Hand expressing before birth: when is it useful and when not?
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Hand expression before birth raises questions for many pregnant women. You may hear that it helps as preparation for breastfeeding, or that it is better to wait until after the birth. There is different advice, there are assumptions and there are persistent myths. That can make it hard to sense what fits your own situation.
Contents
What is hand expressing before birth?
Hand expressing before birth means that in the last weeks of pregnancy you try to collect small amounts of colostrum by hand. Colostrum is the first breast milk, and your body already makes it during pregnancy.
It is about small amounts. One woman notices nothing the first few times, another expresses a few drops or millilitres straight away. The aim is not to build up a large supply. You become familiar with your breasts, practise the technique and perhaps keep some colostrum for the first days after birth.
Hand expressing before birth is a preparatory exercise, not a production test.
Most guidance advises not to start before 36 to 37 weeks. Radboudumc keeps to week 37, and only after talking with your doctor, midwife or lactation consultant. In the DAME study women started from 36 weeks. So do not start on your own, always discuss it with your midwife first.
In practice I often see that women are surprised by how little is visible. That is normal. The amount says nothing about how breastfeeding will go later.
Does expressing speed up labour?
You may have heard it before: "If you hand express prenatally, it can induce labor." The idea that nipple stimulation can induce labor has long been around. And that's why many pregnant women wonder if hand expression is safe towards the end of their pregnancy.
What do older studies say?
This reluctance isn't unfounded. Older, small studies suggested that expressing colostrum before birth might be associated with earlier deliveries or more neonatal unit admissions. This made healthcare providers understandably cautious.
But small studies don't tell the whole story. That's why this topic was later investigated much more thoroughly.
What the DAME study found
The DAME study is a large, well-designed trial in 635 pregnant women with diabetes and a singleton pregnancy. By random allocation, one half began hand expressing twice a day from 36 weeks, the other half did not.
The results were clear and reassuring. Women who expressed before birth did not give birth earlier than women who did not. There was also no difference between the groups in neonatal unit admissions. The researchers call expressing from 36 weeks safe for women with diabetes in pregnancy who are at low risk of complications.
Expressing from 36 weeks did not lead to an earlier birth. That was in women with diabetes, a singleton pregnancy and a low risk of complications. For all pregnant women together, this has not been studied.
Nipple stimulation and contractions
This requires an important distinction. There is research showing that intense nipple stimulation can influence labor initiation.
A Cochrane review of six studies from 2005 looked at prolonged and active nipple stimulation, such as intensive breast massage. It reduced the number of women who had not given birth after 72 hours.
That might sound daunting, but there is a nuance to it. These studies involved women who consciously tried to induce labor with prolonged and intense stimulation. This is quite different from the gentle, brief hand expression sometimes done in the final weeks of pregnancy in preparation for breastfeeding.
Why care providers disagree
This is because it's not a standard part of care and is always considered individually. Factors such as your pregnancy, medical history, and personal resilience play a role.
Therefore, it is normal for one hospital or care provider to be more cautious than another. That does not mean either one is wrong, but that a tailored approach is key.
When expressing before birth helps
By gently practicing hand expression before birth, some women can become comfortable with their breasts, hand expression, and collecting colostrum. This can significantly contribute to a sense of calm and confidence, especially if expressing becomes necessary (temporarily) after delivery.
There are several situations in which expressing before birth is considered more often:
there is diabetes, such as gestational diabetes
the mother has overweight
low milk production was experienced during a previous pregnancy
if the baby is known to be larger or heavier than average (macrosomia)
the baby is expected to be small or light, for example in the case of an early induction or growth retardation (dysmaturity)
the baby has a congenital condition, such as a cleft lip and palate, which can make breastfeeding more difficult
there is a planned caesarean section
there has been breast surgery in the past
there is polycystic ovary syndrome (PCOS)
In these situations, a small supply of colostrum in the first few days after birth can be helpful.
At the same time it is important to know that it is no guarantee of a smooth start. Breastfeeding remains an interplay of mother, baby and circumstances.
How much colostrum can you expect?
Realistic expectations prevent unnecessary doubt.
