The Hands-On Approach to Preparing for Breastfeeding in Pregnancy!

Did you know that milk production begins during pregnancy, and that we can express (or discharge it) by squeezing the breast by hand? In fact, antenatal hand expression - as it’s more formally called - is considered to have lots of benefits, which we outline below and in today’s podcast, as well as what changes your breasts undergo during pregnancy, what colostrum is and why we call it liquid gold!

What Happens to Your Breasts in Pregnancy?

At the outset of pregnancy through to delivery, your body undergoes a great number of changes, and shifts in various hormones cause the breasts to go through various, defined phases. The are:

Mammogenesis

When you become pregnant, estrogen levels rise in the body, increasing blood flow to the breasts, and causing the ductal system to grow and transform. The hormone prolactin causes the nipple and areola to grow. You’ll notice these changes in early pregnancy.

Lactogenesis I

Lactogenesis I is the phase where the breasts transition into producing milk, or more accurately, colostrum. This phase typically begins mid to later in pregnancy, approximately 16 weeks in and onwards, although not seeing these changes by mid second trimester can be quite normal as some start production early and some later. Lactogenesis I brings on the production of colostrum, a substance nicknamed “liquid gold” that is super concentrated with nutrients and important immunologic properties that are tailored towards your newborn, providing them with specifically what their immune system needs. But we do not produce regular breast milk during this phase due to a hormone called progesterone, which is produced by the placenta. Progesterone interferes with prolactin receptors and inhibits the body from making a significant amount of milk, until…

Lactogenesis II

When the placenta is delivered, estrogen levels drop significantly - specifically progesterone - and as a result prolactin is no longer blocked, the message to start producing more breast milk is sent, and the body enters a phase called Lactogenesis II. 

Lactogenesis III

Although milk production begins as an automatic, or endocrine hormonal related process in the body, the transition to Lactogenesis III - or ongoing milk maintenance and production - requires ongoing stimulation of the breast and nipple, and frequent milk removal. This can be done directly by infant feeding, hand expressing, or pumping. 

So What is Hand Expression?

It is the literal use of your hands to compress and massage the breast tissue, in order to express milk. Doing it while you are still pregnant helps to get comfortable with the process and sensation, as well as building up a bit of a colostrum “reserve” that can be used to supplement when feeding your newborn in those first few days, if necessary. 

First thing to know about hand expression is to confirm with your care provider if you should try it. It is not recommended for everyone, as it can cause cramping and potentially trigger labour. Next is to wash your hands and any equipment you might be using to collect the liquid (a spoon, syringe, etc), and follow these steps found on our Instagram Reel on Hand Expression, or tune into the podcast for a detailed step-by-step breakdown from Dr. Sarah!

A few key pointers include:

1. Focus on expressing one breast at a time, not both. It may take several minutes.
2. Get some syringes in advance to save the colostrum. Here is a link to some on amazon we like!
3. You can freeze colostrum to transport to the hospital for your newborn

Why Hand Express Prior to Delivery?

As we’ve mentioned, having a bit of a reserve of colostrum can be extremely helpful for your newborn, if they are born prematurely and taken to the NICU, or are just having trouble latching and everyone is exhausted in those first few days after delivery. Being familiar with how to express milk prior to delivery will also help during those difficult first few weeks of your breastfeeding journey. It can also be helpful if you are having a planned Cesarean section - sometimes there can be a delay in the milk coming in because the body isn't naturally undergoing all the hormonal changes leading up to labor. Having a stash of claustrum and the skills of hand expression in your toolkit can be really empowering in those first few days while waiting for the milk to come in. 

For pregnant people with diabetes, gestational or Types I or II, babies are at a higher risk of having low blood sugars after birth as they are used to receiving the higher blood sugar loads from you. They often need some extra calories, so having some claustrum can really help baby to maintain their blood sugar levels. Colostrum can also help regulate high levels of bilirubin, a compound in the blood that causes jaundice in newborns. Hand expressing can also be super helpful for anyone that may have had breast surgery and altered the connection between certain tissue and ducts, for breasts of a certain shape, or if your newborn has a physical difference such a cleft lip or palate. The benefits go on and on!

Check-out www.firstdroplets.com which is a great, free website offering tutorials on how to do hand expression, tips and tricks for latching, and more! 

Tune in to today’s podcast to learn even more about choosing a provider, or subscribe to The Pregnancy to Parenthood Podcast Series. For the low, one-time cost of $47, get full access to over 40 informative episodes supporting you week by week, focused on the trimester and stage of pregnancy you are in. Tune in every week, or binge listen all at once and come back to the episodes you found most helpful as you move through pregnancy to parenthood!