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Switching sides question.

Posted by on May. 4, 2013 at 6:47 AM
  • 8 Replies
DD is 1 month old.

For the past week, I've been pumping on one side while she nurses on the other during her first feeding of the day...normal day hours. I did the same with my last daughter to build a freezer stash before returning to work.

I think I may have OAL. I don't think I have an oversupply, but I have way more milk than she needs in the morning. She goes longer stretches. Last night was 4 hours & then 3 hours.

Well, today I'm set to pump on the right side. She just ate off the right side. Perfect right? Maybe. I had a TON of milk on the right side (I was engorged even), so I know she mostly got foremilk. I still have a ton of milk on that side & she's done eating.

So, do I put her back on the right side at her next feeding & pump the left or do I go ahead & pump the right & let her nurse on the left?

ETA: my right side always produces way more milk. That's been the case with each baby.
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by on May. 4, 2013 at 6:47 AM
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K8wizzo
by Kate on May. 4, 2013 at 7:24 AM

First, stop pumping at every feeding.  Pump once in the morning, both sides, and then put the pump away for the day.  You are creating an oversupply problem by pumping so much.

Second, don't worry so much about foremilk vs. hindmilk--it's a gradual changeover during a feeding, not a magical switch that flips on at the end.  Put her on the right, next feeding on the left, and NO MORE PUMPING except for that once a day in the morning.

Foremilk and Hindmilk: In Quest of an Elusive Arbitrary Switch.

Over the course of her breastfeeding journey, it is almost inevitable that a mother will encounter the terms "foremilk" and "hindmilk". There is certainly no shortage of confusing and conflicting advice on the concept, which has led to a lot of misunderstanding.


What do the terms "foremilk" and "hindmilk" mean?

In The Breastfeeding Answer Book, "foremilk" and "hindmilk" were defined as follows:
  • "Foremilk" is the milk the baby receives when he begins breastfeeding, which is high in volume but low in fat (1).
  • "Hindmilk" is the milk near the end of the feeding, which is low in volume but high in fat (1).
Actually, the terms "foremilk" and "hindmilk" only really refer to samples of breastmilk taken right at the beginning of a feed ("foremilk") and samples of breastmilk taken right at the end of a feed ("hindmilk"). Even then, the advantage of using these terms is debatable.


Why?


A photo on Wikipedia "helpfully" shows two 25ml samples of human breastmilk: "foremilk" on the left and "hindmilk" on the right:


The problem with showing a sample of breastmilk from the start of a feed together with a sample of breastmilk from the end of a feed is that it tells us nothing about what happens to the breastmilk in between the two samples. Mothers end up mistakenly believing that their breasts make two different types of milk, and wonder how long they must feed for before the "foremilk" magically switches over into "hindmilk" (2).




So if the terms "foremilk" and "hindmilk" are misleading and there's no "magic switch" from one to the other, what really happens?

Since The Breastfeeding Answer Book was published in 2003, research in human lactation has advanced (2), so we now understand more about how breastmilk is produced:

Your breasts make just ONE type of milk


There is no magic switch between two different types of milk over the course of a feed. In fact, there is no sharp distinction between breastmilk at the start of a feed and breastmilk at the end of a feed (3). "Milk does indeed change consistency during a feed - but this happens gradually rather than suddenly" (4).




Why does the consistency of breastmilk change over the course of a feed?


The answer lies in what happens to the fat in breastmilk when breastmilk is
  • produced:
Your breasts are continuously making just one type of milk, containing 'sticky' fat globules that tend to stick to each other and to the milk ducts in the breast as breastmilk is produced (2,3,5).
  • stored in the breast:
Breastmilk produced between feeds moves down towards the nipple and collects in the breast, leaving increasing amounts of fat globules 'stuck' together further up the milk ducts (3).
  • and emptied from the breast:
When let-down occurs, the milk ducts dilate (5) and the milk is ejected from the breast. The milk removed at the beginning of a feed may be lower in fat because the fat globules are still 'stuck' further up in the milk ducts (6). As the feed progresses, multiple milk ejections occur (5) and the breast is emptied, more and more fat globules become dislodged and the breastmilk increases in fat (3,6). This has the overall effect of a gradual increase in fat content of breastmilk in each breast independently as milk is removed.




How do we know that the increase in fat is gradual?


Studies involving several mothers have been conducted in which samples of breastmilk were taken at intervals over the course of a feed. The evidence from these studies suggests that the fat content of breastmilk increases gradually as the breast becomes progressively emptier over the course of a feed (7,8).

