Do you need to worry about Foremilk and Hindmilk?
The science of breastfeeding is relatively new and our knowledge is growing all the time. One significant discovery in the 1980s led to new terminology describing different stages of breastmilk composition during a feed.
Previously, breastfeeds had been strictly controlled by the clock, with mothers directed to limit the time on each breast to exactly 10 minutes. This created a range of problems as individual breasts and babies varied greatly in how they worked together.
Some babies weren't satisfied by feeds as they changed sides too soon. Others became frustrated when their mother tried to keep them on the first breast for ten minutes. And others became distressed when their mother insisted they must latch and feed on the unwanted second breast.
This rigid feeding schedule wasn't evidence-based and led to many breastfeeding women turning to formula feeding instead.
Research had shown how the balance of fat and volume in human milk changes as a feed progresses. Words to describe the process were created: Foremilk to describe the milk at the beginning of a feed and Hindmilk to describe the milk later in a feed.
To avoid babies being swapped from the first breast before they were ready, mothers were now advised to “Finish the First Breast First”. Rather than following the clock, following the baby recognised the unique way individual babies feed. The second breast was to be offered but if the baby indicated they were satisfied, the feed was concluded and the next feed would begin on the alternate starting breast.
Unfortunately, in an effort to prevent one breastfeeding problem, a new one was created! Now rather than focusing on how many minutes had passed, new mothers were worried about keeping babies on the first breast long enough! Some were even given the message they should only give one breast each feed, which sometimes led to supply issues in the following weeks or months.
One breast or two? How many sides is a feed?
Despite efforts to reassure everyone that it is not necessary for the mother to do anything to enable her baby to receive Hindmilk, some educators and supporters were giving strict times to keep babies on the first breast to ensure the baby got the “important “ milk and we have landed right where we began: worried mothers watching the clock instead of their babies!
So, let's unpack all this a little and look at what is happening inside the breast and why we can trust both babies and breasts to get on with what they do best! Communicate!
The Human Breast
The breast is thought to have evolved from a sweat gland, millions of years ago in primitive animals. Today there are still animals who secrete milk onto their skin, where it is licked off by the infant. Two examples are the monotremes - Australia’s own unique Platypus and Echidna!
With the eventual evolution to include a nipple, brests became so efficient that all animals who feed their young milk came to dominate the planet and be known as mammals.
The lactating breast is not like a bladder, filling and emptying. It always has milk immediately available. The system of ducts and glands, just like our household plumbing, always has a reservoir filled and ready to release. This is what we call Foremilk. You might think of it like the water sitting in your garden hose, warming in the sun:
When a baby attaches to the breast, they are immediately rewarded for their sucking by a mouthful of milk, which stimulates further sucking. This triggers the let-down reflex, which happens naturally within moments and the milk inside the breast begins to change. The milk becomes richer and creamier. This is what we know as Hindmilk.
As soon as milk leaves the breast, more takes its place. Every mouthful is higher in fat than the one before. With repeated let-downs automatically triggered by changes in the baby’s suckling. Gradually flowing more slowly as it becomes creamier, until your baby decides they have reached the stage to come off that breast. Why?
Well, we know it isn’t because the breast is empty: studies have shown around 67% of the milk is still available. And it isn’t because the milk stopped flowing: ultrasound imaging shows babies most often release the nipple at the beginning of a let-down.
Secret baby business, perhaps. Need to know basis. Mothers don’t need to know!
What happens next is entirely up to the baby. They might:
enjoy a cat-nap before waking to take the second breast
refuse the offer to accept the second side immediately but begin seeking it a short time later
eagerly move to the second breast and feed as long or longer than the first
accept the second side but suck for a much shorter time before falling asleep
show signs of discomfort before filling their nappy, being changed and returning to the second breast.
fall into a deep sleep cycle against the breast and not waking until ready for the next feed, starting on what was the second side
All these scenarios and more are entirely normal. The baby is meeting their need for breastmilk and sucking, communicating their needs with the breast and removing the volume of milk they need.
If you took samples of a mother’s milk around the clock, you would discover it is never exactly the same. The further apart the feeds, the lower the fat content. And the closer together the feeds, the higher the fat content. The baby works with this. The breast works with the baby. There is no Foremilk or Hindmilk, just breastmilk with different ratios of fat depending on how long it has been between feeds. Automatically, it quenches thirst, satisfies hunger and communicates between the baby’s body and the mother’s. The mother simply needs to set aside her clock and let her baby do their thing.
Trust. Its the hardest part of breastfeeding. Having faith in a system which has worked without clocks since the dawn of time.
Watch the baby, not the clock.
