Colostrum & the Early Postpartum Period

Colostrum is the very first milk that your body makes. Your body begins to produce colostrum around week 16 of pregnancy. It is often called “liquid gold” due to its golden color and amazing, intricate, and perfect design. It is small in volume but packs a major punch in its composition.

 Colostrum is loaded with bioactive molecules that serve many purposes in protecting and promoting health in newborns. The composition protects against infection and inflammation, protects the gut microbiome with healthy microbial colonization, supports healthy organ development, and help mature the immune system. It also has a natural laxative effect from the oligosaccharides that help babies pass meconium, which helps keep bilirubin levels low.

Colostrum feedings during the first few days after the birth are small in volume. This is all part of the protective and beautiful design. Newborn babies have to transition from intrauterine to extrauterine life and use their innate reflexes to help them to survive and thrive. After the birth, the baby’s entire cardiopulmonary system shifts. They have to cry and fill their lungs with air, and their body does not rely on the placenta and the maternal cardiopulmonary system for survival. Colostrum volumes are small (2-10ml per feeding in the first 24 hours after birth) because babies learn to breathe and maintain their suck/swallow/breathe patterns. The sucking pattern for colostrum feedings is very different from mature milk-sucking patterns. Babies do a “burst” of sucking and then pause to swallow and breathe. They usually suck 5-6 times to pull the colostrum drops from the breast, which is thicker in consistency. If colostrum were pouring out at them in multiple ounces after birth, they wouldn’t be able to tolerate the flow and maintain their comfortable feeding patterns.

The small colostrum volumes are also protective for the newborn because their stomach size is small. It is only about the size of a cherry or marble on the first day. It is also very protective for the mother during the immediate postpartum period, as her body is transitioning. Due to the small volume and small stomach size in the newborn, frequent feedings stimulate and protect milk production and help establish a full supply. The frequent feedings and nipple stimulation also promote oxytocin release from the anterior pituitary in the mother’s brain, which causes contraction of the uterus to help control postpartum bleeding. Breastfeeding and holding baby skin to skin also promotes healthy bonding and nurtures the relationship between mom and baby. Baby feels safe and secure when on the mother’s chest. The sound of her heartbeat and voice, the same smell of the familiar amniotic fluid secreted from the Montgomery glands around the areola, and the rhythm of the mother’s heartbeat and breathing are tight and safe.

The delivery of the placenta triggers the shift in milk production. A hormonal shift facilitates the mother’s body to start moving toward the next stage of lactogenesis, where milk volumes will increase in volume and the consistency of the milk changes. There is a sharp decrease in progesterone and a rise in prolactin when the placenta detaches from the uterus. By watching your baby's stools, you will know that your milk is progressing through increasing volumes and changing composition. This process commonly takes about 3-5 days postpartum. Meconium stools mean your milk is in the colostrum stage.

When chairs start to change to dark green and a looser consistency, your milk is most likely in the transitional phase, and when the baby’s chairs are yellow, then your mature milk is transitioning in. The first two weeks postpartum is the critical period where your baby and your body are helping to establish your full milk supply. Ensure that you have someone highly trained (an IBCLC is a gold standard in lactation care) to assess latch, milk transfer, and feeding to determine that you and the baby are both doing well. Early intervention and management are key to protecting the milk supply and the breastfeeding relationship if challenges arise in the early postpartum period.