The puerperium
Vol. 13 No 2 | Winter 2011
Feature
Milk of humankind: best


This article is 11 years old and may no longer reflect current clinical practice.

As has been long recognised by the farming industry, colostrum is nature’s wonder food for newborn mammals, so why aren’t we doing more to ensure our own babies get it?

The dictum ‘breast is best’ is well known, but has created a lot of controversy socially and medically. Those who encourage and promote breastfeeding are often regarded as fanatics and given derogatory names such as ‘breastfeeding Nazis’. In this paper I discuss the history of colostrum use and promotion in medical science, and the value of colostrum for our babies’ health today. The promotion of antenatal expression and storage of colostrum from 34–36 weeks gestation by maternity care providers and its value for primigravida and women with specific health issues is overviewed.

There is no question that when it comes to animals of the importance of the first milk the calf or other baby mammals receive should be its mother’s colostrum. That animal is at risk of dying if it is not fed its mother’s colostrum within the two to four hours after birth and then again 12 hours later. This colostrum is rich in immunoglobulins that will protect that calf against infections. According to Kung, ‘calf mortality increases as the interval between birth and ingesting colostrum increases’.1 This is an important economic imperative in the dairy farming industry. And yet this imperative is not applied to human babies with the same passion. Is this because human reproduction and the health of our babies is not as important to our nation’s economic health as the animals that enable the growth of big industries? Or does our maternity industry believe it has done its job well if a live healthy baby is born to a live healthy mother and whatever happens thereafter is not of as much concern?

History of colostrum for human infants

In the early years of medical history, colostrum was not promoted as a substance to be given to human babies. Traditionally in parts of Africa and Europe, the thick yellow colostrum was regarded as unsuitable for human consumption and thus was expressed and thrown away. According to Kulski et al, most traditional societies did not commence breastfeeding until the milk came in at about two to three days postpartum, a practice that still continues today in some societies.2 Consequently, these babies were given purgatives such as wine and honey to rid their bowels of meconium.3

What is colostrum?

Colostrum is the first milk and is present in the breast from 12–16 weeks of pregnancy. Colostrum (one to five days following birth) evolves through transitional milk (present for six to 13 days following birth) to mature milk (from 14 days and beyond). It is thick and yellow in colour, due to beta-carotene, and has a mean energy value of 67kcal/dl, compared with the energy value of mature milk (72kcal/dl).4 The volume of colostrum per feed varies from 2–20ml in the first three days after the birth of the baby, and is aligned with the size of the newborn’s stomach.

It is a wonder food, but is also regarded as a medicine as it is rich in antioxidants, antibodies and immunoglobulins, especially secretory immunoglobulin A. Colostrum has strong antiviral and phagocytic activity, with its primary function being anti-infective while its biochemical composition has a laxative effect. The frequent and early passing of meconium helps to get rid of excess bilirubin and prevent jaundice in the newborn.

Colostrum as the first food for newborns

Linked with the importance of the baby having the colostrum, as its first food, is the importance of the baby being skin-to-skin with its mother after birth. Being with mother skin-to-skin is the natural habitat for the newborn baby, which has benefits of it colonising its mother’s bacteria, earlier latching and breastfeeding well thus obtaining the first colostrum. Colonising starts during the birth process for vaginally born infants, while those born by caesarean section are more likely to colonise microbes from the air, other infants and the health care staff. It is therefore imperative that those infants born by caesarean section are placed skin to skin with their mothers soon after birth to promote the development of healthy intestinal microbiota.4

Early breastfeeding also promotes tolerance to antigens, thus reducing the incidence of food-related allergies in breastfed babies.4 The development of healthy intestinal flora also reduces the incidence of allergic disease, inflammatory gut disease and rotavirus diarrhea in infants.4

According to Walker, ‘Once dietary supplementation begins, the bacterial profile of breastfed infants resembles that of formula-fed infants…’4 In susceptible families, where there are dairy allergies or a history of insulin-dependent diabetes mellitus (IDDM), one bottle of a cow’s milk formula as supplementation in the first three days of life can increase the risk of the infant developing allergies, IDDM and type 2 diabetes.4 These children thus exposed become adults who have health issues that will affect their future childbearing abilities and health during pregnancy, labour and birth.

Antenatal expression and storage of colostrum

One strategy to ensure that all babies receive colostrum as their first milk is to advise and support pregnant women to express and store colostrum antenatally from 34–36 weeks.5,6 The women who need this the most are primigravidas who are more likely to have longer labours leaving them tired and thus unwilling to deal with the demands of a newborn who wants to suckle often after birth. These women often have sore nipples in the early days as they learn to latch their babies well and become intolerant of on-demand suckling at the breast. The expressed stored colostrum provides food for the baby when the mother might have supplemented the baby with formula, a practice with health risks for the infant. Babies of mothers with conditions such as diabetes and who may be at risk of hypoglycemia neonatally or those who may be separated from their mothers after birth would also benefit from their mothers having expressed and stored colostrum antenatally.

While there have been calls to cease this practice as no randomised controlled trials have been undertaken to demonstrate its efficacy7, there is sufficient positive feedback from women who participated in a pilot study7 and from midwives’ and women’s experiences to support the continuation of this practice. The colostrum expressed antenatally is comparable biochemically2 with that produced after the birth of the baby and there are no increased risks of premature labour being induced by periods of nipple stimulation ranging from 30–110 minutes during pregnancy.5

Most babies have the opportunity to receive colostrum either directly from the maternal breast at birth and/or by the use of stored colostrum. Yet human colostrum does not seem to be valued as highly, despite its proven health benefits, or promoted to the same extent by the health professionals involved in maternity care as bovine colostrum is promoted by the alternative health care industry for strengthening adults’ immune systems. If we are truly in the industry of promoting the health of our people, then we need to take another look at human colostrum for human babies.

References

  1. Kung L. The importance of colostrum for calves. Downloaded
    from http://ag.udel.edu/anfs/faculty/kung/articles/importance_of_ colostrum_for_calv.htm .
  2. Kulski JK, Hartmann PE, Saint WJ, Giles PF, Gutteridge DH. Changes in the milk composition of non-puerperal women. American Journal of Obstetrics and Gynecology, 1981; 139(5):597–604.
  3. Fildes Valerie. Breasts, bottles and babies. Edinburgh: Edinburgh UP; 1987.
  4. Walker M. Breastfeeding management for the clinician. Using the evidence. Sudbury, Massachusetts: Jones and Bartlett; 2006.
  5. Cox S. An ethical dilemma: should recommending antenatal expressing and storing of colostrum continue? Breastfeeding Review, 2010;18(3): 5–7.
  6. Cox S. Expressing and storing colostrum antenatally for use in the newborn period. Breastfeeding Review, 2006;14(3): 11–16.
  7. Forster DA, McEgan K, Ford R, Moorhead A, Opie G, Walker S, McNamara C. Diabetes and antenatal milk expressing: a pilot project to inform the development of a randomized controlled trial. Midwifery doi:10.1016/jmidw.2009.05.009 .tmann PE, Saint WJ, Giles PF, Gutteridge DH. Changes in the milk composition of non-puerperal women. American Journal of Obstetrics and Gynecology, 1981; 139(5):597–604.

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