Scotland is committed to supporting and promoting breastfeeding as the healthiest way to feed your baby (4) becoming breastfeeding friendly Scotland report). Breastfeeding is recognised as a unique interaction between mother and baby which not only feeds and comforts but also helps prevent against infection and disease. (1)

Risk factors in the early neonatal period can make supplementation with formula more common (1). The aim of this guidance document is to reduce these supplements and increase the amount of breastmilk given to at risk neonates.

Where a mother is unable to or does not wish to express in the ante natal period, discussion should take place about the use of donor breast milk in the early neonatal period for supplementation.

Most pregnant women can safely express colostrum from 36-37 weeks' gestation. It is particularly useful where the baby is at risk of hypoglycaemia the first few hours after birth.

This includes:

1. Women with diabetes in pregnancy (pre-existing or gestational).
2. Women having an elective caesarean section.
3. Women with breast hypoplasia.
4. Women with polycystic ovarian disease.
5. Women with reductive breast surgery.
6. Women taking beta blockers (e.g. Labetalol).
7. Women with a complex medical history.
8. Women who have had a previous poor breastfeeding history.
9. Babies identified with cleft lip and/or palate.
10. Babies identified with congenital cardiac/gut conditions.
11. Babies known to have intrauterine growth restriction.
12. Strong family history of dairy intolerance or inflammatory bowel disease.
13. Multiple pregnancy

Antenatal expressing is not recommended when:

1. Women less than 36 weeks pregnant.
2. Women known to have a cervical suture in place.
3. Women who have had threatened preterm labour before 36 weeks*
4. Women who have polyhydramnios.
5. Women who have vaginal bleeding or premature rupture of membranes in current pregnancy.
6. There is known placenta praevia.
7. There is an unstable lie.
8. Maternal medication is contraindicated in breastfeeding

*when a woman is already in preterm labour antenatal expressing can be supported

All women should have a conversation with their midwife regarding infant feeding and colostrum harvesting at their 34-week appointment. They should be provided with an antenatal expressing pack at this appointment.

This pack should contain:

1. Colostrum syringes.
2. Blank labels which should be completed with name, CHI, date and time of expressing.
3. Patient information leaflet.
4. Galipots can also be included to aid collection of colostrum if syringes are proving difficult for collection.

Any woman wishing to collect colostrum antenatally will be taught effective hand expressing technique at their 34 week midwife appointment.

1. It is recommended to start colostrum harvesting between 36-37weeks gestation.
2. Aim to express 2 -3 times in a 24hr period.
3. Start by gently massaging each breast prior to expressing.
4. Total time once proficient should only be 5-10 minutes each session.
5. The use of a breast pump is not advised at this stage, hand expressing only.
6. Painless Braxton Hicks are acceptable whilst hand expressing but if they continue or become regular and painful, seek advice from the midwife.

1. A new syringe should be used for each expression. Ensure cap is on the end of the syringe of once completed.
2. Each syringe should be labelled with the woman’s name, CHI, date and time of expression.
3. Each syringe should then be placed in the plastic bag provided, sealed and stored at the back of the fridge for up to 5 days.
4. Where colostrum will not be used within 5 days, it should be stored in the freezer.

1. When women are coming in for induction, they should be encouraged to leave colostrum at home until needed. This will prevent waste of colostrum if allowed to defrost.
2. When transporting frozen colostrum to hospital it should be placed in a cool bag with cool blocks or ice. If using ice it needs to be placed in a bag to prevent leakage over the colostrum.
3. Staff should store colostrum using the appropriate storage facilities. If not being used within 24hrs then place in freezer or in the fridge if using within 24 hours.
4. Local guidance on the storage of breast milk in hospital should be followed: EBM storage

Off to a Good Start: all you need to know about breastfeeding
This booklet aims to help pregnant women, new mums and their families make decisions about how they will feed their baby. It gives information and practical advice about developing a close and loving relationship with your baby; preparing for breastfeeding when you're pregnant; the benefits of breastfeeding; the difference between breast milk and formula; skin-to-skin contact at birth and the first magical hour; how breastfeeding works (including positioning and attachment); breastfeeding when you're out and about; going back to work; and a troubleshooting guide.

http://www.parentclub.scot/
Website with advice to support parents from pregnancy to teens.

Unicef BFI Hand expressing video
This video guides mothers on how to hand express and talks about the times when hand expression might be useful.

Parent information leaflet - Antenatal expressing
NHSGGC patient information leaflet on expressing colostrum before the baby is born.