Diagnosed Hind/Fore milk imbalance, any advice?

[Feisty Fidget]

So my DD started having algae green poos about 3 weeks ago. We waited 5 days and it still persisted so spoke to the lactation consultant who (after lots of questions) diagnosed a hind/fore milk imbalance.

I was told to express off before every feed. Sadly I can't hand express, so was using my electric pump for 3.5 minutes before (almost) each daytime feed. After 6 days we saw an improvement and her nappies went back to normal. We spoke to the consultant again and told her how it was impractical to express before every feed. She said it was unknown if not expressing would make LO poos go back to algae green.

We cut down on the amount of times I was expressing before a feed and initially all seemed well. I then stopped completely and first the first 2 days all was fine. Now however the green poos are back

Can anyone suggest anything to help with the imbalance? I can't carry my electric pump with me everytime we go out and the amount of milk wasted each day from doing this is heartbreaking. I can't start storing milk until this is sorted as the consultant has said that at the moment my expressed milk will be way too much foremilk.

I'm at my wits end!

 

[noon_child]

Although expressing before a feed will give your LO access to fattier milk, it is not a good long term solution as it will increase your supply - which is usually the main cause of what is called fore milk imbalance!

First off, its important that we really understand what is meant by fore and hind milk. This kellymom article is a great explanation https://kellymom.com/bf/got-milk/basics/foremilk-hindmilk/
As you can see, really there is no such thing as fore milk and hind milk (the guy who coined the words from the dairy industry, spoke last year about how he wished he'd never used them because they are so misunderstood!). There is just milk that has sat in the breast for a while, so the fat has got "stuck", and milk that is newly produced so the fat is distributed through it and picks up the "stuck" fat as it moves through the breast.

The most effective solution is frequent feeds (so the breast never gets, or rarely gets full and the fat can't get stuck. baby will be drinking milk as it is produced and this will be fat rich). Whether or not you try block feeding (feeding from just one breast for a couple of feeds in a row) depends on how quickly your breasts get engorged, as I wouldn't want to risk engorgement in the breast that sin't getting used. Can you provide a general idea of the feeding pattern LO currently has?

 

[Feisty Fidget]

Thank you so much noon child!

My LO has about 8 feeds a day and can go between 2 and 3.5 hours between feeds. Her feed length varies from 13 minutes to 60!

She usually sleeps for 8 hours overnight and rarely takes a feed from 10.30 to 6 ish. She is 9 weeks old.

 

[noon_child]

I also meant to ask earlier if you think the oversupply is causing any problems i.e slow weight gain or weightless, is LO uncomfortable when she poos or getting lots of painful gas?

If the only symptom is the colour of poo, and otherwise she is a healthy baby, then you don't necessarily have to DO anything other than wait for your body to catch up with your LOs feeding habits (did the green poo co-incide with her starting to sleep through?). You've got the 12 week growth spurt to come yet and maybe at that point your oversupply won't be an oversupply anymore - just exactly what she needs!

If you are getting very uncomfortable with engorgement you could see if LO will take a dream feed but you don't have to mess with things if you and LO are both healthy - breastfeeding has evolved to work itself out given time.

 

[Feisty Fidget]

Touch wood, engorgement has never been an issue for me!

LO has had really bad gas since she was about 4 days old (right when she predominantly became exclusively BF) but the green poop has only just started a few weeks ago.

We suspected colic because she seems to have such bad trapped gas and not even gripe water shifts it. Her tummy will go rock hard and she will wring her hands, arch her back and scream with real tears for hours at a time. The only thing that stops the crying is intense bouncing on the yoga ball with her if she falls asleep from exhaustion. There seems to be no pattern to the 'attacks' either. They used to be later in the day, but from about 6 weeks they happen throughout the whole day. My diet hasn't changed at all.

She was born very small, but quickly got back up to her birth weight and has been slowly gaining since. She had a tongue tie snip a few days before the poops started turning green and the consultant said it's because she's more effective at feeding now and so getting more foremilk? But that doesn't help long-term.

 

[SpringCrane]

I had a similar issue with my first. I also had a VERY forceful letdown. The solution that worked for me was to put baby to breast, his suckling would trigger the letdown, and I would take him off the breast and soak a cloth diaper insert (milk would literally shoot out several inches for a few minutes). After I felt my flow easing up, I'd put baby back to breast for a feed. He'd get a full feed on one side.

It solved a lot of problems for us. The forceful letdown was causing him to gulp air and too much "foremilk" wasn't allowing him to get the fats he needed. It regulated itself within a couple of weeks.

Good luck!

 

[noon_child]

Touch wood, engorgement has never been an issue for me!

LO has had really bad gas since she was about 4 days old

I had a similar issue with my first. I also had a VERY forceful letdown. The solution that worked for me was to put baby to breast, his suckling would trigger the letdown, and I would take him off the breast and soak a cloth diaper insert (milk would literally shoot out several inches for a few minutes). After I felt my flow easing up, I'd put baby back to breast for a feed. He'd get a full feed on one side.

It solved a lot of problems for us. The forceful letdown was causing him to gulp air and too much "foremilk" wasn't allowing him to get the fats he needed. It regulated itself within a couple of weeks.

Good luck!

I was going to say if you don't think you have oversupply (where baby would get full before the stuck fat begins to unstick), then the other reason for green poop is baby is coming off the breast before she is truly full. As I know you aren't deliberately timing feeds or anything, I suspected that she could be pulling off to avoid letdowns that are too strong (you have multiple letdowns per feed) or because her tummy is full of gas (something that often happens with tongue tie and/or forceful letdowns because they take in air).

The suggestion from pp is a good idea. Also it really helps to feed in positions that don't allow the letdown to swamp the baby, so if you are slightly reclined and baby is positioned on your tummy/chest, then the milk has to work against gravity and baby has more control over how much goes in her mouth.

Sometimes tongue tie is diagnosed where actually forceful letdown is the problem because babies pull back off the breast to get away from the volume of milk and slow the flow by attaching in a shallow way. Although of course it is entirely possible to have both!

 

[icegurl470]

I had this problem in the first couple months, but it seemed to get better as time went on. Her poops were green and foamy, she would struggle to keep up with the let down of milk whenever I fed her and she filled up really quick on just fore-milk.. I used to pump off a little bit just so she could latch on easily and without milk spraying in her face and then nurse on one side at a time, pumping on the other if I needed to. Shes 5 months now and I only have to do this sometimes in the mornings if my breasts are really engorged. She still gets green poos occasionally but not all the time and not foamy and explosive like they were before.