Foremilk/Hindmilk pumping confusion

[@llli*kckc612]

I'm new to this so please bear with me if this post becomes too long. I had my second child 6 1/2 weeks ago (via c-section at 39 weeks) and decided to breastfeed. For the first few weeks it seems like everything went great with breastfeed then out of nowhere we hit a major snag. My daughter started feeding anywhere between an hour to two hours on my breasts only to be hungry again about 20 minutes later and we would start the whole process over again and would continue in a cycle. In between her feedings I would also pump so when my husband came home from working nights, he could feed her while I took either a nap, shower, laundry, etc. And she never seemed satisfied with the bottle which is 2oz so I would put her on my breast to "top her off". As this kept up, I started getting very exhausted at night and not handling it very well, such as crying excessively and just being too tired to breastfeed so I started supplementing with formula at night just to get some rest.

Ok so fast forward to my question. I want to continue to breastfeed. And lately it's been very hard since my daughter is starting to refuse the breast sometimes so I try to pump since she's more used to a bottle. However when I pump (I pump manually and electric) after about 15 minutes on each breast I don't get anything out, so I squeeze my breasts just to make sure there isn't milk getting left behind, and I store it in the fridge. When I look back at it about an hour or so later, I notice all the pumping I've done (between 2-4 ounces) is very watery with about an 1/8 of an ounce of thick white on top. If I feed that to my daughter (after properly warming and swirling) she screams and cries to eat again about 45 minutes to an hour later. Am I not getting enough hindmilk? And if not, how do pump the hind milk out?

I also wanted to add right now she's on formula because while I gave her the pumped breast milk and my breast, she was extremely gassy and cried constantly from being in pain. And when I did breast feed, I fed until she popped off of me. I feel so discouraged and ready to give up, but I'm trying so hard to keep at it especially with these obstacles. Also, when she was born, she was 7lbs 6ounces, left the hospital 3 days later and she was 6lbs, 12 ounces. Now at 6 1/2 weeks she's 9lbs 10 ounces, but we're doing both breast and bottle. Sorry this is so long and if you're still reading this and giving advice, thank you so much in advance.

[@llli*lllmeg]

Hi, and welcome to the forum!

How are you feeling now, emotionally? Better rested, still having blues? please let us know.

Many moms become overwhelmed in the early weeks and start baby on bottles and/or formula- at least in part, in order to cope. Later they start feeling more on top of things and wish to make breastfeeding 'work' again. Does this sound anything like your situation?

If so, I think there is lots you can try. But I want to clarify some things, because it appears you are concerned that somehow your milk, in particular, is somehow causing issues for your baby.

Fussiness and gassyness are normal newborn issues. So is wanting-actually, needing- to nurse very frequently. At least 10 or 12 times a day in the newborn period. This is normal infant behavior. Formula fed babies may eat less often because they are not being fed a biologically normal diet for a newborn.

Some weight loss is normal in the first few days, and since you have supplemented since then, I cannot tell from what you have written if your baby truly needs/needed supplements or not.

In almost every case, a baby might need supplements for exactly one reason: because baby cannot get enough milk at the breast. If baby cannot get enough milk at the breast, baby will not gain normally. And that would be a possible reason to supplement, either with your own pumped milk or donated milk or formula if mom does not make enough milk. In most cases, there is no other medically sound reason to supplement a breastfed baby.

How milk looks in a bottle is very misleading. Your milk normally separates in the fridge, just as any mammalian milk would that has not been homogenized. Your baby may be getting too much foremilk, which in some cases appears to cause overt fussiness. Typically this only happens at the breast, but I suppose it could happen with pumped milk as well. Also, your baby may be reacting to something you eat that is somehow not in the formula baby is given, but that is an even more remote possibility.

But I suspect you are blaming normal newborn behavior on your milk. This is very common. Sometimes formula meals will cause a baby to sleep unnaturally longish periods and go unnaturally long periods between feedings.

But, may I suggest, the goal is not a calm baby. The goal is a healthy baby, child, and person. And the facts overwhelmingly show that a baby nursed at the breast is going to have normal lifetime health outcomes and a formula fed baby will have subnormal lifetime health outcomes. A baby who is bottle fed expressed mothers milk gets the benefits of the milk, but misses out on the benefits of nursing. But still, feeding a baby expressed breastmilk is much more desirable from a health standpoint than formula.

If you have an issue of forceful letdown, which might worsen the fussiness you describe, that can be fixed while continuing to nurse at the breast. If you have a food sensitivity issue (again I think that is unlikely but if) that can also be solved, while keeping baby nursing at the breast.

