As one of those who give guidelines to moms in the hospital, allow
me to describe exactly what I tell the moms and therefore the
rationale for such advice.

     "For the first few days we suggest a "demand plus"
     approach to frequency.  Feed your baby any time he/she
     shows early hunger cues (which I have already described as
     licking the lips. searching with the mouth or sucking on
     fingers, thumb or fist or anyuthing else that comes close
     enough to "check out").  In addition, if it has been 2-3
     hours during the day and 4 hours or so at night, OFFER the
     breast.  Baby may not be interrested.  If you've been
     gently trying to rouse baby for around 5-10 minutes or so
     and get little or no response, try again later.  It is
     very normal for newborns to be "zonked out" for several
     hours after the first wide awake period.  You will only be
     here 24-48 hours and we'd like to get as many feedings as
     possible in during that time so if there are any
     challenges, we can work through them with you.  It looks
     like we've been ignoring the baby's needs when baby's flow
     sheet says , for example, nursed at 0600 and then nothing
     under feeding until 1700.  If you offer the breast, but
     it's a "no sale" let your nurse know so she can write
     "attempted breast-baby sleepy" or whatever is
     appropriate.  Once baby has learned to nurse effectively
     and your milk supply has kicked into high gear, just let
     baby set the pace.  You don't have to keep offering after
     2-3 hours unless baby turns out to be one who wants to
     sleep all day and feed all night.  Most parents would
     prefer it the other way around, so you might want to keep
     offering frequently during the day in hopes you can
     convince baby to switch.  Sometimes this works, sometimes
     it doesn't."

In other words, this is a guideline/suggestion and hopefully it
doesn't come across as "you MUST feed every 3 hours".  Our nurses
are getting much better about being patient with baby's "zonked out"
phase and not getting themselves (and the moms) upset about it.
Winnie Mading RNC, IBCLC  (working in a hospital where the LC's see
every mom for questions, anticipatory teaching and assistance if
needed and 80% of our 2200-2400 deliveries at least initiate
breastfeeding)

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