Hands Before Hearts: Getting to Know Antenatal Hand Expression
I spend my clinic days watching parents make space in their lives for a person they have not yet met. Cribs get assembled, playlists curated, pantry shelves reorganized—each gesture a small promise that you belong here. One of the quietest, least celebrated preparations is the practice of antenatal hand expression (AHE)—learning to coax the first drops of colostrum from your breasts in the final weeks of pregnancy.
AHE doesn’t require a gadget or an app, only warm hands, ten unhurried minutes, and a willingness to listen to your body. Below is what the research—and years of bedside conversations—told me about why and how to give this skill a try.
Why consider hand expression before birth?
A reserve for the unexpected.
Newborns sometime need extra calories in the first hours—most often because of low blood sugar. Harvested colostrum can serve as a mom-made “backup supply,” sparing babies from formula when supplementation is recommended. This is especially helpful for infants of parents with diabetes or gestational diabetes.
A rehearsal for milk production.
Practicing expression trains muscle memory and builds confidence. Research notes that trying hand expression in the last month can help moms at risk of delayed milk coming-in—those recovering from cesarean birth, coping with pre-eclampsia, or managing hormonal conditions.
A pressure-release valve.
Early engorgement can make latching harder. Knowing how to remove a teaspoon of milk by hand can soften the areola and bring baby closer to a good latch without hooking up to a pump in the middle of the night.
When to start—and how often
Most studies introduce AHE at 36 weeks or later, no more than twice a day, ≤ 10 minutes each time. Always clear it with your obstetric clinician first; nipple stimulation can, in rare cases, trigger contractions.
Reality check: Many moms collect only drops at a time. Volume is not a measure of future supply; it is a reminder that milk production is hormonal alchemy, not a faucet you can simply open wider.
Setting up your mini-milky way
| Step | What It Looks Like | Pro-tip |
|---|---|---|
| Warm-up | Apply a warm compress or take a shower. | Warmth triggers oxytocin, the “let-down” hormone. |
| Mindful minute | Apply a warm compress or take a shower. | Warmth triggers oxytocin, the “let-down” hormone. |
| Massage | Light, circular strokes over the breast—avoid direct nipple stimulation. | Think feather-light “hello” rather than deep tissue. |
| C-hold & compress | Form a “C” several centimeters behind the areola, compress-release-repeat, rotating position every few squeezes. | Watch the UNICEF Hand Expression Video for a visual walk-through. |
| Collect | Express into a small sterile cup; draw droplets into 1–3 mL syringes, label, freeze if not used within 72 hrs. | Store syringes in a zip-bag; transport to the hospital on ice. |
Frequently whispered worries
“I’m 38 weeks and still getting nothing—what’s wrong with me?”
Nothing. Many lactating parents cannot express prenatally yet produce abundant milk after delivery. Colostrum output before birth does not predict supply after birth.
“Will expressing now steal colostrum from my baby later?”
No. Pregnancy hormones hold full milk production in check; the small volume you remove is quickly replaced.
“Is it safe if I have gestational diabetes?”
The largest safety study (the DAME trial) found no increase in premature labor among more than 600 women with diabetes who began AHE at 36 weeks. Still, personal risk profiles vary—partner with your doc.
The evidence so far
Research is ongoing. A stepped-wedge randomized trial now under way is measuring whether structured AHE education improves exclusive breastfeeding rates at six weeks postpartum. Smaller feasibility studies show high parental satisfaction and a sense of empowerment, particularly among families facing socioeconomic barriers.
Scientists are also probing when AHE makes the biggest difference: early initiation of lactogenesis, lower formula exposure, shorter hospital stays for babies of diabetic parents. Results are promising but not yet definitive—so we pair emerging data with age-old wisdom: practice, patience, support.
Weaving AHE into your fourth-trimester game plan
At Rising Star Pediatrics our Fourth Trimester Plan is built on one idea: postpartum is not an after-thought; it is a trimester of its own. Whether you join our program or craft your own village, here’s how AHE can fit:
Share the technique with partners, grandparents, any caregiver who will stand watch in those bleary first nights. Doing so turns feeding challenges into shared missions rather than solitary battles.
Write it into your birth plan—alongside skin-to-skin and delayed bathing.
Pack frozen syringes in your labor bag with a small cooler.
List lactation contacts (hospital IBCLC, community clinic, warm-line) before contractions start.
Final thoughts
Hand expression is an ancient practice wearing modern scrubs—equal parts science and self-trust. Learning it won’t guarantee an obstacle-free breastfeeding journey, but it equips you with one more tool, one more measure of agency, as you navigate the glorious, unruly landscape of new parenthood.
Bring your questions to your midwife, your OB, or to me at your next prenatal visit. Until then, may these small, golden drops remind you that preparation can be gentle, revolutionary work.
Feel free to explore the links below, jot down questions, and bring them to me. Preparation is a conversation, and i’m honored to be part of yours.
References & Further Learning
- International Academy of Breastfeeding & Lactation Educators. “Antenatal Hand Expression” PDF.
- American College of Obstetricians and Gynecologists. “How to Prepare for Breastfeeding in the Month Before Birth” (2024). (acog.org)
- UNICEF UK Baby Friendly Initiative. “Hand Expression Video.” (unicef.org.uk)
- Feasibility study on AHE education in Philadelphia (2023). (internationalbreastfeedingjournal.biomedcentral.com)
- DAME Trial—Antenatal Milk Expression in Diabetes (2023 review). (pmc.ncbi.nlm.nih.gov)
- Safety of AHE from 34 weeks gestation (2024 pilot). (pmc.ncbi.nlm.nih.gov)
