Leading Lactation Insights - February 2023

Breast anatomy research image

A monthly newsletter called Leading Lactation Insights, which features factual and scientific information with no product promotion. It covers cutting-edge breastfeeding & lactation research, clinical news, and expert insights for IBCLCs, lactation consultants, and maternal health professionals.

Information on Antenatal Breast Milk Expression

Maria Lennon, MSN, CNM, IBCLC

Most of the information sheets and protocols found on the internet come from hospitals and health districts in the United Kingdom, but there are a few hospital systems, medical practices, and WIC offices in the United States that are promoting antenatal breast milk expression. Here are a few international resources that are helpful when deciding whether to introduce prenatal breast milk expression in your patient population.

From Breastfeeding USA: An article which summarizes the historical perspective, lists uses and concerns and references studies.
https://breastfeedingusa.org/content/article/expressing-milk-birth-tool-use-special-circumstances

Demirci, J.R., Glasser, M., Himes, K.P. et al. Structured antenatal milk expression education for nulliparous pregnant people: results of a pilot, randomized controlled trial in the United States. Int Breastfeed J 17, 50 (2022). 
https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-022-00491-8

From Gestational Diabetes UK: Has lots of information and an excellent instructional video on how to collect colostrum.
https://www.gestationaldiabetes.co.uk/colostrum-harvesting/&nbsp

From La Leche League international:
https://www.llli.org/breastfeeding-info/colostrum-prenatal-antenatal-expression/

And a personal account of harvesting colostrum:
https://www.llli.org/the-benefits-of-antenatal-colostrum-harvesting/ 

University of Rochester Medical Center
URMC has an information sheet on Prenatal Hand Expression
https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/breastfeeding/documents/prenatal-hand-expression.pdf

Patient Information Sheet from the West Suffolk NHS Foundation Trust (United Kingdom)
https://www.wsh.nhs.uk/CMS-Documents/Patient-leaflets/Maternity/6657-1-Expressing-and-storing-colostrum-during-pregnancy.pdf

O’Sullivan TA, Cooke J, McCafferty C, Giglia R. Online Video Instruction on Hand Expression of Colostrum in Pregnancy is an Effective Educational Tool. Nutrients. 2019; 11(4):883. https://doi.org/10.3390/nu11040883


Improving Mothers’ Own Milk Provision at NICU Discharge: Optimizing Achievement of Secretory Activation and Coming to Volume as Key Strategies 

Paula Meier, PhD., RN
Wednesday, February 15

 

2023 Webinar Schedule

2023 Medela Human Milk Clinical Webinar Calendar

The 2023 Human Milk Monthly Clinical Education Webinar Schedule is now available! Download your copy today!

Information on Antenatal Breast Milk Expression

Maria Lennon, MSN, CNM, IBCLC

Most of the information sheets and protocols found on the internet come from hospitals and health districts in the United Kingdom, but there are a few hospital systems, medical practices, and WIC offices in the United States that are promoting antenatal breast milk expression. Here are a few international resources that are helpful when deciding whether to introduce prenatal breast milk expression in your patient population.

From Breastfeeding USA: An article which summarizes the historical perspective, lists uses and concerns and references studies.
https://breastfeedingusa.org/content/article/expressing-milk-birth-tool-use-special-circumstances

Demirci, J.R., Glasser, M., Himes, K.P. et al. Structured antenatal milk expression education for nulliparous pregnant people: results of a pilot, randomized controlled trial in the United States. Int Breastfeed J 17, 50 (2022). 
https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-022-00491-8

From Gestational Diabetes UK: Has lots of information and an excellent instructional video on how to collect colostrum.
https://www.gestationaldiabetes.co.uk/colostrum-harvesting/&nbsp

From La Leche League international:
https://www.llli.org/breastfeeding-info/colostrum-prenatal-antenatal-expression/

And a personal account of harvesting colostrum:
https://www.llli.org/the-benefits-of-antenatal-colostrum-harvesting/ 

