In almost every conversation I have with a mom about breastfeeding, the subject of foremilk and hindmilk comes up. Most moms have heard about it, and many moms are worried about making sure their baby “gets the hindmilk”. Is there really a need to be concerned? The short answer is no.
Photo credit: Azoreg/Wikimedia Commons
The term “foremilk” is commonly used to refer to the initial milk that a baby supposedly receives at the beginning of a feeding that is more watery and lower in fat content, while “hindmilk” refers to the milk towards the end of a feed that is supposedly higher in fat content. This description does not give the whole picture however, and can lead to a lot of unnecessary worry.
The fat content of breastmilk varies throughout a feeding, and throughout the day. What is important when thinking about fat intake is not how much fat your baby gets per feeding, but how much they get in 24 hours. The “emptier” your breasts are (for lack of a better term, because your breasts are never truly empty) the higher the fat content of your milk. Because of this, fat content tends to be lower early in the morning when most moms tend to feel the fullest, and is usually higher in the evening when most moms feel less full. Over the course of 24 hours, if you are nursing your baby on cue, he gets everything he needs.
Your breasts don’t contain two distinct types of milk (foremilk and hindmilk), it is all breastmilk, and it is all beneficial for your baby. The fat content of your breastmilk gradually changes during a feed, similar to water gradually getting hotter when you first turn on the hot water tap. If you are following your babies cues, and your baby is nursing frequently, the milk at the start of the next feed is still high in fat content (hindmilk), similar to the water from the hot water tap still being warm if it hasn’t been very long since you last turned it on.
True formilk-hindmilk imbalance is rare, and I have only seen it in cases of severe oversupply of milk, or strict timing of feeds. If you are nursing your baby on cue, then there is no need to worry about whether or not your baby is getting enough “hindmilk”. If your baby is gaining weight, content after feeding, meeting milestones etc, then everything is good.
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My babe is gaining weight just fine but last week has went from yellow diapers to runny greenslightly mucusy and extra gassy. I always have one fed off one breast per feeding unless shebstill seemed hungry. My diet hasn’t changed any. Should I maybe do two feedings per breast? I just don’t want to finish my supply. I’m not sure that I have an over supply but I do have forceful letdown
I’m so glad I found this post, been looking for days for a well info post about this.
My girl is spitting up and having hiccups a lot n not really having many poops. I know I have a very fast letdown
But didn’t think this would be the reason for there not being much hindmilk. I usally just feed off one breast for a few hours to have it emptied fully. Every now n then ill pump n check the volume of foremilk/hindmilk , which this time around (3rd baby) there is not a lot of hindmilk. I was thinking it was due to my diet. Will try switching breast during feeds before continuing with diet changes.
I think I am one “rare” person who has true foremilk/hindmilk imbalance. I pump 5 times for 15-20mins max and the morning pump (prev night pump 10pm) lasts bit longer, I dump the first part of morning milk and use the rest and used other pumping sessions milk. Everything looks fine for a week and then I start noticing more watery foremilk coming thorught the 15min or 20min pumping session. My baby gets very gassy and refuses to drink her milk. What can I do?
But what if those indicators are not there? I b/fed my son for 15 months and now I am having trouble with my daughter. She is 2 weeks old and only had 2 “real” (non-meconium) poops since birth. I seem to have plenty of milk, feed on demand, often for hours at a time, she wets through a diaper an hour. She is not gaining weight. I do breast compressions, I try to ensure she empties each breast fully before switching. We are having a genuine hind milk problem and I don’t know what to do!
Hi Vanessa, it sounds as if you’re having an issue with milk transfer, not with hindmilk. What you’re describing is very concerning and needs to be addressed. Have you seen anyone for some in-person help? Sometimes it can seem like a baby is nursing when really they are just “hanging out” at the breast. The wet diapers in the absence of weight gain and appropriate dirty diapers do NOT indicate that she is getting enough milk. Your baby needs to be properly assessed by someone knowledgeable about breastfeeding to determine what the problem is.
Warmly,
Fleur
Yes, I’m seeing my midwife today, going to an LL meeting tonight, and contacting a lactation consultant this week. I thought I was very knowledgable about breastfeeding. This girl has thrown me for a loop!
Hang in there. 🙂 I’m glad you’re getting some in person help. Let me know how it goes!
