Breastfeeding mothers often worry whether their babies are getting enough milk. It’s a common reason for women stop breastfeeding sooner than they had planned to.
One concern for breastfeeding mothers is that there is not enough fat in their breast milk, or that their breast milk is watery.
This can lead to some mothers to believe they have a foremilk and hindmilk imbalance.
There are myths and misunderstandings as to what a foremilk and hindmilk imbalance is really all about.
How do you know whether or not your baby is getting the right mix of breast milk during feeds?
Let’s start by explaining exactly what foremilk and hindmilk are.
Foremilk and hindmilk
Foremilk is term used to describe the breast milk that is higher in water content and lower in fat and calories. The fuller your breast is at the start of a feed, the more foremilk will be available to your baby.
As your breast starts to empty, the composition of your breast milk changes. As the feeding progresses, your breast milk becomes less watery and has a higher fat content. This milk is called hindmilk.
The more frequent feedings are, the more high fat milk your breasts will contain. This is because the emptier your breast is, the less water content your breast milk contains.
The longer since the last feed, the more foremilk your breasts will contain. This helps to quench your baby’s thirst at the start of a breastfeed. Your baby reaches the hindmilk as feeding progresses.
There’s no distinct point during a breastfeed when the milk suddenly changes from foremilk to hindmilk. The milk changes gradually as the feed progresses, because the fat globules are usually the last part of the milk to be emptied from the milk ducts.
If you’ve ever expressed breast milk using an electric breast pump, you might have noticed the change in composition throughout your pumping sessions.
Foremilk and hindmilk imbalance myths
Here are 3 myths and corresponding truths about foremilk hindmilk imbalance:
#1: You need to balance the amount of foremilk and hindmilk your baby is getting
If the explanation of foremilk and hindmilk has your head spinning, you can rest assured that your body knows exactly how to make sure your baby drinks enough foremilk and hindmilk throughout the day and night.
You can encourage this by:
- Breastfeeding on demand, rather than to a timed schedule
- Allowing your baby to finish feeding from one breast before switching sides
- Allowing your baby to determine the length of each nursing session
When you breastfeed on demand, you don’t need to worry about your baby getting too much foremilk and not enough fatty hindmilk. The composition of your breast milk changes throughout the course of the day. Your job is to breastfeed your baby regularly to ensure he is getting enough breast milk overall.
#2: Your baby is breastfeeding too often and getting too much foremilk
Actually, the opposite is true.
The fuller the breast, the more foremilk. The emptier the breast, the more hindmilk.
That means the more frequent the feeds, the more chance a mother’s breasts will be relatively well drained and the milk in her breasts will have a higher fat content.
Foremilk is only the first milk of the feed when there has been a longer amount of time between breastfeeds.
#3: Your baby isn’t gaining weight because you have a foremilk hindmilk imbalance
A baby who is not gaining weight is not getting enough breast milk overall.
If a baby is breastfeeding well and is fed as often and for as long as he wants to, he’ll most likely get what he needs, including the right balance of foremilk and hindmilk.
#4: Your baby is unsettled, windy, or has green stools because he’s getting too much foremilk
If a mother has an oversupply, then her baby might be getting too much milk (including too much lactose). The baby might show signs of lactose overload, including unsettled behavior, wind, loads of green poop, and drenched nappies.
The theory of lactose overload says that if a baby drinks large volumes of breastmilk, there might be too much lactose overall for the baby to digest. The undigested lactose ferments in the gut and releases gas, which causes wind, pain, and loads of very runny or frothy green stools.
You can read more about breast milk oversupply and how to manage it in BellyBelly’s article Too Much Milk? Managing Oversupply of Breastmilk.
Lactose intolerance in babies
From the start to the end of a breastfeed, the lactose concentration is about the same. In other words, there’s about the same concentration of lactose in foremilk as there is in hindmilk.
If you suspect your baby has a lactose intolerance, you should seek professional medical advice.
You can also read more about lactose intolerance in BellyBelly’s article Lactose Intolerance – 4 Facts About Intolerance In Babies.
It has been theorized that fat slows down the movement of milk through a baby’s gut, giving his digestive system longer to break down the lactose. That’s why it’s often advised to have a baby drain the first breast well before offering the second side.
Interestingly, research into stomach emptying rates in premature babies questions this theory of lactose overload. This is because this research has found that the components of breast milk (fat, lactose, protein, foremilk, and hindmilk) don’t influence the rate of stomach emptying.
It also found that stomach emptying rates were about the same, regardless of the volume of the breast milk. This research was done on premature babies, so it might or might not apply to full term babies. Nevertheless, it raises doubts about the mechanisms behind lactose overload.
The take home message here is to feed your baby according to your baby’s individual needs. You do this by following your baby’s hunger cues.
It’s a good way to ensure he gets the right balance of foremilk and hindmilk throughout the day and night
You can read more about following your baby’s cues in BellyBelly’s article Baby Hunger Cues | How To Tell If Your Baby Is Hungry.
#5: Higher fat milk is better than watery breast milk
All breast milk is good milk.
Although it’s true that hindmilk is more concentrated than foremilk, this does not mean that foremilk is not important for your baby. The ‘watery part’ of breast milk is an essential part of your baby’s diet and ensures he stays hydrated, avoids constipation, maintains a normal body temperature and blood pressure. It also makes sure oxygen and nutrients are delivered to the cells of the body.
If you have any concerns about the amount or balance of breast milk your baby is receiving, seek help from a certified lactation consultant.