Articles published on this blog are my opinion only, and may not necessarily reflect the views of any organisations with which I am associated. Please be aware that articles posted on this blog are not intended as a substitute for professional medical advice. If you have a medical problem relating to breastfeeding, please seek further advice from a Lactation Consultant (IBCLC) or trained Breastfeeding Counsellor.

Tuesday, 10 May 2011

Foremilk and Hindmilk: In Quest of an Elusive Arbitrary Switch.

Over the course of her breastfeeding journey, it is almost inevitable that a mother will encounter the terms "foremilk" and "hindmilk". There is certainly no shortage of confusing and conflicting advice on the concept, which has led to a lot of misunderstanding.


What do the terms "foremilk" and "hindmilk" mean?

In The Breastfeeding Answer Book, "foremilk" and "hindmilk" were defined as follows:
  • "Foremilk" is the milk the baby receives when he begins breastfeeding, which is high in volume but low in fat (1).
  • "Hindmilk" is the milk near the end of the feeding, which is low in volume but high in fat (1).
Actually, the terms "foremilk" and "hindmilk" only really refer to samples of breastmilk taken right at the beginning of a feed ("foremilk") and samples of breastmilk taken right at the end of a feed ("hindmilk"). Even then, the advantage of using these terms is debatable.


Why?


A photo on Wikipedia "helpfully" shows two 25ml samples of human breastmilk: "foremilk" on the left and "hindmilk" on the right:


The problem with showing a sample of breastmilk from the start of a feed together with a sample of breastmilk from the end of a feed is that it tells us nothing about what happens to the breastmilk in between the two samples. Mothers end up mistakenly believing that their breasts make two different types of milk, and wonder how long they must feed for before the "foremilk" magically switches over into "hindmilk" (2).




So if the terms "foremilk" and "hindmilk" are misleading and there's no "magic switch" from one to the other, what really happens?

Since The Breastfeeding Answer Book was published in 2003, research in human lactation has advanced (2), so we now understand more about how breastmilk is produced:

Your breasts make just ONE type of milk


There is no magic switch between two different types of milk over the course of a feed. In fact, there is no sharp distinction between breastmilk at the start of a feed and breastmilk at the end of a feed (3). "Milk does indeed change consistency during a feed - but this happens gradually rather than suddenly" (4).




Why does the consistency of breastmilk change over the course of a feed?


The answer lies in what happens to the fat in breastmilk when breastmilk is
  • produced:
Your breasts are continuously making just one type of milk, containing 'sticky' fat globules that tend to stick to each other and to the milk ducts in the breast as breastmilk is produced (2,3,5).
  • stored in the breast:
Breastmilk produced between feeds moves down towards the nipple and collects in the breast, leaving increasing amounts of fat globules 'stuck' together further up the milk ducts (3).
  • and emptied from the breast:
When let-down occurs, the milk ducts dilate (5) and the milk is ejected from the breast. The milk removed at the beginning of a feed may be lower in fat because the fat globules are still 'stuck' further up in the milk ducts (6). As the feed progresses, multiple milk ejections occur (5) and the breast is emptied, more and more fat globules become dislodged and the breastmilk increases in fat (3,6). This has the overall effect of a gradual increase in fat content of breastmilk in each breast independently as milk is removed.




How do we know that the increase in fat is gradual?


Studies involving several mothers have been conducted in which samples of breastmilk were taken at intervals over the course of a feed. The evidence from these studies suggests that the fat content of breastmilk increases gradually as the breast becomes progressively emptier over the course of a feed (7,8).

It's much easier to explain this gradual increase in fat content using pictures...

...so, revealing the crazy lengths I'm prepared to go to so I can prove a point, I visited The Countess of Chester Hospital, where several wonderful people enabled me to take consecutive small samples of breastmilk from one breast only over the course of one pumping session, and professionally photograph the results. The samples were then taken to the Cheshire and North Wales Human Milk Bank, where the fat content of each sample was analysed.


This is the snapshot we got of the gradual increase in fat content of my milk over the course of one pumping session:

A snapshot of my breastmilk:
At the time the samples were taken, I was tandem feeding. My youngest baby was just over 8 months old, had started baby-led-weaning, and was still about 90% breastfed.
Each test tube contains around 6ml of breastmilk.
Note the gradual colour change of each breastmilk sample. This is the gradual increase in fat content from the beginning of a feed (test tube 1) to the end of a feed (test tube 12).


