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  5. Antenatal, general
  6. Antenatal colostrum harvesting (1154)
Important: please update your RDS app to version 4.7.3

Welcome to the March 2025 update from the RDS team

1.     RDS issues - resolutions

1.1 Stability issues - Tactuum implemented a fix on 24th March which we believe has finally addressed the stability issues experienced over recent weeks.  The issue seems to have been related to the new “Tool export” function making repeated calls for content when new toolkit nodes were opened in Umbraco. No outages have been reported since then, and no performance issues in the logs, so fingers crossed this is now resolved.

1.2 Toolkit URL redirects failing– these were restored manually for the antimicrobial calculators on the 13th March when the issue occurred, and by 15th March for the remainder. The root cause was traced to adding a new hostname for an app migrated from another health board and made live that day. This led to the content management system automatically creating internal duplicate redirects, reaching the maximum number of permitted redirects and most redirects therefore ceasing to function.

This issue should not happen again because:

  • All old apps are now fully migrated to RDS. The large number of migrations has contributed to the high number of automated redirects.
  • If there is any need to change hostnames in future, Tactuum will immediately check for duplicates.

1.3 Gentamicin calculators – Incidents have been reported incidents of people accessing the wrong gentamicin calculator for their health board.  This occurs when clinicians are searching for the gentamicin calculator via an online search engine - e.g. Google - rather than via the health board directed policy route. When accessed via an external search engine, the calculator results are not listed by health board, and the start page for the calculator does not make it clearly visible which health board calculator has been selected.

The Scottish Antimicrobial Prescribing Group has asked health boards to provide targeted communication and education to ensure that clinicians know how to access their health board antimicrobial calculators via the RDS, local Intranet or other local policy route. In terms of RDS amendments, it is not currently possible to change the internet search output, so the following changes are now in progress:

  • The health board name will now be displayed within the calculator and it will be made clear which boards are using the ‘Hartford’ (7mg/kg) higher dose calculator
  • Warning text will be added to the calculator to advise that more than one calculator is in use in NHS Scotland and that clinicians should ensure they access the correct one for their health board. A link to the Right Decision Service list of health board antimicrobial prescribing toolkits will be included with the warning text. Users can then access the correct calculator for their Board via the appropriate toolkit.

We would encourage all editors and users to use the Help and Support standard operating procedure and the Editors’ Teams channel to highlight issues, even if you think they may be temporary or already noted. This helps the RDS team to get a full picture of concerns and issues across the service.

 

2.     New RDS presentation – RDS supporting the patient journey

A new presentation illustrating how RDS supports all partners in the patient journey – multiple disciplines across secondary, primary, community and social care settings – as well as patients and carers through self-management and shared decision-making tools – is now available. You will find it in the Promotion and presentation resources for editors section of the Learning and support toolkit.

3.     User guides

A new user guide is now available in the Guidance and tips section of Resources for providers within the Learning and Support area, explaining how to embed content from Google Calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream and Jotforms into RDS pages. A webinar for editors on using this new functionality is scheduled for 1 May 3-4 pm (booking information below.)

A new checklist to support editors in making all the checks required before making a new toolkit live is now available at the foot of the “Request a new toolkit” standard operating procedure. Completing this checklist is not a mandatory part of the governance process, but we would encourage you to use it to make sure all the critical issues are covered at point of launch – including organisational tags, use of Alias URLs and editorial information.

4.Training sessions for RDS editors

Introductory webinars for RDS editors will take place on:

  • Tuesday 29th April 4-5 pm
  • Thursday 1st May 4-5 pm

Special webinar for RDS editors – 1 May 3-4 pm

This webinar will cover:

  1. a) Use of the new left hand navigation option for RDS toolkits.
  2. b) Integration into RDS pages of content from external sources, including Google Calendar, Google Maps and simple Jotforms calculators.

