After your breast milk has been in the refrigerator for awhile, you may have noticed that it separates, with the fattier milk rising to the top. This is totally normal and nothing to be concerned about. However, some women worry that they aren’t making enough of the fatty milk, and that they have something called a foremilk/hindmilk imbalance that is hurting their baby. Here’s how to know if you have one, and how to fix it.
What is foremilk and what is hindmilk?
Foremilk is the milk that flows out of your breasts at the beginning of a pumping session, while hindmilk is the milk from the end of a session.
What is the difference between the two? Because the fatty parts of breast milk stick together, and to the sides of your milk ducts, the milk that is released from your breasts first contains less fat and is more watery. Later, when the breast is more empty, more and more fat begins move out of the ducts and flow out of the breast.
Therefore, foremilk tends to have less fat than hindmilk, as the amount of fat in breast milk will gradually increase during a pumping session.
What is foremilk/hindmilk imbalance?
Foremilk/hindmilk imbalance can occur when a baby fills up pretty much exclusively on foremilk and doesn’t get much of the fatty hindmilk when he eats. This can result in the baby taking in too much lactose and not enough fat.
An imbalance can result in your baby becoming gassy, fussy, having colic symptoms, and having green poop.
What are the causes of foremilk/hindmilk imbalance?
In babies that nurse, this can happen if the baby is frequently switching breasts during a nursing session and gets foremilk from each side, but then they’re full so they don’t continue eating – therefore, they don’t get hindmilk from either breast.
This happens less frequently with exclusive pumpers, because you are feeding your baby a bottle with all of the foremilk and hindmilk mixed together, rather than foremilk first followed by hindmilk. However, many exclusive pumpers have written to me and said that they don’t feel like their milk has “enough” fat in it and they don’t see their milk separate much in the refrigerator.
When should you be concerned about an imbalance?
First, I wanted to note that many lactation consultants agree that foremilk/hindmilk imbalance is not very common. (This is a great piece on the subject.)
Parents often worry when they see that their baby has a green stool. However, foremilk/hindmilk imbalance isn’t the only cause of green stools: green poop can be the result of something you ate (green vegetables or something with food coloring), teething, a virus, or starting solids, for example.
My suggestion is to not be too anxious about green poop unless your baby’s poop is consistently green and he is very fussy. However, if this is the case – most dirty diapers are green over a day or two (and possibly “frothy“) and your baby is not a happy camper, there are some things you can do to try to fix it. (Note: You should call your pediatrician regarding any health concerns that you have for your baby.)
What should you do if you’re exclusively pumping and think you have a foremilk/hindmilk imbalance?
There are a few things that you can try.
- Pump for longer. If you are concerned that there isn’t much fat in your breastmilk, the way to increase it is to pump for longer so that you’re pumping when your breasts are emptier. (Remember, the emptier the breast, the fattier the breast milk.) So, you could try adding a few minutes to each session, or you could drop a session so that that you’re pumping less time but for longer. For example, if you’re doing 8 pumping sessions that are 15 minutes long, you could change your schedule so that you’re pumping 7 times per day for 20 minutes, and see if that helps. Also, you can try doing breast compressions to empty your breasts faster.
- Dump the first ounce. If you have an extreme oversupply (say, you’re pumping over 50-60 ounces per day), and you think you have too much foremilk, you can always bring a separate container with you when you sit down to pump. After you pump the first ounce, disconnect your bottles and pour the milk into the separate container. Then, reattach and keep pumping. If you want, you can freeze this milk and save it to mix with cereal, oatmeal, or purees when your baby is old enough for solids.
- Keep milk from pumping sessions together. Some moms pour everything they pump in a day into a pitcher, and then divide it out into bottles at the end of the day. That’s totally fine to do; however, if you’re having issues with too much foremilk, you can try keeping the milk that you pump from one session into one single bottle (and make sure that session is long enough that you’re getting hindmilk). This way, if you pump until you’re fairly empty, you know that you’re combined the foremilk and hindmilk from one session into the one feeding, and it should hopefully have the right amounts. It’s sort of like block feeding for pumping.
Have you dealt with foremilk/hindmilk imbalance? Or been worried about green poop? Tell us about it!
References- Bonyata, Kelly, IBCLC. “Foremilk and hindmilk – what does this mean?” https://kellymom.com/bf/got-milk/basics/foremilk-hindmilk/
- Breastfeeding Problems. “Foremilk Hindmilk Imbalance.” https://www.breastfeeding-problems.com/foremilk-hindmilk-imbalance.html
- Kellymom. “Mother-2-Mother Concerns: Green Stools.” https://kellymom.com/mother2mother/m2m-green-stools/
- Madden, Katie, RN, IBCLC. “‘The Good Milk’ Foremilk/Hindmilk.” https://balancedbreastfeeding.com/the-good-milk-foremilkhindmilk/
Hi!
