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Foremilk/hindmilk imbalance?

post #1 of 5
Thread Starter 
Does anyone have experience with this kind of problem?
Ds is a shallow latcher, I try so hard, but he just won't hold a good latch. I've seen an LC 2 times, and took him to my chiro who said that it wasn't an anatomical issue. So, I feed him one breast at a time for 4 hours and he still has green mucousy poop and very gassy. I don't think it's overactive letdown, b/c my milk never squirts and hardly ever leaks. So before I tried elimination diet, I fed him on one breast the whole day and pumped the other just to make sure, and he had yellow poop this morning and slept better last night than he had in a while. What I want to know is if anyone had a child refuse to latch correctly? Can I feed one breast per day without affecting my supply? My dh wants to supplement with formula b/c ds is gaining so slowly, and I really don't want to do that!
TIA
Heather
post #2 of 5
Here are my thoughts as someone who has dealt with oversuplly/imbalance for YEARS (I have breastfed 5 babies).

It does sound like foremilk imbalance with the green poo and gas. Also that it cleared up when you nursed from the same breast all day. Just because you don't have overactive letdown (milk spraying everywhere like a firehose) doesn't necessarily mean you don't have oversupply. The two are often connected, but not always.

Since nursing from one breast for more than four hurs DID help, I would suggest you continue to do that, and try NOT to pump too much from the other breast unless you need a freezer stash, or you want to donate. Pumping will increase your supply, and with oversupply you want to decrease it just a bit.

Another option to consider is milk allergy.
I know, it's not a nice thing to hear, but green stools CAN be part of a bigger picture that indicates milk protein allergy. I have 2 kids with milk protein allergies, so I've dealt with THAT can of worms a lot too.
IF the green stools are being caused even partly by milk protein sensitivity, giving him milk-based formula could be a DISASTER for his digestive system!

I'm not trying to tell you what to do, just offering thoughts based on my own experiences, but I STRONGLY urge you not to give him formula. Your milk is far better for him, and easier to digest. Some babies are slow to gain weight, as long as they ARE growing that is OK. Some babies are in the lower "percentiles" on the growth charts, well guess what? Some ADULTS are shorter/smaller than average, like me! All 5' of me!

I really think a few weeks off of dairy to see if that helps is a good idea. I know it's hard. I know! But we keep saying we'd do anything for our babies... here's our chance to prove it! When you think about it, which do you love more: cheese/milk? or your baby? Duh, no-brainer. That really helped me when I was feeling a martyr complex coming on about my dairy-free diet.

I hope your baby is feeling better soon!
Kathryn
post #3 of 5
I totally agree with Heather (Katiesmom). We struggled with a combination of Hindmilk - Foremilk imbalance, &/or Oversupply (without the overactive letdown), and Egg/Milk/Dairy Protein intolerance or allergy. To complicate things further there may have been some sort of secondary lactose intolerance (which is different than an intolerance or allergy to Dairy Protein). The secondary lactose intolerance may have been caused by antibiotics at birth disrupting the good bacteria in DD1's gut.

The fact that you had such a good result with one extended block feeding is a sign that you can get this under control but I think Heather is right and I wouldn't assume that there isn't a Dairy Protein intolerance or allergy. Therefore I suggest you consider an Egg/Dairy elimination diet and eliminate soy as well since a significant percentage of people that have a problem with dairy have a problem with soy as well. Also, you might want to eliminate beef, at least initially, since some people with a cow milk intolerance have a problem with beef as well. Fortunately I was able to eat beef.

If there is any sort of Dairy Intolerance / Allergy involved then any cow milk based formula would likely be a disaster and soy could easily be a problem too. Which only leaves some extremely expensive supposedly hypoallergenic formulas that some babies barely tolerate.

I was doing very extended block feedings (as long as 6 - 8 hours at one point). Fortunately I never had a problem with engorgement. I also did an Egg/Milk/Soy elimination diet but because DD1's intolerance was mild to moderate I didn't have to be too religious about hidden ingredients. Although you might need to be. I think Kellymom may have a list of hidden dairy to avoid (casein, whey, milk solids, etc.). Eventually I learned by accident that I could eat Mozzarella. Apparently some people who are dairy intolerant can eat certain hard cheeses (the type varies from person to person). I think I was ok with Provolone too but I was never certain with Swiss or Cheddar.

