By Laura Silvas, RN IBCLC

If you have ever left your pumped milk in the fridge overnight, you may have noticed the separation of the breastmilk. Rest assured, this is completely normal and expected. What you are seeing is the two types of milk that your body creates - foremilk and hindmilk.

What are foremilk and hindmilk?

When your baby initially latches, and as your letdown occurs, the first type of milk your baby will receive is the foremilk. This milk is the thinner, more watery part of your milk that you will see separates at the top of the bottle. It sometimes has a bluish tinge, although it can be other colors depending on the foods/drinks you've consumed. This thin, sweet milk encourages the infant to suckle quickly. While this milk does contain lactose and protein, it is lower in fat than the hindmilk that the infant will receive later in the session.

The thick creamy part of the milk, hindmilk, is high in fat and calories. This milk sits higher in the breast and is only released once your baby has been suckling for a while. It is critical that with each nursing session, the infant is latched and draining the breast well to obtain this type of milk. Hindmilk ensures proper growth and nutrition and is important for your baby's development.

How do I know if my baby is getting hindmilk?

With letdown as you first start pumping or nursing, the flow of your foremilk begins. Often, if you are pumping or the baby unlatches at this point, you may see spraying of the foremilk. As you continue to empty your breast, you will release the hindmilk. This is often referred to as the second letdown. Women experience many different feelings with let down, including but not limited to itching, tingling, warmth, pain, sadness, or pain. However, some women feel nothing at all. To determine whether your baby is receiving enough milk, keep a diaper count of how many times your baby wets their nappy, how many bowel movements they have per day, their weight gain, and satisfaction at the breast/after a feeding.

On the other hand, things that can contribute to your infant receiving more foremilk than hindmilk include short or sleepy nursing sessions, inadequate pumping sessions (too short, wrong flange sizes, too much suction, etc.), or the infant "snacking" at the breast. When your baby is not getting enough hindmilk, you may notice a change in your baby's bowel movements, as the consistency changes from yellow and seedy, to a frothy green. The infant will also not be as satisfied after feeding or only have a short time between feeds, as they are processing the foremilk quickly and not receiving much fat.

How Do I Increase Hindmilk?

If you have concerns regarding your infant's growth and development (especially with premature babies), you may be wondering how to increase your hindmilk production. As always, ensure that your baby is latching correctly and properly draining the breast. Other ways to ensure your baby gets the hindmilk they need include:

• Suitable size flanges while pumping are something to consider as well. Applying heat compresses a few minutes before and during breastfeeding can help.

• Massaging the breast while nursing or pumping to help move the milk down the breast can be helpful. Think of your breast as a clock, massage clockwise for a couple of minutes, and then counter-clockwise, including under the breast and the armpit.

• Lastly, ensure that you are eating a balanced, healthy diet. Increasing the amount of healthy fat sources in your diet can increase the amount of fat in your milk. Try eating more avocados, olives & olive oil, nuts, and flaxseed. Remember to keep hydrated and take in plenty of water throughout the day.

Conclusion

While your baby is receiving both foremilk and hindmilk, sometimes more hindmilk may be needed. If you have any concerns about your baby's growth and development, reach out to your healthcare provider or lactation consultant.