Foremilk vs hindmilk imbalance. Is it a fact or a myth? This is a long-debated topic among lactation professionals! To understand the question we need to better understand breastmilk composition. When people start discussing foremilk vs hindmilk they are usually discussing the fat content of milk and how an imbalance could affect the infant.
The foremilk is the milk that infants get at the start of the feeding and the hindmilk is what they get towards the end. However, it is the same breastmilk. There is no precise moment when the milk switches from one to another. Breastmilk tends to have a higher fat content towards the end of the feeding. The fat globules settle within the alveoli (milk storage stacks) and as the volume of breastmilk decreases during the feeding the higher the amount of fat that is released in the milk. The amount of fat in breastmilk will vary with each feeding. It depends on how frequently the breast is emptied and how much milk the infant removes. Maternal diet contributes more to specific types of fatty acids available than overall fat content, although research continues to explore this idea more.
Usually there is no need to worry about the amount of fore vs. hindmilk your infant is getting. It should all level out in a 24hr period. It’s important not to set a time limit at the breast. For example, feeding for 10 minutes on one side and then switching is now known to be counterproductive. These limits could potentially lead to limiting the amount of fatty milk your infant gets. A better practice is to watch your baby during the feeding. Look for frequent wide jaw movements. When the swallows slow (look for flutter sucking) compress the breast for a few seconds to encourage the baby to finish that side. When this technique is no longer effective, remove the infant from the breast, burp, and offer the other side. Think dinner and then dessert. The infant will likely feed longer on the first breast. The next feeding you would start by feeding on the second breast. This method allows the infant to adequately drain the breast and doesn’t rely on arbitrary time limits.
Occasionally the fore vs. hindmilk balance comes into play with a slower-growing preterm infant in the NICU who is mostly receiving pumped milk. For instance, you have a mama who is pumping 6oz of breastmilk per feeding and the infant is taking ~ 2 oz per feeding. This particular infant could benefit from extra fat in the breastmilk. In this instance using lacto-engineering could be helpful. Lacto-engineering is when you utilize the higher fat milk and prioritize that for feedings and save the foremilk for another time. This is not to say that foremilk is any less beneficial than hindmilk, it merely illustrates breastmilk’s uniqueness.
Another scenario where the amount of foremilk vs hindmilk could be relevant is with someone who has an oversupply. An example could be a plump infant who feeds very quickly at the breast and ends up being fussy, gassy, and having watery green poops. This kiddo is likely filling up with a larger volume of foremilk compared to the total amount of milk available to him or her. Breast massage before the feeding may help with the mixing of the fore and hindmilk. Another strategy is to feed only off of one breast per feeding. Frequently burping is also helpful.
In both of these situations, the breastfeeding pair would be best served by working with a lactation professional who can assist with their unique situation. The above suggestions are only general recommendations and there are many other factors that an individual assessment would take into consideration. Mama Coaches are Registered Nurses who are specially trained in lactation. We provide individual assessments and recommendations in person (depending on location) or virtually for everyone. See our map to find the Mama Coach nearest to you!