Regarding whether you can or should pump on the other side, I started pumping towards the end of my maternity leave. I can't say whether that made things better or worse but I do agree with the previous poster that (from everything I've read) that could aggravate oversupply if that is part of your problem.

At the time I was going through this I sought feedback here --and on another more mainstream board-- on whether decreasing my refined carb intake and increasing my fat intake (preferably healthy fat) might increase the amount of fat in my milk. The common wisdom is that you can affect the **quality** of the fat through your diet but not the **quantity**. If you search Kellymom you'll find that opinion there.

However, there is at least one Australian study that suggests you can control the amount of fat in your milk. I can't remember the specifics well but they put nursing Moms of colicky babies on a low refined carb, higher fat diet and they saw an improvement in the babies. Of course, there were a couple of assumptions here: 1) that the colic was due to some sort of sugar overload (whatever the cause) and that 2) the improvement was because the sugar to fat ratio in Mom's milk had been lowered.

I was somewhat disappointed in the moderator's of the more mainstream board that even after providing them with links to all the studies and data I could, that they would not even suggest to Moms with these issues that it couldn't hurt to increase their healthy fat intake, especially if they are one of those people who gravitate towards junky carbs while avoiding fat. They will freely agree that it couldn't hurt and yet they won't suggest it, I suspect because in their minds it creates one more burden of breastfeeding that might discourage Women. I would be glad to dig out the references to those studies although I don't know if any website links would still be good.

I would think this suggestion to lower highly refined carbs and increase (healthy) fat intake is especially important for women who may have little or no fat in their diet. If they suspect an Egg/Milk/Dairy intolerance or allergy and they eliminate those foods they inadvertently wind up on a very very low fat diet which --theoretically-- could aggravate any sugar overload issues their baby may have.

As far as any weight gain issue. I would think that as the amount of hind milk increases (through block feeding) that the ratio of protein and fat in your baby's diet would increase and that your baby's weight would increase accordingly. In the interest of full disclosure I seem to recall reading about one study that said that isn't the case.

One final thought. If you do wind up pumping for relief from engorgement and you don't have an immediate need for stored milk, you could try letting the milk sit in the fridge and skim the fat off of the top. You could then use the Hindmilk to supplement the beginning of a block feeding when your DS is getting the foremilk. If you are worried about Nipple Confusion (or flow preference) check out Kellymom for tips on how to feed Expressed Breast Milk (EBM) without using a bottle (cup feeding, finger feeding, dropper, etc.) You could freeze the low fat milk left after skimming and save it in case the sugar issue resolves and you think you might need it later.

Good luck. You have my heartfelt sympathies.
~Cath
post #4 of 5
Thread Starter 
Thanks, ladies!
Today is the second day of feeding on one breast, we'll see how it goes. If after Christmas he is still not better from the gas and green poop, I will eliminate dairy for a few weeks and see if that does the trick. Thanks for the suggestions, and he is NOT going to get formula! Dh is just getting worried, but he hasn't had much say in those kinds of decisions.
post #5 of 5
In the meanwhile you might want to try keeping a food diary. Some foods take longer to create a reaction than others so it can take awhile to detect a pattern.

I learned very early on that eggs were out. I had a couple of egg sandwiches one week and while the reaction wasn't immediate it was close enough in time that I stopped eating eggs. That was relatively easy.

I started cutting back on milk almost on more of a hunch, but I started getting some pressure from MIL (through DH): "you need to drink milk for calcium, blah, blah, blah". I got tired of listening to it so I drank one medium sized glass of milk (which isn't something I normally do) and within half an hour she was screaming and pooping. The poop was coming out so fast I wound up holding her over a waste basket for a couple of minutes til it was over.

I don't necessarily recommend that approach but it is a dramatic illustration of how a food diary can help, it just takes longer to detect a pattern.

By the way, I never heard the "you need milk" spiel again.

~Cath
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