Holistic Babies London
When science meets holistic therapies
19. Jan, 2021
Colostrum Harvesting in Pregnancy- Part 2
This is part 2 of this article.
Babies are very responsive to emotions and stress; babies feel anxieties. The more relaxed you are, the happier your baby will feel.
If you have your colostrum to feed in the initial unsuccessful breastfeed, you will feel more relaxed and empowered. You will not feel under so much pressure to successfully breastfeed in the first few days, which will give you more time to learn. You will feel less pressurised to offer your baby a bottle.
- Babies who do not feed: difficulties with feeding always have underlying issues. It is not that babies do not WANT to feed; it is that they CANNOT feed for various reasons. Here are some examples:
Babies born before 37 weeks (premature) and babies born small for gestational dates (less than 2500g) are at higher risks of hypoglycaemia Low blood sugar) and will, therefore, be closely monitored.
Offering colostrum at regular intervals will help them maintain their glycemic (blood sugar).
Because of their small size, they may get tired quickly at the breast or their mouth may be too small to take enough breast tissue and ensure a good feed, the lack of padding in their cheeks also means they do not create enough vacuum to maintain the latch.
- Birth: in the event of a birth by caesarean section, ventouse or forceps, it is not unusual for the baby to be very sleepy and unresponsive at the breast, especially if the window of opportunity or "golden hour" has been missed.
- Caesarean section: the lack of contraction & passage through the birth canal means the baby may be relatively "mucousy". The stomach fills with fluid, and the baby does not respond to the breast until the fluid is expelled (vomited). Given colostrum will help "wake up" the baby who should then be keener to go to the breast and feed more successfully.
Caesarean sections can also be quite traumatic for the baby (traction on the neck as the baby is delivered). As a result, the baby may have a sore neck/ shoulders/ stiff muscles (making the feeding uncomfortable.)
Feeding may become a struggle: short feeds, shallow latch, slipping off the breast (leading to sore nipples), prefers one side to the other, always sleeping with the head turned in the same direction, strong suction leading to sore nipples once again.
- Forceps and ventouse: those can be very traumatic for a baby and can lead to bruising, scaring, cephalohematoma, chignon, palsy, pain, headaches etc. Babies suffering from head trauma may behave in 2 very different ways. They may be irritable, screaming/ not wanting to be put down/ constantly feeding/ high pitched cry (those babies need to suck on the breast to soothe themselves). Sucking acts as a pain killer in babies and helps them cope with pain and discomfort. Topping up these babies with formula is often pointless as they will most likely take vast amounts of milk as they use the teat of the bottle to soothe themselves.
The mother will often see her baby drinking a lot of milk, simply because sucking helps release endorphins and makes the baby happy. She will feel dis-empowered ("I could not feed my baby"), feels like a failure for being unable to attend to the baby's most basic needs.
The baby's stomach is now filled with formula, and now she is refusing to feed at the breast. She may be very sleepy or continues to cry due to discomfort (probably from the birth).
The bottle didn't solve any issues and may have created more problems!
The second behaviour is seen in the baby who "shuts down": the baby experiences the "hang-over of birth": Everything hurts so much that the baby prefers to be left undisturbed, sleeping or on mum or dad's chest. Every stimulation will induce pain and crying.
These babies will often cry when picked up or held and will prefer to sleep in their cot, with the light dimmed (and show a little more interest at night when all is dark and quiet, if you have ever had a migraine, you will relate!). These babies should also be fed regularly with colostrum and left to rest until they feel better & decide to feed.
- Babies with bruises: those babies are at even more risk of jaundice. As colostrum is highly laxative and bilirubin (that causes jaundice) is excreted in meconium, it will help flush the bilirubin in the stools.
Babies affected by the trauma may have difficulties latching or sustaining a good latch. It is essential to have them reviewed early on by a chiropractor or an osteopath specialist in newborns' health to offer them a good start (and prevent sore nipples).
Other issues:
Tongue-tie: Another reason why a baby may not feed, or feed poorly may be tongue-tie.
Sadly, many babies are not diagnosed with tongue-tie until feeding issues impact weight gain, milk production, or breastfeeding comfort.
If the latch/position is correct, if the baby is putting on weight and "feeding well" but mum is still sore, the baby must be seen by a lactation consultant who will then recognise the issue.
Some tongue-ties are very obvious, others much more challenging to diagnose (at times the tongue tie may be "buried" underneath the mucosa of the mouth). In this event, it is essential to protect mu express and offer colostrum as soon as possible. No one can predict which baby will be tongue-tied.
