Intro

All content of this blog is my own opinion only. It does not represent the views of any organisation or association I may work for, or be associated with. Nothing within this blog should be considered as medical advice and you should always consult your Doctor.

Foremilk/Hindmilk and a lot of confusion!

As this article I wrote was published by the ABM this month, thought I would share here too :)  You can also find it on http://www.iwantmymum.com/

Something that comes up a lot is the question of foremilk, hindmilk and how to ensure baby gets not too much of the first and enough of the latter. It’s really no surprise parents are confused as often Health Professionals give conflicting advice; ranging from only offer one side to ensure baby obtains hindmilk, through to timing feeds and giving a set amount of time on each side.

So what’s the deal?

Recently in the world of breastfeeding support, there has been a movement to drop the terms “fore” and “hind milk”. Why? Because breasts only make one type of milk and using two names proves confusing to many.

The milk at the start of a feed is lower in fat and higher in lactose (sugar) than the milk nearer the end of a feed – therefore the first was labelled “fore”, the latter “hind”.

Science has since explained how and why.

As the breast fills, the increased volume of milk causes the sticky fat globules to adhere to the walls of the alveoli, and to each other. This means that when letdown occurs and the milk moves down the ducts, that which is expelled first is lower in fat - because it has moved down without large amounts of fat (that’s still stuck higher up).

As this milk is expelled, it allows the fat to become dislodged and then this can also begin moving towards the nipple. Thus the milk gradually becomes fattier as volume within the breast decreases. At the end of a feed when the breast is nearly empty, fat moves freely and levels are at their highest.

So - the fuller the breast, the more lower fat milk will be released, the emptier the breast, the less fat adheres to the side and so milk is fattier earlier into the feed.

Given all of the above – which advice about feeding is best?

The fact is that there is no magical amount of time to spend at the breast as there are too many variables.

We know that whilst most women are capable of producing roughly the same mean amount over 24 hours, the amount held in the “initial store” varies from mum to mum (NOT related to breast size) . Babies also feed at different rates; some will be fast, effective “power feeders”, and others take their time as though savouring every mouthful. Much like adults really, how often at a table is everyone ready for a round at exactly the same time?

So let’s look at how trying to apply the rules often suggested works out.

Take a mum with a pretty typical supply - she puts baby to her breast and he gets a nice hit of thirst quenching lower fat milk. As he feeds the fat levels start to increase and he’s just starting to feel satiated. Suddenly the mum (looking at the clock) realises baby has been feeding for the x minutes she was advised to feed for and swaps him over to the other breast.

Baby is met with more thirst quenching but lower fat milk, which fills up his tummy – but due to the overall lower levels of fat, he’s hungry again half an hour later, possibly windy and very unsettled too as his body struggles to breakdown the higher levels of lactose.  Any unprocessed lactose can sit fermenting and symptoms can be very similar to those of a dairy or secondary lactose intolerance, colic or reflux.
Baby b in contrast, has quickly and effectively munched his way through mum’s smaller initial store and is ready for another big hit rather than the drip drip he is receiving. He’s had lots of fatty milk from the first breast and so quite enjoys more quenching milk, like a mid meal beverage. He might even go on to empty that one too…

So two babies have responded completely differently to the same course of action.

This time, instead of swapping at x minutes – this mum is concerned about sticking to one breast as advised to ensure baby gets hindmilk. This suits baby a, as this time he gets to finish his feed.

Baby b however is as mentioned, ready for more big guns – but instead is repeatedly coaxed back on to the first breast. Eventually baby gives up and falls asleep or remains unsettled, crying then windy and wants to feed again 30 minutes later.

See why there are no hard and fast rules?

The only way to know how long to feed your baby and on which breast is to watch the baby – they are the ones feeding, and they (believe it or not) know where the milk is at.

When baby is feeding she will let you know she has finished with that side by either falling asleep, or pulling away from the breast. This is likely to take roughly 10-20 minutes. Some babies do it in less and thrive, others slightly longer; but if baby is feeding for much longer ie 40 mins plus and then wants to do the same the other side or naps briefly and lightly before wanting to resume feeding (ie appearing unsatiated) it may be worth seeking support to ensure baby is feeding effectively.