So you have to decide-will you/can you start nursing your baby again while you work on these possible issues, or not? Because I honestly have no idea how to fix this if you continue to formula feed, or primarily formula feed.

The other crinkle is, at this point, do you make enough milk for your baby? Even if your production was normal in the beginning, it is possible that with the supplementation it no longer is. That has to be figured out as well. If you don't, there are many ways to increase your production.

We are happy to help you be providing you with information and support. You may also want to seriously consider seeing an IBCLC if you have not already, or at contact a local LLL Leader to assist you?

[@llli*bfwmomof3]

Hi mama, welcome to the forum!

Okay, some questions first so we can better understand where you are now.
1) Are you nursing at the breast at all currently? Or is it all pumping and feeding by bottle? If you are nursing, how many times per day? How many times per day are you pumping? And how many ounces of expressed breast milk from the bottle are you giving?
2) How much formula are you giving? Total amount of formula in the day, and amount of formula you give with each feeding.
3) When you were nursing at the breast, how was baby's latch? Was nursing painful?

The appearance of your breastmilk in the fridge is totally normal. Unlike cow's milk that you buy at the store, which is homogenized, breastmilk is not homogenized, so it will separate into a more watery layer and a cream layer. Generally foremilk/hindmilk is not something you have to worry too much about, as long as overall baby is getting enough milk.

Your baby's pattern of constant breastfeeding also sounds normal - she may have been going through a growth spurt at that time, explaining the more frequent feeding. But generally newborn babies spend most of their time nursing and sleeping!

How is your mood now? Do you still have the excessive crying or has that gotten better?

It sounds like breastfeeding got off to a good start, so there's no reason you shouldn't be able to continue breastfeeding. We can help you figure out how to get back on track!

[@llli*kckc612]

Hi mama, welcome to the forum!

Okay, some questions first so we can better understand where you are now.
1) Are you nursing at the breast at all currently? Or is it all pumping and feeding by bottle? If you are nursing, how many times per day? How many times per day are you pumping? And how many ounces of expressed breast milk from the bottle are you giving?
2) How much formula are you giving? Total amount of formula in the day, and amount of formula you give with each feeding.
3) When you were nursing at the breast, how was baby's latch? Was nursing painful?

The appearance of your breastmilk in the fridge is totally normal. Unlike cow's milk that you buy at the store, which is homogenized, breastmilk is not homogenized, so it will separate into a more watery layer and a cream layer. Generally foremilk/hindmilk is not something you have to worry too much about, as long as overall baby is getting enough milk.

Your baby's pattern of constant breastfeeding also sounds normal - she may have been going through a growth spurt at that time, explaining the more frequent feeding. But generally newborn babies spend most of their time nursing and sleeping!

How is your mood now? Do you still have the excessive crying or has that gotten better?

It sounds like breastfeeding got off to a good start, so there's no reason you shouldn't be able to continue breastfeeding. We can help you figure out how to get back on track!

Thanks for the response and to answer your questions: I'm only nursing at the breast when the breast milk I feed her from the bottle isn't enough. I give my daughter 3 ounces of breastmilk, sometimes she will want more, sometimes 3 ounces is enough or sometimes it's too much and she won't finish it. Right now I am only feeding her the breast milk during the day and evening and she wants to feed every 2 hours.

Once midnight hits she gets a formula bottle and she'll take anywhere between a 2-3 ounce formula bottle, depending on how much she feels like eating (I always offer her 3 ounces) and she'll want to eat every 3 hours, sometimes 3 1/2 hours. If I give her a formula bottle at midnight, she'll want another around 3 or 3:30, then another at 6 or 6:30. Once 9am comes around then I start the breast milk bottles until about 11pm or midnight, since sometimes she'll want to eat a little earlier than midnight. I started the formula initially because I read online that if a baby gets too much foremilk then they will be extremely gassy and want to eat constantly, as well as not get the extra nutrients that hindmilk also offers.

Now when I pump, I pump as much as I can when she's not needing me to feed her, change her, or hold her. She's been congested lately (allergies) so she's been wanting to be held a lot more now, but I am still able to pump as much as I can with getting anywhere between 2-4 ounces from both breasts together. I myself do have a milk sensitivity so I only drink almond milk and eat vegan cheese and lactose free yogurt. I don't know if that is what is making her gassy and upset since I was eating the stuff when she was first born and while I was pregnant.