I’ve had problems with oversupply and imbalance in the past. I’ve nursed 8 babies. The telltale sign for me is when baby goes from yellow poo to stringy green spinach poo. A lot of moms will claim this is a sign of allergies and to start eliminating foods from their diets.
I’ve always been able to remedy this by nursing on one side per feeding. Finally, with my 6th baby, I nursed from one side only from the get-go (which drove lactation consultants at the hospital batty) but it worked for us. No issues.
I AGREE!!! I am concerned that I am seeing that the imbalance is a “myth” more & more (and seldom does someone state it is rare – they call it myth) on alllll sorts of mom sites with mommas, much less experienced than me advising other mothers they need elimination diets & I HATE this. As a very experienced nursing mother who also has educated myself as extensively as I can, locally I am the boob lady….as we have little resource here. And over & over I have seen dramatic & immediate change in behavior by encouraging mother to try single side feedings. What I have seen that is RARE….food sensitivity.
In this fay & age when young moms panic quickly over normal nursing behavior & switch sides simply because babe fusses a bit…it seems far more likely to me to be foremilk issues than thinking as a race suddenly so many babies can’t tolerate mom have dairy or gluten? Really? Nursing behavior in babies is no different than 1000 yrs ago, mother behavior in modern culture is strikingly different. I absolutely am seeing a trend toward moms being made to feel like they have to eat these very limiting diets due to claims the imbalance rarely occurs. I think it happens a LOT in early nursing & often goes away on it’s own as baby ages. I also think this often coincides with the 4 weeks many moms think it takes for elimination diet to “work” & therefore they are getting false confirmation that it was “the” culprit. I think sensitivities exist I think imbalance exists. I think feeding off one side for 2-3 hr blocks is such an EASY experiment it ought to be one of the first things to try to rule out for fussy, gas & green slimy/mucousy poops.
Let me rephrase the last part. Interview your pediatricians before the baby is born and see how much knowledge they have on breastfeeding. Some doctors are very knowledgeable, but seems that more and more doctors these days just turn to formula when a baby is not thriving.
My daughter was not growing! She only gained 2 ounces in a month and a half while breastfeeding, so we did have some issues! However, she was meeting her milestones and was very alert and happy. Not fussy and not sleeping all the time. So I wish I would have seen a lactation consultant to fix the BF issues instead of just supplementing with the formula. I whole-heartedly believe that a lactation consultant could have helped me remedy the issue without the use of formula and we would be growing and still breastfeeding today.
I wish I would have known all of this. I listened to everyone else when they said there was something wrong with my supply and started supplementing with formula. Obviously that was a downward spiral that killed my milk supply. My daughter is only 4 months old and now is pretty much solely bottle fed 🙁 I have tried everything to get my supply back up, but now she is refusing to nurse, I can’t pump anything, and supplements (like fenugreek, oatmeal, ect) are not working. I am working with two lactation consultants, but we aren’t making much progress. Once the bottle was introduced with supplementing it went downhill VERY fast.
I urge everyone to see a lactation consultant before you supplement based off of a doctors recommendation. Doctors mean well, but honestly they just don’t know enough about breastfeeding. I wish I would have!
Hi Rachel:
Glad you are getting mothers to think about this. I am finding a huge number of moms who are now seeing their babies growth start to slow well below average around three month so age. These mothers THOUGHT they had an oversupply, but may have simply had a forceful milk ejection reflex. Over time, from having each breast initially drained only four times per 24 hours, then dropping to three times per 24 hours when the baby starts to feed only 6 times a day — the supply then starts to crash. I’m beginning to think that this and overly aggressive sleep training are the two biggest causes (and sometimes intertwined) of failure to thrive among 3-6 month old babies.
As for the posters who think they have oversupply on this website — I don’t really see you as oversuppliers if you are managing the supply by responding to your baby’s cues. If your baby is swallowing nicely on one breast and then happy and satisfied after feedings and you aren’t feeding the freezer with a lot of extra milk — then you have a normal healthy supply for your baby and you have a feeding routine that works for you. I love Fleur’s comment above. Says it perfectly.
Best Susan Burger, MHS, PhD, IBCLC
Hi Rachel,
Thanks for a great question! If nursing on one breast per feed is working for you and your baby (content, growing baby, normal poop etc), then everything is fine and there is no need to worry about “foremilk” and “hindmilk”. Nursing on one breast per feed works very well for some moms and babies.
