“The Good Milk”
There aren’t two types of milk in your breasts. There isn’t low-fat milk and high-fat milk, good milk and bad milk, thin milk and thick milk. There is just breastmilk.
Do you know how they make skim milk? Probably not, because very few of us have ever seen raw or unhomogenized milk. When you milk a cow, the milk comes out warm and fluid into the bucket. The milk is chilled and the fattier milk rises to the top. Then, whoever is processing the milk “skims” the fat off the top. What is left is a low-fat or no-fat version of milk. Get it? Skim milk?
If you have pumped and put your milk in the fridge, you have noticed the same phenomenon. As the milk cools, the fattier, more opaque milk rises to the top and the bottom portion of the milk appears thinner, more translucent. Perhaps you would call this milk more “watery.” But, it isn’t watery. It doesn’t lack nutrients. It is just lower in fat.
Breastfeeding moms read a lot about foremilk and hindmilk and, for lack of a better term, obsess about it. I talk about this with moms way more than I care to. Why?
Because, in my opinion, this is a completely nonsensical and irrelevant topic 99% of the time.
We don’t know the fat concentration of your milk when the baby first starts nursing, nor do we know the rate at which the milk gets fattier.
You may have read or been told that you must nurse for at least 15 minutes for the baby to get the “good milk” a.k.a. “the hindmilk.” Not true. Some babies get it immediately, for some babies it takes 45 minutes. This depends on your milk supply, the time of day, the last time you nursed, and whether Jupiter is approaching Saturn.
What we do know (and when we say “we,” I mean people who help women based upon evidence, not based upon what Dr. Spock preached in 1978) is that something triggers a baby to release the breast when they have had enough fatty milk. That is why it isn’t a good idea to time a baby’s feeding and pop him off at some set arbitrary time. It is also why you shouldn’t keep putting baby back on the same boob to “empty it” even if he is popping off. If he seems done with the first boob, whether it has been 10 minutes or 45 minutes, by all means, offer the second one!
What we also know is that the hindmilk takes longer to get out of the boob than the foremilk because it is thicker. Like a milkshake takes longer to pour than a glass of milk. So, yes, technically the baby gets the milk that flows out easier first. But, it isn’t like skim milk, skim milk, skim milk, half-and-half. It is more like skim milk, 1%, 2%, whole milk, half-and-half–meaning that the milk gets progressively fattier as the feeding goes on. This also explains why your baby camps out on the boob all evening long and cluster feeds. In the evening time, you may have noticed that your breasts feel less full. Many women tell me they “have nothing left” in the evening. Not true. Your boobs have milk, but it is mostly that thick fatty milk. So, baby needs to suck extra long to work that thick yumminess down to his mouth. Since it is lower in volume and takes longer to get out, he is there longer (and often falls asleep from all that effort). But, your reward is that a belly full of fatty milk yields a nice chunk of sleep for baby (and hopefully for you as well).
Speaking of the “empty boob,” we know that a boob is never empty, so it is a very silly thing to say. Depending on how much milk you make, your baby chooses to drink about 70-80% of that milk and typically no more. As baby is drinking from the breast, your breast is already refilling. Now, you may not be able to pump anymore out, but it is still in there, getting ready for the next feeding.
“But Katie,” you say, “my baby’s poop was green and I Googled green poop and it said my baby has foremilk/hindmilk imbalance.”
Ahh, poop. As a mother, you will be very interested in your child’s poop until you can trust him to properly wipe himself (around five to seven years old). You will discuss your child’s poop with your husband at the dinner table. You will text your mom about it. You will set it aside during a diaper change and come back to it later to take a closer look.
Here are a list of possible appearances of your exclusively breastfed baby’s poop:
spinach green (it may even look like it has spinach in it)
*black (not including the first few days of meconium)
*small spots of bright red blood in any colored poop
*streaks of mucusy blood in any colored poop
I address poop a bit in next week’s blog, but know this: All of the above colors are normal except those with an asterisk. If you baby’s poop is black, call your pediatrician ASAP. If your baby has a lot of blood in his diaper, like a bothersomely large amount, call your pediatrician ASAP. It isn’t normal, but it isn’t a reason to freak out and immediately only eat turkey and brown rice and/or switch to formula.
For lime green poop and poop that has a little bit of blood, I am going to give you my nurse/motherly advice for when odd things happen.
(Disclaimer: Severe injury, extremely high fever, or other obvious emergencies obviously don’t count here. Use the good sense God gave you.)
When something odd happens…
The first time, take note and say, “Huh. That’s weird. It is probably a fluke.”
The second time, pay attention and look for trends: “I am going to watch closely to see if this happens again.”
The third time, seek help: “I had better call my pediatrician on this one.”
But, we were talking about lime green poop, right? If a baby is having lime green poop most diapers of the day and is extremely fussy, then I will entertain the conversation about foremilk/hindmilk imbalance.
In the meantime, if your baby’s poop isn’t lime green or bloody, you get to stop obsessing. We can talk about other reasons why your baby may be fussy. We can talk about ways to soothe your baby. But, can we please stop talking about at what point exactly your milk switches from water to ice cream? Just nurse your baby on one boob. When he seems done, offer the other one. If he wants it, great; if not, fine. Start with the second one next time.