Holly is right that such assertions need to be be looked at critically.  But if a baby isn't eating, formula supplementation is likely to happen quickly, without necessarily a research-based rationale, so the hand-expressing could also be seen as a low-tech defensive move, to see if we can head-off concerns about blood sugar, bilirubin levels or too much weight loss.

Looking up "early initiation of breastfeeding" brings up lots of public health statements on getting breastfeeding going in the first hours is lifesaving in developing countries, where babies are just the same as in places with more material advantages.  If the 10 Steps say "feed in the first hour" then it seems logical to do something if that's not happening.

There is some research on milk removal in the early days being important for the long-term calibration, though much of it concerns pump-dependent NICU mothers (and likely mothers of healthy term babies have more slack in the system)
https://lactationmatters.org/2011/09/06/is-pumping-out-of-hand-why-hand-expression-in-the-first-3-postpartum-days-is-important/

Interestingly, this study found a difference if a mother of a VLBW baby started milk removal within the hour vs within six hours 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4352698/

This from Position Statement  #3065
from the National Association of NeoNatal Nurses includes

> Mothers should be instructed to pump within 1 hour of
> delivery, which has been correlated to early lactogenesis II and increased milk
> volumes at 1 and 3 weeks post delivery (Parker et al., 2012).
> The use


Yes, babies are generally born water-logged, with some resources, but why push the system more than is necessary.  People often cite the fact that in the 50s and 60s, babies weren't fed for 24 hours, but many of those babies had Thanksgiving meals of formula starting then.

My sweeping generalization is probably because I don't work in a hospital (and thus it's easy for me to say all sorts of things), but am meeting with mothers weeks out -- often with milk production issues, non-latching babies and almost everyone had supplements starting in the hospital.  So perhaps it doesn't hurt to err on the side of getting milk out of mothers and into babies to see if we can head any of that off.  

Margaret Wills, IBCLC, Maryland, USA





>> 
>> Date:    Sat, 11 Feb 2017 02:36:25 +0000
>> From:    Holly McSpadden <[log in to unmask]>
>> Subject: Re: How long is too long for the newborn to go without eating?
>> 
>> And this is based on what research?
>> 
>> HollyMcspdden, IBCLC
>> 
>> Sent from my iPhone
>> 
>>> On Feb 10, 2017, at 10:10 AM, Margaret Sabo Wills <[log in to unmask]>
>> wrote:
>>> 
>>> The question is not just about the newborns's possible reserves for
>> riding out any particular amount of time without eating.  We're also
>> learning more about the importance of early calibration-- even in the first
>> hours -- in promoting the ongoing supply -- milk removal is so important
>> for getting the body to invest in this new metabolic activity.  So if
>> nothing vigorous is happening in those first couple hours of cozy
>> skin-to-skin, I would encourage hand-expressing onto a spoon frequently to
>> give the baby some "bonus" milk to wake them up to the wonderful world
>> waiting, and to start sending the message to the mother's body.
>>> 
>>> I'd even add pumping if the baby isn't doing his/her job by the end of
>> the day, warning the mother she'll not see big amounts, but that anything
>> removed "places the order" and we'll syringe up every drop to give to the
>> baby.  I'd rather err on the side of promoting supply for the long-term
>> picture if the baby needs some time to step up to the job.  There's no
>> downside to some little spoonfuls of colostrum, which may head off the
>> cascade of supplements that will come if there's too much weight lost, or
>> problematic blood-sugar readings.
>>> 
>>> Margaret Will, IBCLC Maryland, USA
>>>            ***********************************************

>> 

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