Remove test tubes 2-11, and the result is a picture similar to the one on Wikipedia:



This shows a sharp contrast between the breastmilk at the very beginning and the breastmilk at the very end of a feed only - it tells us nothing about what happens to the breastmilk in between the two samples. Only the photo containing all 12 test tubes shows the complete picture: a gradual increase in fat content.




So what's that stuff that rises to the top of expressed breastmilk?


When breastmilk is left to stand for a while, it separates into two layers. This isn't the separation of "foremilk" from "hindmilk"; it is simply the fat in the milk rising to the top, not the separation of two different kinds of milk (4).


The reason this separation doesn't occur in a bottle of cow's or goat's milk you buy in a shop is that this milk has been homogenised.


"Whole homogenised milk is identical in fat and nutrient content to whole standardised milk however it has undergone a process known as "homogenisation" which breaks up the fat globules in the milk. This spreads the fat evenly throughout the milk and prevents a creamy layer forming at the top." (9)






After a while, the breastmilk in our test tubes separated into two layers (click on the image to open a larger version in a new window):




Note that the breastmilk in test tube 1 does, in fact, contain a layer of fat.


Note also the increasing thickness of the fatty layer that collects at the top of the breastmilk from test tubes 1-12. This further demonstrates a gradual increase in fat content from the beginning of a feed (test tube 1) to the end of a feed (test tube 12).


Again, removing test tubes 2-11 shows only a sharp contrast between the thin fatty layer that rises to the top of the breastmilk at the very beginning, and the much thicker fatty layer that rises to the top of the breastmilk at the very end of a feed.




This photo tells us nothing about what happens to the breastmilk in between the two samples. Remember: only the photo containing all 12 test tubes shows the complete picture: a gradual increase in fat content.




Showing us pretty pictures is nice, but how much fat did the breastmilk samples actually contain?


Before I continue, I must stress that this is just a snapshot of my breastmilk. It is unlikely that the results shown here will be an exact reflection of what happens to every mother's breastmilk. However, it does provide a rough idea of what happens, so here are the results of the analysis of each sample of my breastmilk:




TS = Total Solids, ie. the bulk of the rest of the milk
Protein, carbohydrate, fat and TS values are in grammes per 100ml


If looking at raw data isn't your thing, here's a line graph showing the amount of protein, fat, carbohydrates and total solids present in each of my 12 breastmilk samples (fat content is shown in red).




The graph clearly shows there was a gradual (if slightly wobbly) increase in fat content as the breast is emptied. Quite plainly, there is no arbitrary "magic switch" between two different types of breastmilk during a feed.




Remember, though, that all of this is just a tiny piece in a vast breastfeeding jigsaw...



Although it is true that the fat content does gradually increase as the breast is emptied, it is important to understand that the difference in fat content between milk at the beginning of a feed and milk at the end of a feed can vary greatly from mother to mother. Not only this, but it can vary greatly over a 24 hour period, even among individual mothers (2). The difference in fat content can also depend to some degree on the amount of time elapsed between each feed (this is truer the younger the baby is) - another reason why it might not be a good idea to wait for your breasts to "fill up" before a feed.


The fuller the breast,

  • the lower the fat content of the milk
  • the greater the difference in fat content between the breastmilk at the beginning and end of a feed (2,3)

The emptier the breast,
  • the higher the fat content of the milk
  • the lower the difference in fat content between the breastmilk at the beginning and end of a feed (2,3)

This is not simply a case of the longer the feed, the higher the fat content: if there is a shorter gap between feeds (such as during periods of cluster feeding), the milk at the beginning of a feed may not necessarily be low in fat (2,10).

"Babies can show a wide variety of feeding patterns, suckling for varying lengths of time and at varying intervals over the course of a day, and maintain a healthy weight" (4,10)



Whilst fat is important, we can and do get far to preoccupied with the issue of fat content - take another look at the graph showing the amount of protein, fat, carbohydrates and total solids present in each of my 12 breastmilk samples:


Did you spot the line labelled 'TS' (Total Solids)? That line represents all the other components of breastmilk which are important too!


The most important thing to remember is this:

In the vast majority of cases, as long as you are:


  • breastfeeding on cue
  • and allowing your baby to come away from the breast spontaneously at the end of a feed,
there is no need to worry about what's in the breastmilk your baby is getting. ALL of the components of breastmilk are essential for the growth and the physical and mental development of your baby, not just its fat content.



Last edited: 25/09/11
_________________________________________________________


If you liked this article, please consider making a small donation to Cheshire and North Wales Human Milk Bank (a charity which does a fantastic job of getting breastmilk to our most vulnerable babies), without whom this article could not have existed.

