Foremilk Hindmilk Imbalance: What Breastfeeding Moms Need to Know

One of the things a breastfeeding mom worries about most is whether her baby is getting enough to eat. After all, you can’t really see the “bottle” draining. And if that’s not enough to stress about, some moms wonder whether their baby is getting the right kind of breast milk. There's lots of talk in breastfeeding circles about foremilk (watery, low-fat milk baby first gets when nursing) and hindmilk (the high-fat cream that follows). But is this something you really need to concern yourself with when nursing your baby?

The short answer is no.

"Breast milk is breast milk -- it all serves a great purpose," says Leigh Anne O'Connor, a lactation consultant in New York City. "Foremilk and hindmilk are the same thing; it's the fat content of the milk that is removed that varies. Most women do not need to worry about it at all." 


Research shows that there's no real reason to worry about foremilk and hindmilk while you're breastfeeding. As long as your baby seems to be nursing happily and healthfully, he'll get all the milk fat he needs. There's nothing you actively need to do for this to happen.

The problem arises when there is a foremilk/hindmilk imbalance -- that is, when a baby gets too much foremilk (and not enough cream). This can happen when mom cuts feedings short, switches "sides" too soon, or nurses too frequently. As a result of this imbalance, your baby might not gain enough weight and he could have some digestive issues.

Look for these warning signs:

In your baby ...

  • gas or discomfort
  • green foamy poop
  • blood in her poop
  • not gaining weight
  • colic
  • baby wanting to breastfeed all the time

In mom ...

  • Breasts constantly feel full
  • Painful or uncomfortable breasts
  • Plugged ducts or mastitis (breast infection)

More from The Stir: The Ultimate Guide to Breastfeeding

The good news is that while foremilk/hindmilk imbalance can cause some annoying, uncomfortable symptoms for you and your baby, it's easily remedied.

Here's what to do:

  • Avoid switching breasts while baby is actively nursing. Be sure to let your baby finish each breast before offering the second so he gets to that creamy milk essential to his growth. If you're not sure if he's finished, let him nurse until he comes off on his own or falls asleep. At that point, offer your other breast if he's interested. If he's not interested, you can express a bit of milk to prevent engorgement.
  • Pump before you nurse.  Doing so will help your baby consume less foremilk per feeding. If this works, you should notice that your baby is not as fussy (hallelujah). Her poop will become less watery and more yellow. O'Connor advises that not all women should pump before feedings; for some, a bit of hand expressing will take off the right amount without dealing with the dreaded machine. 
  • Nurse more frequently. Waiting too long between feedings can reduce the fat content of breast milk. The milk left over from the previous feeding mixes with the watery foremilk, so your baby is "full" before he gets to the cream.

In general, trust yourself. If you've got a happy, growing baby, just keep doing what you're doing. If something doesn't seem right or you or your baby exhibit symtoms of a foremilk/hindmilk imbalance, talk to your doctor or lactation consultant.

Have you ever dealt with a foremilk/hindmilk imbalance?


Images © Andria Patino/Corbis; ©

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