My mood is a lot better than a few weeks ago. Right now I'm doing it all alone at night since my husband works and have been since our daughter was 4 days old. He started his job back in May and our daughter was born in July, so they told him that he didn't "qualify" for paternity leave and had to use his 2 paid days off for her birth and the day after. He called off the additional 2 days without pay, to help me at home since I did have a c-section. After that I've been going at this alone at night and sometimes during the day when he needs to sleep. My mom lives in California and I live in Indiana and being here is not financially possible for her right now. His mother, well she put in for vacation time off to help me, but when the time came she decided to take off with her friends for over a week and the couple of times I have called her to help me during the day she just looks at her watch and constantly asks if I'm finished doing what I need to do because she promised to meet her friends at a bar or something. Basically, I'm an inconvenience to her, so I don't ask for her help anymore and she doesn't really come see my children anyhow. My father in law lives in another city and the only time he saw my daughter was the day she was born and hasn't since then. He doesn't care to visit since his "new" wife only likes him to be concerned with her and her daughter, so that's where the overwhelming crying came from. But it has gotten better and there are times when my daughter has been extremely gassy and cried nonstop for an hour and it becomes overwhelming for me and I just cry, but I haven't had that happen in the last week and a half.

I really feel ill informed about what my milk looks like even though I talked to a lactation consultant in the hospital. I thought she wasn't getting any hindmilk because the milk looks very watery and not creamy except for the tiny thin line on top.

[@llli*lllmeg]

So besides your husband, you have no other adult help, it sounds like? And you have some older kids too?

Husband works at night? Is that why you are on your own at night?

Your pump output sounds entirely normal, - how many times per day you pump?

What is your goal? If you could wave a magic wand and have whatever you wanted, would you like to nurse baby at the breast, or nurse combined with pumping and bottles, or both combined with formula?

A baby this age wanting to be held pretty much constantly is normal. Do you have a baby sling or wrap? Does baby sleep near you?

What happens in the hospital and the information you were given there about the first few days of nursing is basically irrelevant at this point. Just about everything about breastfeeding changes dramatically in the first few weeks. If you are also dealing with a recovery from a c-section, you body and mood also tend to change dramatically in that time.

You cannot tell anything about your milk by looking at it in a bottle. But there is absolutely no reason to think anything is wrong with your milk.

If you want to get more informed about breastfeeding, this website and www.kellymom.com are good general info online resources, and the book The Womanly Art of Breastfeeding (8th edition) is an excellent book.

[@llli*mommal]

Terrific questions from LLLMeg. If you could wave that magic wand, what would happen?

I just want to point out that a lot of what you're seeing sounds very normal. Pumping 2-4 oz at a time: excellent. Breastfed babies who are nursing at the breast typically take just that amount. Baby feeding frequently, sometimes less than an hour after she last ate: normal. Breastmilk digests quickly and completely, and infant tummies are tiny. Seeing a relatively thin-looking layer of cream on top of separated milk: normal. Human milk is high in sugars and carbohydrates and low in fat compared to the milk produced by other types of animals; proof that human babies are designed to feed frequently.

A baby needing to feed soon after finishing a feed is not necessarily an indication that she didn't eat enough or that your milk was "deficient" in some way. Babies are biologically driven to feed frequently and they have a high need to suck. I know those 2 things together can drive a new mom bonkers, particularly if she has other responsibilities to take care of. But they are normal!

[@llli*kckc612]

So besides your husband, you have no other adult help, it sounds like? And you have some older kids too?

Husband works at night? Is that why you are on your own at night?

Your pump output sounds entirely normal, - how many times per day you pump?

What is your goal? If you could wave a magic wand and have whatever you wanted, would you like to nurse baby at the breast, or nurse combined with pumping and bottles, or both combined with formula?

A baby this age wanting to be held pretty much constantly is normal. Do you have a baby sling or wrap? Does baby sleep near you?

What happens in the hospital and the information you were given there about the first few days of nursing is basically irrelevant at this point. Just about everything about breastfeeding changes dramatically in the first few weeks. If you are also dealing with a recovery from a c-section, you body and mood also tend to change dramatically in that time.

You cannot tell anything about your milk by looking at it in a bottle. But there is absolutely no reason to think anything is wrong with your milk.

If you want to get more informed about breastfeeding, this website and www.kellymom.com are good general info online resources, and the book The Womanly Art of Breastfeeding (8th edition) is an excellent book.

I don't have any adult help and my son is 5, which he helps when I ask, but he of course sleeps at night and goes to school during the day. When he was born my mother in law was always there to help even when I didn't ask, but this time around she doesn't want to and the last few days has made comments about how me doing both breast and formula is making my daughter unhappy and gassy and I don't need to breastfeed, but I don't pay attention to her nonsense.

