The short answer is C.
Women can and often should express colostrum during birth under certain circumstances. The term for expressing colostrum before birth is called Antenatal Milk Expression, or AME.
Hand expression is an incredibly valuable tool. When many mothers think of expressing breastmilk, a breast pump is the first tool that pops into our heads. But with good technique, hand expression can be potentially more effective at milk removal than pumping! This is particularly important during the first days after birth when the body is producing the first milk, colostrum. Colostrum is thick and syrup-like in consistency. Breast pumps do not do a good job of removing colostrum. Conversely, hand expression is an effective way to express colostrum from your breast.
Hand expression is a learned skill, but with some practice it becomes efficient and easy! When I am teaching my clients, I encourage them to practice daily. Usually by the tenth time, you will be a pro. A benefit in AME is all of the practice has taken place previously, so if a new mother is in a situation where expressed colostrum is needed shortly after birth, she can more easily hand express without the learning curve.
For certain situations, having some expressed frozen colostrum before birth comes in handy. For example, babies born to mothers with diabetes are more likely to have blood sugar drops after birth. These babies can be fed expressed colostrum to stabilize their blood sugar as opposed to having formula. Mothers with a history of breast surgery, long inductions, blood loss, or c-sections sometimes have a delay in milk production. Expressed colostrum can be fed to the baby to give the mother’s body more time to get in milk making mode, avoiding formula. This is also very helpful for babies that may have feeding challenges or are admitted to the NICU.
Always speak with your healthcare provider and lactation consultant before beginning AME. If you are high risk for preterm labor, you may be advised against this, as nipple stimulation is used as a natural method of induction.
It is suggested to begin practicing AME around 35 weeks gestation. Rub your hands together to warm them and hand express for 2 minutes on each breast. Most women will be able to express a few drops which can be collected and stored in a syringe sealed with a cap. A few drops may not seem like a lot, but newborns eat very small amounts after birth, typically consuming about a teaspoon per feed the first day of life.
Store in the refrigerator until you have collected enough to almost fill your syringe, leaving a small amount of free space. Then freeze it. As the colostrum freezes it will expand, but the space you leave in the syringe will allow for this expansion. Store in an insulated cooler with ice when you travel to your birthing center or hospital for labor. To thaw, you can place it in a cup of warm water.
Every expecting mother will benefit from having good hand expression technique, and AME can make breastfeeding much smoother in certain situations. Always know your options and be prepared. Happy breastfeeding.