Hi Tricia,
I think that we need to consider each baby individually. In our hospital,
the protocol for a baby under 3 kilos is to wake every 3 hours. We are less
strict about waking larger babies and generally let them go 4 hours. If a
baby goes 6 hours without eating we check their sugar so I will encourage
the mother to wake her baby to eat before having to prick her heal.
Generally around 4 hours I will at least make sure that the baby is
unwrapped and on the mothers chest to encourage her to start rooting.
This week I worked with a very small  baby (2.450) at night who ate
throughout the night on and off. She finally fell into a deep sleep around
4:30 in the morning. There was no way that I was going to wake her poor
exhausted mother at 7:30 but the nurse who took over for me on the morning
shift insisted. I tried explaining that the baby had eaten all night long
but she still insisted on waking the mother and baby to eat. Fortunately it
did not discourage the poor mother too much.
We also need to look at risk factors for low blood sugar and
hyper-bilirubin  and take all these things into account.
All the best,
Chayn Fogelman IBCLC RN

On Wed, Feb 8, 2017 at 4:32 AM, Tricia Shamblin <
[log in to unmask]> wrote:

> I was reading Nils Bergman's recent article that states that newborn's
> physiology suggests a feeding schedule closer to hourly when awake.
> https://www.evergreenhealth.com/WorkFiles/Bergman_2013_Stomach_Capacity_
> Feed_Interval.pdf
>
> I see this too with cluster feeding in the first few days. Had a patient
> this week whose baby fed 7 times in 10 hours and then was sleeping for 4
> hours on day 2. In the past I've said that if baby sleeps more than 3 to 4
> hours attempt to wake baby, but I'm now questioning this. I feel this
> mother really needed sleep. Baby had 10 feedings in previous 24 hours. What
> do you think? Should we advise to wake baby?
> Trying very hard with staff to get away from "breastfeeding every 2 to 3
> hours." But when I tell them to do gentle waking if baby sleeps more than 3
> hours, I feel like we are right back in the same place with unnecessarily
> waking a sleeping baby that has been feeding well. Would love to hear
> others thoughts and what they do.
> Tricia Shamblin, RN, IBCLC
>
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