Thank you for providing such helpful info! I was wondering, is it possible to have an imbalance without having an oversupply? I am currently pumping with a few nursing sessions during the day. I only manage to pump what he eats in a day so I don’t believe I have an oversupply. When I pump I only have a very thin layer of fat at the top (pumping for 20-25 min with hand expression).
Baby has been having watery green poops for a couple weeks now with a decent bit of gas. I’ve been to the doctor and stopped eating dairy/soy incase it’s caused by a sensitivity to that, but nothing is helping.
Hi Rita! I do think it’s possible without an oversupply. How many times a day are you pumping?
Hello,
My baby is very fussy/cholic. Her nappies have been grassy green the past day.
I produce a lot of milk, it goes all over the place, my daughter pulls her head back off my breast only minutes after starting a feed then cries and I struggle to get her to re latch and often she will only latch on the other breast visa versa.
She has a lot of wind, I’m doing my best to keep her upright after a feed and winding her.
she strains a lot before eventually passing wind, goes red in the face and is in obvious discomfort.
I took her for her 6 week check yesterday and the dr diagnosed an umbilical hernia, probably from draining to pass wind.
Could there be an imbalance?
Hi Bev! Congrats on your new baby! If she is switching breasts early on, I do think that could be an issue with an imbalance. I am not an expert in nursing, though, so you might want to see a lactation consultant for help!
My little one is 5 weeks old and I EP and top off with a bit of formula as my supply is low. His poop for the past few days has been green and watery and he is a bit fussy. I’m suspecting I have a case of milk imbalance. My milk separate as the image above. With 80% of the bottle being foremilk and 20% being thicker hindmilk. I am pumping 8 times a day, 15-20 each session. What can I do to regulate the ratio better??
Hi Nora! I think that is actually a pretty good ratio. Is it possible that he has a virus instead?
In the picture above, is that a good ratio? Should the foremilk/hindmilk be 50/50? Are there any good to eat that make more fattier milk or is it all really only related to how long/often you pump? Thank you for your dedication to the subject! You are helping so many, including myself!
Thanks so much Casey! That is probably a larger ratio than I have usually had. Just a small layer of fat is fine (and so is this)! I have heard that some foods can increase breastmilk fat but I don’t know that it’s supported by research (and the empty breast is). It wouldn’t hurt to try it! I hope that helps!
My boy is 5 weeks old and nursed for the first 3ish weeks but now I exclusively pump. His last couple of poops have been yellow but frothy/mucus-y. Is this a foremilk/hindmilk imbalance or maybe an allergy? He also drinks a few ounces of formula each day because I don’t produce enough just pumping. He’s very fussy and gassy and only poops once a day after massage and bicycle kicks and occasionally rectal stimulation.
I think it could be either an imbalance or an allergy – I’m so sorry I can’t answer this better. Do you notice a layer of fat on your refrigerated bottles? And how often do you pump and for how long?
Hi, I have a 6wk old and am EP. I pump about 5-6 times a day at 30mins each. I always see maybe about a half inch of hindmilk fatty layer on top and the rest is the foremilk! How can I resolve this? Also if I try to pump for longer sessions, say 40mins, will this mean my next pump session will have more hindmilk and less foremilk? I’m a bit confused as to why breasts should be fully empty- does this decrease foremilk in the sessions after?
Also, forgot to add, that I am already dumping the first few minutes of foremilk- the clear thin blue tinted milk. I always get at least 2oz of it from each breast!
Hi Jay! Congrats on your 6 week old! Is your baby having symptoms of imbalance? I just want to get the full picture.
Thank you!!! I noticed that she started getting greenish poop diapers yesterday…not so much frothy but they definitely look like avocado color…I have not eaten anything green recently. She does get gassy as well. Otherwise she is ok.
My son is 5 days old, I exclusively pumped every two hours for 20-30 minutes but decided that the exclusively pumping life isn’t ideal with a 2 year old so I tried to get my son to latch and he successfully does! But, I am producing way too much milk. Do I need to worry about losing my milk completely now that I’m on his feeding schedule and not a pumping one? He isn’t keeping up with my milk supply and I’m trying not to pump (unless my boobs are rock hard and I’m uncomfortable) then I only pump till the discomfort is gone. I want to be able to keep breast feeding but I am worried I’ll lose my milk completely?
Hi Alexis! I am not an expert on nursing but your supply is determined by how much milk is removed – so if your son is removing all the milk he needs at the breast, I think you should be fine to pump less or not at all. I don’t think you will lose your supply completely. You might want to talk to an IBCLC about how to make the transition to nursing (since that is not my area of expertise) – you might want to gradually decrease the amount you pump rather than stopping all at once, and she might have strategies for overactive letdown if that’s a problem? I hope this helps! 🙂
I’m pretty sure this is what I have. My milk separates very fast and usually in a 5 oz bottle here’s about a 1/2” of “watery” milk on the bottom. How can add more fat to my milk? I pump about 2-3 times a day and get about 10 oz each session.
Hi Brandi! How long do you pump usually? The best way is usually to pump longer. Though if you’re pumping 2-3x per day they are probably already pretty long?