If you are a breastfeeding or pregnant mom, chances are good that you have heard the terms “foremilk” and “hindmilk” in relation to breastfeeding. I hear or read these words almost daily in my life as a lactation consultant. I have pretty much reached the point where I want to rip my hair out every time I hear or see them.
I first remember hearing the words about 12 years ago while working for another lactation consultant. At the time, many moms were still being told things like “nurse baby on one breast for 10 minutes, burp baby and then nurse on the other breast for 10 minutes.” We saw moms on occasion who complained of fussy, gassy babies with green, frothy stools. I remember hearing the lactation consultant teaching moms about the “thirst quenching” foremilk that came at the beginning of a feeding, followed by the high fat “dessert” of hindmilk that came at the end of the feeding. If mom had an abundant milk supply and baby was being taken off of the first breast after 10 minutes and then moved to the other side for 10 more minutes, baby was likely not getting to the hindmilk and would be gassy and fussy. These moms were instructed to nurse baby on one breast per feeding, letting baby take as long as he needed to finish. This often corrected the problem and both mom and baby were happy.
It started innocently enough as a way to correct a fairly uncommon problem. However, the idea of “foremilk/hindmilk imbalance” is definitely a case of a little knowledge being a dangerous thing. Instead of seeing moms who are told to nurse baby for 10 minutes on each breast, I am seeing moms who are told to always nurse baby on just one breast per feeding and to make sure he stays for at least 20 minutes (or some other arbitrary time) so that he will get the hindmilk. I now see more babies with poor weight gain and moms with low milk supply than I ever saw fussy babies with green stools. I talk to moms on a daily basis who want to know, “How long does baby need to nurse before he gets the hindmilk?” I see babies who are not gaining weight and mom has been told that it is because baby is not getting enough hindmilk. In almost 10 years as a lactation consultant, I have yet to see one baby who is not gaining weight due to a foremilk/hindmilk imbalance. I have, however, seen several babies who are not gaining weight because they are not allowed to consume all of the milk available to them at each feeding. I talk to moms who report that baby fusses and cries at the end of every feeding as they are repeatedly trying to put baby back to the same breast and he refuses. I convince them to give the other breast a try and baby latches beautifully and drinks well. Mom is worried though because she has been told to only feed baby on one breast per feeding or he will never get enough hindmilk. It’s time to stop the madness!
Who is right? Feed babies on both breasts for a certain number of minutes per breast? Feed baby on only one breast per feeding and make sure he stays “long enough”? How is a mom to know what to do? You might be surprised to learn that I think they are both wrong. What is the problem here? The problem is that one-size-fits-all advice with breastfeeding fails to acknowledge that breastfeeding is a living, dynamic relationship between two individuals. While breastmilk averages 22 kcal/oz, it actually varies in calories from mom to mom and even from feeding to feeding. Moms produce milk at different rates; milk flows at different rates from mom to mom. Babies vary in how quickly they draw milk from the breast. One-size-fits-all advice just doesn’t work. So how is a mom to know how long to nurse baby or how often? One breast or two? How will she know if baby is getting the hindmilk?
The answer is two-fold – First, and most important, pay attention to the baby. Unless we disrupt the process or try to do too much directing, baby will take just what he needs. If you feed your baby when he shows hunger cues and let him stop when he is finished he will generally get what he needs. When babies are hungry, their hands are fisted and near their mouths. When they are full, their hands and arms relax. Nurse baby on one breast until he either lets go on his own or falls asleep with hands & arms relaxed. Try to burp him and then offer the other breast. If he takes it, let him nurse until he either lets go or falls asleep again. He will generally nurse for a shorter period of time on the second breast. If he doesn’t take the second breast, then offer that breast next time baby cues to nurse. Trust your baby to lead. Sometimes the waters are muddied by babies who let go because they have trouble staying attached to the breast or because they need to burp. If that is the case, they will generally try to immediately re-attach. Sometimes babies (especially newborns) will fall asleep before they are finished, especially if they are not latched well. Newborn babies will do a better job of staying awake at the breast if mom does breast compression during the feeding. Some babies will grow and gain well on one breast per nursing, some babies need the additional milk from the second side. Every baby and every mom is different. My first baby wanted/needed both breasts each feeding and was a very slow nurser, often taking 30-45 minutes per side when he was a newborn. My second baby usually only took one breast per feeding and was a very fast nurser – she was usually finished within 5-10 minutes and rarely nursed for comfort. They both grew very well, despite two totally different nursing patterns.
The second part of the answer is simply to understand what is happening in a lactating breast. Believe it or not, your breasts do not make two kinds of milk (fore milk and hind milk). Your breasts simply make breastmilk. Breastmilk is not homogenized. The fat separates from the liquid. Between feedings, the fat will begin to separate and cling to the sides of the milk ducts. As baby begins nursing and milk flows through the milk ducts, the fat will be gradually washed off the sides of the ducts. Fat content will gradually increase throughout the feeding. There is no magic point where the foremilk stops and the hindmilk starts. If baby is nursing very frequently, the fat won’t have much of a chance to separate and the fat will be more evenly dispersed throughout the feeding.
There is no need to stress. No need to watch the clock. Just nurse your baby and focus on learning to read his cues. This is how the system is designed to work.
Disclaimer: Yes, I know that there are exceptions. Some babies don’t nurse well and will struggle to draw any milk from the breast. Some moms have major problems with over-production. These problems need to be addressed individually, not by creating one rule for every situation.