This is a really good question. I did a lit review when we started using the
AAP hyperbilirubinemia nomogram as our pedis put "insufficient
breastfeeding" as one of the risk factors. (God bless them all!)
So then the question was - what is insufficient breastfeeding in the first
24 hrs? The only reference I was able to find was a VERY old Larry
Gartner/AAP Breastfeeding Committee policy that said insufficient
breastfeeding = less than 4-6 times in the first 24 hours.

One of the problems with a quantitative research study on this topic is that
our labor and birth practices are so out of whack that we don't know what
normal is anymore.

We still have a 10% epidural rate and 25% cesarean rate (how sick that I'm
excited) and note that our primip babies almost always nurse well within the
first hour and then sleep till about 20 hours, then cluster feed. Usually
the moms sleep while the babies sleep.

Our multiparous moms mostly keep their babies in their arms and they are
"always breastfeeding."
Just more anecdotal evidence....Who among us will find someone to do this
study??!!

Dawn Kersula MA, RN, IBCLC, FACCE
in southern Vermont - at the northern tip of all that New England rain and
thankful that the Connecticut River is roaring but not raging today

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