Questions about pre-expressing and storing colostrum...BARB?

OKays, so due to my having type 1 diabetes our little man will have to go to special care for at least a few hours after birth so they can monitor his BSLs and keep an eye on him.

I have started to pre express colostrum this past two days into a syringe so I can freeze it in the hopes they can use this for top ups rather than formula but I just want to make sure I am doing it right.

I have been hand expressing today into a 5ml syringe and got 3mls in total.....I have put it in the fridge with the hopes of adding to it later and hopefully having a full 5 mls to freeze at the end of the day. Is 3 mls okay for my second day of expressing? How much should I be expecting to collect each time? How many times a day is it safe to pre express without the risk of contractions etc?
Is it safe to add to the syringe like I mentioned and freeze once a day or should I be freezing after each express even if the syringe isnt full?

Is it normal to have sore/tender breasts/nipples after this? Is this just part of the toughening up process or am I expressing wrong?

Any tips on manual expressing techniques would be most appreciated as I have struggled to find any decent "instructions" online.

i think that's all for now....oh....one more......how much do you reckon I would need overall to tide him over for top ups if he was to spend say absolute max 24 hours in SCN (is more likely to be 8-10 hours but best to over cater than runout...LOL).

Thanks in advance everyone.....

:)

go and check out the ABA website - they have loads of info on hand expressing and check out youtube for videos of it. Don't forget too that if you can only get x amount now, you will be able to get more once bubs is here, plus you will have all those gorgeous hormones to help you. And if bubs is unable to BF while in SCN, it may be best to express milk then anyway to stave off using formula to regulate BSL's

I checked the ABA website but the directions were all a bit sketchy and referred more to expressing milk than colostrum. Haven't checked You Tube..that's a great idea...thanks for that.

My point in pre expressing now is the time he will be in special care will be before my milk comes in and also I will be having a scheduled caeser so I may not be able to express straight away after he is born, that will depend on the nurses in theatre recovery and also how I respond to all the drugs etc etc. I will also be struggling myself to readjust to some major major changes in my insulin needs as soon as the placenta is delivered and trying to express too much straight after the birth may cause issues whilst I am resorting out my own balance of lovely hormones and dealing with potential hypos etc!.....I just want to have a supply on hand as it is almost a certainly he will have at least one hypo and need to be force fed by either tube or syringe to stabilise his sugars...I would rather it is my liquid gold than formula......

Of course! I forgot about the upheaval you could have. Expressing will be the same for colostrum and breastmilk as far as I know, just that with colostrum there wont be as much as milk. I think Inana posted some info about it for me a few years back and I will see if I can find it for you.

ETA - I can't find the info Inana posted for me sorry.

Over the first couple of days my DS didn't really have the hang of attaching - we'd syringe feed a few ml at a time on day 1, and more like 10 ml a time on day 2. So I think you're doing well.

I think I saw you were going to Jessie Mac - it might be worth calling them and asking to speak to Ellyce (who is their main lactation consultant, and a lovely nurse) and getting her advice too.

Edited to add: freeze in less than a full syringe lots - there's no guarantee that bub will want the full syringe, and you may waste stuff, whereas if it's in 3ml lots then they can always unfrost another syringe

Dear Melbel,
You are doing a great job of preparing for your little one, but unfortunately the medical advice you have been given is substandard. It is important that your baby remain skin to skin with you. This will optimize his blood sugar levels. If your baby is not symptomatic, then blood sugars should not be taken til after the baby's first feed. Neonatal blood sugars will be low post birth -it's normal - diabetic or not. The baby's physiology has unbuilt protective mechanisms to deal with this.
Breastfeeding protects against the onset of type 1 diabetes and exposure to cows milk (which is what formula is) is a risk factor.
The biggest challenge is generally stabilizing the mothers blood sugar levels- you may need to test more often.
You method of expressing and quantities expressed seem about right. I would be concerned that, given the information you have recieved so far your medical advisors might be expecting to give your baby quantities of milk that would not be physiologically normal (in the first 24 hrs a baby would take about 37mls of colostrum in 7-10 feeds.
You probably need to have a very frank discussion with your medical advisors about their expectatios and yours. The question "why" is always useful -ask that you've provided with the evidence for any suggested interventions.

Totally hear where you are coming from Barb and have researched all that side of things.....unfortunately it is hospital policy that he be monitored in special care....they are not willing for him to be monitored in my room at all. we have already had that discussion much to my chagrine....my compromise is that he is not to be given formula which is their standard practice, hence why I am expressing now to give him the best possible start.....I will also get a chance to feed in recovery before he goes up, I have made a big noise about that one, unless of course he has any unforseen issues that need immediate attention.