_________________________________________________________
Many thanks to:


Lynda Coulter (Cheshire and North Wales Human Milk Bank) for very kindly agreeing to analyse the samples of my breastmilk.
Janet Beech and Linda Gendler (Cestrian Ward, The Countess of Chester Hospital) for entertaining my mad idea and helping to co-ordinate the experiment.
Becca Williamson (Bosom Buddy breastfeeding peer supporter) for being my extra pair of hands.
Jenni Ross (Medical Photography, The Countess of Chester Hospital) for taking such excellent photos of my breastmilk samples.
_________________________________________________________


This article has been republished as a guest blog on Acorn Pack


_________________________________________________________
References

53 comments:

  1. How long was your pumping session. In other words over what length of time were the tubes of milk obtained.

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  2. This is so interesting and answers a lot of questions that I had - thanks for laying it out like this.

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  3. Okay, so do you advocate timed nursing on each side per BFing session or one breast at one feed?

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    1. breastfeeding on cue
      and allowing your baby to come away from the breast spontaneously at the end of a feed,

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    2. I suggest dinner on the first side (ie. let baby stay until he/she seems done or is no longer actively sucking (you can stimulate baby to keep sucking if sleepy), and desert on the 2nd side ( unless you have a milk oversupply, always offer 2nd breast). If feeding on only one side due to oversupply, be aware that it will down regulate your supply and that eventually baby will start to need both breasts at a feeding.
      RN, IBCLC

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  4. what a FANTASTIC article! kudos to you for thinking to analyse your milk, this will stay in my "favourites" list for a long time to reference to for friends becoming mums... just AWESOME! thank you!

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  5. Hi Anonymous,

    Thanks for your question!

    On "advocating timed nursing on each side per BFing session:

    "Allowing your baby to come away from the breast spontaneously at the end of a feed" (as I stated in the article), means that it is the baby who signals when he has finished drinking. Timed nursing doesn't allow for this, because if feeds are timed on each side, it is the clock/mother telling the baby when to stop feeding. It's a case of watching your baby, not the clock.

    On "advocating one breast at one feed":

    Exactly how long a baby will feed at each breast for depends on many variables, such as breast storage capacity (unrelated to breast size) and fullness of breast at the start of a feed. As discussed in the article: "Babies can show a wide variety of feeding patterns, suckling for varying lengths of time and at varying intervals over the course of a day, and maintain a healthy weight" (4,8) It is a good idea, as Jack Newman says, to "finish" one breast first and then offer the other. It's worth bearing in mind that ome babies will happily take both breasts during a feed, whereas others may return to the first breast again afterwards, for others still, "block feeding" (ie feed from the same breast only for a couple of feeds in a row) may be appropriate (in cases of oversupply). While yes, there are indeed babies who will feed from one breast only, it would be unwise to observe this behaviour and apply it to every case.

    So, a feeding pattern isn't simply a case of what I would "advocate" - as long as you are feeding on demand and allowing the baby to come off the breast spontaneously at the end of a feed, it's a case of working out what works best for each individual mother and baby relationship. Read your baby, not the books.

    I hope that answers your question.
    A-M

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  6. Hi MermaidLiili,

    Thanks for your question!

    I decided not to include how long the pumping session was in my article because it may cause mothers to worry unnecessarily about how long it takes for them to express the same amount of milk. On top of this, watching the clock and timing feeds can lead to all sorts of trouble, so I wanted to move away from that.

    The length of time a feed takes is NOT a good indicator of how much milk your baby is getting - good indicators are watching to see whether the baby is swallowing (indicating that there is milk transfer), whether the baby is gaining weight, and nappy output.

    I can't recall exactly how long it took to produce the milk samples (we did jot down times, but I didn't keep that data). But, for information purposes only, test tube 1 was filled in under a minute; over the course of the next 10 minutes, the test tubes 2-10 were filled, it took about 5 minutes to fill test tube 11, and it took 20 minutes to fill test tube 12. This doesn't tell us how long a feed should take at each breast, as this varies from mother to mother - all this tells us is that the milk at the beginning of a feed is simply faster-flowing, and the milk at the end of a feed is slower-flowing.

    I hope that answers your question?

    A-M

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    1. Thank you so much for this information. What an excellent study and so helpful. Not to mention you have the same name as me and same spelling :) i rarely come across another Anne-Marie with the hyphen and the e. Thanks Mama!