University of Rochester Medical Center
URMC has an information sheet on Prenatal Hand Expression
https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/breastfeeding/documents/prenatal-hand-expression.pdf

Patient Information Sheet from the West Suffolk NHS Foundation Trust (United Kingdom)
https://www.wsh.nhs.uk/CMS-Documents/Patient-leaflets/Maternity/6657-1-Expressing-and-storing-colostrum-during-pregnancy.pdf

O’Sullivan TA, Cooke J, McCafferty C, Giglia R. Online Video Instruction on Hand Expression of Colostrum in Pregnancy is an Effective Educational Tool. Nutrients. 2019; 11(4):883. https://doi.org/10.3390/nu11040883


Improving Mothers’ Own Milk Provision at NICU Discharge: Optimizing Achievement of Secretory Activation and Coming to Volume as Key Strategies 

Paula Meier, PhD., RN
Wednesday, February 15

 

2023 Webinar Schedule

2023 Medela Human Milk Clinical Webinar Calendar

The 2023 Human Milk Monthly Clinical Education Webinar Schedule is now available! Download your copy today!


Clinical Pearls in Lactation

This column is for lactation practitioners to share clinical challenges, successes, observations and pearls of wisdom with colleagues. If your submission is selected for publication in a future issue of Human Milk Insights, you will receive a $25.00 VISA gift card.

submit your pearl

Antenatal Breast Milk Expression – What’s the Hype?

Maria Lennon, MSN, CNM, IBCLC

A lot of parents are reading about and asking clinicians whether they should express colostrum before their babies are born. Antenatal breast milk expression (aBME, AME, AHE) is the hand expression and/or pumping and collection of colostrum during pregnancy. It’s not recommended for everybody.

The benefit of expressing colostrum prenatally is to have a supply of colostrum available for supplementing infants who may be at risk of hypoglycemia, or whose mothers are at risk of delayed lactogenesis in order to avoid the use of infant formula in the early days after birth. 

It is always recommended that a mother check with her midwife or obstetrician before beginning aBME, as the release of oxytocin could cause uterine contractions which may be contraindicated in certain conditions. Also, aBME should not begin before 36 weeks gestation. 

Expressing and storing colostrum prenatally may be helpful if the mother has Diabetes of any kind (gestational or pre-gestational), if she is planning a C-section, or has any condition which may delay the onset of lactogenesis (pre-eclampsia, history of low milk supply, insufficient glandular tissue, etc.). It may also be recommended if the baby has intrauterine growth restriction, is small for gestational age or is expected to have a cleft lip or palate, a congenital heart defect, Down Syndrome or is at risk of hypoglycemia at the time of birth.

Mothers are instructed to hand express small amounts into sterile syringes or small, food-safe containers with secure lids and to freeze soon after collection. They should store in small amounts, as newborns need only a few milliliters per feeding. It’s recommended that the colostrum be thawed under running warm water and used within 24 hours after thawing.

Antenatal milk expression has become quite popular despite the fact that there is an absence of high-quality research studies of its benefits or harms. In a comment to the Lancet in 2017, Dr. Pamela Berens mentions that the results from a 2014 Cochrane review concluded that there was “no high-level systematic evidence to inform the safety and efficacy of the practice”. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31505-2/fulltext.

Although, more scientific studies need to be conducted, many women have expressed satisfaction in being able to bring frozen containers of their expressed colostrum to the hospital for use if needed for supplementation after birth. They were able to exclusively feed their own milk to their infants and were able to avoid the use of infant formula.


