Here you go. It's a bit mammoth, and bear in mind it was written for a not-diabetic audience, really!
The first I'd really heard of colostrum harvesting was at my 16 week midwife appointment., where my midwife mentioned it in passing and suggested I perhaps looked into the details to see if it was something I'd be interested in doing. Having had type one diabetes for 18 years, and being determined to breastfeed our baby, I was really interested to find out why it might be a beneficial thing to do.
I knew roughly what to expect about being pregnant with diabetes, having read the NICE guidelines and the various information available from organisations like Diabetes UK. In short, due to my diabetes, there was a risk of my baby being larger than average and having difficulties controlling his or her own blood sugar after birth. Basically, the baby of a diabetic mum is exposed to his or her mum's blood sugar levels during pregnancy, which, however well controlled you are, will be different to the norm. Therefore, their body often produces extra insulin to help deal with this. This doesn't stop automatically after birth, so baby needs a little while to re-adjust their own insulin production, and are at risk of low blood sugar during this time. My understanding was that this is when the pressure to give a formula feed can become greatest ? and although giving formula as a one off in the early days doesn't mean breastfeeding will fail, I was aware that it isn't always the most helpful solution when trying to establish breastfeeding.
As you probably know, finding any sort of information about pregnancy and diabetes in standard pregnancy books is pretty impossible ? you usually come across a paragraph or two telling you about the risks and dangers, but not much practical information. Info on colostrum harvesting is much the same! -
What I managed to gather was that by expressing some colostrum ante-natally, you could potentially help baby in the case of low blood sugar after birth, potentially avoiding the need for formula or other intervention. Any mother will tell you that giving birth is exhausting, and the idea of a 'back-up' feed, almost, seemed a sensible enough idea for me! I was lucky that my husband was, and is, very supportive of breastfeeding, and agreed that this seemed like a good idea.
I was fortunate enough to meet the Infant Feeding Co-ordinator at my hospital through our NCT course in the later stages of my pregnancy, and she was able to give me a few more pointers on looking for info. Armed with this, I re-visited my midwife, and we discussed what would be the best course of action. She provided me with sterile 1ml syringes to collect the colostrum in, and gave me some guidance on the best way to go about it. The NHS leaflet gave a basic overview of hand expressing, which was all I used to get me started.
So, knowing that I would be induced at just past 38 weeks, I started expressing around a week before. I decided to try three times a day (after meals, just to help my late-pregnancy hazed brain!) and just took myself off to what would be out baby's bedroom and did what I could. The first few times I struggled to express anything, but as I got used to the technique (and I guess as my body got used to what was going on!) I found that each time there was a little bit more. After each session, I'd put the syringe back in the packaging, seal the packet with tape, put the date on and freeze it.
I'm not sure now how much colostrum I took into hospital when I was induced, but it was definitely worth having done! We packed it into a cool bag with freezer blocks, obviously not knowing how long it would be until it was needed. Once I was admitted to the delivery suite and assigned a midwife, we mentioned that we'd brought it with us, which caused a bit of confusion. Luckily the midwife was able to get hold of the IFC, who popped it into the SCBU freezer until needed.
20 hours after my induction started, Christopher was born by emergency caesarean section after getting his head well and truly stuck. We'd gone to theatre for a spinal and trial of forceps, but his position meant that they didn't even try forceps. Weighing in at a hefty 10lb 11oz, we weren't at all surprised! I was given help in recovery to get him latched on and fed, and he seemed to get on quite well.
The policy at our hospital was to check baby's blood sugar every three hours, until they had three readings in a row that were within the acceptable levels (I think NICE says 2.0 is the lower limit, but ours used 2.5, iirc). Christopher's first couple were on the low side, and he was quite obviously shakey in the same way that I am when I'm hypo. It was here that the benefit of my expressed colostrum really became apparent. We were able to syringe feed him what we'd taken into hospital, giving his blood sugar an immediate boost, before letting him have access to the breast in his own time. Somehow it also lightened the pressure on us both ? breastfeeding may be the most natural thing in the world, but it does take time and effort to do it right, and any new mother will tell you that after birth, you're exhausted and overwhelmed, without mentioning the obstacle of having had a caesarean and being restricted on positioning!
I think in total we gave two small feeds of pre-expressed colostrum, and Christopher's blood sugar was soon stabilised. We've not looked back since ? he was breatfed exclusively for 6months, and I carried on alongside solids til he was 13m old. It wasn't all all been easy - we had huge issues with early days weight loss and ended up back in hospital - but we feel sure that the knowledge and support in the early days played a huge role in helping us get this far.
My advice? Some of it is what I say to any of my friends intending to breastfeed ? get as informed as possible before baby arrives. Have an idea of what's normal and what's not, have telephone numbers and details of where to get help if you need it. Seek the advice and support of other breastfeeding friends ? a very close friend of mine kept her mobile on 24/7 when Christopher was small in case I needed help in the middle of the night! It shouldn't hurt - anyone who tells you everything looks fine despite pain is wrong, to be blunt! From a diabetes point of view, don't be afraid to ask questions and find out as much as you can about what will happen in those early hours and days, and what you can do about colostrum harvesting to make things easier.