As for pumping, I usually pump between 3-5 times in 24 hours. And my ultimate goal is to get her back on breast milk exclusively. I don't mind putting her on the breast, but sometimes it will interfere (lack of a better word) if we have to go somewhere. I also like pumping because my husband loves to feed her and they get that extra bonding time together.

I will look at the website provided and I do feel a lot more confident that what I'm seeing when I'm pumping is normal. I thought that since she was constantly hungry that I wasn't giving her anything other than foremilk. I will definitely keep at it and thank you for all the advice.

[@llli*lllmeg]

OK. Occasional convenience bottles aside, basically you would like to nurse exclusively? A newborn (even at 6 weeks) will typically need to nurse at least 10 times a day. If baby is not nursing (gets a bottle) then you will need to pump for that time. Pumping on top of nursing would also help increase your milk production if needed. But try not to overwhelm yourself. Breastfeeding is actually quite easy once it gets going, and nursing only is way easier without all the pumping and bottles.

It sounds like your MIL is not interested and it really bothers you, which I get. But this is her loss, and it sounds like her presence would be even more undermining to you than her absence! So, this is probably a good thing. Help is great, but many of us have made even the challenging newborn period work without help from extended family. You can do it.

Your 5 year old sleeps at night and goes to school during the day, so that gives you time alone with your baby which is what you need. I suggest, keep baby on you, snuggled to you, sleeping safely on you, as much as you can. Nurse whenever baby cues, or even when there is no cue. Keeping baby close to you with her head above her tummy will likely help with at least some of the fussiness. Frequent nursing will also almost surely help. It is normal for a baby to want to nurse very frequently-cluster nurse- for at least part of the day. Let baby. This will help your milk production and cut down on the fussies.

Your husband can help by making sure you have easy to eat food and fresh clean water available when you are at home alone with baby-sandwiches, cut up or easy to hold fruit and veges, muffins, etc. so you can easily feed yourself during the day. Talk to your husband about family meals he can make, or do easy to make, make ahead meals like crockpot meals, casseroles etc.

Let cleaning for the most part GO for now. If you are like most moms, you see the mess much more than your family does. Let it go, or get help with it on the weekends.

Do only what is needed housekeeping wise and leave the rest. Clean clothes are needed, folded clothes are not. Food must be cooked, but the pots can soak in the sink. etc.

The newborn period is intense, but it is SHORT. Baby will fall into a more manageable rhythm soon enough.

[@llli*bfwmomof3]

As for pumping, I usually pump between 3-5 times in 24 hours. And my ultimate goal is to get her back on breast milk exclusively. I don't mind putting her on the breast, but sometimes it will interfere (lack of a better word) if we have to go somewhere. I also like pumping because my husband loves to feed her and they get that extra bonding time together.

Why will putting her on the breast interfere if you have to go somewhere? Are you worried about nursing in public? I would say probably MOST mothers are nervous about nursing in public at the beginning. But with practice you can get used to it and then nursing is SO convenient - no need to worry about packing bottles and taking milk along - baby's food is always available and at the right temperature! Here is a link to the "Nursing in Public" forum: http://forums.llli.org/forumdisplay....ursing-Apparel. You might want to browse around or even start your own thread. Some ideas: start in a very low-key situation, like nursing in front of a very close friend or relative that you think is likely to be supportive, or in front of a mirror, or at a La Leche League meeting. Or some stores have a specific nursing area where there will be other nursing moms. Keep in mind that if you go out on an errand, nursing in the car is usually an option.

As for your husband feeding baby - there are a lot of ways that he can bond with baby without feeding her. My husband loved keeping our babies skin-to-skin on his chest - and they loved it too! He can carry baby in a wrap or sling as well (maybe while he's preparing those sandwiches for you that lllmeg mentions!).

Over the long run, it's harder to pump all the time - pumping in public is a lot harder than nursing in public, and usually the pump isn't as good at extracting milk as baby, so it's harder to maintain your supply. Pumps can wear down making output harder to maintain after you've been at it a few months. Not to say that you should never pump, of course - eventually you might want an evening out with your husband. But I do think it will be easier for you if you switch over to mostly nursing, rather than mostly pumping!

If you do want to mostly breastfeed, and eventually get off the formula, here is some step-by-step information on how to do that: http://kellymom.com/bf/got-milk/basi...rease-formula/

One thing that really helps with nighttime nursing is to learn how to do side-lying nursing. I had no idea about that early on with my first, so I'd always turn the light on, sit up in bed etc - very tiring! As compared to side-lying nursing, where you lie face-to-face with baby, in the dark, and doze while baby nurses. There's a picture in this article: http://www.llli.org/llleaderweb/lv/lvaugsep00p63.html. You can modify the position as best suits you.