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Why you might consider this and the practicalities

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This technique involves expressing colostrum in the final few weeks of pregnancy. It can also be referred to as 'colostrum harvesting' and is advocated by some NHS Trusts.

Mothers are normally advised to wait until around 36 weeks before starting antenatal expression. Mums who are having multiple births may sometimes start sooner as giving birth earlier is more likely.
Why do it?
For some mothers, it can be a useful tool that helps ensure their baby will start life without the need for formula supplementation. The importance of exclusive breastfeeding for all babies has been well-established by scientific research.

Colostrum contains vital immunological properties and helps to colonise the baby's gut with healthy bacteria that protect against allergy and disease.

It also contains the perfect balance of proteins, fats and micronutrients needed for human babies as well as acting as a laxative to help the passing of the first tarry meconium stools.

Some babies may experience difficulties with feeding or maintaining their blood sugar levels during the first few days after birth and therefore may require supplementary feeds.

These include babies:

whose mother had diabetes in pregnancy or who has a history of diabetes.

with a cleft lip or palate identified during pregnancy.

with congenital conditions e.g. Down syndrome or cardiac complications.

diagnosed with intrauterine growth restriction.

whose mother is taking beta blockers to control high blood pressure.

who are twins or triplets.

Where there is a family history of cow's milk protein sensitivity or type 1 diabetes, families may be particularly keen to avoid the use of early formula supplementation.

Some women may need to consider supplementing feeds from an early stage if there are concerns over their ability to make and/or secrete milk.

These include women:

who have a breast hypoplasia (limited breast development).

who have had previous breast surgery.

It is important for a mother to discuss her plans to express antenatally with her healthcare provider. It may not be recommended if you've been at risk of preterm labour in previous pregnancies, or have a surgical stitch, for example.

It is recommended to express antenatally by hand rather than use an electric or manual breast pump. Colostrum will be produced in quite small quantities and can easily stick to the bottles or pump parts and be harder to collect. A pump at this stage is likely to be more uncomfortable than gentle hands. Try hand expressing for a few minutes, 2 or 3 times a day.

If you hand express and use a syringe to draw up the individual drips of colostrum, you can use these syringes for storage prior to birth. Your health care provider may be able to supply you with sterile syringes.
How to hand express:

Always wash your hands before expressing.

Applying a warm compress to your breast or expressing after a warm bath or shower can help the flow of colostrum.

Get yourself comfortable. Perhaps seated and leaning slightly forward but find what works best for you.

Start with a gentle breast massage, stroking from the back of your breast towards the nipple to encourage the let-down reflex.

Put your thumb above the nipple and your first few fingers below the nipple. You will be cupping the breast in a 'C' shape.

With your thumb and fingers, feel a few centimetres back from the nipple.

Press back towards your chest, then compress (press your fingers together), and release.

Repeat this process, building up a rhythm. Press, compress, release.

It may be useful to look online for videos of hand expression techniques.

Colostrum should start to arrive drop by drop. Initially it may just be a glisten on the end of your nipple, and it may take a few days of practice before drops appear.

Collect the colostrum into a clean container, like a syringe (1ml or 2ml syringe). If nothing happens, adjust your finger position slightly to find the spot that works for you. Try not to pinch your nipple or slide your fingers uncomfortably over the skin.

Rotate the position of your fingers and thumb around the areola (imagine a clock face) and repeat the expressing process to stimulate and remove colostrum from different parts of your breast.

Express each breast twice during each session.

Colostrum can vary in appearance. Sometimes it may appear quite thick and yellow or orange and at other times paler and thinner. Expressing colostrum antenatally will not decrease or increase your milk supply after baby is born.
Storage of human breast milk
Colostrum can be collected two to three times each day in the same syringe. You will need to store the syringe in the fridge between uses.

At the end of the collecting day, the colostrum can be frozen - place the syringe into a zip-lock bag before putting into the freezer. Label the syringe and bag (separately) with the date and time of when you expressed.