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  7. YES YES YES! Thank you, this is what I always explain to mamas about hind/fore milk! It's the collection of the fat in the milk that is "sitting idle" in your breast that causes "formilk".

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  8. Hi, I was wondering, do you think there is any marked difference to a baby (health wise) between milk fed straight from the breast, and fore- and hindmilk expressed and mixed together into a bottle? Thanks!

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  9. Nice one. Fascinating stuff!

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  10. I'm still a tad confused. When you mentioned let your baby unlatch...can you help me out with a question. Sometimes my daughter can be asleep so I try to unlatch her and she starts to suck so hard again..so I say ok she's not done...and this can go on for an hour....Do I unlatch her or continue to let her suckle?

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  11. Hi Nedra,

    That's an interesting question.

    The Womanly Art of Breastfeeding (8th Ed) published by La Leche League suggests that there IS a difference between milk fed straight from the breast and milk which is expressed and mixed together in a bottle.

    As far as the milk itself is concerned, the main difference between the two is that direct breastfeeding facilitates a feedback mechanism between the baby and the breast, enabling the milk to change subtly during the meal, day or year to match subtle changes in your baby's requirements. One instance where this happens is with shared immunity to illness. In terms of fat content though, the difference is that direct breastfeeding allows the baby to design his own meal. The Womanly Art of Breastfeeding suggests he can choose how much fat he wishes to take in according to hunger/thirst.

    If the baby is taking expressed milk from a bottle, the breast isn't receiving the feedback from the baby, so it is less able to change subtly according to his needs. In addition, the baby isn't able to design his own feed according to his requirements, eg. for fat intake.

    As for there being any "marked health difference" between a baby who receives milk straight from the breast and a baby who receives all the fat swirled together in a bottle of expressed milk, this is, as ever, a question of balancing risk, and it is up to each individual mother to make a decision based on which risks she is happy to take. Remember that, if you are not breastfeeding directly from the breast, expressed breastmilk really is the next best thing. The next best thing after that is breastmilk from another mother. Infant formula is the fourth best option. This is because the risks increase the further down the list of options you go. And risks are only absolute retrospectively.

    I hope that goes some way to answering your question.

    A-M

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  12. Thank you SO MUCH for posting this! I get very frustrated when I hear mothers believing professionals telling them that their baby isn't getting enough hindmilk, especially when the efficiency of the baby makes a HUGE difference!! Thanks for doing the research!!

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  13. Hi Anonymous,

    It's hard to give you ideas and info without having more information from you.

    Is your baby feeding effectively? Ideas: Ask a trained breastfeeding counsellor to check your baby's latch (and milk transfer). Check out Jack Newman's website http://www.drjacknewman.com/video-clips.asp where he has some great breastfeeding video clips - you might find the "good drinking" and "nibbling" ones useful?

    Could your baby be frustrated by the milk flow? Idea: Babies respond well to milk flow, so breast compressions might help? See http://www.drjacknewman.com/help/Breast-compression.asp Also, it is a good idea after the first breast is "finished", to offer the other breast.

    What is your baby's weight gain like? What's your baby's nappy output like? See http://www.kellymom.com/bf/supply/enough-milk.html for what is expected.

    If this behaviour happens in the evening time, it's good to know that it's not uncommon. See http://www.kellymom.com/babyconcerns/fussy-evening.html

    However, without knowing more about your situation, it's hard to give you effective information. Talking this over with a breastfeeding counsellor would be a good plan, as they will be able to discuss far more with you than I can over the internet, and should be able to put your mind at rest.

    A-M

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  14. Apologies to those of you who have left comments on this post which have not appeared (including one from a mother I would encourage to contact a breastfeeding counsellor for more effective help than I can give via the internet). Blogger experienced huge technical problems this week, meaning the comments were sadly lost. Thank you all for your kind, encouraging comments - I appreciate them!

    A-M

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  15. Wow AMAZING article! I learned so much!

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  16. Thanks for this, very interesting. Good to understand how my milk "works" so to speak.

