“You need to nurse for 20 minutes on the first side and then move baby to the other side for twenty minutes.” or "You have to empty the first breast before going to the second breast".
Did anyone ever tell you these things? What if your baby only nursed for ten minutes? Did you ask what would happen? I suspect you may have been told that is not long enough for your baby to get the hindmilk (higher fat milk). Is 20 minutes that magic “long enough” time frame? What if baby wanted to be there for 25 minutes? What happens then? Do you have no more milk?
Have you ever expressed breastmilk? What does it look like? Have you expressed more than one time? Did your milk look the same each time? I suspect it varied from thin, watery and blue, to yellow and thick. Did you notice a difference with the time of the day you pumped? How about before a feed or after a feed?
What does the research say? In point form the basics are:
· As the baby feeds the content of the milk the baby receives is higher in fat
· Each feeding can vary in fat content over the course of the day
· The fattiest part of one feed might actually contain the same fat content of the start of another feed
· Milk is milk; no real need to differentiate foremilk and hindmilk. Some is more concentrated, some less so, but your baby needs it all.(Hindmilk would be better called "concentrated milk" and foremilk "dilute milk")
· Babies all stay at the breast for different lengths of time and what satisfies them varies
· The breast is not a reservoir. It is never “out” of milk. If babe hangs out nursing more milk will “let down”. If you switched breasts milk may flow faster because more milk is in that breast, but there is no rule to have to take a baby off one side to put him on the other because of foremilk and hindmilk. Yes, if we want "moremilk"
Is there a time when we might pay more attention to foremilk and hindmilk?
· Is there an issue with baby sleeping at the breast?
· Is there an issue with baby being fussy at the breast?
· Is there an issue with babes weight?
· Is baby swallowing at breast?
· Is baby relaxed, with wide open hands and content at the end of feeds or no?
If there are any of these types of concerns, seek out an IBCLC to address the concerns. It may be somewhat related to the so called foremilk/hindmilk. It can sometimes be ONE factor to take into account for the whole picture when some of the above issues are seen. But it would not solely be a foremilk/hindmilk issue.
When a woman plans to breastfeed her baby and that plan doesn't go accordingly, it can be a time of many emotions. This emotion is often referred to as "guilt". There is a common saying, "we shouldn't make women feel guilty for not being able to breastfeed." Of course, we shouldn't. There are so many factors, however it is not a black and white, can or can't, choose to or not, it works for some, not for others, etc.
"Don't make her feel guilty"
I don't want a mother to feel guilty, but I do want her to recognize her feelings about her situation. Feelings are not negative. Feelings are just feeling. And we need to feel to work through the struggles.
We need to explore the feelings women experience when it comes to feeding their infant. Everything we see now is "Breast is Best". We have become a society that is "great" at encouraging breastfeeding but we are not a society that is even "good" at supporting and sustaining breastfeeding. This means many women are not meeting their breastfeeding goals. With that comes many feelings.
Mothers who intended to breastfeed but struggle to meet that goal, feel a sense of loss. We know there is a connection to loss of breastfeeding and postpartum depression. We need to recognize that many mothers experience grief, and not guilt, in the postpartum period. I feel like grief is confused for guilt or a feeling of failure and it is not interchangeable. Mothers need to be given the opportunity to grieve what they had planned, what they believed postpartum would be like, the support they would receive but did not. Hearing “now, now dear, it’s ok, formula feeding is ok” doesn’t really help. It doesn’t help because it is not about breastmilk over formula. It’s about an expectation mothers had. It’s about a decision they thought they had control over, only to find out breastfeeding is difficult, but more so motherhood is difficult! It is all more difficult than society lets people believe. Breastfeeding is not well supported. It is not understood well. So many myths and wise tales still exist and are perpetuated daily, holding women back.
Women are finding themselves alone, feeling isolated & without reliable resources.
Women who choose formula from the start don’t feel this way because they got to make that choice consciously. Women who planned to breastfeed but missed out on proper supports don’t feel like they had any other options but to give up their plans to breastfeed. That’s not a choice. That’s survival. We need to guide mothers to the appropriate, breastfeeding educated resources in a timely manner. Mothers deserve to have choices, someone who can offer solutions that are acceptable to them & who can provide support and counsel when breastfeeding isn't the best option for them.
Many mothers will be able to relate to this experience. The experience looks the same; a routine infant check up appointment, baby gets a weight check, the parents are asked some questions about development, etc. Upon looking at the weight, it is determined the infant is not gaining weight as expected. What does this mean? What is the cause? What should be done?
