Zena writes:

at the  clc conference that I attended last spring.  There was info.  about
there not being such things as hindmilk or foremilk.  I am just  trying to
understand this better.  Any comments or sites with this  information?
My main question is "what about foremilk inbalance,  then?"
I heard Peter Hartmann say this last year in New Mexico and again this year
in Vermont.
He queried, "When does foremilk end and hindmilk begin?"
Because we know that fat content is so variable from feed to feed and that
sometimes the first milk received from the breast might have a good deal of fat
 in it, we can't apply the concept of foremilk to every feed.
I don't think this means that the foremilk imbalance is an incorrect
concept.  When the breast is very full with lots of stored milk that's  accumulated
over a longer time after a feeding, the first milk received is less  creamy.
If our breasts work anything like those of mice, there are  electron
micrographs of mouse alveolar epithelial cells that show the fat  globules clinging to
the cell before a let-down, and then little craters marking  the spot where the
globule emerged onto the cell membrane surface after the  let-down when the
milk fat globule has become loose.  (I think I have these  filed -- from
something I came across in the early 90s.)
Also in the ultrasound studies Peter H. and his lab does of the breast it  is
the human milk fat globules that are large enough to show up on ultrasound
studies that are moving forward toward the nipple during a let-down, and then
in  the unused breast streaming back up into the breast (when the milk as
nowhere to  go i.e., no baby drinking it).
From this evidence I would imagine that in the fuller breast the first milk
obtainable has less cream in it until the fat mixes in more with the milk
already in the ductules near the nipple.
Mardrey Swenson, IBCLC

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