It's much easier to explain this gradual increase in fat content using pictures...

...so, revealing the crazy lengths I'm prepared to go to so I can prove a point, I visited The Countess of Chester Hospital, where several wonderful people enabled me to take consecutive small samples of breastmilk from one breast only over the course of one pumping session, and professionally photograph the results. The samples were then taken to the Cheshire and North Wales Human Milk Bank, where the fat content of each sample was analysed.


This is the snapshot we got of the gradual increase in fat content of my milk over the course of one pumping session:

A snapshot of my breastmilk:
At the time the samples were taken, I was tandem feeding. My youngest baby was just over 8 months old, had started baby-led-weaning, and was still about 90% breastfed.
Each test tube contains around 6ml of breastmilk.
Note the gradual colour change of each breastmilk sample. This is the gradual increase in fat content from the beginning of a feed (test tube 1) to the end of a feed (test tube 12).


Remove test tubes 2-11, and the result is a picture similar to the one on Wikipedia:



This shows a sharp contrast between the breastmilk at the very beginning and the breastmilk at thevery end of a feed only - it tells us nothing about what happens to the breastmilk in between the two samples. Only the photo containing all 12 test tubes shows the complete picture: a gradualincrease in fat content.




So what's that stuff that rises to the top of expressed breastmilk?


When breastmilk is left to stand for a while, it separates into two layers. This isn't the separation of "foremilk" from "hindmilk"; it is simply the fat in the milk rising to the top, not the separation of two different kinds of milk (4).


The reason this separation doesn't occur in a bottle of cow's or goat's milk you buy in a shop is that this milk has been homogenised.


"Whole homogenised milk is identical in fat and nutrient content to whole standardised milk however it has undergone a process known as "homogenisation" which breaks up the fat globules in the milk. This spreads the fat evenly throughout the milk and prevents a creamy layer forming at the top." (9)






After a while, the breastmilk in our test tubes separated into two layers (click on the image to open a larger version in a new window):




Note that the breastmilk in test tube 1 does, in fact, contain a layer of fat.


Note also the increasing thickness of the fatty layer that collects at the top of the breastmilk from test tubes 1-12. This further demonstrates a gradual increase in fat content from the beginning of a feed (test tube 1) to the end of a feed (test tube 12).


Again, removing test tubes 2-11 shows only a sharp contrast between the thin fatty layer that rises to the top of the breastmilk at the very beginning, and the much thicker fatty layer that rises to the top of the breastmilk at the very end of a feed.




This photo tells us nothing about what happens to the breastmilk in between the two samples.Remember: only the photo containing all 12 test tubes shows the complete picture: a gradual increase in fat content.




Showing us pretty pictures is nice, but how much fat did the breastmilk samples actually contain?


Before I continue, I must stress that this is just a snapshot of my breastmilk. It is unlikely that the results shown here will be an exact reflection of what happens to every mother's breastmilk. However, it does provide a rough idea of what happens, so here are the results of the analysis of each sample of my breastmilk:




TS = Total Solids, ie. the bulk of the rest of the milk
Protein, carbohydrate, fat and TS values are in grammes per 100ml


If looking at raw data isn't your thing, here's a line graph showing the amount of protein, fat, carbohydrates and total solids present in each of my 12 breastmilk samples (fat content is shown in red).




The graph clearly shows there was a gradual (if slightly wobbly) increase in fat content as the breast is emptied. Quite plainly, there is no arbitrary "magic switch" between two different types of breastmilk during a feed.




Remember, though, that all of this is just a tiny piece in a vast breastfeeding jigsaw...



Although it is true that the fat content does gradually increase as the breast is emptied, it is important to understand that the difference in fat content between milk at the beginning of a feed and milk at the end of a feed can vary greatly from mother to mother. Not only this, but it can vary greatly over a 24 hour period, even among individual mothers (2). The difference in fat content can also depend to some degree on the amount of time elapsed between each feed (this is truer the younger the baby is) - another reason why it might not be a good idea to wait for your breasts to "fill up" before a feed.


The fuller the breast,

  • the lower the fat content of the milk
  • the greater the difference in fat content between the breastmilk at the beginning and end of a feed (2,3)

The emptier the breast,
  • the higher the fat content of the milk
  • the lower the difference in fat content between the breastmilk at the beginning and end of a feed (2,3)

This is not simply a case of the longer the feed, the higher the fat content: if there is a shorter gap between feeds (such as during periods of cluster feeding), the milk at the beginning of a feed may not necessarily be low in fat (2,10).

