COLOSTRUM HARVESTING: Eight Things to Consider
By Stephanie Ondrack
Colostrum harvesting is very trendy right now. Lots of people are being advised to do it by their care providers, internet articles, doulas, or friends. It is being advised as a safe and easy thing you can do ahead of time to help prepare for breastfeeding/chestfeeding. But it is not always necessary. In fact, in some cases there might be a few downsides.
What is colostrum harvesting?
Colostrum harvesting is the act of extracting your colostrum while you are still pregnant, and saving it to give to your baby after the birth. Colostrum is the first milk we produce, which is extremely thick, comes in minimal quantities (we measure it in drops), and is a medically-miraculous concentration of immunities and nutrients. It bridges the transition from your baby’s foetal to newborn digestive system, clearing the meconium and priming your baby’s gut to process your incoming milk. Babies are meant to ingest nothing but colostrum for the first few days as your milk is ‘coming in’.
Colostrum harvesting can be done by hand expression, or with an empty syringe, with the hole placed over the nipple, so that the suction extracts colostrum from the ducts. Pregnant women these days are often advised to collect colostrum during the last few weeks of pregnancy, and then store it to give to the baby after the birth.
Why is colostrum harvesting popular?
Colostrum harvesting was originally prescribed as an intervention to be used if, and only if, the baby was likely to be separated from the mother for medical reasons immediately following the birth. If the baby was in the neonatal intensive care unit, for example, then the colostrum could be given to the baby instead of, or alongside, any formula or fluids. If the baby was too small, weak, or in any way unable to latch on to the breast, the stored colostrum provided an immediately available and ideal food for the baby, so the mother didn’t have to face the stress of pumping right after the birth, and artificial milk could be avoided or supplemented.
For all these reasons, it was soon suggested for pregnant people diagnosed with gestational diabetes as well, so their babies would have guaranteed access to the extra colostrum to circumvent other supplements. Next, as a way to prevent jaundice, since colostrum helps clear the excess bilirubin after the birth. Before long, articles were trending about the benefits of colostrum harvesting for anyone, caregivers and doulas were recommending it to the general public, and pregnant people started assuming it was a normal thing to do during pregnancy to prepare for successful breastfeeding.
But while helpful for some people, colostrum harvesting during pregnancy is not necessarily a good idea for everyone.
Why shouldn’t everyone harvest their colostrum?
It is easy to find articles on the benefits of colostrum harvesting, so here are a few potential downsides one might consider as counterweights: eight things to consider when you are thinking about whether or not to try antenatal colostrum extraction.
Colostrum Harvesting is a Medical Intervention
Extracting colostrum before the baby is born is not a physiological part of normal mammal birth. Medical interventions should be specific and targeted–with the intention of preventing, fixing or responding to a particular issue–rather than generalised over a well population. A medical intervention that solves a problem for one situation can create a problem in another if it is not medically warranted. Crude examples might include wearing a cast, or prescription glasses, or antibiotics, or getting heart surgery. Although all corrective or life-saving when warranted, none of these interventions are helpful or justified in the absence of a cause requiring them. This is the same with colostrum harvesting. If there is no cause, it serves no purpose, and might even disrupt the normal process.
Historically, many medical interventions have been advised with the best of intentions to improve labour, birth, or breast/chestfeeding, only for it to be discovered decades later that they had unintended consequences, sometimes just by subtly interfering with the physiological process. The most scoping study on antenatal milk collection found that it lacks “high quality evidence”, which to me means we should recommend it with caution, with full disclosure of potential or suspected pros and cons, and only to pregnant people who might specifically benefit from it. For example, if there is a likelihood of separation of parent and baby after the birth.
Extracting Colostrum During Pregnancy is Precipitous
The pregnant body is not expecting to feed the baby before the baby is born. As you can imagine, the order of events is usually that the baby is born before it breastfeeds. This can be important. Lactation is part of our birthing process. The intricately choreographed hormonal sequence that results in lactation begins in pregnancy. Our prolactin levels are suppressed during pregnancy by progesterone, so that the only drops of milk that squeak through in tiny amounts are the purest essence of milk: colostrum. Extracting colostrum prior to its intended and physiological time is usually unnecessary, and can potentially be disruptive to the physiological order of the hormonal sequence. In extreme cases where there is a pre-existing risk factor, there is a small chance of triggering premature labour. Nipple stimulation or breast pumping is a well documented way to induce labour, which is an obvious downside to doing it too soon if you are at risk of premature labour. But more often, it runs the risk of simply confusing the body’s normal building of hormones.
