Susan questioned whether there's there's such a thing as a foremilk/hindmilk imbalance.  Here's my image of it, based initially on an ILCA session by Michael Woolridge maybe 15 years ago, with additions pieced together rom this and that:

Michael showed us the varying fat levels within a feed, from milk siphoned off as the feed progressed - a series of vials each with a thicker and thicker layer of cream.  A clear increase in fat over time during a feed.  But he also studied women in, um, somewhere in Asia I think, who nursed without restriction.  They would have no such variation in fat, he said, because they nursed frequently.

Why would that make a difference?  I picture the fat in our milk as sticking to the alveoli, just as cream might stick to a sponge (and I don't remember who I got this from).  Squeeze the sponge lightly and the lower fat milk runs out.  Keep squeezing, and the more reluctant fat eventually gets squeezed out as well.  Ah, but then the baby stops!  There's higher fat milk that's left kind of swirling around just inside the nipple, with nowhere left to go but back up into the ducts (a matter of gravity I suppose?) as the milk begins to separate again.  Give it enough time, and it retreats high enough into the breast that it has to be pulled down at the next feed after a considerable amount of foremilk has been swallowed.  Ah, but if the baby starts to nurse again fairly soon after having stopped, that swirling-around-inside milk hasn't had time to separate.  The fat content pretty much picks up where it left off - fairly high and fairly uniform throughout the feed.  That foremilk-hindmilk pattern that Michael illustrated so well is simply an artifact of artificially-stretched feedings.

At least that's the image I have in my mind.

Diane Wiessinger, MS, IBCLC  Ithaca, NY  USA
www.wiessinger.baka.com

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