The frozen colostrum can be stored for up to six months in the freezer. Once thawed, it should be used within 24 hours.
Is it safe?
The oxytocin hormone released when expressing, stimulates the uterus. Opinions differ on whether expressing colostrum antenatally is likely to induce labour. Those who advocate it do not believe that expressing would constitute sufficient stimulation to start labour. Sex while pregnant and breastfeeding through pregnancy both release oxytocin and both are generally considered safe while pregnant. If you experience any cramping in your uterus however, you should stop expressing and discuss your choice with your healthcare provider.
Transporting your frozen colostrum
You can take syringes of frozen colostrum into hospital using a freezer block and insulated bag. The colostrum can be defrosted under a running warm tap or at room temperature.

It's a good idea to mention your colostrum stores on your birth plan and make sure staff are aware in advance of your wishes in certain situations. The hospital may have access to a freezer for storage once you arrive.

After the birth, breastfeeding should usually be unrestricted. Ideally, a baby should feed successfully at the breast and the antenatally expressed colostrum would remain unused.

If your baby is experiencing difficulties with breastfeeding at this time, you may be encouraged to express some fresh colostrum to give to your baby. You may also use any colostrum you have brought into hospital with you in preference to using any formula.

If harvested colostrum ends up being 'wasted' because you are able to establish early exclusive breastfeeding, this is a cause for celebration rather than commiseration!

The process of antenatal expressing however, gives you a back-up if things don't go to plan which many families find reassuring. You'll also start your breastfeeding with a good sense of how to hand express and confidence about how your breasts work.

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Expressing your milk before your baby arrives - ABM

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Antenatal expressing is expressing colostrum in the final few weeks of pregnancy. Find out if it could be a useful tool for you.

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Follow three mothers as they share their tips on the joys and challenges of feeding twins.

The rest of the DVD can be viewed by clicking through the links below. While they work very well as stand-alone films, From Bump to Breastfeeding is best viewed as a whole:

From Bump to Breastfeeding

From Bump to Breastfeeding extra films

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At Best Beginnings we believe in the power of collaboration to create and provide quality-assured and evidence based information for families. All of our content is co-created with parents and healthcare professionals and vetted by external Healthcare bodies and parents. Read more

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Follow three mothers as they share their tips on the joys and challenges of feeding twins. Vimeo Video http://www.vimeo.com/11739595 The rest of the DVD can be viewed by clicking through the links below. While they work very well as stand-alone films, From Bump to Breastfeeding is best viewed as a whole: From Bump to Breastfeeding 1.

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National guidelines on twin and multiple pregnancy and birth

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Multiple pregnancy: antenatal care for twin and triplet pregnancies

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This guideline has been updated and replaced by NICE guideline 137

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video showing you how your twins can sleep safety

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Twins and Multiple Births Association (Tamba)

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What to expect at different ages for premature to full term twins

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Expecting twins or multiples then start here

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Expecting twins or multiples then start here

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Top tips for those expecting multiples

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Breastfeeding help

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The Twins Trust office will be closed for the festive period from noon on 21 December, re-opening at 9am on 2 January.

Over the festive period, some of our support services will be closed or reduced.

Accessing support

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Twins Trust - We support twins, triplets and more...

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Supporting you through every milestone of your journey with twins, triplets or more. From being pregnant with twins, triplets or quads through to parenting twins, triplets or quads, we are here for you.

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Free helpline for all twins and multiple issues

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Twins Trust - We support twins, triplets and more...

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Supporting you through every milestone of your journey with twins, triplets or more. From being pregnant with twins, triplets or quads through to parenting twins, triplets or quads, we are here for you.

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Includes a specifically on special care twins and multiples

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This information is available in verified by experts in our Editorial Board including representatives from Royal College of Midwives, Royal College of Paediatrics and Child Health and Royal College of Psychiatrists as well as other key health organisations in the UK. To download Baby Buddy, visit the relevant app store of your choice:

Introduction

The first video from the Small Wonders DVD explains the different levels of care your baby might need, and who might give it. We meet some of the families and hospital staff, and guide you as to how to use this DVD to get support, wherever you are on your journey.

