Colostrum, Hand Expression and Pumping: What you need to know as a new mom

If there is one piece of advice I could give to a new mom about breastfeeding BEFORE you have your baby, it’s to get breastfeeding support before baby is born!  Hand expression, colostrum and pumping are some of the most underused and underdiscussed topics, leading to a shit ton of misinformation on social media!

Getting support early may sound biased since I’m a certified lactation counselor, but I know from personal experience and was preaching about getting breastfeeding support while still pregnant before I became a certified professional.

Colostrum: the details

Colostrum is a very unique liquid, I think.  Your body starts producing it during pregnancy, somewhere between 14-20 weeks.  Some women leak and some don’t! Either can be considered normal.

It’s so special that for the first few days after baby is born, they rely on your colostrum to help build up their immune system and give them antibodies to fight off germs. 

Colostrum is usually a darker, thicker yellow color.  Once “your milk starts coming in,” it will turn to a more cream colored liquid, what we usually refer to as breastmilk.  All of it is breastmilk though!

Hear this, know this:  COLOSTRUM COMES IN SMALL AMOUNTS!  It is unrealistic to think that on day 1, you will make ounces of colostrum.  In fact, you will only start with drops.

Your baby’s stomach is the size of about a cherry on day 1.  And with each day, it gets bigger.  Here is a great visual from medela:

Your baby only needs about 5-7mL per feeding on day 1.  1 ounce is 30mL so you might make an ounce between both breasts on the first day.

This means that pumping colostrum is not very efficient.  This is where hand expression comes in.

Hand expression allows you to collect each of these drops and actually give them to your baby so they’re not lost in the pump parts or the bottle.

You can express colostrum into a medicine cup or a spoon and give to your baby.

There is also something you can do called colostrum collection/harvesting during pregnancy.  You must speak with your provider and make sure you are not at risk for pre-term labor to collect colostrum while still pregnant.

You can start collecting colostrum around 37 weeks pregnant, after you have talked with your provider.  This allows you to have colostrum ready in case your baby needs to be supplemented.

Colostrum collection doesn’t mean you shouldn’t feed your baby on-demand at the breast.  You absolutely should allow for uninterrupted skin to skin until the first breastfeed takes place and bring baby to breast based on feeding cues.

Let’s talk about the ins and outs of hand expression now!

Hand expression: The Ins and Outs

Hand expression is a lost art and totally underused!  There are several times where hand expression would be incredibly useful and more beneficial.

• For colostrum collection/harvesting
• During the first few days, expressing into a medicine cup or spoon to give to your baby
• To help relieve engorgement
• To get the flow of breastmilk started
• In a pinch and you don’t have a pump
• Can be more stimulating than a hard, plastic electric pump

With lots of way to use hand expression, I’m going to teach you how to do it correctly.

To express colostrum, you need a clean medicine cup or spoon.  To express breastmilk, after it has come in, you will need a clean bottle or bowl.  There are a few easy steps to remember to hand express.

1. Wash your hands prior to expressing.
2. Sit upright and even lean over your collection container so gravity can help with expression.
3. Place you hand in a C shape, just behind the areola, not too close to the nipple because you could compress the milk ducts and milk will not come out.
4. Gently push back towards chest wall
5. Then squeeze/compress breasts until milk comes out.
6. DO NOT slide fingers towards nipple.  This technique doesn’t work.
7. As soon as your drops or stream of milk stops, release the squeeze and push back towards chest wall and squeeze again.
8. Continue until milk stops and rotate hands to a different area of your breast(s) to ensure you express from many milk ducts.

Real talk here: the first time you hand express is probably not going to be efficient.  Keep practicing!  It will get easier and you will become more efficient.

Here is a great video that I love to share with clients on hand expression so you can see it done correctly, in action! (HINT: fast forward to about 3 minutes)

Pumping 101

Now that your milk has come in and breastfeeding is working well for both you and baby, you may be ready to start pumping.

And if breastfeeding is not going well in those early days, let’s work together and create a plan with pumping and breastfeeding.

You should be able to get a pump for each pregnancy through your insurance. You can check here to see what’s covered!

These pumping tips are somewhat general and can be applied to any pump.

You will need to measure your nipple size and make sure you have the correct flange size.  A lot of companies recommend you size up flange sizes.  DON’T DO THIS! 

You risk milk not being expressed efficiently as well as pain and discomfort, leading to more difficulty pumping.

If you are between sizes, then you can size up to the next size.  For example, my client recently measured a 20mm flange size.  20mm is not a “true” flange size so I advised her to try 21mm flanges.

Otherwise, keep your flange size.

Having the correct flange size should be comfortable and should yield milk!  This is super important!!!!

Next, your vacuum and suction (depending on the pump you have, will just be one button) should only be turned up until comfortable.

MYTH:   Turning up your settings will yield more milk!

False!  Please keep pumping comfortable.

Start your pump on the let-down mode, which is where the rhythm is faster with shorter ‘sucks.’  Do this until you get a let-down, typically 1-2 minutes.  Then switch to expression mode, where the ‘sucking’ mimics baby at your breast.

If you do not get a let-down, look at pictures of your baby or smell something they have been on, like a blanket or piece of clothing. This should help release oxytocin to stimulate a let-down. IF PUMPING IS UNCOMFORTABLE, please reach out for a pumping consult.  We can troubleshoot what’s going on! 

Pumping should not be uncomfortable!

Some equipment you may need to make pumping easier and more comfortable:

1. Hands free pumping bra
2. Coconut oil
3. Correct flange size for each nipple and at least 2 sets
4. Bags for collection *PRO tip* freeze them flat to save room
5. A bag to hold all of your pumping supplies
6. Car charger/plug-in
7. If you are pumping at work/away from your home, a lunchbox with freezer packs to keep the milk chilled.

Wearable pumps

Wearable pumps are becoming more and more popular!  My advice on that is to use them once your milk supply and pumping routine are well established AND if you make a little more than enough breastmilk for your baby. 

Those pumps do not typically work well for low milk supply since the motors are smaller and there may not be enough suction.

If you are an oversupplier, you may quickly overfill the small compartments.

If you want a wearable pump, make sure to have a double electric pump to use for other times!

There is so much out there on colostrum, hand expression and pumping, that I wanted to share information from a lactation professional who has taken courses on these topics.  Please email me if you need support on any of these topics!