"Babies can show a wide variety of feeding patterns, suckling for varying lengths of time and at varying intervals over the course of a day, and maintain a healthy weight" (4,10)



Whilst fat is important, we can and do get far to preoccupied with the issue of fat content - take another look at the graph showing the amount of protein, fat, carbohydrates and total solids present in each of my 12 breastmilk samples:


Did you spot the line labelled 'TS' (Total Solids)? That line represents all the other components of breastmilk which are important too!


The most important thing to remember is this:

In the vast majority of cases, as long as you are:


  • breastfeeding on cue
  • and allowing your baby to come away from the breast spontaneously at the end of a feed,
there is no need to worry about what's in the breastmilk your baby is getting. ALL of the components of breastmilk are essential for the growth and the physical and mental development of your baby, not just its fat content.
lillybug222
by Bronze Member on May. 4, 2013 at 9:44 AM
Thank you for this information. I thought I was clear in my post. I only pump once a day. In the morning. On one side as she nurses on the other. I have zero desire to pump more than that & this will build an adequate amount before I go back to work.

This is my third baby, so I'm comfortable nursing & know when/how to pump. I simply questioned switching sides because this is my first baby who has gained weight rapidly which concerns me. Perhaps it shouldn't, but it does.


Quoting K8wizzo:

First, stop pumping at every feeding.  Pump once in the morning, both sides, and then put the pump away for the day.  You are creating an oversupply problem by pumping so much.

Second, don't worry so much about foremilk vs. hindmilk--it's a gradual changeover during a feeding, not a magical switch that flips on at the end.  Put her on the right, next feeding on the left, and NO MORE PUMPING except for that once a day in the morning.

Foremilk and Hindmilk: In Quest of an Elusive Arbitrary Switch.

Over the course of her breastfeeding journey, it is almost inevitable that a mother will encounter the terms "foremilk" and "hindmilk". There is certainly no shortage of confusing and conflicting advice on the concept, which has led to a lot of misunderstanding.


What do the terms "foremilk" and "hindmilk" mean?

In The Breastfeeding Answer Book, "foremilk" and "hindmilk" were defined as follows:
  • "Foremilk" is the milk the baby receives when he begins breastfeeding, which is high in volume but low in fat (1).
  • "Hindmilk" is the milk near the end of the feeding, which is low in volume but high in fat (1).
Actually, the terms "foremilk" and "hindmilk" only really refer to samples of breastmilk taken right at the beginning of a feed ("foremilk") and samples of breastmilk taken right at the end of a feed ("hindmilk"). Even then, the advantage of using these terms is debatable.


Why?


A photo on Wikipedia "helpfully" shows two 25ml samples of human breastmilk: "foremilk" on the left and "hindmilk" on the right:


The problem with showing a sample of breastmilk from the start of a feed together with a sample of breastmilk from the end of a feed is that it tells us nothing about what happens to the breastmilk in between the two samples. Mothers end up mistakenly believing that their breasts make two different types of milk, and wonder how long they must feed for before the "foremilk" magically switches over into "hindmilk" (2).




So if the terms "foremilk" and "hindmilk" are misleading and there's no "magic switch" from one to the other, what really happens?

Since The Breastfeeding Answer Book was published in 2003, research in human lactation has advanced (2), so we now understand more about how breastmilk is produced:

Your breasts make just ONE type of milk


There is no magic switch between two different types of milk over the course of a feed. In fact, there is no sharp distinction between breastmilk at the start of a feed and breastmilk at the end of a feed (3). "Milk does indeed change consistency during a feed - but this happens gradually rather than suddenly" (4).




Why does the consistency of breastmilk change over the course of a feed?


The answer lies in what happens to the fat in breastmilk when breastmilk is
  • produced:
Your breasts are continuously making just one type of milk, containing 'sticky' fat globules that tend to stick to each other and to the milk ducts in the breast as breastmilk is produced (2,3,5).
  • stored in the breast:
Breastmilk produced between feeds moves down towards the nipple and collects in the breast, leaving increasing amounts of fat globules 'stuck' together further up the milk ducts (3).
  • and emptied from the breast:
When let-down occurs, the milk ducts dilate (5) and the milk is ejected from the breast. The milk removed at the beginning of a feed may be lower in fat because the fat globules are still 'stuck' further up in the milk ducts (6). As the feed progresses, multiple milk ejections occur (5) and the breast is emptied, more and more fat globules become dislodged and the breastmilk increases in fat (3,6). This has the overall effect of a gradual increase in fat content of breastmilk in each breast independently as milk is removed.