Most women express before birth:
a few drops
sometimes a few millilitres
sometimes nothing at all
That is normal.
Colostrum is made in small, concentrated amounts. It is exactly matched to the stomach of a newborn baby. That stomach is still small in the first 24 to 48 hours.
For comparison: newborns take small amounts at each feed in the first days. On average they ask for 8 to 12 feeds per 24 hours. That does not mean every baby drinks the same or fits exactly one number. Variation is normal.
Hand expressing before birth is therefore usually not a way to build up a supply. It is mainly a way to become familiar with the process.
And perhaps more important: you learn that numbers can give support. The interplay between baby, body and situation always leads.
Collected colostrum is stored in small amounts, chilled or frozen.
When is hand expressing before birth not advised?
Hand expressing before birth is not suitable for everyone. Hospitals advise against it when there is an increased risk of preterm birth. That includes a previous preterm birth, placenta praevia and severe high blood pressure. A shortened cervix or a stitch in the cervix is also a reason not to do it. The same applies to vaginal blood loss in this pregnancy and to earlier preterm contractions in this pregnancy.
Do you feel contractions or a tightening belly while expressing? Stop and discuss it with your midwife.
Are you unsure? Then it is important to talk to your midwife or doctor. Looking together at what is safe in your situation often brings more calm than weighing it up alone.
Downsides and points to consider
Prenatal hand expression isn't a standard recommendation, nor is it a fixed step in preparing for breastfeeding. If you choose not to start, you're not missing out on anything and you're not doing anything wrong.
Prenatal hand expression doesn't guarantee an easy start to breastfeeding and says nothing about how much milk you'll produce later. It also says nothing about your body, your commitment, or how well you'll care for your baby later. Some babies need supplements after birth, regardless of whether colostrum was expressed before birth, and that's part of the normal process.
Prenatal hand expression is therefore primarily a possibility, not a benchmark or a test. What feels comfortable for one person may not be beneficial for another.
For some (expectant) mothers, expressing can actually cause uncertainty, especially when little or no colostrum is visible. This feeling is perfectly understandable, but it can sometimes unintentionally add tension at a time when rest would be helpful.
For some women, waiting until after the birth actually provides more peace, and that peace is at least as valuable.
If you plan to pump regularly after birth, choosing a breast pump is a separate story.
Frequently asked questions
Does hand expressing before birth speed up labour?
The DAME study followed women with diabetes, a singleton pregnancy and a low risk of complications. Expressing from 36 weeks did not lead to an earlier birth. This has not been studied for all pregnant women together.
What is the difference between hand expressing and intensive nipple stimulation?
Hand expressing is gentle and short. The studies that saw an effect on contractions used long, active stimulation, such as intensive breast massage.
When can expressing before birth be useful?
With diabetes, such as gestational diabetes, with earlier low milk production, or before a planned caesarean section. The same goes for other situations in which expressing after birth is more often needed.
Can you build up a supply of colostrum before birth?
Usually not. Expressing before birth often gives small amounts. It mainly helps you get familiar with the technique.
Is hand expressing before birth always safe?
It is not advised with a higher risk of preterm birth, placenta praevia or a shortened cervix. The same goes for vaginal blood loss or earlier preterm contractions. If you get contractions while expressing, stop and talk to your midwife.
From which week can you hand express before birth?
Usually from around thirty-six to thirty-seven weeks, and only after talking it through with your midwife or obstetrician. It is advised against if there is a raised risk of premature birth, or if contractions have started.
For some women, prenatal hand expression brings peace of mind. For others, it can be stressful. You might find yourself starting each session with expectations, or feeling disappointed when you see little. Sometimes comparisons creep in, with stories or images from others.
If you find that hand expressing gives you more stress than confidence, stopping is not a failure but self-care.
If you find that hand expressing gives you more stress than confidence, stopping is not a failure but self-care.
Listening to what it does to you is just as important as following advice. And trust that your body does not need a manual to become a mother.
Love,
Bobby
Sources
Written by Bobby, maternity nurse at Bobby Kraamzorg. Last updated: September 2026.