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The Importance of Colostrum

Ellen Penchuk
Seymour CT USA
From: LEAVEN, Vol. 40 No. 6, December 2004 - January 2005, pp. 123-25.

I learned about breastfeeding at a young age, sitting on my grandmother’s knee. She was a nurse-midwife and doula in northern Maine, USA during the early 1900s. She told me of her life and of her passions.

Grandmother’s tales of riding through blinding snowstorms in horse-drawn sleighs to attend to laboring women and assist them with the birth of their babies kept me mesmerized. She spoke of the miraculous beauty of birth and how inspiring it was to gently ease a baby out of the womb. She felt truly honored to have welcomed so many babies into the world.

She would wrap newborns in warm blankets and help them to the breast for their first feed. She said the first breastfeeding made her job of delivering the placenta much easier. After the nursing was over she would hold the baby and the new mother would express a few drops of colostrum into the newborn’s eyes. My grandmother said that this protected them from eye infections and promoted good vision. This practice would continue, several times a day, until the new mother’s milk came in.

When I questioned my grandmother about why colostrum was so important to babies, she told me that all mammals needed it to survive. All the farmers knew that fact; it was just plain, common sense. Colostrum provided immunities against a host of infections and newborn animals would die without the protection their mothers’ colostrum offered them.

So began my fascination and curiosity about the qualities of human milk. After all these years, I have yet to satisfy my curiosity and my fascination has only grown. The more that I read and research human milk, the more I am in awe of its qualities—and it all begins with colostrum.

Lactogenesis I, the first stage of lactation, when colostrum is made, begins midway through pregnancy. The breasts are already primed to begin secreting this magical fluid. During the first half of pregnancy, estrogen prompts the ductal system to proliferate and grow. Progesterone is responsible for the increase in size of the lobes, lobules, and alveoli. The breasts become larger and veins may be seen through the skin’s surface. As these changes take place, the areola becomes larger and darker; the nipples become more erect. The Montgomery glands under the areola also enlarge. The breasts then begin their secretory phase, filling the alveoli with colostrum. The breasts become more distended and heavier, preparing for breastfeeding. Lactogenesis I continues until the mother’s milk comes in (Riordon 2005).

After the delivery of the placenta, Lactogenesis II begins. The sudden drop in progesterone triggers this stage of lactation. The new mother will start to produce mature milk within three to five days. The milk continues to be a mix of colostrum and mature milk for up to two weeks postpartum, through the transitional milk stage.

A newborn is birthed into our environment sterile. Immediately, bacteria begin colonization on the baby’s skin and in his mucosal membranes, which are located throughout his body (Hanson 2004). A newborn baby who is fed colostrum exclusively has an enormous advantage over the artificially fed baby because of the protective immunities that are offered. Colostrum’s qualities are unique. It is species specific and designed for the development of human infants (Lawrence and Lawrence 1999).

The newborn’s stomach at birth is the size of a marble, which means that it holds less than a quarter of an ounce of milk (Scammon and Doyle 1990). Colostrum’s small doses are designed for the human infant. These early feeds are easily digestible. The laxative qualities of colostrum encourage the passage of meconium, the baby’s first stool. As meconium is expelled from the baby’s intestines, his stomach grows to the size of his fist. This growth occurs rapidly during the first three days of life.

Frequent breastfeeding should be encouraged. It is common for newborns to "wake up" on the second day of life and want to go to the breast often. They may exhibit cluster feeding behavior, nursing on and off for hours, and then sleeping for a few hours. This is normal newborn behavior. This timetable of breastfeeding frequently encourages the meconium to be expelled from the baby and greatly reduces any potential difficulties the baby may have with jaundice. Frequent feedings also encourage the transition to a mature milk supply to begin as soon as possible (ILCA 2000).

Colostrum is a living fluid, resembling blood in its composition. It contains over 60 components, 30 of which are exclusive to human milk. It is species-specific, designed for human babies (Neville and Neifert 1985).

This fluid is rich in immunoglobulins, which protect infants from viruses and infections (Lucas 1998). The main immunoglobulin in human milk is secretory IgA (sIgA). The antibodies produced are specific to the mother’s environment and are targeted against the pathogens in the infant’s surroundings. It is also responsible for continuing the passive immunities that were provided in utero by the placenta, such as poliovirus and rubella.