How do we know that the increase in fat is gradual?


Studies involving several mothers have been conducted in which samples of breastmilk were taken at intervals over the course of a feed. The evidence from these studies suggests that the fat content of breastmilk increases gradually as the breast becomes progressively emptier over the course of a feed (7,8).

It's much easier to explain this gradual increase in fat content using pictures...

...so, revealing the crazy lengths I'm prepared to go to so I can prove a point, I visited The Countess of Chester Hospital, where several wonderful people enabled me to take consecutive small samples of breastmilk from one breast only over the course of one pumping session, and professionally photograph the results. The samples were then taken to the Cheshire and North Wales Human Milk Bank, where the fat content of each sample was analysed.


This is the snapshot we got of the gradual increase in fat content of my milk over the course of one pumping session:

A snapshot of my breastmilk:
At the time the samples were taken, I was tandem feeding. My youngest baby was just over 8 months old, had started baby-led-weaning, and was still about 90% breastfed.
Each test tube contains around 6ml of breastmilk.
Note the gradual colour change of each breastmilk sample. This is the gradual increase in fat content from the beginning of a feed (test tube 1) to the end of a feed (test tube 12).


Remove test tubes 2-11, and the result is a picture similar to the one on Wikipedia:



This shows a sharp contrast between the breastmilk at the very beginning and the breastmilk at thevery end of a feed only - it tells us nothing about what happens to the breastmilk in between the two samples. Only the photo containing all 12 test tubes shows the complete picture: a gradualincrease in fat content.




So what's that stuff that rises to the top of expressed breastmilk?


When breastmilk is left to stand for a while, it separates into two layers. This isn't the separation of "foremilk" from "hindmilk"; it is simply the fat in the milk rising to the top, not the separation of two different kinds of milk (4).


The reason this separation doesn't occur in a bottle of cow's or goat's milk you buy in a shop is that this milk has been homogenised.


"Whole homogenised milk is identical in fat and nutrient content to whole standardised milk however it has undergone a process known as "homogenisation" which breaks up the fat globules in the milk. This spreads the fat evenly throughout the milk and prevents a creamy layer forming at the top." (9)






After a while, the breastmilk in our test tubes separated into two layers (click on the image to open a larger version in a new window):




Note that the breastmilk in test tube 1 does, in fact, contain a layer of fat.


Note also the increasing thickness of the fatty layer that collects at the top of the breastmilk from test tubes 1-12. This further demonstrates a gradual increase in fat content from the beginning of a feed (test tube 1) to the end of a feed (test tube 12).


Again, removing test tubes 2-11 shows only a sharp contrast between the thin fatty layer that rises to the top of the breastmilk at the very beginning, and the much thicker fatty layer that rises to the top of the breastmilk at the very end of a feed.




This photo tells us nothing about what happens to the breastmilk in between the two samples.Remember: only the photo containing all 12 test tubes shows the complete picture: a gradual increase in fat content.




Showing us pretty pictures is nice, but how much fat did the breastmilk samples actually contain?


Before I continue, I must stress that this is just a snapshot of my breastmilk. It is unlikely that the results shown here will be an exact reflection of what happens to every mother's breastmilk. However, it does provide a rough idea of what happens, so here are the results of the analysis of each sample of my breastmilk:




TS = Total Solids, ie. the bulk of the rest of the milk
Protein, carbohydrate, fat and TS values are in grammes per 100ml


If looking at raw data isn't your thing, here's a line graph showing the amount of protein, fat, carbohydrates and total solids present in each of my 12 breastmilk samples (fat content is shown in red).




The graph clearly shows there was a gradual (if slightly wobbly) increase in fat content as the breast is emptied. Quite plainly, there is no arbitrary "magic switch" between two different types of breastmilk during a feed.




Remember, though, that all of this is just a tiny piece in a vast breastfeeding jigsaw...



Although it is true that the fat content does gradually increase as the breast is emptied, it is important to understand that the difference in fat content between milk at the beginning of a feed and milk at the end of a feed can vary greatly from mother to mother. Not only this, but it can vary greatly over a 24 hour period, even among individual mothers (2). The difference in fat content can also depend to some degree on the amount of time elapsed between each feed (this is truer the younger the baby is) - another reason why it might not be a good idea to wait for your breasts to "fill up" before a feed.


