LuAnn, I have seen babies who accept not being fed enough.  I worked with a 
mom who had a baby who had to be awakened for every single feeding and 
took forever to take the smallest amounts.  The baby was not back to birth 
weight by 2 weeks, was not transferring more than an ounce at the breast, 
did not want to wake to eat, etc.  Everyone told the mom how great it was 
the baby was sleeping!  Never wake a sleeping baby. Thank goodness she 
trusted her instincts.  However, even when offered the extra nutrition, baby 
seemed uninterested and would sleep long stretches.  When mom expressed, 
she was only able to get about 1/2 ounce sometimes an ounce every two 
hours.  Baby was 38 week induction followed by cesarean...and I have found 
38 weekers "look great" but suck lousy.  For three weeks before I saw mom, 
this baby was looking like she was feeding, but not.  Only taking in minimal 
amounts of milk and sleeping to conserve calories.  Mom supplemented with 
expressed milk and formula in the smallest amounts, but very frequently to 
give baby a chance to learn to accept and expect more food.  Things did 
improve after that, but mom was never able to get her supply in completely 
even with much effort on her part.  

I wish people working with babies understood that how it looks does not mean 
a baby is actually transferring milk.  I also wish we could lose the myth that a 
sleeping baby is a happy baby who does not need to eat. Somehow moms 
need to learn a baby should wake to eat! It is not always okay to let a baby 
sleep long stretches without eating.  I have had a huge problem lately with 
swaddled babies not gaining well, not waking to feed, and moms so happy that 
baby is just sleeping so nicely.  When I say "unswaddle" and call me to see if 
things change, sure enough, baby starts to wake more frequently to be fed.  
We assume new mothers know what they do not know. I have had moms 
say "oh yes, my baby is sucking nicely" only to look and see the baby is barely 
moving jaws let alone suckling deep and strong.  New moms have no idea 
what breastfeeding should feel like and it looks like the pictures, and their 
baby is sleeping happily for hours and hours, so of course it must be great.

For this baby LuAnn is working with, the amount of the milk transfer at that 
one feeding after six hours of not eating would concern me.  What would also 
concern me is the possibility that the baby is only receiving that amount 
about 4 times a day!  That is 8 ounces of food every 24 hours!  No wonder 
this baby is sick.  OR because the baby is sick the baby is not eating.  Either 
way, a huge problem.  I agree with the 'protect the milk supply' and 'feed the 
baby' because regardless the baby needs to eat.  I would probably stick to 
the small amounts, but do so every two hours until the baby was seeking more 
volume without encouragement to accept it.  Poor baby!  Must have just been 
to hungry to even cry.  Yikes.  I hope this is a first time clueless momma who 
will quickly accept a new plan of action.

However, for the average healthy baby nursing well, I do not think they need 
4-6 ounces of milk per feeding.  I think this thinking comes from a formula 
feeding understanding of feeding where digestion takes longer and uses more 
calories.  Babies do sleep longer on formula, it just is what it is.  That is why 
so many mothesr assume there is a problem with thier own supplies...babies 
wake to eat.  I do not think babies would naturally choose to stretch 
feedings...I think we encourage the behavior with pacifiers and ignoring early 
cues to be offered the breast. Since most babies are separate from their 
babies (not in constant contact or even in the same room) baby may stir to 
signal for a feeding, senses the absences of mother and goes back to sleep 
missing an opportunity to be fed.  I have seen mothers miss a cue to be fed 
because it has been less than the time they were told to wait for feeding.  
Also, in the hospitals if babies are in nursery, they are not fed on cue and 
mothers are told that it is 'not time' even when a cue is given further teaching 
mothers to not answer the cue. Our cultural climate is not topless with 
unlimited access to feeding.  I can see stretching nursings when solids begin, 
but before that, I am not so sure that long intervals between feeding is a 
baby driven behavior

I wonder even with all we know about production, intake, etc. if we are 
looking at a biological norm or a cultural behavior when it comes to feeding 
timing and duration.  If a baby is taking 4 ounces 10 feeds a day, that is 40 
ounces. Is that the expected intake? Not according to what I am reading 
which puts it at closer to 820-85- Mls per day, which is much less than 40 
ounces per day.  Even if we stretch the feedings to make them only 8, that is 
still 32 ounces a day.  If we are talking 6 ounces, that is 48 ounces a day.  
Also, I wonder about those countries where scales are not part of the 
equation.  Sure, for the subset of moms in the studies we see what we see in 
production, etc.  But, mother baby feeding behaviors vary by culture.  Access 
to breastfeeding varies by parenting style.  Breast for food only vs breast for 
food and nurture. 

If milk is digested in less than 3 hrs, why are we expecting babies to feed so 
infrequently?  What is the harm in frequent feedings that perhaps last less in 
duration as the baby masters sucking and  breathing and moms flow rate is 
increasing.  I would love to see a study where every single cue to feed was 
answered and babes were allowed to determine duration and length of 
feed...then see what intake is per feeding and over all.  If storage capacity of 
breasts plays a role, it seems unfair to say a baby must receive more per 
feeding than some mothers are capable of storing.  It seems more likely that 
small frequent feeds that match moms production and storage would work just 
as well as large infrequent feeds provided by the mothers with greater storage 
capacity.  A range of normal production allows for less than 4-6 ounces a 
feeding for a 4 week old.  And if the research is true that production levels 
out after a few months and remains constant, than the older baby also needs 
much less than 6 ounces at a feeding if being offered the breast frequently 
enough.  (Assuming of course that everything is normal for the dyad...ability 
to produce full supply and ability to transfer milk.)

I find the whole topic of supply, demand, growth, feeding patterns, etc. to be 
very interesting.  I think we have more to learn about what normal really looks 
like because this is one area that is so influenced by parental choice it is hard 
to know what a baby would really want...and honestly, every baby is different 
so even if we do know what a particular 200 babies want, that says nothing 
about my particular child.

Take care,
Pam MazzellaDiBosco, IBCLC, RLC

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