Running usage statistics reports using Google analytics

  • Wednesday 23rd April 2pm-3pm
  • Thursday 22nd May 2pm-3pm

To book a place on any of these webinars, please contact Olivia.graham@nhs.scot providing your name, role, organisation, title and date of the webinar you wish to attend.

5.New RDS toolkits

The following toolkits were launched during March 2025:

SIGN guideline - Prevention and remission of type 2 diabetes

Valproate – easy read version for people with learning disabilities (Scottish Government Medicines Division)

Obstetrics and gynaecology induction toolkit (NHS Lothian) – password-protected, in pilot stage.

Oral care for care home and care at home services (Public Health Scotland)

Postural care in care homes (NHS Lothian)

Quit Your Way Pregnancy Service (NHS GGC)

 

6.New RDS developments

Release of the redesign of RDS search and browse, archiving and version control functionality, and editing capability for shared content, is now provisionally scheduled for early June.

The Scottish Government Realistic Medicine Policy team is leading development of a national approach to implementation of Patient-Reported Outcome Measures (PROMs) as a key objective within the Value Based Health and Care Action Plan. The Right Decision Service has been commissioned to deliver an initial version of a platform for issuing PROMs questionnaires to patients, making the PROMs reports available from patient record systems, and providing an analytics dashboard to compare outcomes across services.  This work is now underway and we will keep you updated on progress.

The RDS team has supported Scottish Government Effective Prescribing and Therapeutics Division, in partnership with Northern Ireland and Republic of Ireland, in a successful bid for EU funding to test develop, implement and assess new integrated care pathways for polypharmacy, including pharmacogenomics. As part of this project, the RDS will be working with NHS Tayside to test extending the current polypharmacy RDS decision support in the Vision primary care electronic health record system to include pharmacogenomics decision support.

7. Implementation projects

We have just completed a series of three workshops consulting on proposed improvements to the Being a partner in my care: Realistic Medicine together app, following piloting on 10 sites in late 2024. This app has been commissioned by Scottish Government Realistic Medicine to support patients and citizens to become active partners in shared decision-making and encouraging personalised care based on outcomes that matter to the person. We are keen to gather more feedback on this app. Please forward any feedback to ann.wales3@nhs.scot

 

 

Antenatal colostrum harvesting (1154)

Objectives

The purpose of this policy is to ensure that all staff within NHSGGC understand their role and responsibilities in supporting expectant woman to antenatally hand express colostrum.

  1. To provide staff with education and guidance when supporting women with high risk pregnancies to hand express colostrum from 36+6 weeks pregnant.
  2. To improve ease, comfort and skill around the technique of hand expressing.
  3. To give women the confidence in their ability to breastfeed.
  4. To optimise breastfeeding initiation rates and maintenance.
  5. To reduce supplementation with formula milk unless clinically indicated.

NHSGGC is committed to providing the highest standard of care to support expectant mothers to antenatally hand express colostrum.

This guideline is to be used by clinical staff to provide support for women planning to antenatally hand express colostrum. It is well researched that exclusive breastfeeding for the first 6 months of life has many health benefits for both mother and baby. (1)

Antenatal colostrum harvesting has been shown to increase maternal confidence for all breastfeeding mothers (2). Risk factors in the early neonatal period can make supplementation with formula more common for some women - in particular for babies of mothers with diabetes, essential hypertension and twin pregnancies as these babies can have trouble controlling their blood sugars. (3)

NHS Greater Glasgow and Clyde (NHS GGC) supports UNICEF Baby Friendly Initiative (BFI) standards around supplementation only when clinically indicated.

Antenatal Colostrum Harvesting is when a mother collects colostrum in the final weeks of pregnancy and freezes for use after birth. The frozen colostrum is taken to hospital and stored until required. This can be given to the baby in the first few days after birth and can avoid the need for artificial milk supplementation.

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.

Editorial Information

Last reviewed: 13/06/2024

Next review date: 30/06/2027

Author(s): Claire Govan, Gillian Bowker.

Version: 1

Approved By: Maternity Governance Group

Document Id: 1154