Day 12: The Art of Breastfeeding and Avoiding Foremilk / Hindmilk Imbalance

Today is a rainy day and the little guy is taking what I hope will be a little longer afternoon nap.  I talked on the phone today with a good friend of mine who is eagerly anticipating the birth of their baby, and that led into a very short “dude talk” about breastfeeding.  I realized maybe it would be good for other guys (or maybe not only the guys) if I wrote about it here.

Having a baby in Sweden, there is a lot of social pressure to breastfeed.  There are many classes you can and should attend before having the baby, and one was all about breastfeeding.  In this class, they essentially told us that the baby will just naturally find their way to the breast as soon as they are born and are placed on the mother’s chest.  They also told us it was all very natural/instinctual and basically eluded to the idea that breastfeeding is so natural and easy, it will be a lovely experience.  This might be true for some dream parents (those are the same parents whose newborn baby never cries and sleeps thru the night from day one), but this was not the case for us.  It was difficult.  Stressful.  Painful.  Emotionally draining.  And that’s just how I felt – I know that for the baby and my wife it was even more intense.

We had our baby at SÖS (Stockholm Söder Sjukhuset), and the birth itself was quite traumatic (I might share about that at some other point), and then afterwards we were brought to the gorgeous BB Hotel (awesome views of the archipelago, nice food, nice and fresh rooms).  It was all so sudden – it was like 2 hours after he was born, and we were saying, “What do we do now?”  A midwife did a quick checkup and when we asked about breastfeeding, they told us to change to the channel on the tv that shows you how to do it.  We did that, and all it did was show us propaganda about how great it is to breastfeed (we were thinking, “ok, we know how great it is, but what exactly do we do to make sure we are doing it correctly?”).  In other words, nothing on the TV about how exactly to do it and what kinds of things to look out for.  So we tried, and the baby seemed to eat a little, and then fell asleep, and this would happen every time we tried.

We asked midwife after midwife to show us how to breastfeed (every time they came to check), and they would just give us a general “ah, you can do this or that”, but it was all very non-committal.  Like when you ask someone about the different neighborhoods when you are moving to a new city.  We even called them and asked multiple times for someone to show us because we did not feel it was working right – and nobody would come.  Finally, after 1 full day of asking for them to show us how, a more “senior level” midwife was doing a routine room visit and noticed the baby was a little “sluggish”.  The midwife said, “no, he is not eating right, let me show you.”  So here are some steps to follow based on that instruction:

How to breastfeed a newborn baby:

  1. For the first few times, squeeze a little breast milk out to get them to show interest in the nipple – it tastes sweet and they will like the flavor, but they need to know where it comes from.
    1. you can also do this onto a spoon, to give them a taste, and to get them more interested in having more (it’s like giving them an appetizer)
  2. The baby will be lying down in the mother’s arms, but basically their nose needs to be at the nipple, and when they open their mouth this will bring their chin upward/forward and make it so the milk goes down the throat easier – if the nipple is not a “reach” for them, then the “line-up” of the mouth and nipple is not working as efficiently as it could
  3. The baby will open their mouth, and often it will not be open wide enough.  If the baby is not opening BIG, they need to be pulled a little away from the nipple, and then they need to try again.  Basically the baby must, as the nurse said “gapa stort!” (open wide!)
  4. In that moment that they have their mouth open wide, you need to pull the baby’s head onto your breast all the way – the mom does this by putting her hand between the baby’s shoulder blades and pulling the baby towards her breast – the baby must essentially have their mouth as wide over the breast as they can with the nipple basically at the back of the mouth (they breathe thru the nose, don’t worry) 😉
  5. The baby should then be switched when the breast is no longer giving them milk – which could be after 10 minutes, 15 minutes, 20 minutes – just depends on the mother and the baby (more on the timeline further below)

How do you know if the baby is not latched on correctly?

  • If you can see the nipple, you should probably try again because the baby is probably not latched on, which would lead to pain for the mother
  • Nipple shape – if it is squished instead of rounded (in other words smashed instead of looking like a version of a new eraser on a wood pencil), that means the nipple is not back far enough in the baby’s throat – again, it will lead to pain for the mother
  • Pain – if it is really painful, it is not right (makes sense, right?)
    • This would include pain after the feeding, too
Note where the nipple is - waaaay back in the throat.  So if you can see the nipple when they are eating, they need to open wider.
Note where the nipple is – waaaay back there.  image from http://www.privatehealthvisitor.com/blog/breast-feeding/breastfeeding-making-it-work/

When do you switch breasts?

