Hi Ladies,
I need your wise advice and opinions about telling mothers of newborns to breastfeed every 2 to 3 hours. I had a friend who had a healthy, full-term baby at a local hospital recently. When I went to visit her, on her whiteboard was written, Breastfeed every 2 to 3 hours. This baby had no issues, no hypoglycemia, etc., and within the first 14 hours it had breastfed well 3 times and had one sleepy 5 min feed (which occurred because even though the infant was in a deep sleep, mainly because the nurse told her it had been 3 hours so it was time to feed the baby). When the infant was sleepy during the feed the nurse said that the baby needed food and was very insistent that the mother hand express her breastmilk and feed it via syringe to the infant because the last breastfeed was more than 3 hours earlier (I thought she should take a nap because she looked exhausted!). When the LC (IBCLC) came in later I asked her about why the nurses were recommending breastfeeding every 2 to 3 hours, instead of on cue at least 8 to 12 times a day. She said because that is a normal feeding pattern for a newborn baby and a good guideline for babies. They need to make sure that the babies eat enough and they do tell the mothers that if the baby wants to eat sooner than that, that is fine. But if the baby goes more than 3 hours without a feed at any point they require that the mother hand express her colostrum and feed to the infant, regardless of how many feeds in a 24 hour day. The mother told me later that throughout the day everyone had really stated every 2 to 3 hours, only one nurse once had added - if the baby is hungry sooner that is fine. I did not see any discussion from nursing staff or LC about what a feeding cue looked like. There was a lot of discussion about, "It's time to feed the baby." "The next feeding will be at about 11:00." 
I have to say that I was really surprised to hear an IBCLC assert that a newborn baby will normally feed about every 2 to 3 hours. I have not really seen that typically in a newborn. They cluster feed, sleep all day and then eat all night typically and have variable sleep/wake cycles. And are usually diffuclt to awaken during the first 24 hours. I feel if the baby gets 6 good breastfeeds in the first 24 hours, that is an awesome start, and I'm wanting at least 8 every day after that. Coming from a BFHI hospital, all of this talk about breastfeeding every 2 to 3 hours was really shocking to me. Discussing time frames or hours or schedules is really avoided there. And in their opinion every 2 to 3 hours is a schedule, I believe. The other IBCLC's opinion is that it isn't a schedule because they added, "Or whenever your baby is showing signs of hunger" at the end of their statement. I feel that I have found in my practice that one of the most damaging things that we can tell a new mother is to breastfeed her baby about every 2 to 3 hours because it really sets them up for false expectations. The baby then typically wants to cluster feed and the mother is thrown off by the fact that the baby is not doing what we told her it was going to do and typically she assumes this means that something is wrong, like she doesn't have enough milk, and then supplements with formula. It also leads to them watching the clock all day and not the baby. They really are more prone to ignoring feeding cues with that advice, I think.
I'm also concerned about the early supplementation via a syringe (not curved-tip, just regular). The next day after x3 syringe feedings, the baby was beginning to have more difficulty latching to the breast and when it did, it did not want to open his mouth wide. He really wanted to latch very shallow to the breast. I'm worried that these early syringe feeds are causing the baby to imprint to the syringe and they like the fast flow better, like a bottle, and it encourages breast refusal and a very closed-mouth sucking pattern. What does everyone else think?
I would also love to hear what other hospitals and IBCLC's are recommending as far as feeding guidelines to parents during the first few days. How long is too long to go without waking to eat? What do you have them do then? When do you begin hand expression? What means of supplementation do you use? I myself prefer spoon feeding colostrum if necessary and then cup-feeding mature milk for short-term supplementation, or an SNS if baby will latch, or sometimes finger feed with SNS if no latch. But if supplementation is going to be long-term, for weeks, usually go more towards bottle-feeding breastmilk. I typically recommend feeding on cue and just attempting a feed and skin to skin if 3 hours have gone by, although I do state that soon after delivery many babies can have a long sleepy period of up to 6 hours which is normal and fine. But other than that, if 5 hours have gone by with no feed or if baby has reached 12 hours no latch, then hand express and give EBM. But it also depends, I think on how many feeds the infant has had in the prior 12 to 24 hours and if there are any other medical problems (like jaundice) or signs of dehydration, etc. I do think it helps to have some standardized guidelines about this for parents and nurses, especially having them in writing, a plan they can follow can help with alleviating fears and get more consistency of practice.
Thanks everyone for your help!
Tricia Shamblin, RN, IBCLC



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