    Jenni

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  17. Thank you for your very interesting article that clearly dispells the myth being circulated by midwives to new mothers in the Hunter Region in Australia emphasising the need to 'drain' the breast of hindmilk! My daughter recently gave birth and wanting to do the most 'up to date' right thing for her baby subscibed to the advice of letting her newborn suckle up to an hour on the one breast until he falls asleep to ensure getting ALL of the 'hindmilk'. The fact is, he falls asleep on and off during what you might call the second half of the session because he is getting tired from working so hard and expending energy to get the milk, thus negating the whole 'hind milk' issue. He is not settling and when he does, it is for short periods of time eg: half an hour, hour and is immediately at his fist. My suggestion as a mother of three thriving babies and a practising childcare worker was to try letting him feed up to half an hour, swap sides and then let him feed until he falls asleep (so he didn't have to expend the energy fighting for the milk) but this was stomped on by the visiting midwife who continued to push the 'hind milk' from one breast issue. The baby isn't getting the amount of sleep required by a newborn and while I do advocate demand or cluster feeding, it is becoming beyond a joke. I have been looking at a number of web and blog sites on the issue to help me become more informed but all I see is a myriad of young mothers all experiencing the same problems and others constantly telling them to 'hang in there'.
    This is a wonderful time in life and it shouldn't be being made this hard for young mothers. Breast feeding is one of the most natural things in the world and being made to stress about 'hindmilk' and carry around breast pumps everywhere they go to alleviate the 'unused' breast is just rediculous. New mothers should be 'enjoying' their babies.
    Although I am now a grandmother, I am also a childcare worker who keeps up to date with issues. I have a lot of young friends in their twenties and thirties who are new or young mothers so I am not out of touch and they all agree that all of this emphasis on 'hindmilk' is going too far. They also have had happy, healthy thriving babies who were contented between feeds (whether demand or routine) and they have all fed on both breasts.
    I would appreciate your comment on this Anne- Marie.
    P.S. The same midwives told her it was unnecessary to burp breast fed babies.

    Cheers, worried mum.

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  18. Dear Anonymous,

    Congratulations to your daughter on the birth of her baby! And congratulations to you on becoming a Grandmother.

    As a breastfeeding peer supporter, and without knowing the full details of your situation, I am unable to give advice; however, I can give you some ideas and information which may be helpful.

    May I suggest your daughter get someone (such as a Breastfeeding Counsellor or IBCLC) to check the baby's attachment at the breast? If the baby is suckling for an hour at a time and still not appearing satisfied, this could be a sign that the baby's latch needs attention in order to make the milk transfer more efficient.

    Your daughter is doing absolutely the right thing in feeding on demand; as for how long to feed from each breast, a good place to start is with Jack Newman's advice:

    "Finish" the first breast first, then offer the other side.

    "Finishing" the first breast doesn't mean timing a feed on the first breast, then switching sides; it means allowing the baby to feed as long as he wants from the first side, waiting until he is no longer actively drinking (see Jack Newman's website below for details), then offering the other side. Your daughter may wish to use breast compressions as the breast becomes emptier to improve milk flow (see Jack Newman's website below for details). Babies' feeding patterns can vary greatly, but as your daughter becomes more confident in reading her baby's cues, this should become much easier.

    For further information, you may be interested in reading the following websites (you will have to copy & paste the links into your browser):

    Dr Jack Newman
    http://www.drjacknewman.com/
    There are some excellent video clips and information sheets on here, in particular you may be interested in reading his Protocol to Manage Breastmilk Intake http://www.nbci.ca/index.php?option=com_content&view=article&id=29:protocol-to-manage-breastmilk-intake&catid=5:information&Itemid=17

    Kellymom website (written by an IBCLC)
    http://www.kellymom.com/bf/

    Australian Breastfeeding Association
    http://www.breastfeeding.asn.au/bfinfo/index.html
    The ABA also have a national helpline you can call if you wish to contact a Breastfeeding Counsellor.

    I hope this information is useful to you.
    A-M

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  19. You can feel justifiably proud of your article. I found it fascinating. Well done!

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  20. Totally brilliant. Thanks. So valuable for women, their families and midwives

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  21. I don't really understand why this was a necessary "study." I haven't read any where that there is a "magic switch" from foremilk to hindmilk, or that they are two completely different milks. Also, I have never heard it recommended that a baby stay on for as long as possible to make sure he/she gets all of the foremilk and hindmilk. The only time I hear of foremilk and hindmilk being an issue is when a baby is having physical problems that indicate that they may not be receiving enough fat, which usually has to do with scheduled feeds and perhaps oversupply. So this blog article, in my opinion, doesn't do much in the way of dispelling any false or mythical beliefs of foremilk and hindmilk.

