Expressing and collecting the first milk (colostrum) for your baby in the NICU

This information leaflet is intended for parents/ carers with babies who are, or are going to be, admitted to the Neonatal Intensive Care Unit (NICU). It is intended to help establish the best possible start when learning to express breast milk, and, in the long term, until your baby is able to breastfeed directly.

What is colostrum and why it is used?

The first milk you produce is called 'colostrum'. You may have heard colostrum described as ’liquid gold’, and not just because it’s yellow, but because it is the ideal nourishment for your baby in the first days of life. Colostrum is highly concentrated, and packed with valuable nutrients. It can help to protect your baby’s gut, and contains antibodies that can help protect your baby from infection. It’s also easy for your baby to digest, and so encourages the passage of meconium (baby’s first poo).

It is normal to initially produce small amounts of breast milk, so don’t be concerned that it might be a sign you would be unable to breastfeed. When your baby is born, their stomach capacity is very small [about the size of a marble for a newborn term baby (born above 37 weeks gestation)], so the first few times you express breast milk you may just get small amounts.

Hand expressing is useful because:

• It is the most effective method to remove and collect colostrum in the first few days.
• Your colostrum can be given to your baby when they are not ready to feed directly from your breast.
• It can help encourage your baby to feed and help your milk start to flow.
• It can help your baby to attach if your breasts are full, to clear blocked ducts and relieve mastitis, as it can target a specific area of your breast.

Let's get started

Expressing can take time to establish and can be challenging in an already stressful situation. However, it can be very rewarding to know your baby is receiving your milk.

Prolactin and oxytocin are the hormones necessary for making milk. To stimulate the production of these hormones, it is recommended that you follow the 'golden rules'.

Golden Rules

• Before you start, wash your hands and ensure you have a clean syringe to collect the milk in.
• Start by expressing as soon as possible after your baby is born, within the first two hours – this will boost your milk supply in the short and long term.
• Carry on expressing eight-ten times each day for the first two to three weeks until your body has established its milk supply.
• Express at least once between midnight and 6am, when your hormones are at their highest levels – it will help to boost your milk supply.
• Fit expressing to your lifestyle, such as cluster pumping instead of fixed intervals.
• Use a good combination of hand and pump expressing.

Breast massage and hand expressing

The leaflet 'Breast massage and hand expressing technique' explains how to:

• get your mind and body ready to express
• start with breast massage
• hand express your milk

Support with expressing

It can be helpful to get support from a partner, friend or others who are expressing milk. Getting help from another person will make you both part of the process and increase your confidence and wellbeing. Your healthcare team will also be able to support you.

You can use your mobile phone to scan the QR code below, or use this link to the Cambridgeshire and Peterborough Healthy Child Programme website (opens in a new tab); either will direct you to a video of breast massage and hand expressing with some top tips.

If your baby is in the NICU, once you have collected your colostrum, please make sure that your milk is delivered to the NICU as soon as possible.

How to store your breast milk

Room temperature (fresh, after expressing)

• Can be safely kept for up to four hours.
• Should be kept as cool as possible, ie not in direct sunlight.

Fridge

• Fresh breast milk can be stored in your fridge for up to 48 hours.
• Store milk at the back of the fridge (4 to 5°C).
• After 48 hours, freeze your milk for up to three months in the back of your freezer.
• If your baby is not in the NICU, you can keep the milk in your fridge for up to five days.

Contacts/ further information

For more colostrum syringes or for further support, please speak to healthcare staff on the Delivery Unit, Close Observations Unit, Sara Ward, Lady Mary Ward or the Neonatal Intensive Care Unit.

To contact the Maternity Infant Feeding Team: CUH.rosiehospitalinfantfeedingsupportline@nhs.net

To contact the Neonatal Infant Feeding Team: CUH.nicuinfantfeeding@nhs.net

References/ sources of evidence

Hand Expression of Breastmilk (opens in a new tab)

Hand Expression Video (opens in a new tab)

Neonatal Unit Guidance - Implementing the Standards (opens in a new tab)

Expressing and storing breast milk (opens in a new tab)

Expressing your breast milk (opens in a new tab)

Special thanks to Nina Morley from Cambridgeshire and Peterborough Community Services for granting permission to use the breast massage and hand expressing link.