Following the alert period just after birth, most newborns are sleepy by nature 
and fall asleep when they have finished the first side, typically snoozing for a 
half a minute to a half hour before waking up on their own to go to the second 
side.  I give mothers anticipatory guidance about this as the baby finishes the 
first side and sleeps.  

As the mother holds her sleeping baby, we continue a quiet chat about 
newborn behavior, counting diapers, observing wet diapers for pale yellow to 
clear urine, observing for expected color changes in stools from placenta-poop 
(meconium, so dark green that it's almost black) to part placenta-poop and 
part milk bowel movements (transitional stools) to all-milk bowel movements 
by day 5.  It's so nice to describe the changes in the baby's bowel movements 
in this way, because parents learn in the discussion that the movement of 
digested milk all the way through the baby's intestines will lighten the 
remaining meconium until there is no more meconium left, which is evidenced 
by the appearance of yellow stools.  I like to teach parents with gentle humor 
to celebrate their baby's diaper changes.  

During this chat, almost always the baby wakes right up in that half minute to 
half hour time span.  I then point out that the baby has awakened within the 
half minute to half hour time span that is so common but not required, since  
sometimes a baby is full after one breast, and suggest this is a nice time to 
see if the baby needs to burp before going to the second side.  

The mother could try burping the baby right after he falls asleep from the first 
side, but why not admire his beautiful state of sated slumber, which is such 
lovely reinforcement to the mother for having nourished her baby.  His 
relaxation can be pointed out re: his physical changes from flexion at the 
beginning of the feed to relaxation at the end of the feed.  He can be offered 
a burp opportunity when he rouses from sleep for the second side, and maybe 
even checked for a diaper change then.    

When newborns finish the second breast and fall asleep, parents often feel 
they must now dress the skin-to-skin baby for further sleep - - which is fine 
of course, but this act of dressing the baby typically wakes him right back up 
and he again begins searching for the breast.  Now dressed for sleep but 
awake again, many new mothers appear distressed that although they have 
fed the baby on both breasts, the act of dressing him has apparently and 
inadvertently awakened him, and many mothers often appear concerned about 
what to do at this point.  So of course this is an ideal time to point out that 
sometimes babies want a Baby Buffet or the third or fourth breast, etc. - -just 
as other members of the family sometimes must go through a buffet line.  
Before the second or third breast, he can be dressed, although he should stay 
out of the blankets for better positioning, unless he is a little one who seems 
to need swaddling.  

As the awake baby is being cuddled by his mother on her chest for a possible 
burp, he will soon begin searching/rooting for her breast, and as he begins 
rooting, this is a beautiful time to reinforce his readiness for the second breast 
or third breast.  

I also like to teach parents about watching and enjoying the Baby Ballet - - 
the movement of the baby searching/rooting for the breast, hands to mouth, 
fists to mouth in advancing hunger, tighter and tighter flexion of arms and 
hands as hunger advances, arms held flexed as baby begins the feed, flexion 
gradually loosening in fingers and hands as the baby gets closer and closer to 
satiety.  When the baby is skin-to-skin with his mother or just unwrapped 
from his blankets, you can even point out the flexion in his feet (toes pointing 
straight up) at the beginning of the feed, how during the feed he gradually 
loses the tight flexion as warm milk enters his tummy, and how relaxed he is - -
from his head to his toes - - at the end of the feed (fingers, arms AND FEET  
no longer flexed, limp arms etc.).  In the very early newborn period/first 3 or 4 
days, when the baby wants the 3rd breast after having been wakened by the 
act of dressing him before he is put in his hospital crib, this last round of 
nursing is usually brief, followed by the baby going into a deep sleep - - deep 
enough that if the mother feels compelled to place him in his hospital crib, 
that movement of placing him in the crib usually doesn't wake him at this 
point, particularly if he was dressed prior to that last round.  

Staying this long with a mother is a longer consult, to be sure, but it can pay 
off so beautifully in teaching the mother to observe her baby so she can learn 
his normal behavior, and to not be worried that he didn't immediately and 
efficiently go from the 1st breast to the 2nd breast followed by immediate 
sleep for a certain amount of prescribed time.  In describing the normalcy of 
the baby's sleepy pause between breasts, I like to use the analogy of adults 
who feel full after a nice meal, but who also feel too full for dessert.  Rather 
than eating the dessert when we are really too full for it, many of us like to 
wait 15 minutes or 30 minutes or so to have dessert, because when we have 
room for dessert, the experience is more pleasant.  Parents can immediately 
relate to this, and I often use gentle humor in stating that newborns are no 
more efficient than we are at mealtime, while also reinforcing that older babies 
are more efficient with feeds and are typically finished in shorter periods of 
time.  This is true unless, of course, the baby is hitting a growth spurt re: 
cluster-feeding, which is great to talk about, too:  teenagers seem to be 
hungry all the time, but they will never do anything as dramatic as the 
newborn who will be doubling weight in 4 to 6 months and tripling weight in a 
year.  Everyone knows teenagers are always hungry and we even laugh about 
it, in celebration of their blossoming.  In a wealthy society, we can feed our 
children, even if it must be with food stamps/federal assistance during tight 
times.  Almost always, there is great wealth at the mother's breast (last 
sentence spoken for LactNet).  

The field of motor learning teaches that much of our learning is consolidated 
during sleep.  Presumably mothers really need daytime naps in hospital and at 
home, since they are acquiring motor skills, too.  

Debra Swank, RN IBCLC RLC
Ashburn, Virginia USA





 

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