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  22. I was fortunate to work with Jack Newman for over a year at the St. Michael's breastfeeding clinic in Toronto, often just the two of us with clients. I do appreciate the information and breakdown of this article however I would love to see more emphasis placed on mother's being able to look at their baby to tell when they are drinking or just sucking. Before working with Jack I took a certificate program through Humber College on breastfeeding support. Although I finished top of my class with a 98% average I still found I was only able to effectively help about 50% of my clients. It wasn't until working with Jack that I was able to help 100% of my clients although some I had to refer to Jack as medication was required. The reason I am sharing all this is that even though I was somewhat skeptical of Jack's simple techniques, once I embraced them I was able to see the difference. I like to break down his techniques into three basic (but important categories).
    1. Know how to tell (by watching the chin) when a baby is drinking and when it is just sucking.
    2. Get a good latch (this means a baby with the head slightly tilted back - nose to nipple).
    3. Breast compression (which aids in emptying the breast. Important in not just getting the higher fat milk but also in keeping/increasing milk supply, which increases flow, and therefore keeps the baby at the breast instead of fussing and coming off).

    In my experience with working with Dr. Newman, there are very few situations where a baby should only be fed from one breast and as this article states, it's generally when a mother has an oversupply of breastmilk. Therefore, all others should seriously try to avoid the practice. My advice is always to offer the first breast at the earliest signs of needing to feed (crying is a late hunger cue and means an upset baby that is harder to latch). Keep feeding until the baby is no longer actively drinking, try breast compression to get the baby drinking again and when the baby stops actively drinking again it's time to switch sides and do it again. I often tell parents to not worry about a wet diaper at the beginning of a feeding but take the time to change the baby between sides as the baby will be more content and it will help to wake her/him up for the second side.

    I'm guessing the author of this article already knows all of this but wanted to emphasize it for the many parents that might not. You can view videos on Jack's website or find them on YouTube at www.youtube.com/user/thebirthden.

    Happy breastfeeding! Carol-Anne Brockington

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    1. Thank you for that, I found it very helpful. I know this is an old comment, but if you do read this reply I'd appreciate more information on how to tell when baby is actively drinking, rather than sucking non-nutritively.

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  23. Fascinating article, thank you! I'm going to share it and keep it to reference in the future!

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  24. Hi Anonymous,
    I think it's wonderful that you are so well informed about how breastfeeding works! In an ideal world, no there would be no need whatsoever for a "study" such as this; however, as a peer supporter, I have encountered a lot of misinformation and myths about foremilk/hindmilk, and for this reason, felt it was necessary to address the topic. I have known too many women who have given up breastfeeding before they wanted to because of poor information - I hope this goes some way to address that problem.
    A-M

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    1. I agree there are so many breastfeeding myths out there some strange and some very persistent....sadly havent seen much improvement over the past quarter century despite good information being available....thanks for doig what you can to help advance understanding of breastfeeding

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  25. Hi Carol-Anne!

    Thank you so much for your input - I appreciate it! I am indeed thinking of following up this article with one which includes information about how to know when a baby is no longer actively drinking at the breast, as I have received a lot of feedback to tell me mothers are needing to know this. It's in the pipeline - I'm a busy mum of 4, so I'm a slow blogger. Sorry.
    A-M

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  26. No worries Anne-Marie! I'm a homeschooling mother of 6 so I totally understand being busy =}. It's one of the reasons I thought to mention it, it's hard to cover everything in one article. I look forward to reading the article on actively drinking when you get to it. Keep up the good work, Carol-Anne

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  27. This article is awesome - thank you so much for the time to put it together. It is such a valuable resource for women. I was wondering if I could do a feature on your article on my website http://www.pregnancy.com.au Let me know what you think. I could promote Cheshire and North Wales Human Milk Bank.

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  28. Hi, aussiemidwife,
    Thank you for your feedback & for getting in touch! I'd be very happy to discuss this further with you by e-mail. Feel free to contact me on thefunnyshapedwoman @hotmail.co.uk (delete the space - I just find typing it like that reduces spam in my inbox).
    Looking forward to hearing from you!
    A-M

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  29. Just wanted to say thank you for all of your information and taking the time to reply.
    In the meantime, my daughter has been visited by an 'experienced' practitioner who has set her on the right path to success both practically and information wise. The baby is feeding, settling and sleeping anywhere from 21/2 - 4 hours between his naturally occurring feeds now, a Godsend for my daughter who was becoming quite sleep deprived. It might be noted that he is now feeding from both breasts, taking milk mostly from the first and finishing on the other.
    I wish these 'textbook' experts would take a leaf out of Carol Anne's book and get some 'real experience' before peddling their misinformation on to young women who want to do the right thing for their newborns.
    I believe ONLY practioners with EXTENSIVE 'practical' experience should be allowed to give support to young mothers, not young girls who think their textbook is gospel and that they presume to know everything.
    Breastmilk is breastmilk and as long as the baby is feeding properly and getting enough of it, it will be happy, healthy and growing. Lets all stop trying to be scientists disecting everything and use what God gave us to feed our babies and get on with it!
    Have a nice day everyone! Enjoy your babies and children!
    From 'worried mum'- now 'happy mum'

