAndObstetrics/BreastmilkGuidelinesForAntenatalHandExpressingOf.pdf
bmjopen.bmj.com/content/4/10/e006571.full
www.royalberkshire.nhs.uk/patient-information-leaflets/Maternity/Hand%20expressing%20colostrum_feb15.pdf
www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjmkojk_sjPAhWDIcAKHch2BMYQFggcMAA&url=http%3A%2F%2Fwww.grhc.org.au%2Fdocument-library%2Fdoc_download%2F232-the-antenatal-expression-of-colostrum&usg=AFQjCNFExXrP1FgUHEPyxQhYKAqe-t8n0A&sig2=DH0dl8EAOk5V2OlQB7_IgQ&bvm=bv.134495766,d.ZGg

Good luck!

Hi, I had gest diabetes in first pregnancy and was told to try expressing beforehand and just keep in freezer at home so oh could bring in once baby arrived. In the end I didn't manage to express anything beforehand (just wasn't producing milk then) but managed to bf straight off and baby was fine. Continued bf until she was 10 months old and had full mouth of teeth! Good luck

Amazing post from jelly.
Like shimmy I had GD and was advised to express. I built up a tiny little stash which felt like insurance to me, and the idea that it might help my supply was a nice bonus.
My first was a bit sleepy after a c-section and although I didn't need to use my stash I was confident expressing into a syringe and gave him that to get his appetite going before latching him on.
I did it again with my second, again I didn't use it but it gave me confidence.
Don't worry if you get just 0.1ml to begin with.

Reading with interest. Where do you get the syringe from and what do they look like then how do you feed the baby with it? I'm 39+2 but might start to try and get my flow going. I'm leaking a bit anyway

I used wee pots!!! You can use anything you can sterilise... Eg can use boiling water to swill around a plastic bowl a few times to sterilise it, use that to express into (easier I found to have a bigger thing to aim for) , then pour into proper expressing pouches for freezer. I also managed to get a load of pots from the donor breast milk bank for free, they'll send them out to you prospectively often. Donor breast milk bank I used only accepted bottles /jars, not bags for some reason so I was handy I'd used wee pots!
Sterilising is important ish but not as much as formula bottles as the bugs can exist in the formula powder itself, breastmilk should be sterile when it comes out of you!

Syringes I think you can get from pharmacies, just ask for enteral syringes. Or the hospital will give you some (you can sterilise and reuse)

Can use syringes to slowly drip the milk into the babies mouth as they suck /lap it up. Or use tiny expressed milk feeding cup (again postnatal ward should be able to help)
I think a few of those leaflets had some practical details on

I expressed from 36/40 and had about 100ml Ebm in freezer by the time I gave birth and thank god I did. DS was in NNU with meningitis and I lost a lot of blood, my lack of milk meant he needed some from somewhere else.

I've been advised to do this for different reasons (baby has cleft lip and probably palate) - I couldn't get it to work initially on my own so my midwife demonstrated it for me. The big thing that I was getting wrong was not pressing nearly hard enough - for me, at least, I need to press my breasts really quite hard to get the colostrum flowing and (according to my midwife) I have really good supply already so it's not that.