Breastfeeding Baby Establishes Supply/Demand
The first few days of bodyfeeding are important. After being born, the baby’s immediate and constant suckling helps our oxytocin levels surge, which is one of the cues that tells the placenta to detach, which in turn halts the flow of progesterone. As the remaining progesterone gradually dissipates over the next few days, the baby suckles almost constantly, which activates our prolactin receptors. These sequenced events, synchronised and coordinated after the baby is born, cause our milk to ‘come in’. The more the baby can suckle over the first several days of life, the more effectively and quickly your milk will appear. But if we are feeding the baby with previously collected colostrum from a syringe instead of feeding the baby at the breast, the maternal body might not be getting enough of those vital cues to bring forth milk. Because it is the amount that the baby extracts that tells your mammary glands how much to produce, feeding the baby on the side might accidentally cause your body to produce less. Since milk production is based on supply & demand, having an extra supplier can reduce your body’s perceived demand. Even if you harvested colostrum ‘just in case’, we know that people who have it on hand tend to use it. Any time the baby gets milk from an alternative source–even your own previously extracted milk--your body is being told to lower its own milk production in response.
This, I think, might be the biggest concern about recommending antenatal milk collection to all pregnant people across the board: that it increases the likelihood of feeding the baby the previously collected milk instead of bodyfeeding, or instead of bodyfeeding the baby enough. Newborns nurse intensely and almost constantly for the first few days. Topping them up with collected colostrum can disrupt this normal and important process. When I hear stories of people struggling with milk production, I often wonder if the challenges trace back to this first step of eroding the supply/demand sequence in the important first few days when milk supply is usually established.Instincts, Latch Issues, and Nipple Pain
Babies are born with a strong reflexive brain instinct to seek the breast and latch on. Their first experiences with latching on inform their next attempts, and create a mental template, or a brain road map, on how to do it again. When we feed our baby out of a bottle or syringe, it confuses this hard-wired expectation. Babies get better and better at latching effectively and painlessly if we provide the right conditions and allow them to use their instincts. But we might undermine the process if we confuse them with artificial nipples, or milk from unexpected sources. This can confound the baby’s attempts to build upon experience, and can create misleading false ‘successes’ in their budding brain map. It can lead to trouble latching, which too often results in breastfeeding/chestfeeding struggles, nipple pain, and potentially reduced milk supply. A poor latch often means poor milk extraction, which can affect the demand side of the supply/demand cycle. Like all interventions, sometimes the benefits outweigh the risks, such as if, for any reason at all, the baby can’t nurse or you are separated from your baby. But if you have access to your baby and the baby latches well, feeding the baby at your body is the best way to activate proper latching instincts.
The Baby Creates the Milk
Whenever you nurse your baby, the baby communicates with your body in order to create the kind of milk they need. The suckling technique, their hormones, their size, and most significantly, their saliva, all send messages to your mammary glands to form the milk exactly to their immediate stage of health, development, growth, and biology. Your milk is thus custom-ordered, from temperature, to water-content, to vitamins, to fats, to hormones, to medicines, to quantity, so that it is precisely attuned to your baby. When your baby nurses from a bottle, cup, or syringe, they are fervently sending signals that your body is not receiving. The baby is trying to increase hydration, or adjust the temperature, or activate an antiviral, but the messages aren’t getting through. For the baby, it’s like the control panels aren’t connected to anything. It’s a frustrating disconnect and prevents your lactation system from adjusting your milk to meet the baby’s exact needs. For a brand newborn, fine-tuning your milk can be important for their health. And they can’t do it if the colostrum isn’t made-to-order, directly from your body.
The Milk Creates the Baby
The baby generates and customises your milk and milk-supply everytime they latch on, but they also get information directly from your body. This includes up-to-the-minute immunities from what you have been exposed to, adjustments for the temperature you are in (for example, the weather or the heat in the room), loving hormones such as the oxytocin-exchange, and also sleep/wake hormones. Your milk is constantly shifting in hormones based on your circadian rhythms, and this immediately starts educating your baby’s sleep/wake cycles. Every time your baby nurses, their body is seeking these things, especially the oxytocin, which in turn activates your own parenting instincts. They don’t get it from a syringe or bottle of pre-pumped milk, only directly from your body. In fact in some cases, such as the sleep/wake hormones, the baby gets misleading information from pumped milk. Baby to body communication is a two way process where information, hormones, and immunities are exchanged every time the baby nurses.