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  30. Hi Anonymous,
    So glad to hear that your daughter has now received the right information and support - it certainly sounds like mother & baby are much happier! Enjoy your grandchild!
    A-M

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  31. Thanks for this, excellent explanation of the issue.
    Do you mind if I link to your article for our peer support group FB page? I'm trying to come up with a collection of useful links to signpost mums to, esp subjects like this which are hard to explain well without diagrams/demos.
    Regards, Becki. PS in St Ives, Cornwall

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  32. Hi Becki,
    Yes, you are welcome to link to this article from your peer support group FB page! Also, if you tag my page on FB, I will add you to my list of pages.
    Best wishes,
    A-M

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  33. Over nearly 5 years of supporting mothers to breastfeed, I've encountered the foremilk/hindmilk confusion, and the advice to 'drain' the breast, countless times. This article explains the facts very clearly, and I was pleased that it coincides precisely with the way I explain it in antenatal classes. Really nicely done, thank you.

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  34. Amazing Article, Thanks for share such informative Article...

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  35. Thank you so much for this article. I have been constantly stressed out for the past 8 weeks feeding my daughter. She had only gained 150g in a week when she was 3 weeks and I was told she wasn't getting any hindmilk by one nurse. I was told to only feed for 20mins by another (she was constantly glued to my chest) and I was spoiling her. Glad to know there wasn't a problem with my milk and had I in fact kept going with feeding as long as she wanted, she may have gained more than 150g that particular week.
    This is my second baby. Breastfeeding wasn't working out. I was told I wasn't making enough hindmilk hence is low weight gain and me being a new mother, had no idea what I was doing regarding breastfeeding so I switched to formula. I am a bit angry with you.. where was this article in 2009 when my son was born :) I wish I knew then what I know now. Maybe I would of persevered longer.
    I think there is way to much focus on this whole foremilk/hindmilk thing and your article has thrown out all that and has explained clearly how things actually work.
    I am now thankfully not listening to anyones "advice" and I go with my baby. If she's happy to feed for 5mins or an hour, we go with the flow and if she wants one side or both or both and then back to the first, we go with it :)

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  36. Hi Rebecca,

    Thank you for your feedback! I'm so glad this article has helped you... I can also relate to feeling a bit angry with me too - I felt the same way when I came across the information I needed a few years too late to save my first breastfeeding relationship. We mothers can only ever do the best we can with the information and support we have at the time.
    Wonderful to hear your feeding is now baby-led - it's such a happy experience to follow your instinct. I hope you have many more happy breastfeeding months to come.

    A-M

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  37. Funny i guess I have never given it that much thought because I just naturally assumed that it was a gradual thing. I never once thought there was a switching-point, or "two different kinds of milk", I didn't realize that people thought that...

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  38. That is so fascinating! Thanks so much for doing this, and for posting your results! This is such a helpful post- I get the question "how long do I need to feed before she's getting the hindmilk?" often, and I'm glad to have this great explanation to point to.

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  39. Thank you so much for your commitment to help in the understanding of this highly talked about issue :) I have a question that I would sure appreciate your input on...
    My son is 12 days old, and has been spitting up a lot for the past week. Sometimes his poop is green, but today it I had the unfortunate experience of watching him empty his bowels during a diaper change, and the green poo came out as pure frothy bubbles, and there was lots of it. It was like watching him poop soap suds, it was awful! I have what I would describe as an overactive milk production since about three days after his birth. He definitely loves to suck a lot, but I find I can't put him on the breast just for comfort, as he just gets way too much milk and then just spits it right back out. For the last few days, I have been only feeding on one side per feeding, but letting him stay on that one side as long as he wants. Often when he is awake, he is fussy. I have taken to giving him a pacifier, as it seems to satisfy his high need to suck. He has gained over an average of an ounce a day though since birth, so it's not like I'm worried about him gaining at this point. My concern is more for his tummy's and bottom's comfort (he always seems to have a bit of a diaper rash).
    Until I came across your article here, the green frothy poop has lead me to believe my overactive milk supply is causing the problem, along with a fore/hind imbalance. Do you have any insight on what may be causing this kind of bowel movement, spitting up, and his general fussiness? I was about to try, as other sites have recommended, expressing some milk into a towel before starting to feed, to alleviate both the forceful initial milk stream, and to 'get to the hind milk' quicker. However after reading your post, I'm not so sure about this method. Any comment on this?
    Thanks,
    Michelle

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    1. Hi Michelle,

      Apologies if my article has confused you - it was my intention to describe what to expect as normal in the vast majority of cases, rather than deal with supply issues.