Having a stock of colostrum filled syringes will provide reassurance that the baby is fed and will buy time until a tongue-tie specialist assesses the situation.
-Intra-uterine malposition: it will sound ridiculous to remind everyone about this, but babies have spines and muscles too!
Imagine sleeping awkwardly for a whole night and waking up with a sore neck? Babies do experience this too. The ideal position by the time of birth for any baby is LOA: Left, occipito- anterior, which means, head down, back of the baby to mum's left, with a fully flexed head (chin to chest). Sometimes, babies have a different idea and will find themselves in less comfortable positions: breech, OP (occipito-posterior: back to back with mum), face/brow presentation etc. These less than optimal positions may lead to discomfort and musculoskeletal issues such as torticollis.
Sometimes, the jaw/neck/shoulders are sore, and it makes feeding difficult (and show symptoms similar to a tongue-tie but with the baby often feeding better on one breast versus the other).
Once again, offering colostrum until a chiropractor or osteopath review has happened will buy time and saves your nipples! Feeding side-lying can also help as it puts less pressure on your baby's head, neck and shoulders.
ARE THERE ANY RISKS IN EXPRESSING COLOSTRUM IN PREGNANCY?
It is a common worry, and often pregnant women are given the wrong information. There are no known risks in expressing colostrum in pregnancy in pregnant women who are not at risk of premature labour and birth. Unless there are threats of premature labour (cervical stitches, previous premature birth), it does not induce early labour as believed by some (uninformed) professionals.
At the end of the day, if it were labour inducing in the low risk woman, we would use this method to induce labour rather than artificial hormones!
Some pregnant women carry on breastfeeding their older child until they give birth (and continue to feed both after the birth, what we call tandem feeding) with no increased incidence of premature labour.
Further information:
HOW AND WHERE DO I STORE COLOSTRUM?
Colostrum can stay 6h at room temperature, 4 days in the fridge, 6 months in the freezer.
HOW MANY SYRINGES WILL I NEED?
From day 0 to day 3, a baby needs between 5 and 7mls of colostrum many times a day. It may be 1 ml every few hours.
Ideally, the collection should be made in 1ml syringes. If you can store 3 days' worth, then it is ideal, but any amount will do!
At first, it may seem as if there is nothing. Often it is due to lack of experience and poor technique. With the support of a midwife, breastfeeding specialist or IBCLC, you should soon see a few tiny drops appearing. Do not despair if nothing happens initially: by stimulating the breasts, colostrum will eventually occur. I have taught colostrum harvesting to many women with great success. They managed to store a large amount and were greeted with cheers when they rocked in the maternity unit with a bag of yellow syringes!.
WHAT TO DO NEXT?
Syringes should be labelled with:
- Date when the colostrum was expressed
- The time when it was expressed
- Your full name & hospital number (on the maternity notes).
- Bring to the hospital in a small cooler bag with an ice pack. All maternity/ NICU units have a fridge to store milk.
- There is no need to bring all of them in if the birthing partner can go home and get a daily supply (5 to 7 syringes).
- They can be taken out of the fridge a few hours before feeding.
- Make a note in your birth plan that you have expressed colostrum antenatally. Clarify that if you cannot feed your baby, it should be administered.
Many maternity units across the country recommend colostrum harvesting. Unfortunately, due to the lack of time/ staffing/budget, mothers-to-be are not taught how to hand express until they are born.
Hand expressing colostrum in the few weeks before the birth will allow saving the precious colostrum. It will also empower you in knowing that your baby will have the best food available to her. You will also become familiar with your breasts and be more confident at both breastfeeding and expressing milk.
AM I PESSIMISTIC IN YOUR ABILITIES TO BREASTFEED?
The short answer is no, of course! After working for 12 years on the wards and then in the community, I have sadly met too many struggling mothers whose experienced breastfeeding could have been improved if taught how to hand express antenatally. Teaching antenatal hand expressing is also a requirement of UNICEF Baby Friendly Initiative.
Approach this as your first step to learn to breastfeed and to get to know your breasts! There is something truly empowering about the experience of harvesting colostrum!
Stephanie is an International Broad Certified Consultant in training. She has completed her 90 hours required breastfeeding theory. She has been supporting breastfeeding women for the past 12 years both in the NHS and the community.
To book an antenatal breastfeeding workshop/ colostrum harvesting session, please contact admin@holisticbabies.co.uk