Harvesting Colostrum Denormalizes the Process
If we mistake breastfeeding / chestfeeding for nothing more than giving food, we make some incorrect assumptions about how lactation actually works. And in that context, I can see why collecting colostrum ahead of time to have on-hand would seem like a good idea. But lactation is more like an umbilical cord that transfers living cells to the baby, and bridges the divide between life support in the womb and the outside world. Your mammary glands are like an external system for the baby, functioning as the baby’s immune system, medical care, and systems-stabiliser as the baby gradually adapts to extra-uterine regulation and self-sufficiency. Your own body continues to grow the baby even after the birth. Although it can be beneficial under many specific circumstances, extracting colostrum ahead of time and offering it in a syringe or bottle is not equivalent to what happens when the baby is at the breast. If you and your baby are able and wanting to bodyfeed the old-fashioned way, it serves purposes beyond just feeding.
Colostrum Extraction is Usually Unnecessary: Your Body Works Just Fine
We have a knee-jerk tendency to turn to “stuff” to solve or prevent lactation issues. And we have absorbed a subliminal message over the last few generations that when it comes to birth and breastfeeding, our bodies might not work properly without interventions. But in the absence of a particular problem, items/gadgets are rarely necessary. The physiological interactions between the baby and the mammary glands are far more complex and nuanced than is commonly understood. Interfering, even with the best of intentions, can sometimes cause unintended problems that may then require further interventions to solve. Advising all pregnant people that they always have to do something additional and novel to get their body to do something entirely normal creates the impression that the mammalian physiological process isn’t likely to work on its own, or that the baby won’t be able to do it properly. It can dilute trust in our bodies’ and our babies’ abilities. Instead of assuming you need to do extra antenatal tasks, trust your body, trust your baby, and trust the process. It usually works just fine without any interference.
In Conclusion
There is a very understandable desire to do everything one can in advance to increase the odds of success with breastfeeding/chestfeeding. Extracting colostrum has been promoted as one of the forward-thinking things you can do ahead of time to encourage your baby’s human milk consumption. In some specific cases, this is probably true. If you know that there is a reason that your baby is more likely to require supplementation, having your own colostrum available might be well advised. For example, there is preliminary research indicating that it might be beneficial in cases of maternal diabetes. Or if you are giving birth somewhere that routinely separates parents from babies, this might also be a compelling reason. In other words, in certain cases the benefits will outweigh any downsides. This can be a medical, or a personal decision, such as if you just want to reassure yourself that you can indeed produce milk.
Most of the concerns I have raised have not been studied as such (or at least not in this context), but have been derived from other known aspects of lactation. The most comprehensive review of antenatal milk collection suggests that the focus of future studies should be on pregnant people with gestational diabetes rather than a general population, and that there is insufficient evidence to recommend it globally. It is also worth noting that most of the scant research that exists primarily measured success by how much human milk versus artificial milk the baby consumed in the early days, and not on any of these more subtle or long-term concerns. My thoughts on this have been shaped by recently hearing so many pregnant people tell me that they thought they “had to” extract colostrum in order to bodyfeed successfully. Whenever an intervention, or any ‘extra step’ is thus normalized–or perceived as a ‘have to’ rather than an option– I think we should pause to consider all the possible pros and cons, and make sure the pregnant person knows that they make their own decisions based on their own situation, preferences, and goals. Harvesting colostrum may or may not be something you choose to do, and it will probably depend on many things. I know when I was first pregnant, I wanted all the information, all the thoughts, and all the considerations, so I could weigh it all carefully against my specific circumstances and beliefs, in order to make my own choices.
If you want information or support with any method of feeding your baby– before or after your baby is born– come to our feeding clinics and we will help. We can help with breastfeeding, bottle-feeding, or any combination. If you are considering antenatal colostrum harvesting, know that some people enjoy doing it and feel like it helped them feed their baby in the early days. And other people feel like it is an unpleasant chore, and only did it because they thought they had to. For the majority of people, there is no compelling need to do it at all. So in the absence of a particular reason, harvesting colostrum accomplishes no specific purpose, but might add an unnecessary task or complication to physiological breastfeeding/chestfeeding. For the general population, harvesting colostrum is simply unnecessary, and might even have a few downsides.
Stephanie Ondrack supports all methods and choices of feeding your baby, and believes in as much information as possible so everyone can make their own best decisions.