Alexiyah Coughlin, BSN, RN, IBCLC
One of the latest and greatest questions is whether pregnant parents should express milk before the baby is born! This is a relatively new concept, and expert opinion is ever-changing over the last several years. Let’s examine the risks and benefits of prenatal expression.
Risks
- Stimulation of contractions
The same hormone that elicits milk letdown also causes onset of labor by stimulating onset of uterine contractions. Oxytocin is released with nipple stimulation, so prenatal expression may be responsible for early labor onset. Keep in mind that we generally consider it safe to breastfeed an older baby throughout pregnancy, unless there are specific risks that would prompt us to advise against it. Thus, it’s a little uncertain whether a small amount of occasional prenatal expression would cause onset of labor. On the flip side, nipple stimulation has been utilized as a natural way to help the body into labor when moms are overdue. Either way, as a general rule of thumb, prenatal expression is most safe once you’ve reached term pregnancy at 38 weeks. If you start having contractions, it’s safest to stop the stimulation and talk to your OB provider.
- Depletion of colostrum
There are some providers who suggest that prenatal expression will deplete colostrum before baby is born. While there isn’t a ton of research on this topic, those who promote prenatal expression maintain that the body will still produce colostrum when baby is born. Amazingly, we see that when we induce lactation in a non-birthing parent, we observe that they don’t usually produce colostrum. Thus, colostrum production is a physiologic response to birth.
- Mastitis
As soon as we start expressing milk, we are at risk for mastitis. Expression of milk stimulates prolactin, which calls for more milk production. Mastitis can be caused by poor milk removal or bacterial entry from damaged nipples. It’s worth noting that we really aren’t sure the risk of mastitis with prenatal expression, but it’s something to keep in mind and report to your obstetrical provider if you have signs or symptoms, including breast pain and/or redness, fever, chills, body aches, or general flu-like symptoms.
- Disappointment in output
One of the most important concerns to discuss is the fact that prenatal expression is unlikely to produce a robust amount! Some may not get more than drops, and there is a possibility that you get no milk at all. This is especially true if this is your first baby. It’s imperative for moms to understand that what you achieve prenatally is not a prediction for what your supply will be postpartum.
Benefits
- Get to know your breasts!
The biggest perk of prenatal expression is simply getting to know your breasts and becoming comfortable with stimulation. Some are incredibly sensitive with stimulation, and this can be heightened during pregnancy. Know that your comfort may increase after your baby is born and the pregnancy hormones sharply decline.
- Familiarize yourself with your pump
You can express with hand expression or pumping! If you’re going to express during pregnancy, it’s a good idea to try out your pump. This can help you get used to your pump functions. Know that it’s important that you have the right size flanges! Ill-fitting flanges can cause pain and damage. Note that your nipple size may change after baby is born, so re-sizing at that time is recommended.
- Have a little expressed milk to bring to the hospital
Milk can take a few days to come in! In some scenarios, this process can be delayed. One benefit of prenatal expression is having a small amount of breast milk that you can give your baby during this timeframe. Expressed breast milk can be helpful in baiting baby to the breast, or providing to baby if you don’t have much production in the first couple of days. This is not necessarily needed, but a bonus, and may be especially helpful for babies who are having issues with blood sugar and need more calories right upfront. Store your prenatal milk in syringes or on spoons in the freezer, which will make for easy use in the hospital. Make sure to bring your own storage, as many facilities won’t store prenatal milk in their freezers. Note that it’s always preferred to give baby fresh milk, especially at birth, because they really need the colostrum! Try nursing at breast first and using your prenatal milk as a back up.
- If you have risk factors for low milk production
Some may be at risk for low milk production. Prenatal expression may help “prime” for a more promising chance at a good milk supply. If you’re unsure whether you have these risk factors, scheduling a prenatal visit with a lactation consultant may help you determine your risk.
In conclusion, prenatal expression is not for everyone, but more and more lactation consultants and providers are suggesting prenatal expression for a myriad of reasons. It’s best to have a discussion with your lactation consultant and obstetrical provider to find out if prenatal expression is safe for you.
For more support on prenatal pumping and familiarization with your Rumble Tuff pump, schedule an appointment with one of our IBCLCs here. You’ve got this, and we’ve got you!
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