In the second video from the Small Wonders DVD, we meet three families, two who had time to prepare for life in a neonatal unit and one who had very little warning. We see three births, one of which is the birth of triplets, and we follow the babies being prepared for transfer to the neonatal unit.

First hours

The third video from the Small Wonders DVD provides a look into the first hours and days in the neonatal unit and shows you how you, as a parent, can play a very important role in your baby's care.

Expressing breast milk

The fourth video from the Small Wonders DVD shows how mothers can express breast milk for their baby within a few hours of giving birth (if at all possible mothers should express milk within the first 6 hours after giving birth). Starting to express breast milk early and expressing milk often will help your body produce plenty of milk for the weeks and months to come.

Holding your baby

The fifth video from the Small Wonders DVD shows how skin-to-skin contact (also known as 'kangaroo care') can help both you and your baby. You will see families move from being nervous to being able to hold their babies with confidence.

Your time in hospital

The sixth video from the Small Wonders DVD follows families as they begin to feel more confident in caring for their babies on the neonatal unit. You will also see how some of our families cope with their baby's condition getting worse.

Feeding independently

The seventh video from the Small Wonders DVD follows four families as they learn to help their babies feed independently of tubes. Although some babies may go home being fed by tube, most will be feeding independently before they are discharged from hospital, whether they are breastfeeding or formula-feeding.

Preparing for home

The eighth video from the Small Wonders DVD covers what to expect when your baby is ready to leave hospital. We follow five families as they prepare to go home.

First months at home

The ninth video from the Small Wonders DVD follows nine families enjoying the early weeks and months at home with their pre-term baby. They all have different experiences and challenges.

Twins and triplets

The tenth video from the Small Wonders DVD follows four families who had twins or triplets and discovers some some of the joys and challenges that come with having more than one baby.

Bereavement

This video from the Small Wonders DVD is only for families who have to deal with bereavement. We have included it because parents asked us to. Only watch this video if you feel it will be helpful to you and please be aware that everyone's experience of bereavement is different and may not reflect your own. This film follows the journeys of families who lost babies during filming and chose to carry on sharing their experiences to help others.

The twelfth and final video from the Small Wonders DVD shows the families whose journeys we have been following in films 1 to 10 looking back on their experiences and sharing their thoughts and feelings.

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The Impact Lead will focus on developing Best Beginnings' frameworks for monitoring and evaluating our national and international work ensuring that learning continues to be captured in ways that can be shared and used for effective advocacy and influencing. The successful candidate will also play a pivotal role influencing policy and its implementation within the maternity, early years, digital health and public health context.

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The Small Wonders videos have been designed to help you on your journey with your sick or premature baby.

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Twins Trust - We support twins, triplets and more...

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We're still here for you...We're changing how we work so we can keep supporting you and your families during the COVID-19 pandemic.

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Practical help for families in need

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Home-Start UK is a leading family support charity. Thousands of volunteers offer vital support and practical help to families and children facing challenges around mental and physical health, isolation, disability, post-natal depression, money problems and more.

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Your reaction to finding out that you're pregnant with twins may have been anything from surprise to shock. But there are lots of reasons to be excited about bringing two babies into the world at the same time. Here are just a few of them:

1. Knowing that you're only going to have to go through pregnancy once to end up with two children.

2. Enjoying the fun of choosing two baby names that fit together perfectly.

3. Being able to hold one baby in each arm while feeling a huge rush of love and pride.

4. Watching your babies sleep peacefully, side by side.

5. Only having to establish one routine.

6. Getting all the sleepless nights over and done with in one go.

7. Watching them carve out their own identities as they grow.

8. Knowing that they are going to have a best friend in each other for life.

9. Enjoying the attention that twins inevitably attract.

10. Feeling confident that they can help each other on their first day at school.

11. Discovering all their amazing little differences.

12. Watching them create their own secret language and games.

13. Knowing that they will never be lonely.

14. Loving the fact that they are constant playmates and can entertain each other.

15. Feeling special because you've joined the exclusive club of twin mums.

16. Not having to give baby number two (if only by a few minutes!) hand-me-downs.

17. Only having to bake one birthday cake and throw one birthday party a year - in the early years at least.

18. Seeing them learning and encouraging each other to reach their milestones.

19. Watching them taking care of each other when one is upset or hurt.

20. Knowing that their shared history means they have one of life's most unbreakable bonds.

Get some great coping tips for the first months with your twins.

Last reviewed: January 2020

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Your reaction to finding out that you're pregnant with twins may have been anything from surprise to shock. But there are lots of reasons to be excited about bringing two babies into the world at the same time. Here are just a few of them: 1.

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It is unusual for multiple pregnancies to go beyond 38 weeks, so if you are expecting a twin birth or more than two babies you will need to consider your options early.

Vaginal delivery of more than one baby

People often assume that if you are expecting more than one baby they must be born by caesarean section. In fact, almost half of all twins are born vaginally and the process is similar to having a single baby.

If the first baby is in a head down position, it's usual to consider having a vaginal delivery. However, there may be other medical reasons why this would not be possible. For example, if you have had a previous caesarean section, you're usually not recommended to have a vaginal birth with twins.

If planning a vaginal delivery, it is usually recommended that the mother has an epidural for pain relief. This is because if assistance with delivery is needed, it's easier and quicker when the mother already has an epidural in place.

If you have a vaginal birth, you may need an assisted birth, when a suction cup (ventouse) or forceps are used to help deliver the baby.

Caesarean section for multiple births

If you are expecting more than one baby, you may choose to have an elective caesarean section from the outset of your pregnancy. Alternatively, your doctor may recommend a planned caesarean section later in the pregnancy as a result of potential complications.

Your babies' positions may determine whether they should be delivered by caesarean section. If the presenting (first) baby is in a breech position (feet, knees or buttocks first) or if one twin is lying in a transverse position (with its body lying sideways), you will have to have a caesarean section.

Some other conditions might also mean you will need a caesarean section, for example if you have placenta praevia (a low-lying placenta) or if your twins share a placenta.

If you have previously had a very difficult delivery with a single baby, you may also be advised to have a caesarean section with twins.

Even if you plan a vaginal delivery, you may end up having an emergency caesarean section. This could be because

the babies become distressed,

the cord prolapses (when the cord falls into the birth canal ahead of the baby),

you have high blood pressure,

the labour is progressing slowly,

an assisted delivery doesn't work.

In very rare cases, you may deliver one twin vaginally and then require a caesarean section to deliver the second twin if the baby becomes distressed. This occurs in less than 5% of situations when twins are born.

Special care

As multiple pregnancies are generally less likely to carry to full term, parents expecting more than one baby should be prepared for the possibility that their babies may come early and spend some time in a neonatal intensive care unit. These can sometimes be quite upsetting places to begin with, and parents can think their babies look small and vulnerable amongst all the technology. It may be a good idea to try to visit the neonatal intensive care unit on a hospital tour during your pregnancy to prepare yourself for the possibility that your babies may spend some time here.

Although the thought of having premature babies may be worrying, studies have shown that premature multiples mature more quickly than single babies born at a similar time and multiples are often better equipped for early starts. Some premature babies may only need a short stay with little medical treatment.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about pregnancy, labour and life with a new baby.

The Twins & Multiple Births Association (Tamba) provides support and information to parents expecting twins, triplets or more babies. They publish a Healthy Multiple Pregnancy Guide, which is available free on Tamba's website if you register.

NHS choices also provide information on delivering twins.

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It is unusual for multiple pregnancies to go beyond 38 weeks, so if you are expecting a twin birth or more than two babies you will need to consider your options early. People often assume that if you are expecting more than one baby they must be born by caesarean section.