      From your description, my first thoughts are that you may indeed be encountering oversupply, as you suspect. If you have the book "The Womanly Art of Breastfeeding" (8th Edition), there is some very helpful information on pages 409-412 about dealing with oversupply. This IS a fixable issue - to start you off on the right track, you may consider the following strategies:

      - Feeding on one side each time (so higher fat content milk is available to baby at each feed, and milk production is slowed in the other breast)
      - Block feeding (meaning you feed on one side as many times in a row as you need to, whilst not getting uncomfortable on the other side)
      - A one-off pumping session on both sides to fully drain both breasts of milk, then feeding frequently and on cue afterwards (see http://www.internationalbreastfeedingjournal.com/content/2/1/11).
      - Trying a laid back/biological nursing position (might be more comfortable for baby if your flow is quite strong)
      - Limiting pacifier use (ideally stopping). Pacifiers mean the baby is spending less time at the breast removing milk, resulting in more of the lower-fat milk at the start of a feed, which exacerbates the oversupply issues you may already be facing. Feeding frequently and on cue will help fix the problem.

      Please do get in contact with a breastfeeding counsellor or IBCLC who will be able to further support you in dealing with oversupply.

      In addition, I notice that you mention your baby constantly has nappy rash from the frothy poo, so you and your baby may find it useful to get support from an IBCLC who can give you extra guidance and support with any food intolerances if they are present, as these can cause the symptoms you describe.

      Hope that helps!
      A-M

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  40. This is very interesting, thank you. As the second oldest of 12 I knew a fair amount about breastfeeding before my daughter was born. I didn't hear about the fore/hind milk until I started breastfeeding her. It was kind of confusing but as my Mom had always fed her babies and never had any problems I followed her advice/example and everything went well. It is nice to finally understand what it really is though.

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  41. Hi Funny
    The only reason I was reading your article is because my five months old son's poop was green. I have exclusively breastfed him sice he was a day old. He has never had green poop before, so when I noticed the change, I decided to check it out. I am just thrilled there are other mothers out there who enjoy breastfeeding.


    However, a question for you. Do my breast get empty signalling change of breast for my son to continue breastfeeding? I get the impression changing breasts after a feed occurs only when the breast I empty.

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  42. Hi funny, very interesting!
    One question, my son is five month and exclusively bf. Out of curiosity, does emptying the breast means I should press the breast to check for any more milk before changing breasts. I tend to press my nippl to check if it empty before giving him the other breast.

    Springnsunshine.

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  43. Gracias por este articulo, me gustaria saber como se realizó la determinacion de carbohidratos, grasas y proteínas?
    saludos.

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  44. Dear Ann-Marie,

    You said, "When breastmilk is left to stand for a while, it separates into two layers. This isn't the separation of 'foremilk' from 'hindmilk'; it is simply the fat in the milk rising to the top, not the separation of two different kinds of milk. The reason this separation doesn't occur in a bottle of cow's or goat's milk you buy in a shop is that this milk has been homogenised."

    Yes, exactly! We drink raw, whole cow's milk and it looks just like that with the cream rising to the top. Goat's milk is the same, as I'm sure most other animals' breastmilk is.

    Thanks for your clear, concise article on foremilk and hindmilk! :)

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  45. To some previous posters, I disagree that "draining" the breast isn't good information. The breast should be soft and the flow should discontinue, thus it has been "drained" prior to starting the other breast. I do agree however, that the emphasis on doing so to get "all" the hindmilk needs to stop. If the baby drinks until content, mom should be sure that baby is getting all it needs, and always offer the second breast. It's maybe not necessary to even discuss foremilk/hindmilk with the average breastfeeding mom. If she asks, a small explanation of the way it works should be discussed but that it is certainly not something to worry about.

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  46. really in both types of milk different are looking clearly. but which one is good for health.
    tow tubes

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