“Fore” and “Hind” Milk Facts and Considerations

The ability to produce enough milk is a common concern among breastfeeding mothers. The falsehood that women might have insufficient milk supplies, a lack of proper education and role models, and the loss of breastfeeding as a cultural norm, have all contributed to perpetuate this myth. In fact, almost all women are capable of producing adequate volumes of milk for their babies.

The duration of each feeding is, very likely, the most important concern. Some breastfed babies are nursed constantly, for brief periods of time, because a mother confuses a baby’s need to suckle for comfort, or to relieve gas pains, as hunger. Sometimes these short, frequent feeds can cause a problem by giving the baby large amounts of “fore” milk, the milk which comes early in a feed and is higher in lactose (carbohydrate). Large amounts of “fore” milk, not followed directly by “hind” milk, can leave a baby irritable and colicky with abdominal cramps. The desire for the baby to suckle, to help relieve discomfort, may be interpreted as hunger and the baby may be switched to the full breast too quickly. The baby must stay on one breast long enough to remove the “hind” milk that comes in the last two-thirds of a feeding. “Hind” milk, which is richer in fat and calories, completes the nutritional value of each feeding, and leaves the infant more satisfied and full.

Pumping the breast milk and completely draining each breast combines the “fore” and “hind” milk into one bottle. Many mothers find their babies fed this way appear more content after a bottle-feeding. However, this may simply be caused by the fact that the feedings on the breast are too brief or that each breast is not fully drained before switching to the other side. Feeding with only one breast per sitting may alleviate this dilemma, but this tactic may not leave the feeding mothers with the optimal level of comfort after each feeding.

The “hind” milk is not only important for nutritional values and for rounding out each feeding, it can be extremely essential for some babies (preemies, multip les or low birth weight) when a higher calorie count for each feeding is the main consideration. Sometimes mothers are advised to pump their milk for several minutes and then stop to change collection bott les. The milk collected after the first several minutes is called “hind” milk and it tends to be higher in calorie-rich fats. The earlier milk obtained while pumping is called “fore” milk and it is higher in other nutrients. Some choose to freeze the “fore” milk for later use if they are collecting only the “hind” milk for early, weight gaining feeding.

Some women choose, for an assortment of reasons, to pump their milk and bottle feed their babies (using their own milk exclusively). Citing a wide variety of reasons, the most common are:

  • a constant nagging worry that their baby is not getting enough milk. This concern usually centers around a distrust of nature – that is, when some mothers cannot actually see the amount of milk the baby is consuming at each feeding, they become concerned the baby is not receiving adequate nutritional needs
  • some mothers simply need more sleep than others and choose to pump so they can sleep through the night and a spouse, or nanny, can attend to the night feedings
  • in extraordinary instances, some infants never can latch on properly either due to an ill formed pallet or some difficulty with their mothers nipp les (i.e. an inversion that cannot be corrected)
  • in very rare instances, an inability of mother and baby to feel comfortable and adjust to having their child suckle their breast

Pumping and measuring the expressed milk allows some woman the control they need because they are able to see how much their babies consume at each feeding. This reality gives them the peace of mind they could not achieve without physically seeing the bottle emptying of their milk.

Mothers who pump and feed, for whatever reason, are often able to avoid using supplementary bott les of formula. They quickly realize their bodies operate on a system of ‘supply and demand’. When breast milk is removed, the body will produce more. If the milk is left in the breasts, a signal will be sent to stop producing more milk.

Other mothers who choose to pump and bottle-feed their breast milk to their babies frequently discover their babies will take more from the bottle than they have pumped, or that they seem to take in from a breastfeeding. Mothers who are exclusively pumping for their baby’s breast milk feeds should use, at best, a fully automatic, piston-style electric breast pump. A hospital-grade pump, that is usually rented, is best for long-term pumping. It is essential to maintain an adequate milk supply at all times if the desire is to use breast milk, exclusively, for every feeding. Massaging your breasts before and during pumping can also increase milk yield.

When a baby is not stimulating the milk supply with deep suckling, a double pump, pumping both breasts at the same time, is best. The result is higher prolactin levels for greater milk production. Another benefit of using a high quality pump is reduced pumping time as a less powerful pump could take as long as 25 minutes to produce the same result. With a quality breast pump, each breast should be pumped for at least ten to 15 minutes per session, at least six times in a 24-hour period (more frequently if possible). Pumping at least one time in the middle of the night is optimal because between 1 a.m. and 5 a.m. prolactin levels are at their peak. Often low or reduced milk supplies correlate with sleeping through the night or a tendency to pump less frequently than once in a five-hour period. The ideal time span between pumping intervals, on average, is 2.5 hours.

Another cause for a drop in breast milk supply is fatigue and stress. Napping with your baby, snuggling and frequent skin-to-skin contact will aid in keeping a pumping mother’s milk supply abundant. Some pumping mothers claim a round of ” power pumping”, pumping for twenty minutes, stopping for twenty minutes, pumping again for twenty minutes and repeating three times works to fool the body into thinking there is a demand for an hours worth of feeding in a two hour period thus increasing the milk supply through the ‘supply and demand’ model. Using this method twice a week, which not only increases the milk supply but should produce a few extra ounces for storage, can assist a mother with a baby going through a growth spurt, or a mother who finds she is constantly working to keep an adequate milk supply available for each feeding. Some mothers simply use ‘power pumping’ for extra stimulation alternating it in tandem with actual breast-feeding when they are going to be with their babies for longer periods of time than usual (i.e. working mothers on long weekends or vacation).

Some women, surprisingly, produce copious amounts of milk that can actually cause problems for both mother and baby. An overactive letdown reflex can result in overfeeding and a colicky nature exhibited by the baby. In addition there are women who find their milk lets-down (flows) so rapidly that their babies are overwhelmed. This overabundance of milk all at once can negatively affect the breastfeeding relationship, leaving the mother and baby less than satisfied. The results of an over-active letdown and overabundant milk supply can be:

  • an excessive amount of air in the baby’s belly as a result of gulping the milk
  • a baby may take in too much low fat, “fore” milk and not enough of the filling, high fat “hind” milk at some feeds. This can reduce the satisfaction levels after the feedings and possibly lead to colic.

Reducing the overall production of milk and helping the baby balance the intake of “fore” and “hind” milk is the main goal of managing an over-active letdown reflex. Some woman find expressing their milk with a pump, and bottle-feeding their baby will alleviate this problem all together. Often times the forceful letdown reflex cannot be managed, either by feeding with only one breast at a time, alternating positions to use gravity to adjust the flow of milk, frequent burping, or nursing a sleepy baby exclusively. When all other attempts fail, the pump to bottle, where the appropriate nipple size can control the flow of milk, is a viable alternative.

Some women who choose to pump and bottle feed find, no matter how hard they try, they are always playing “catch up” trying to produce adequate ounces for the bottle feedings to satisfy their babies. Some simply remain convinced their breastfeeding infants seem constantly hungry or dissatisfied. Others still find, no matter what technique they try, they simply cannot develop a master plan that works for both mother and baby. Whether the issue is a milk supply that appears to remain low or an overabundance of milk and an over-active letdown reflex, the pump to bottle is a solution that may work. Consultation with a qualified lactation consultant, detailing any pumping routine adopted, may ease these worries and aid in assisting with increasing a milk supply. Often times any problems are remedied after a feeding assessment is completed and slight alterations in pumping routines are accomplished and, as always, a mother should always trust her instincts.

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