There is no
>> Need for criticism as we all have the same goal , to support & encourage breastfeeding . Thank you to all who work with moms & babies in whatever capacity & timeline you interact with these couplets . Just like Mommy wars , working or stay @
>> Home we would do well to support. , be open , work together because really we are working for the same goal . Thanks 2 all , Sue Boyer RNC, IBCLC , Modesto , Ca
>> Sent from my iPhone

Apologies Sue, I didn't mean to offend. I'm also an L&D nurse and an IBCLC. I work in a similar environment, probably worse, a large percentage of our patients have no prenatal care, drug and alcohol abuse, homelessness and poverty. I have MD's who give moms staydol when they are 9 cm dilated. It's hard for a baby to breastfeed when they are in respiratory distress. 
 
But what I'm talking about here is best practice. I would like us to look at what we are doing. Is telling your patients to nurse every 2-3 hours really working for them? Is this best practice? Or is it resulting in more FTT, slow weight gain and jaundice? I believe that it is resulting in confusion for the mothers and slower weight gain for the infants. First of all, this information is for healthy, full-term infants. If you have an infant is late preterm or received IV pain meds in labor you will need to monitor feed-sleep patterns more closely, that does not necessarily mean you will need to intervene, but it should be more closely observed, IMHO. Some of these babies will do fine on their own, some won't, but it bears closer observation.
 
However, telling moms to nurse every 2-3 hours is confusing for many mothers, especially in the early days when they have colostrum, because most newborns do not eat like that. In utero, the baby was constantly swallowing very small amounts of amniotic fluid. When they are born, they are expecting to eat the same way. So then, in my experience, many mothers are shocked and confused when the baby wants to eat very frequently, or stay on the breast for 45 min and nip and nap, or wake up and breastfeed again 20 min after a feeding. When mothers are told to breastfeed q 2-3 hours, what often happens is that the baby is missing tons of feedings because the mother thinking that the "baby can't be hungry again because he just ate." Also, I see many of the mother's are increasingly frustrated because we have told them that the baby is going to nurse q 2-3 hours and that is not what is happening. Many women then assume it's because they don't have enough milk and
 reach for the bottle, when this is really just the normal course of breastfeeding and if we had prepared them for it, they would be able to handle it better.
 
How many of us have seen babies in cribs across the room trying to shove their whole fist in their mouth, and then mom says, he can't be hungry again I just fed him? It's not 2 hours yet. I have that happen all the time. I think when we tell them nurse q 2-3 hours, we are setting them up for failure. 
 
What I see is often less nursing during the first 24 hours, and I think it is normal. A study cited by Academy of Breastfeeding Medicine (I used this for a neo about how much to supplement a bfd baby) was that they saw an average of 6 feeds in the first 24 hours, consisting of an average of 6 ml per feed. Babies are often awake and alert for the first couple hours, cueing to feed, and then very sleepy for the first day. Babies arrive in this world well-nourished, they are not going to immediately starve to death. Many of them have a belly full of amniotic fluid and are uninterested in breastfeeding for awhile. We need to reassure new parents, not panic them. Then on day 2 they often wake up and cluster feed the next couple days, much more frequently than q 2-3 hours. And at this time, if the baby is allowed to breastfeed unrestricted, on demand, they are much more likely to have a good weight gain.
 
Another problem is that when we say 2-3 hours, I think most babies are not going to gain well only eating 8 times a day, especially from days 2 through the first couple weeks, most babies are going to need to nurse much more frequently than that. Unless the baby is getting on the breast for an hour at a time, 8 times is probably not frequently enough on day 2 until lactogenesis 2 begins. When mother's mature milk comes in, I think infants will often naturally go longer between feeds. I see that it is the babies who are not breastfed unrestricted from day 2 on that really have poor weight gain and jaundice.
 
For me, I see much more success with moms when I tell them to nurse their baby on cue, and then I explain what feeding cues are. It also helps the mother get to know her baby better and feel much confident in mothering her child. Infants of mother's who nurse their infants on cue, IMHO, have much better weight gain and less jaundice than those who nurse q 2-3 because those babies are often missing lots of feeds. That's why BFHI step 8 is encourage women to breastfeed on demand. When we say q 2-3 hours, it is also not compliant with the 10 steps. I also tell that although many people will tell her to breastfeed 8 to 12 times a day, most babies who breastfeed on demand will probably feed 10 or more times a day and that is normal, many babies who only breastfeed 8 times a day will not get enough milk. Nursing schedules are also disempowering to mothers. 
 
What I see more often is that babies breastfeed very differently on day 1, day 2, day 3, day 4, etc. What I prefer to tell mothers is, "It's best for you and your baby to feed the baby whenever he shows signs of being hungry. (Then we talk about feeding cues) Most babies will eat a lot for the first couple hours after birth and then sleep for awhile. Most healthy babies are going to wake up on their own and tell you when they are hungry. Its much easier to get a baby to breastfeed when they are showing feeding cues. The average baby eats about six times in the first 24 hours, and then about 10 times a day after that for the first couple weeks. But it varies from baby to baby, it may be more than that. It's more important to look at the total number of times per day that the baby is eating, and how often they are voiding and stooling, rather than eating on a schedule. (If the baby is eating 12 times a day, I don't really care if the baby sleeps for 5
 hours once a day or doesn't eat in any regular pattern) Following your baby's hunger cues will help you get to know your baby better, and usually help your baby gain weight faster. If your baby is not waking to feed, or he is not voiding and stooling frequently, or begins to turn yellow, you may need to feed your baby more often and call your Pediatrician. If babies are wrapped up tight in blankets in their crib, they will often sleep through feedings. So we recommend holding your baby skin to skin on your chest as much as possible in the early days, it helps get the baby interested in eating and it helps to increase your milk production. If it has been a long time since baby ate, unwrap your baby and put him on your chest, skin-to-skin."
 
I tell the mom that but then usually one of the RNs will come in the room and say, "what? the baby only ate six times in the first day? You better give him formula!"
 
Anyone have similar observations?
 
Tricia Shamblin, RN, IBCLC

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