References:
Casey, J.R.R., Banks, J., Braniff, K., Buettner, P. and Heal, C. (2019), The effects of expressing antenatal colostrum in women with diabetes in pregnancy: A retrospective cohort study. Aust N Z J Obstet Gynaecol, 59: 811-818. https://doi.org/10.1111/ajo.12966
Chapman, T. (2012). Antenatal breast expression: A critical review of the literature. Midwifery, doi: 10.1016/j.midw.2011.12.013.
Cox, S. G. (2006). Expressing and storing colostrum antenatally for use in the newborn period. Breastfeeding Review, 14(3), 11-16.
Johnsen, M., Klingenberg, C., Brand, M. et al. Antenatal breastmilk expression for women with diabetes in pregnancy - a feasibility study. Int Breastfeed J 16, 56 (2021). https://doi.org/10.1186/s13006-021-00393-1 

Medela Spotlight on Practice article Arilede Miano, LDN, IBCLC article contributor for Leading Lactation Insights.

Spotlight on Practice

This column is for lactation practitioners and facilities who wish to acknowledge the work of others. We invite you to submit suggested practitioners or facilities you would like to spotlight. If you have a suggestion, email education@medela.com.

send a nomination

This month we are spotlighting Arilede Miano, LDN, IBCLC

Megan Quinn

Arilede Miano, LDN, IBCLC – WIC Program, usually goes by Nica – her forever nickname – and has been working for Maryland’s WIC program since 1998. She currently works at the Prince George’s County Health Department and she is the Breastfeeding Coordinator and Breastfeeding Peer Counselor Program Coordinator. She shares that she originally pursued a career in healthcare because she always paid attention to others’ health issues as a child and always had a strong desire to help people. She says “I had a particular interest in what people were eating. Remember those big encyclopedia collections? No Google back then for research! I’d make a mess in the living room and read many books about science, anatomy, and physiology.” Once in college, Nica was excited to have the opportunity to pursue nutrition and graduated with a Bachelor’s in Human Nutrition from the Federal University of Santa Catarina in Brazil. 

Nica soon began working at a 300-bed hospital as the lead dietician and was eventually promoted to the maternity hospital in her city in Brazil. There, she immersed herself in learning more about lactation and spearheaded several programs to enhance mom and newborn care, including development of prenatal classes, coordinating the hospital’s human milk bank, and much more. In 1994, Nica was part of the team who received a UNICEF award for their Baby-Friendly Hospital and the hospital became a reference for outstanding breastfeeding promotion and support throughout their region. Shortly after, Nica met her husband and moved to his hometown in Maryland to begin their lives together. She began working for the WIC program in the late ‘90s, where she says “I could have all the room to practice my passion – which is to help moms and babies have a healthy start in life.” Nica became an IBCLC a few years later to further expand her knowledge and interactions with other lactation professionals.

Currently, Nica’s role is heavily involved in guiding parents to provide healthy nutrition for their babies, children, and selves. She offers individual and group nutrition and breastfeeding classes, individual counseling for high-risk participants, trains staff and breastfeeding peer counselors, and oversees the breast pump loan program. Nica is proud to share that when she started in WIC over 20 years ago, the WIC breastfeeding initiation rate in her county was about 37% - and now data shows that this fluctuates around 85 – 87%! “I am also a member of the Maryland WIC Breastfeeding Committee, where I collaborate with the state WIC office to provide training for employees statewide,” she shares. “This has been incredible, exciting, and a successful journey.”

In her free time, Nica enjoys volunteering in the community and spending time with her husband, Skip, and their two cats. They like boating, visiting waterfront restaurants on the Chesapeake Bay, and especially when their son visits and brings the fish and crabs he catches in the Bay! Their daughter will soon graduate college. As a family, they love visiting Brazil and staying close to their roots there. Thank you for all that you’ve done for families all over the world and to help moms and babies be their healthiest selves!


Thank you to this issue's contributors!

Maria Lennon, MSN, CNM, IBCLC

Nurse-Midwife, Perinatal Education Consultant - Sedona, AZ

Katie McGee, RN, BSN, IBCLC

Education Consultant - Westchester, IL

Kim Colburn, BPC

Medela U.S. Medical Education Specialist

Megan Quinn

Medela U.S. Corporate Communication Specialist

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