It often is quite shocking to parents, especially mothers, to hear this news. They are perplexed because they thought feeding, usually breastfeeding, was going ok. How is it possible that baby isn’t gaining weight? How is it possible she didn’t know that baby wasn’t growing as expected? Can anything be done?
Common reasons provided for this phenomena is that mom has low milk supply, baby isn’t getting enough hind milk or baby is too sleepy and isn’t feeding often enough. I don’t think it is quite that simple.
What I find in these scenarios, because I get calls often after an experience like this, is that what is not communicated to the parents is why we do these checks, why they matter, what they mean and what should be done with the information.
The simple answer is that we expect babes to maintain their own curve that they plotted on at birth (or more ideally 24 hours). When babies start to drop off that curve, this gives us a sign to look and assess what might be happening. This is a clue to ask some more questions and see if there are other pieces that can help tell us what might be happening. We want to know more about feeding behaviour, mood, output.
Often what I hear is that there is no way baby needs to eat more. They are happy, content, sleep well, don’t really fuss. The opinion is that there is no way it is possible the baby isn't eating enough. People expect a hungry baby to cry, be irritable, to unsettled. I am going to say this is simply not true. I am sometimes more concerned about that “good baby” that sleeps well and always content. A very misunderstood piece of infant wellbeing is that weight gain influences appetite. What I mean by that, is that if a baby is gaining well, they demand to fed and show signs of being hungry regularly with easily identified feeding cues. What we think is a content baby because they have a calm mood, could be a baby who is content but not getting quite enough intake. A baby that is lower weight than expected, will have a lower appetite and will in fact cue less to be feed, will have subtle cues, likely won’t have a late hunger cueing & overall may make little fuss about it. If mother offers they will feed, but commonly have short feeding sessions. When they are being feed, their appetite is low so they do not do an efficient job, leading to milk being left in the breast and the body slowing down production. I give the example that if they are getting 70% of their intake requirement, they will eat at 70% efficiency (this will very baby to baby). This over time can cause a low supply, which influences their feeding because babies like flow...so low flow, means less interest in feeding and the cycle continues.
If none of that concern is explained to a family, they leave these routine visits confused and bewildered as to why some one had a concern or what they could/should do about it and have no idea why it happened in the first place. There are lots of factors to consider to understand why this is happening & what the appropriate action for each case should be.
If you are experiencing a difficult feeding situation where weight gain is a concern, booking a consult with an IBCLC is advisable. With a good assessment by an IBCLC, the root cause can often be determined and a solid plan can be put into place to get the baby fed, get weight gain concerns addressed, increase milk supply, maintain breastfeeding, etc.
Other things to note in cases of lower than expected weight gain could be:
Has someone suggested to you that your baby isn't gaining weight as expected and the solution is to get baby to ingest more hindmilk? It has become common knowledge that fat content of milk changes throughout breastfeeding. This is true. Milk doesn't change in each feeding session in the same way...it changes over the course of the day and feeding patterns. The anxiety about whether or not baby is feeding "long enough" to get to the hind milk is not necessary.
Something else that is true is that the longer a baby feeds, the more letdowns occur and more fat is released into the milk from the milk making glands, however...there are some things that need to be pointed out and kept in mind.
Foremilk and hindmilk are not two different kinds of milk. Women do not produce a low fat milk and a high fat milk. It is simply that the first milk a baby receives at the start of a feed is foremilk and the milk after that is hindmilk. The change is gradual It is not based on a percertange of fat content, like skim, 1%, 2% or whole milk that we are used to thinking of. There is no magic time in a feed that changes the fat content or we can see a switch of kind of milk. There is no percentage of fat a baby needs to be able to gain wright. On this note, all the foremilk is not always lower fat than all the hindmilk. Foremilk from one feed might have a higher fat content than hindmilk from the next feed, previous feed or other feeds in the day.
With this all in mind, when there is a weight gain concern, the focus needs to be on increasing intake of milk and looking at the factors that might be impacting intake & not trying to avoid foremilk. Strategies to avoid formal and increase hindmilk consumption are ideas like pumping foremilk before a nursing session, so baby can only access hindmilk or keeping baby on one breast for 15 or 20 or 40 minutes, depending on who is giving the instructions. In fact, sometimes these strategies means the baby is getting even less milk than before. It is the total daily milk intake that determines successful weight gain. We cannot look at one feed as the way it is for all feeds. We need to look at each day and all the breastfeeding sessions combined and then address ways to increase milk intake overall.
If you find yourself in the situation of having an infant that is not gaining as expected, not gaining at all, slowly gaining or losing weight, I suggest a full evaluation with an IBCLC.