The main function of sIgA, along with other immunoglobulins, is to "paint" the lining of the infant’s stomach and intestines. These surfaces are then able to defend the baby against viruses and bacteria by not allowing pathogens to adhere to them (Alm and Engstrand 2002). Some of these incredible immunoglobulins actually attack pathogens and kill them. These components are important in fighting and preventing necrotizing enterocolitis (NEC) in premature infants, which can be fatal (Hanson & Korotkonva 2002). These defensive actions provide the newborn with optimal protection.

There are many other qualities of colostrum that make it truly unique. Colostrum contains high amounts of sodium, potassium, chloride, and cholesterol. This combination is believed to encourage optimal development of the infant’s heart, brain, and central nervous system (Oddly 2002; Rivers 2003). This may account for the prolonged secretion of colostrum in mothers who deliver their babies prematurely. All these components offer premature infants the best chance for the optimal development of their fragile organs.

Colostrum is also high in protein, about three times more than is in mature human milk. These important proteins assist in providing adequate nutrition to breastfed infants. They aid in the defense against infection and facilitate the baby’s development of important physiologic functions (Lonnerdal 2003). Proteins are also responsible for maintaining the baby’s blood sugar. This is particularly important for babies whose mothers are diabetic or have experienced gestational diabetes during their pregnancy.

Colostrum is saturated with fat-soluble vitamins and minerals. It is often a yellow or orange color, reflecting the high levels of beta-carotene, one of the many antioxidants present. Antioxidants act as cell protectors in the infant’s body and enhance his immune system (Hanson and Korotkonva 2002).

The color of colostrum varies. It may be clear, bright yellow, white, orange, pink, green, and light brown (Wilson-Clay and Hoover 2002). Foods or beverages that a mother may ingest could be the cause of these different colors. The vitamins or medicines that she takes also may affect the color. Pinkish milk is sometimes caused by dried blood in the milk ducts and is referred to as "rusty pipe syndrome." Small amounts of blood in human milk are not harmful to the newborn, so there is no need to discard the milk or discontinue breastfeeding.
How often have you heard these statements?

  • He was so hungry and my milk wasn’t in yet, we just had to give him formula.
  • The nurse said that I only had a teaspoon of colostrum. I wasn’t going to let her starve until my milk came in, so we gave her bottles.
  • We had to make sure that his blood sugar was stable, so we gave him formula.
  • She wanted to just nurse and nurse. The second day, my milk wasn’t in, she was so hungry, and the pediatrician said that I didn’t have enough to satisfy her. I was told to start supplementing with formula.
  • She has jaundice, so they had to give her some formula.
  • She was so little, only five pounds. The pediatrician said that it would take too much energy for her to breastfeed, so we decided to bottle-feed her.
  • My mother said that colostrum is just old milk and it has no nutritional value, so I have been pumping and throwing it away. Once my milk comes in we will start to breastfeed. Until then, I will give him formula.
  • He was over nine pounds and there was no way I would make enough milk for him. He lost seven ounces in the first three days and the pediatrician was concerned, so we started him on formula.

I work as a lactation consultant and hear these statements all the time. I am sure that you have also heard similar stories. How do we, as knowledgeable La Leche League Leaders, inform expectant mothers about colostrum and its importance to their newborn baby?

We can start by speaking of the advantages of colostrum for newborns (Lucas 1998). Let pregnant mothers know that it makes a huge difference in the development of the immune system of their baby. Empower them with the confidence of trusting their bodies to provide what their babies need. Encourage them to give their babies the very best beginning: colostrum!

Let mothers know that even one supplemental bottle of artificial infant milk can sensitize a newborn to cow’s milk protein (Kalliomaki and Isolauri 2003). Formula changes the gut flora in breastfed babies by breaking down the mucosal barrier that colostrum provides them (Ogawa et al. 2002). This violation allows pathogens and allergens entry into the baby’s system (Ogawa 1992). For this reason, artificial supplements should not be given to infants who are at a high risk for allergies (Zieger 2003). In susceptible families, cow’s milk proteins may also increase the risk of a baby or child developing insulin-dependent diabetes mellitus.

Incorporate information about the wonders of colostrum into Series Meeting 1: "The Advantages of Breastfeeding." Use flash cards, make a poster, and ask questions such as:

  • What have you heard about colostrum?
  • What do you think is (was, or will be) the most valuable quality in colostrum for your baby?

You can also apply this information to Series Meeting 2, "The Baby Arrives: The Family and the Breastfed Baby." Expand your discussion to include basic information about the size of baby’s tummy, how frequent feeds in the first days are normal, and why they are important to their baby’s development. Questions to ask include:

  • How often did your newborn want to nurse in the first few days?
  • How did your newborn communicate that he wanted to nurse?