I just want to make sure I am doing it right and I also want to make sure I dont over do it and bring on premature labour issues......Is there a maximum amount of time you should express for a day in the pre birth weeks?

Parenting and Child Health - Health Topics - Breastfeeding - expressing and storing breastmilk
for how to hand express.
And it might be worth asking to have one of the rooms beside the SCN.

Just a technicality. Put a date on your milk so you know which stuff is the 'oldest' so that can be used first. SCN is big on dates where milk is expressed & frozen. Just saves them having that as an arguement. Also ask if it is possible to read their policy/procedure and blood sugar testing and treatment of a baby with a diabetic mother so you know how your hospital treats a baby of a diabetic mother.
Well done on getting organised for you little one. I did this too and took in a heap of milk and it saved any formula being used at all.
Best of luck!

Hi Melbel,

When I had my DD, they only took her to SCN long enough to test her BSLs and top her up. After that she was free to come to my room and I just brought her to them at the designated time for her BSL to be done - will they let you do that at all?

She only had 2 low BSLs, first was after her first feed and she was topped up with 10 mL of formula - I wish it had've been colostrum but that's another story. The next test was also low, but I gave her a feed after it and it came back up to normal so they were happy with that. I reckon if you had about 20 to 30 mL if you can manage it that would be heaps, but I'd be having a chat with them to see what their protocols are with regards to what BSL levels they top up at, how often they expect bub to feed and how much at each feed etc.

My understanding is that it's OK to add to the syringe of frozen colostrum as long as you chill the fresh lot you are adding first.

Oh and make sure they don't try and top up with bottles, my SCN were going to until I insisted she be fed by cup instead - she wasn't sick enough to need tube feeding.

HTH a little and best of luck!

Hi,

It's unfathomable that any hospital would implement a policy that was known to put at risk the wellbeing of a mother and baby.....just "because it is policy".
You are doing a great job being so proactive in this. Whist expressing will stimulate the release of oxytocin, this will not act on the uterus unless the uterus is "ready" to go in to labour - so don't worry about this. Often mothers are warned against expressing, when no-one would consider asking them to refrain from sex and orgasm, which also releases oxytocin.
The quantities of colostrum are going to be small, though it varies from woman to woman. Be gentle with yourself - nipples can be sensitive at this time.

The Australian Breastfeeding Association have a good paper on antenatal expressing - give them a call. It's by Sue Cox and is from their journal "Breastfeeding Review"

I know Barb..it does seem abit draconian.

Thank you so much for putting me in touch with Ellyce KMN......We had to go in for routine CTG monitoring today and I went up to the ward and she happened to be there..we had a great chat. She reckons five mls yesterday was awesome and to keep it up and gave my some specimen jars to better store it rather than in the syringes. Apparently the SCN policy is a fairly recent one and came about after a baby that shouldn't have been let out to the room was and bad things happened....her belief is that it will be reviewed in time as people like me kick up a fuss as she also agrees that it does seem a bit OTT to have such a blanket policy so she has given me the business card for the unit manager to ring tomorrow to "have a chat" to....and believe me I will be having a chat!!!
She did also say that if Connor is still in SCN later in the day of delivery they will get me up a wheel me down to him if possible......so I have a few avenues of investigation to follow up on. So we are aiming to get about 80-100 mls of colostrum stored between now and delivery day which would mean even I wasnt able to feed him myself there would be zero need for formula...so at least I have a plan now.....best case scenario we never need to use it but it will be there just in case!

Oh and to answer whoever said make sure I have a room near SCN...they are all near the SCN in Jesse Mac...the SCN and nurses station are kinda in the centre with the rooms in a square formation around it if that makes sense, so I know he will not be far away!

I know it will be more invasive but if there are problems with his BLS they can do a drip instead of formula, and they can have it for a few days as well.

DD was born with extremely low BLS of 0.9, she was on a drip and they also gave her formula, I was upset that I never got asked or approved giving of formula and I had no idea that they could have kept giving her what she needed through a drip - she had it on her arm for 5 days! So was no more invasive!!

I think it was all too much stress for me, a Midwife came up and hand expressed, OMG :o wasn't prepared for that, it was sooo painful and I would get so upset trying, as I was constantly competing against what the Paed were prescribing, everytime I got close to having enough they would up it, I just wanted the formula to stop, and I was trying so hard but I just couldn't express very much at all.

I think it is wonderful that you are being so prepared, I know that next time I would like to be more prepared as well, but based on my history I wouldn't be able to start trying until quite late, but I am planning on a FT bubba next time so won't need the NICU or SCN ;)

When ever he is in SCN, try for kangaroo cuddles as much a possible, lots of lovely skin to skin, it really does make a huge difference.

You are doing a wonderful thing for Connor, what an amazing mumma you are :D

Take care xxoo