I've just visited the LLL website posted by Karen on stooling
patterns.  http://www.lalecheleague.org/llleaderweb/LV/LVDecJan98p123.html
While it is a beautifully written, very informative and very useful paper
it was published back in 1997 and research has changed what we now know
about the relationship between foremilk and hindmilk, hence some of the
statements and advice in this paper are now known to be incorrect.
The only difference between foremilk and hindmilk is in fat content.  Fat
content is directly related to degree of breast fullness, and increases in
a linear fashion.  It is not possible to tell when foremilk stops and
hindmilk starts.  In a woman with a large breastmilk capacity, the first
feed of the day will start with very low fat content (the foremilk) and
finish with marginally higher fat content (hindmilk).  By the last feed
late that evening when her baby has decreased the milk in that breast
considerably, the milk at the beginning of that feed may have substantially
more fat in it than the milk at the end of the feed in the morning.  Using
the terms foremilk and hindmilk should be done with reservation and care to
prevent confusion.

A baby who is receiving insufficient "hindmilk" but is well hydrated,. ie
lots of low fat milk because mother has an ample supply, is usually the
baby who stools very frequently with large, frothy, explosive stools,
sometimes a shade of green.

Also advice that all mothers should be feeding 10 to 12 times in 24 hours
is just as erroneous as saying they should all be feeding 4-hourly.  All
babies are different, but even more important, all mothers and their breast
capacities are different.  I'm sure we all know of babies who are
beautiful, chubby thriving babies who only breastfeed 5 or 6 times a day.

And just an anecdote to add to this:  a colleague who was unable to
breastfeed directly at the breast chose to express her milk for her
baby.  She expressed twice a day for 6 months and obtained more milk than
the infant could consume.  She had a fantastic capacity!!  While I wouldn't
advise a new mother to start with this pattern I think we still need to be
aware of the individuality of all mothers.

Denise

*************************************************
Denise Fisher MMP, BN, IBCLC
BreastEd Online Lactation Studies
http://www.health-e-learning.com

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