I work in a hospital that still does normal births (but is struggling with a
29% cesarean rate even though we had 2 VBACs this month out of 30
births). For the past three months every vaginally born baby has been
offered the breast within an hour of birth. (A Quality Improvement project
of two nurses,  Aimee Creelman MSN, IBCLC formerly of San Francisco and
Gloria Baldwin RN, CLC.)

Our Hyperbilirubinemia Guidelines say that a baby's bili level will be
checked at 24 hours if there is "Insufficient Breastfeeding" - so the
question the nurses asked me (the pedis wrote the guidelines!) was, "What is
SUFFICIENT breastfeeding?"

So as far as I'm concerned, this is another area where we can only do
experience-based practice. The only "evidence" I found in my search was a
phrase in Larry Gartner's ancient article about jaundice in the breastfed
infant - and I think the phrase was "4-6 times in the first 24 hours".

As Gonneke notes - our babies, after their first skin-to-skin, often spend
way too much time in their little plastic bassinets. (We are working on that
too - thank God for good conferences, Nils Bergman, and passionate nurses!!)


What we see with Brattleboro babies is, that they usually nurse wonderfully
that first hour, then sleep a good 4-6 hour stretch, and do not nurse a lot
- until around 20-24 hours of life, when they cluster feed and seem to make
up the other feeds to make up Larry's 4-6.

Mothers don't seem to sweat it when we tell them this seems pretty normal to
us. They say, "Well s/he certainly knows what to do, that first feeding s/he
was teaching me!" If we wish the baby would wake up and eat, we put them
skin to skin. We are also working hard on encouraging parents to recognize
early feeding cues. That can be hard when parents are tired - it's also hard
when we are mostly drifting in and out of rooms. Sometimes I'd like to just
move in for a shift with a mom and dad and babe and help a little more!

If a baby doesn't wake up for those cluster feeds we move to skin-to-skin.
But it's usually not a problem in the 2nd 24 hours, when babies are hoping
for a bountiful supply soon. I have been AMAZED at how regularly we see
those warm, full breasts at 48 hours after the placenta fell out, no matter
how parous the mom ie first babies same as fifth.

Dawn Kersula MA, RN, IBCLC, FACCE
in Brattleboro, VT USA
where the Breastfeeding Art Show is just about ready to leave Amy's Bakery
and Cafe for another year. Great tattoos on the pix this year!

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