The fuller the breast,

  • the lower the fat content of the milk
  • the greater the difference in fat content between the breastmilk at the beginning and end of a feed (2,3)

The emptier the breast,
  • the higher the fat content of the milk
  • the lower the difference in fat content between the breastmilk at the beginning and end of a feed (2,3)

This is not simply a case of the longer the feed, the higher the fat content: if there is a shorter gap between feeds (such as during periods of cluster feeding), the milk at the beginning of a feed may not necessarily be low in fat (2,10).

"Babies can show a wide variety of feeding patterns, suckling for varying lengths of time and at varying intervals over the course of a day, and maintain a healthy weight" (4,10)



Whilst fat is important, we can and do get far to preoccupied with the issue of fat content - take another look at the graph showing the amount of protein, fat, carbohydrates and total solids present in each of my 12 breastmilk samples:


Did you spot the line labelled 'TS' (Total Solids)? That line represents all the other components of breastmilk which are important too!


The most important thing to remember is this:

In the vast majority of cases, as long as you are:


  • breastfeeding on cue
  • and allowing your baby to come away from the breast spontaneously at the end of a feed,
there is no need to worry about what's in the breastmilk your baby is getting. ALL of the components of breastmilk are essential for the growth and the physical and mental development of your baby, not just its fat content.

Posted on CafeMom Mobile
Ilaynasmommy
by on May. 4, 2013 at 10:14 AM
Thank you tor posting. I also wondered about hindmilk and foremilk.
Posted on CafeMom Mobile
aehanrahan
by Group Mod - Amy on May. 4, 2013 at 12:47 PM
The rapid weight gain indicates oversupply. I suggest block feeding. Don't switch sides every feeding.
Posted on CafeMom Mobile
lillybug222
by Bronze Member on May. 4, 2013 at 12:54 PM
My fear with block feeding is that my right side already produces wayyyy more than my left side. Always has. I don't want to produce even less on my left side. I do block feed if she eats for a short amount of time on one side. Otherwise, I switch her with each feeding. 9/10 she only eats on one side--she nurses on that side 15-30 minutes & is done. I'm not forcing her to switch to the other side. Throughout the day I am not engorged & I do not feel full. It's mostly in the middle of the night/first thing in the morning.


Quoting aehanrahan:

The rapid weight gain indicates oversupply. I suggest block feeding. Don't switch sides every feeding.

Posted on CafeMom Mobile
K8wizzo
by Kate on May. 4, 2013 at 1:32 PM

I wouldn't worry about it then.  Your supply will regulate over time.  No worries.

Quoting lillybug222:

My fear with block feeding is that my right side already produces wayyyy more than my left side. Always has. I don't want to produce even less on my left side. I do block feed if she eats for a short amount of time on one side. Otherwise, I switch her with each feeding. 9/10 she only eats on one side--she nurses on that side 15-30 minutes & is done. I'm not forcing her to switch to the other side. Throughout the day I am not engorged & I do not feel full. It's mostly in the middle of the night/first thing in the morning.


Quoting aehanrahan:

The rapid weight gain indicates oversupply. I suggest block feeding. Don't switch sides every feeding.


gdiamante
by Group Mod - Gina on May. 4, 2013 at 2:02 PM


Quoting lillybug222:

My fear with block feeding is that my right side already produces wayyyy more than my left side. Always has. I don't want to produce even less on my left side.
You will over time no matter what. To your original question, NO wrong answer. Do whatever you feel more confortable doing.
I do block feed if she eats for a short amount of time on one side. Otherwise, I switch her with each feeding. 9/10 she only eats on one side--she nurses on that side 15-30 minutes & is done. I'm not forcing her to switch to the other side. Throughout the day I am not engorged & I do not feel full. It's mostly in the middle of the night/first thing in the morning.
Then don't change anything. It's only one month and things will even out.
aehanrahan
by Group Mod - Amy on May. 4, 2013 at 11:17 PM
You can nurse more on the left side than the right to try to even it out a bit. Like maybe two feedings on the left and only one on the right.
Your supply will adjust with just one side per feeding and switching each time. That's what I did with my second


Quoting lillybug222:

My fear with block feeding is that my right side already produces wayyyy more than my left side. Always has. I don't want to produce even less on my left side. I do block feed if she eats for a short amount of time on one side. Otherwise, I switch her with each feeding. 9/10 she only eats on one side--she nurses on that side 15-30 minutes & is done. I'm not forcing her to switch to the other side. Throughout the day I am not engorged & I do not feel full. It's mostly in the middle of the night/first thing in the morning.




Quoting aehanrahan:

The rapid weight gain indicates oversupply. I suggest block feeding. Don't switch sides every feeding.

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