Dr. Jen and all,
Sometimes we see this in babies born via c/s or mom's who got lots of IV
fluid. Sometimes it only looks bad on paper - look at the clinical signs of I&O.
But if the big problem is lack of night nursing, mom and baby need to get
together. I know YOU have spent many nights in the hospital (as a resident and an
MD) ;-) but mom's don't always realize that is it perfectly normal for baby to
have marathon nursing sessions really early in the morning or late at night.
Strangely enough, it coincides with their 20th to 24th hour of life.
Hmm.....your normal sleep wake cycle for a newborn. If you look at the research, babies
will have 4-5 "good" feeds in the first 24 hours of life...along with 2-3
lazy, brief nursings. In the 2nd 24 hours, they wake up a bit more and nurse
"good" around 6-7 times. (My partner and I use poor, fair good and well to judge a
feeding, based on latch and swallowing, seldom do I chart a "nursed well"
until baby is over 24 hours old. I wanna hear frequent swallows and see an alert
baby with good output!) Skin to skin will help as first time moms (or first
time nursers) will miss those subtle feeding cues.

I explain it to mom like this: remember when you were pregnant? When you
walked around or moved during the day, baby was rocked and soothed by your body's
motion. What happens when you laid down in bed at night and stopped moving?
Why yes, baby started to move and kick - he/she was awake. This explains the
wake/sleep cycle and why very new babies are up in the wee hours. Then I explain
normal newborn development and why they seem to wake up the day you go home.
(No flames please, this is an observational theory but it seems to have some m
erit. And it makes moms more responsive and understanding of those night
feedings in the early days.) If mom and baby want to nap during the day (in the same
room - gasp - even in the same bed - that's wonderful). Please do the same at
night. Keep your baby with you as much as possible. Get an assessment of the
baby at the breast at several different times of day. Watch output, listen for
swallows.
Mary Kay Smith, RN, IBCLC
Romeoville IL near Chicago

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