OK.  I'm going to address the problems I see with "blocked feedings".  I see mothers whose babies get used to the higher force of fuller breasts.  As milk production decreases because of block feedings, and babies get older, they may refuse to nurse on both breasts even when production has decreased, thus sending production into a lower range.  On the weight scale, babies go from high weight gain to lower weight gain, etc.  I would rather see a mom hand-express a fair amount, recline to feed with baby above and leave some milk in the first breast, repeat the process on the second breast to reduce supply.  I know there's differences of opinion but milk storage capacity varies and is a factor in this situation and needs to be taken into account as well as baby's oral anatomy and other factors.  The lactose overload theory has been jumped on by formula companies and used to market formula to these moms as being the solution.  Why bother breastfeeding when there is a wonderful product for only $300 a month? (tongue firmly in cheek)

-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Ingrid
Sent: Friday, August 17, 2012 9:59 AM
Subject: Re: green poop

I'm surprised to hear people on this list still talking about foremilk/hindmilk 'imbalance' - the following is an excellent explanation of what's actually going on, stolen in part from (I think) Sandra Yates:

Undigested lactose in the gut can lead to bloating, pain, gas, flatulence, pain, and watery, explosive (sometimes green and mucousy) stools.

The biggest factor in digestion of lactose is the level of fat received by the baby.  Fat levels in any one feeding are largely related to how long it's been since the last feeding (shorter intervals = higher relative fat
content) and how well a breast is drained ('empty' breast = high fat, full breast = low fat). 

We don't make two kinds of milk (even though people refer to foremilk and
hindmilk) - as milk is produced in the breast, the fat globules in the milk tend to stick to each other and to the walls of the alveoli (where the milk is made).  Between feedings, milk collects in our breasts and gradually moves out towards the nipple, leaving more and more of the fat "stuck"
further back in the milk ducts.  The more time between feedings, the lower the fat content of the milk easily available to the baby at the beginning of the feeding.

Once let down is triggered, milk is squeezed down the ducts until it becomes accessible to the baby.  Milk production is not faster during let down - the flow is simply faster.  There are several let downs per feeding, even though most of us only feel the first one.  (Milk Ejection Reflex/MER)

As the breast starts to empty, the fat globules begin to dislodge and move down the ducts (let down facilitates this process).  So further into each feeding, the higher the fat content of the milk, as more and more fat globules are forced out.  The end result is that milk gradually increases in fat as the feeding progresses.

Think of each nursing session as being like turning on a faucet.  The first water you get out of the tap is usually cold.  As the water runs, it gradually gets warmer and warmer and warmer.  This is what happens with the fat content in milk, gradually increasing in fat content throughout the feeding.  

If there is a long period of time before the faucet is used again, then you go through the cold-to-hot process once more, but if you turn the water on fairly soon after it was used, the water is either pretty warm or still hot, depending upon how long it's been since the faucet was last on.

This is how it works with milk as well - the longer the time between feedings, the lower the fat content at the beginning of the next feeding.
If feedings are closer together, you're starting off with a higher fat content.

Letting the baby decide when to come off the first breast helps ensure that each breast is drained as well as possible, and that the baby has received as much fat as is available from each 'serving'.  In some cases, block feeding (using only one breast for a period of time, ranging from 3 hours to
12 hours depending on the mom) is needed to slow down milk production.

Ingrid
LLLC Leader, IBCLC

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