There are a lot of opinions on this one.  The midwife who taught us how to breastfeed told us to feed from 1 side for 10-15 minutes and then switch sides.  Our little guy was falling asleep after 10 minutes of eating, so we had a lot of trouble with this.  What eventually ended up happening was he was eating for 10 minutes from 1 side, then 10 minutes from the other, and then he was falling asleep.  The problem with is is that my wife’s breasts still had milk in them.  You might not think this is a problem, but actually it is a huge problem, and here’s why:

Foremilk / Hindmilk Imbalance and Lactose Overload:

Breastmilk is made up of 2 kinds of milk: Foremilk and Hindmilk.  The way it works is basically the foremilk is sweeter, and it is the milk at the beginning of the feeding – I think it must be nature’s way of getting the baby to want to eat.  The Hindmilk is a little “further back”, and it’s where the majority of the nutrients and fat are.  All mothers have this, so if your baby has this problem, it has nothing to do with YOU, it’s all about managing the ratio.   You want your baby to have a mix of both milks.  But in the case that we had, the baby was never “emptying the breast”, so he was mainly getting a lot of foremilk with a little hindmilk.  Who cares, right?  The baby’s body cares.  Here’s what happens when they do not get enough of a balance of foremilk and hindmilk:

  • VERY gassy baby
  • Irritable baby = colicky baby
  • Grunting baby
  • Green poop
  • Vinegary-smelling poop
  • Explosive poop
  • Baby constantly hungry
  • and more, but you get the picture, right?

The science of it is like this: the Foremilk is very sugary, and those sugars cannot all be digested.  They end up sitting in the intestines and being absorbed into the walls of the intestines, where they actually ferment.  This fermented sugar gives off a lot of gas, which is very uncomfortable for the baby, and leads to grunting in their sleep and just a lot of gas in general.  Our little guy had so much gas that sometimes it led to explosive poop, which might be a funny story for another time.  Anyway, all this created a situation with literally every one of those above issues were present – and I found out about it when the poop finally changed to being green (should be yellow), and when I went to change the diaper and it smelled like vinegar (instead of buttery).

I found this information by googling “baby’s poop smells like vinegar” – and then there was a link to an article buried in a forum about breastfeeding, and the article with all the information about Lactose Overload (and much more) was found at BabyCareAdvice.com.

Basically, just make sure you are making the baby latch on correctly and feeding your baby from each breast until it is completely empty before switching.  If the baby falls asleep, there are things you can do to keep them awake (if they REALLY need to eat).  If the breast is not “finished” but they are, then you start from that breast again next feeding.  If you always alternate, you will find yourself in the vicious cycle of foremilk-foremilk-foremilk, because they will always think they are full too early, and then you will feed them foremilk all the time.

Your Role in Breastfeeding (as the father)

As the father, it’s your responsibility to set your breastfeeding partner up for success by being supportive – cheer them on, tell them how great they are doing, if they get frustrated and distraught, be there as a coach to remind them of the steps.  Point is, don’t just say, “oh, it’s feeding, that’s her thing” – it is YOUR thing, too.  Also, make sure she has a lot of water – always get her a fresh glass (or get her a water bottle and refill it before every feeding), make sure she has enough pillows (get her the feeding pillow), and so on.  Do your part – even though you do not have breasts, you can still contribute.

I wanted to purchase one of these, but to my disappointment, they do not really sell them.  image from http://a.dilcdn.com/bl/wp-content/uploads/sites/8/2011/06/manary-gland.jpg
I wanted to purchase one of these, but to my disappointment, they do not really sell them. image from http://a.dilcdn.com/bl/wp-content/uploads/sites/8/2011/06/manary-gland.jpg

Further Resources

Definitely make sure you search around for help elsewhere on this.  Breastfeeding is not easy, and everyone’s different, but the fundamentals I mentioned above are still there.  Here are some good sites!

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4 thoughts on “Day 12: The Art of Breastfeeding and Avoiding Foremilk / Hindmilk Imbalance

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