Breastmilk is Breastmilk!

How often have you heard the words “foremilk” and “hind milk”? What thoughts or phrases come to mind almost immediately when these words are discussed?

  • Fat milk or high calorie milk
  • Watery milk
  • Lactose intolerance
  • Green stools
  • Milk imbalance
  • Keep baby on one breast until he comes off on his own
  • Feed baby only on one breast per feeding so he gets more of the “hind” milk
  • Timed feeds for no less than 15 minutes
  • “I kept my baby on the first breast for an hour to get that hind milk and she is still not gaining weight”

How are we educating our clients and other professionals? Are we increasing unnecessary anxiety in already overwhelmed new parents? Or can we turn one teachable moment into a positive experience?

Since becoming an IBCLC many years ago, joining a brand new profession was exciting. Were we sitting on the cusp of new science and research? Possibly. But did we create a whole new culture of helpless parents? In our quest for increasing breastfeeding rates, we may have created a whole new science that brought with it steps, regulations, and many protocols. Not all of this is bad–however, in addition to what we have taught, along comes Dr. Google, sending parents into information overload about a subject that is just plain normal. Nothing more and nothing less.

All milks are species specific; perfect for each mammal’s own babies. Other mammals are really not worried about the different milks they give to their young since it is all just milk. Did the words “hind” and “fore” milk come about through scientific research? Nancy Mohrbacher, IBCLC, FLCA, talked about her own input in the early 2003 edition of The Breastfeeding Answer Book, and quoted on page 34 how the baby received the “fore milk” which is high in volume and low in fats, and the more milk the baby drank from the same breast, the volume decreased and “hind milk ,” or fattier milk, increased. With that knowledge in place, the mothers were reminded to let baby finish the first breast well, before offering the next breast.

I will suggest that this description might have come about in reaction to early hospital protocols in place to help prevent sore nipples. Day 1: feed each breast for only 3 minutes per side, every 4 hours. Day 2: increase the feeding time to 5 minutes each side and on day 3, 10 minutes. These steps would be just fine because a baby got all it needed in the first 7 minutes. Babies were so frustrated and very hungry, so formula would be offered as per the orders of baby or mom’s doctor based on which formula company had given the best convincing talk at hospital rounds.

Prescriptive breastfeeding protocols would daunt the hearts of most new mothers. Research was needed to overcome the many obstacles to understanding human breastfeeding behavior. While learning to understand the science of how human milk is made in the breast is fascinating, scientists have studied human lactation for probably only the past 15 to 20 years. Before that, much instruction came from the dairy industry.

There is only one kind of milk and there is no magical time when the high water and lactose content of human milk turns into the fattier “hind” milk. How can a baby finish one breast before being offered the next breast, when milk is continually being manufactured in all those wonderful little cells and breast structures? The further apart the baby nurses, or the mother pumps, the more lactose and water is drawn into the milk, and the fuller breasts will feel. Feeding less frequently is a First World breastfeeding behavior. This does not really appear to be much of an issue in countries where exclusive breastfeeding is the norm and feeding frequency might be 20 breastfeeding sessions in 24 hours. But that is probably a subject for another time. Breastfeeding babies get just the right amount of nutrients while all their sucking needs are met and they feel safe.

Research states that the average baby drinks about 750 mls. in 24 hours. Does it matter if a baby drinks 30 mls. per hour or 90 mls. every three hours? The final content and amount is just right for each baby. Can we stop maternal angst by minimizing our use of the words “foremilk” and “hind milk”? Breastfeeding is just plain normal. Frequent short feeds might be just what the baby ordered.


Attie Sandink

RN, IBCLC, CLE, CBE, Lactation Educator Faculty

Attie Sandink is a Registered Nurse, an International Board Certified Lactation Consultant, and Childbirth Educator, and can often be found teaching Child Birth Classes, giving breastfeeding support and education or assisting in the birthing process or catching the occasional baby when necessary. She continues to do training sessions for CAPPA Canada that are in keeping with the 20 Hour Lactation Management course as it ascribes to all standard of the Breastfeeding Committee of Canada. Presently Attie is a Lactation Educator for CAPPA Canada. Attie continues her education regarding Kangaroo Mother Care and the mother/ infant behaviour response. Learning to understand these natural instincts has changed her practice from assisting mothers and infants to breastfeed, to more of guiding role, understanding this process in a much more hands off and normal, allowing the mother and infant dyad to perform instinctually whenever possible. Her husband and her four older sons have been very patient with her passion to support new families.

Copyright CAPPA 2016

References if required. Feel free to ask me.

1 thought on “Breastmilk is Breastmilk!”

  1. Nice! I’ve been an IBCLC for 20 years and have seen one breastfeeding “epidemic” after another over the years as we do more research and learn more about human lactation. From sore nipples and nipple shields to foremilk/hindmilk imbalance, lactose intolerance, reflux, to the current epidemic of lingual ties. I know that these issues can and do exist, but we tend to go overboard with the help of Dr. Google andFacebook advise. Like birth, we have over analyzed and mechanized a natural process. I hope that we can increase the practical side of lactation practice as we continue to learn.

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