As Leaders, we need to be aware that, in some cultures, it is believed that colostrum is old milk that needs to be discarded—that the early milk has no value and may even harm a newborn baby. Mothers in these cultures begin breastfeeding when their milk supply increases and generally nurse for an extended period of time. Rather than challenging a mother’s cultural beliefs, we need to be respectful, sensitive, and offer accurate information tactfully (Mohrbacher and Stock 2003).

The benefits of colostrum can also be mentioned in Series Meeting 3: "The Art of Breastfeeding and Avoiding Difficulties." Questions to ask mothers include:

  • How did you learn to tell if your newborn was getting enough colostrum?"
  • How often does (or did) your newborn stool his diaper?

Ask new mothers to share their experiences about the first few days of breastfeeding. Each mother and baby dyad is unique and we can learn from all of them.

My grandmother lived for 96 years. We spoke often about the wonders of birth and breastfeeding. I am thankful that she saw all of my children born and breastfed. She was so very proud of my involvement with La Leche League. She thought that it was wonderful that women could be so supportive of each other in their mothering choices. And she was proud of all of us for offering our babies the very best: human milk.

As she was so fond of saying, "Colostrum is the most valuable food that a baby will ever ingest in his lifetime. Breastfeed your baby early and often."

References

Alm, J. et al. An anthroposophic lifestyle and intestinal microflora in infancy. Pediatric Allergy and Immunology 2002; 13(6):402.
Hanson, L.A. Immunobiology of Human Milk: How Breastfeeding Protects Babies. Amarillo, TX: Pharmasoft Publishing, 2004.
Hanson, L. and Korotkonva, M. Breast-feeding may boost baby’s own immune system. Pediatric Infectious Disease Jour 2002; 21:816-821.
Hanson, L. and Korotkonva, M. The role of breastfeeding in the prevention of neonatal infection. Seminars in Neonatology 2002; 7(4):275-281.
International Lactation Consultant Association. Position Paper on Infant Feeding. Raleigh, NC: ILCA, 2000.
Kalliomaki, M. and Isolauri, E. Role of intestinal flora in the development of allergy. Curr Opin Allergy Clin Immunol 2003; 3(1):15-20.
Lawrence, R.A. & Lawrence, R.M. Breastfeeding, A Guide for the Medial Profession, 5th edition. New York, NY: Mosby, 1999.
Lonnerdal, B. Nurtitional and physiologic significance of human milk proteins 1,2,3,4. AJCN 2003; 77(6):1537s-1543s.
Lucas, A. Programming by early nutrition: An experimental approach.J Nutrition 1998; 128:401s-406s.
Mohrbacher, N. and Stock, J. THE BREASTFEEDING ANSWER BOOK, Third Edition. Schaumburg, IL: LLLI, 2003.
Neville, M. and Neifert, M. Lactation, Physiology, Nutrition, and Breast-Feeding. New York, NY: Plenum Press, 1983.
Oddy, W. The impact of breastmilk on infant and child health. Breastfeeding Rev 2002; 10(3):5-18.
Ogawa, K. et al. Volatile fatty acids, lactic acid, and pH in the stools of breast-fed and bottle-fed infants. J Pediatr Gastroenterol Nutr 1992; 15(3):246-7.
Riordan, J. Breastfeeding and Human Lactation, 3rd edition. Boston, MA: Jones and Bartlett, 2005.
Rivers, L. The long-term effects of early nutrition: the role of breastfeeding on cholesterol levels. J Hum Lact 2003; 19:(1).
Scammon R.E. and Doyle, L.O. Observations on the capacity of the stomach in the first 10 days of postnatal life. Am J Dis Child 1990; 20:516-538.
Wilson-Clay, B. and Hoover, K. The Breastfeeding Atlas. Austin, TX: LactNews Press, 2002.
Zeiger, R.S. Food allergen avoidance in the prevention of food allergy in infants and children. Pediatrics 2003; 111(6):1662-1671.

Ellen Penchuk has been a La Leche League Leader for over 25 years and served as Area Professional Liaison for Connecticut USA for a term. She has been an International Board Certified Lactation Consultant since 1985 and is employed as a lactation consultant.Ellen and her husband, Alex, live in Seymour, Connecticut, USA and have three children, Evan, Larisa, and Jared.

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