Sharon, thanks for clarifying: "The 5 hours or more basically refers to
experienced moms that let their
babies sleep. 8-12 feedings per day in the early weeks may not occur if
they
expected the baby to wake up and ask for a feeding."
However, I would be interested in the reason you chose 5 hours and 8-12
feedings. I know we might all have rules of thumb, but I am unaware of any
research which indicates that babies whose feeding pattern does not fall
within this practice (even in the early days) require intervention.
I looked up the evidence for step 8 'encourage breastfeeding on demand' of
the WHO/UNICEF Ten Steps to Successful Breastfeeding (Evidence for the Ten
Steps to Sucessful Breastfeeding, 1998, WHO, Geneva). The conclusion is:
"The breastfeeding pattern, that is the unmber of episodes and the total
duration of suckling per 24 hours, varies widely between mother-infant pairs
and over time, so truly unrestricted breastfeeding cannot follow guidelines
based on mean values.'
Much of the discussion is around *frequent* feeding, but I know from my days
of doing BFI assessments that the limits given for length of time of
'allowing' the baby to sleep (usually set somewhere between 8 and 12 hours
when there is a limit in a UK maternity unit -- at least, last I heard,
anyone know different?) varied, and it was one of the difficult concepts to
get over to staff that a fixed *outside* or maximum limit for feed frequency
is addressed in this step as much as the inside or minimum limit for feed
frequency. An assessment of the individual baby remains the guide for
knowing if there is a reason to wake the baby.
Of course, you may be talking about a population of drugged babies, born
part-way down the cascade of intervention, where timing is a further
intervention needed to prevent the iatrogenic side-effects of the mode of
antenatal care and the style of birthing. In that case, I would hope that
your guidelines reflect the reason they are needed -- so that if any babies
are ever born through a less interventionist style, they will be allowed to
develop their own feeding pattern!
I would be interested in knowing where the five hours is written up and also
if others out there are using this guideline or have other limits. If the
latter, do please include the evidence. I know this is a tedious bore for
everyone, but I remain continually fascinated about the origins of these
limitations.
Magda Sachs
Breastfeeding Supporter, BfN, UK
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