So, I understand the analogy about hot water left in the tap if you don’t wait too long to turn it on. That makes sense to me if you’re going to nurse your baby next time on the same breast that you finished with; the hindmilk would be right there. But what about those of us who nurse only on one breast per feeding and then go to the other breast for the next feeding. If a baby nurses, say every three hours, he wouldn’t get to repeat a breast for about six hours, which is probably too long for the hindmilk (hot water) to be right there waiting. So in instances where moms nurse on one side per feeding, are those babies getting more foremilk than babies who nurse from both sides? (I ask because I have oversupply and have curbed it by sticking to one breast per feed.)
I had “oversupply/over-active let-down reflex. I solved it by simply feeding on one breast (as many times as he wanted) for a 4 hour block of time (for example left breast from 1-5pm). I would pump the other side. Then I would switch and only feed on the right breast from 5-9 pm. This insured he got enough of the fat to help him process all of the sugar in the foremilk. My son was initially diagnosed with reflux, since the symptoms are almost identical. The meds didn’t help, and then I stumbled upon oversupply info, tried the suggestion and had a MUCH happier baby in 12 hours. A previous post mentioned “green poop”–this can indicate the oversupply issue, that’s probably why the doc was asking…
Great blog! Thank you for clearing that up for me. For the longest time I was filled with lingering questions about what those two terms really meant. You description was perfect.
Like the other moms who posted above. I also had issue with oversupply and had an overactive let down. My babe had lots of frothy green poop and choked on my milk numerous times…I did a couple things to help while my body worked out its kinks. I always nursed on demand. I only nursed from one boob per session (this is what helped the most, which I could tell because his poop was no longer green, but that lovely golden color) and I would express some of my milk into a towel (since I had no need to store it) when it was letting down too fast. Finally after about four months of nursing my body figured it out and we are still happily (and exclusively) nursing at 13 months!
For the vast majority of moms, there really is no need to worry about whether or not their baby is getting enough hindmilk. True oversupply is certainly one instance where an actual imbalance can happen, and frothy green poop along with a gassy, unhappy baby are usually the main indicators. Block feeding is one method of dealing with oversupply, and I’ve posted about another method here: http://blog.nurturedchild.ca/index.php/2011/02/23/managing-oversupply/
I was like Gina, severe over supply, foremilk/hindmilk imbalance, and forceful ejection. I had it with my first, worse with my second, but not so bad (thankfully) with my third. I began to only nurse on one side per feeding, that did help a lot.
I was one of those with quite an oversupply right away. I did indeed figure out my baby was getting way too much of the “foremilk” so to speak. After much reading and trial and error I eventually had to come up with my own little system that worked. The reason I knew something wasn’t quite right was because I was feeding on demand but my little guy never seemed satiated for very long and he was quite fussy. He also had green stools often. I produced so much of the “foremilk” (high lactose, low fat) he was being bombarded (and I mean bombarded!) with it at the beginning he always felt too full to stick around for the high fat stuff. Eventually my unsophisticated system (breastfeeding truly is an art isn’t it?) became that I would express an ounce or so into a cup first and keep him happy w/ a paci to release some of the pressure and reduce the low fat/ high lactose milk so he would keep going for the “hindmilk.” I think I also figured out I had overactive let down. Sounds crazy but I had to do this for the first six months or so until things leveled off. I know I’m probably an exception not the rule but thought it may be helpful for any new moms who may be frustrated and trying to figure out what to do. My pediatrician of course wanted to treat my baby for reflux but my gut instinct told me it was a breastfeeding issue not a physical issue for him.
thanks so much! this info needs to get out there and you are doing a great job….so many moms worry about this – to the detriment of BF and even the relationship! listen to your baby and get (good) help if you have questions!
Great post! Even my daughter’s pediatrician asked if my daughter was getting enough hindmilk when I brought up her chronic green poop. I informed the ped that yes she was getting plenty because I nurse on demand and I finish the first breast first. All too often, people take a topic and just run it in to the ground when really they are over stressing it! Like you said, if you are feeding your baby when he or she is hungry then it is all going to even out in the end.
If mums could just stop being told rules of how to breastfeed and just be given the space and support to do so, it would be a much less stressful experience.
Great post, thanks xx
Thank you, I will share this as this often comes up but more in regards of mums thinking they haven’t got enough milk due to breasts feeling empty.
Nev