I've had good success with the following plan when the baby fits our criteria for insisting on a minimum number of feeds per 24 hours.  This includes near-term babies and small for dates babies, the ones we don't want to lose any more weight than absolutely necessary.  We start it while they are still inpatients and they are much more ready to go home after trying it out for a day.

Baby is offered breast when she cues to feed or when three hours have passed since last feed, whichever comes first.  Mother sets the alarm on her mobile phone when baby feeds, to go off in three hours.  If baby pre-empts the alarm, she re-sets it for three hours from then.  Parents keep track of how many times the alarm is the signal to offer breast and how many times the baby cues to feed first.  Parents also keep track of how many feeds there are, and a diaper log.

If the baby has fed 10 times between the parents' breakfast and their bedtime, they do whatever the h*** they want at night.  I suggest letting the baby decide when to feed and if they are comfortable with that, then they do.  Some parents are too nervous for that so they follow the alarm system at night too, but rarely for more than one night :-)  A lot of parents realize at the end of 24 hours that they don't need to bother setting the alarm because their baby works just fine.  The parents who have needed to wake the baby many times are encouraged to continue, and expect the baby to start spending more time in alert, calm state as she matures.

If at any feed the baby does not suckle convincingly, the mother expresses whatever she can and feeds it to the baby by spoon, cup, hook or crook.  I don't even care how she does it.  A lot of times the baby's appetite is awakened by the expressed milk and it perks up and feeds afterwards.  Sometimes the baby is drowsy.  That's ok, they have another opportunity no later than 3 hours afterwards.  Skin to skin is a given; also baby-led, laid-back breastfeeding.  

The baby is weighed once a day, naked, and as long as she is not losing weight after day four, and peeing and pooping, the plan continues until the parents have forgotten they needed a plan or baby has surpassed birth weight.

This often turns a baby who has been difficult to rouse and nearly impossible to feed into an eager, willing and alert feeder who gives the parents infinitely more confirmation that they have what it takes to keep her alive and that she is excited to be there with them.     

Before they go home I make sure the parents have a general idea of how much a newborn takes in 24 hours based on the 15% estimate.  Happily I live in a country using the metric system so this does not exceed my comprehension nor that of the parents.  I want them to know we are talking about *roughly* half a liter from about day 7, not 5 tablespoons and not 5 gallons.  Even our NICU is sending babies home with little more information or instruction than that, and it works SO MUCH BETTER than detailed dictatorial orders for how much and when, emphasizing the need to know exactly how much the baby has taken in at each feeding episode.   When they realize what a huge amount the baby consumes, relative to its body weight, they understand without further explanation why eight feeds are not enough, since the baby can't possibly take in one eighth of its daily needs at one time.  

The only question they have once we have written down the plan is 'why didn't anyone else explain it to us this way?'

Rachel Myr
Kristiansand, Norway

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