Babies can also pull away from the breast shortly into a feed due to discomfort and one reason for this might be they need to burp! So if baby pulls off after a few minutes of effective feeding - winding before reoffering the same breast can be an idea as sometimes they will then continue happily feeding!

If they had actually finished with that side, when reoffered baby will perhaps feed for a moment or two (or refuse outright) before repeating the sign to let you know they’ve done ie sleeping or pulling away.

You can then offer the other side. Again there are no rules and if you need to run to the shops or drive to a baby group and baby is happy and content; you can always offer the other side when you get there, or when baby lets you know they are ready for more. That’s the convenience and ease of breastfeeding over having to prepare and use something instantly.

Some babies will always have at least some of the second breast, if not all – others will refuse satiated from one – some will have two and some feeds and one at others!

As you get to know your baby you will recognise roughly how long they like to feed, whether they get windy and so on – until which side becomes as instinctive as lifting your top. Each mother and baby combination is unique but following your babies cues ensures you meet the needs of your baby.

12 comments:

  1. With both my children I was around them all the time during their infancy and soon it just became extremely second-nature, all of it. I was fortunate that besides only one incident (where I required surgery & had to have medicine) we didn't run into any problems. But then... I was also in a breastfeeding-supportive environment (friends and family and partner). I think support is one of the biggest influences of breastfeeding successes.

    Thanks for another great article!

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  2. A great article, I had read it in the abm magazine, and think it is a very valid point. Mums do worry about a lot of things, if they could understand the process better they would feel more confident. HP's should know this, and either should learn the reality of breastfeeding or refer women on to peer supporters or breastfeeding counsellors. It is so unfair that Mum's think they are doing the right thing and think they are 'doing it wrong'.
    We are getting better tho.

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  3. As you know, I think this is a great article! But I know it's nice when people actually COMMENT ON THE BLOG, so here I am doing it.

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  4. Someone sent me this article a month or so ago when I was having issues with my baby who was fussy, colicky and having scary looking green diapers. I thought he had a milk allergy or something wrong healthwise. Another mother suggested foremilk/hindmilk imbalance and I was so confused. I thought milk was milk was milk. They sent me this article and it was so helpful!! I ended up block feeding him due to oversupply and he is a much happier baby now. A great post for new breastfeeding Moms!! Thanks:)

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  5. Hi R
    Many thanks for your comment and glad the article was helpful :)

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  6. Fab article. After breastfeeding my two boys for a year at least, I like to think I've gained quite a good knowledge of breastfeeding. It always gets to me how so many people give up feeding purely because they don't understand the physiology of how breastfeeding works.
    I haven't read through all your blogs here, but have you written/considered a blog on establishing the milk supply and growth spurts etc? I find myself often explaining to friends with new babies just why it is so important to feed on demand, especially in the early days, and that they're not 'spoiling' their baby by feeding them when they want.

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  7. I have always tried to understand how breastfeeding works but the problem I have is that I can only feed on one side due to mastectomy, so my babies have always fallen asleep on the breast but then would wake up looking for more after 20 mins. There's not a lot I can do about this as I've nowhere else to go once milk has slowed. Besides this though I have no doubt I produce enough as they were both big babies and weight gain is perfect :)

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  8. Great explanation of how this works - I tend to use the hot tap analogy which seems to work well although without going into all the detail.

    Have added this post to my useful breastfeeding info links page.

    Thanks!

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  9. Best explanation I've seen so far. So true, watch the baby.
    My health professionals insisted only feeding from one side and baby was never satisfied. I'm sure there was also a latch issue but I was always told there wasn't. With second baby, I watch her, and not the time, and she's always satisfied.
    Simple. (and it feels great because it wasn't simple first time around!)

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  10. Hello! this is a great article I wish I had read when my first baby was small.
    May I have your permission to translate it on my blog and link to your article?
    my e-mail: alexsm579@yahoo.co.uk

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  11. Love this, think it should be compulsory reading for new mums. It would have definitely helped me, luckily my local BF support group was on game to help! Ten months and still going strong : )

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  12. Thanks for this clear and accessible article - on the brink of ABM breastfeeding counsellor training so will be regularly reading this blog from now on! :)

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