Don't have much time for Lactnet these days, but had to dash off a reply to this one.  People keep referring to Hartmann's research to validate keeping the baby on one side to prevent foremilk/hindmilk imbalance.  The research is much more complex than that and Peter Hartmann himself feels that this whole issue has been greatly misunderstood by many LCs.

Firstly, during the first few days there is no foremilk/hindmilk issue - there is colostrum which comes out rather slowly, compared to what will be coming a week or two later, and in relatively small amounts.  I have found that breast compression is easier than constant switching at this point and probably more effective as it does not disrupt a baby who is just learning to feed.  But telling a mom with a newborn to keep the baby on one side until he is done or the breast has been emptied is quite meaningless, especially for a primip.  How do you tell if the baby is done if he keeps falling asleep?  And how do you tell if a breast feels "empty" when it doesn't feel "full" in the first place?

Secondly, mothers with enough milk at one feeding to justify some concern about foremilk/hindmilk will not usually have to worry about switch nursing because the milk will be coming quickly enough anyways.  If there is only enough milk for a very short letdown period, then switching is not a problem and is probably going to help the mom to build up a better supply in both breasts.  Breast compressions can be used as well.

The concentration of fat in milk is related to several factors, most especially how empty the breast is.  The end of a feed on a very full breast may actually have less fat, by percentage, than the beginning of a feed on a relatively empty breast.  So if a mom is feeding freqently enough that her breasts are never becoming overly full, then the foremilk/hindmilk thing is not likely to be an issue - the percentage of fat in her milk is probably fairly stable throughout the feed.  Moms who only feed once every 3 or 4 hours may have some concern, but not necessarily.  I think that we have gone from one extreme to the other - from recommending ten minutes on a breast to only one breast at a feed.  Unless a baby is showing signs of a feeding problem - weight gain issues or GI problems - then I don't see any reason to even bring this issue up.  Moms are getting very uptight about the foremilk/hindmilk issue and they have no idea what it really means.  Just one more thing to worry about for no reason.

Looking forward to seeing you all in Florida.  Haven't been to the ILCA conference for a while as it always coincides with County Fair, which is a big deal for 4H groups.  Am trying to get my kids ready for fair (without me) and pack for my trip.  It is going to be a crazy week.



Warmly,
Sharon Knorr, BSMT, ASCP, IBCLC
Newark, NY (near Rochester on Lake Ontario)
mailto:[log in to unmask]

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