Contact us

Early expression: The golden hour for golden drops

By Amy Paradis, NNP

Breastfeeding has a number of benefits for both mom and baby. However, whether to breastfeed your newborn baby is a very personal choice. Mothers preparing for the birth of their baby, especially first-time moms, usually have many questions about lactation and breastfeeding. Having a baby prematurely adds to the stress and concerns mothers have about their ability to breastfeed and the obstacles that she may face having a baby in the neonatal intensive care unit (NICU).

One such obstacle is establishing an adequate breastmilk supply. Mothers of premature babies are more likely to have difficulty with milk supply owing to a variety of factors. These include cesarean birth, adverse maternal health conditions, such as hypertension and diabetes, and the stress of having a baby in the NICU. In addition, mothers of very premature babies are often unable to put their baby to their breast for several weeks because of the baby’s health. However, it is well known that early initiation of breastfeeding after birth improves lactation success.1

Therefore, pumping or hand expression must be incorporated into the lactation plans of preemie moms. Early first expression of milk from the breast is key to establishing an adequate milk supply and providing early colostrum, which is essential to the premature or sick baby. A study looking at mothers of very premature babies found that those who expressed their milk within 1 hour of birth had a better milk supply at 6 weeks post-delivery and had an earlier start of stage II lactogenesis (increased breastmilk volume after colostrum), when compared to mothers who delayed expression (between 1 and 6 hours).2

For moms seeking to express milk right after birth, a very useful skill to learn is hand expression. If a baby is unable to breastfeed directly, a mom can use her hands to massage her breasts and express milk. Hand expression requires no extra equipment and, when used along with a breast pump, may improve milk supply. Instructional resources with video support and step-by-step instructions are available from the World Health Organization.


  1. Furman L, Minich N, Hack M. Correlates of lactation in mothers of very low birth weight infants. Pediatrics.2002;109(4):e57.
  2. Parker LA, Sullivan S, Krueger C, Kelechi T, Mueller M. Effect of early breast milk expression on milk volume and timing of lactogenesis stage II among mothers of very low birth weight infants: a pilot study. J Perinatol.2012;32(3):205-209. doi: 10.1038/jp.2011.78