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Breastfeeding Basics

Marie Davis RN IBCLC

THE FIRST FOUR WEEKS: BABY

 

Do I HAVE to wake the baby for feedings?

Many babies are sleepy in the first few days of life. This is especially true if the mother had a long labor, received pitocin or pain medications or if there is a great deal of molding or bruising of the baby's head. It is important to wake the baby for feedings at least every two to three hours during these early days. The new mother should not "skip a feeding so she can rest," unless she is severely tired. Repeatedly skipping breastfeedings can interfere with the milk supply and cause engorgement.
Some newborns may not wake for hunger pains in the first few days. Letting the baby sleep may contribute to weight loss and dehydration. To wake a sleepy baby: stimulate by giving the baby a "sponge bath" (washing the baby with a washcloth and water ony); undressing, provide skin to skin contact; talk to the baby, rocking and patting may also help. Lower the environmental temperature ( the baby will fall asleep if it is over 80°F (Lawrence and Lawrence 220) ). The mother should be advised to use pain medication only as needed. Seek medical assistance if the baby seems too sleepy, doesn't want to nurse as often as expected, or constantly falls asleep at the breast before at least ten minutes of active sucking and swallowing.
Once mother's milk is in, she needs to stop "watching the clock" and watch the baby. The baby will now need eight to ten feedings in a 24 hour period; some more some less. Nursing styles differ, but I usually recommend that she go no longer than three to four hours during the day time and one six hour stretch at night before feeding the baby. Of course, if the baby demands more often, she should feed him.
Thre comes a point where mom can "trust" that the baby will wake up for feedings. For the full-term infant this is around the beginning of the second week.( Moms with premature infants should consult the baby's doctor regarding feeding schedules) At that point mom can let the baby determine the feeding schedule. Remember if a baby sleeps for long stretches at night, they will nurse frequently during the day, to get the amount of milk they need.

 

How do I know if baby''s getting enough?

Breastfeeding mothers always ask this question. She can be assured that all is well if at five days of age:

  1. Her milk is in, as evidenced by mild engorgement of the breasts
  2. She hears consistent infant swallowing at the breast.
  3. The baby has at least six to eight very wet diapers per day.
  4. Infant stools have turned yellow and follow most feedings.
  5. The baby begins to self wake for feedings every two to four hours.
  6. The baby has eight to ten feedings per day.
  7. Satiation occurs (baby relaxes or melts at the breast after several minutes of nursing with active swallowing).
  8. The infant has gained weight from hospital discharge weight.

 

Mothers often need to be reminded that babies suck reflexively. Sucking does not always suggest that baby is still hungry. Reflexive suckling means that baby will suck on anything that is put in or near his mouth. I doesn't mean he's hungry. A baby may empty a bottle of water or formula, right after breastfeeding, due to this reflex.

LATCHES scoring self assessment for breastfeeding in the early days.

 

Should I give my baby supplemental bottles of water or formula until my milk comes in?

Supplemental bottles of water or formula are not recommended for the normal healthy newborn. There is a very real danger of ARTIFICIAL NIPPLE PREFERENCE in these early days. There is also some evidence that the hard surface of the bottle nipple is a "super-normal stimulus." So that when the baby returns to the breast, he may not react to the soft nipple and areola with suckling.

A baby must LEARN how to nurse. It is best to avoid the use of bottles of water or formula for at least the first three weeks. By giving bottles, the baby may have difficulty learning to do both or he may develop a preference for the fast, easy flow and/or hard surface of the bottle nipple. In addition, mother's body must be convinced that there is a baby to feed while the milk making hormones are at their highest levels. Bottles of water or formula can lower the milk supply or lead to painful engorgement. Water and formula do not prevent jaundice.

 

What if my baby needs bottles after birth because of a medical problem?

It would be foolhardy to refuse the use of bottles for a baby who is ill. If the baby gets used to the bottle and is having difficulty latching on, the mother should try:

"Laid Back Breastfeeding." Seriously, babies KNOW what to do, let them do it! (see: Biological Nurturing ) Sometimes all the things we; as healthcare providers, do to help; hinder the entire process.

Using clutch hold for better control of the latch-on; this will give her better control of the head and a clear view of the baby's mouth.

Dripping water or formula down the breast as the baby attempts to latch on.

Tell the mother to be patient. A baby should never be FORCED to the breast. Never grab the baby's head. Stop trying if the baby becomes agitated or upset. Let baby calm down and try again.

If the problems persist, she should seek assistance from a lactation consultant.

 

What if my baby won't latch-on at all?

The number one rule is: FEED THE BABY. If she can express enough milk, she should give it to the baby in a bottle. If she is unable to express enough milk then formula is necessary.

Remind the mother that if her baby is not latching on that she needs to pump her breasts at regular intervals (eight to ten times per 24 hours) to maintain her milk supply until she can get assistance from a lactation consultant with the latch-on problem.

 

Is it normal for my baby to have liquid stools?

Normal breastfed stool is almost all liquid with small milk curds. It is yellow, resembling runny egg yolks and has very little odor. The baby will most likely have a stool every time he nurses. Sometimes the stools are rather explosive sounding. Diarrhea in a breastfed baby is rare. Diarrhea stools are frequent, green in color, full of mucus and/or blood flecks and are rather foul smelling. If there is any doubt, the mother should contact the baby's physician immediately. True diarrhea in a baby quickly leads to dehydration. The breastfed baby may occasionally have diarrhea type stools accompanied by colic like crying if a mother is taking stool softeners after delivery. Stool softeners and laxatives are not recommended for the nursing mother.

 

Is it OK if my baby sleeps all day?

A baby can be overly sleepy in the newborn period. Some infants just stir around a little in their cradle, and if left alone, will fall back to sleep. It is important for the mother to observe the infant for sleep-wake cycles. She should attempt to wake the baby when he begins to stir.

To wake the baby, mother should pick him up, unwrap him, talk to him, play with him, and/or rub his feet. Any combination of these may be needed to wake the baby for feedings.

 

What if my baby is awake all night? Will he ever sleep through the night?

For about the first four weeks, most babies have their days and nights mixed up. In utero, the mother's daily activities "rocked" the baby to sleep. Remind her of what happened every time she got into bed at night: the baby would wake up and begin to kick. The baby should settle into a normal day/night routine soon.

Babies begin to sleep through the night (defined as sleeping a six-hour stretch) somewhere around eight to twelve weeks of age. Some babies take longer. Body weight may also play a role. Many babies begin to sleep through the night when they weigh twelve pounds. There are the occasional few who don't sleep through the night until toddlerhood. Mothers frequently believe that if they give the baby formula or start solid food, the baby will sleep better. Feeding method makes no difference! Giving the baby cereal will not make the baby sleep through the night. It could backfire and make the baby more wakeful or cause gastric distress.

 

What about parenting advice that recommends scheduling feedings or not allowing the baby to nurse on demand so he will learn a routine?

Unfortunately, this idea has become popular again lately. Babies have no sense of time. Letting him cry it out, even for a few minutes can be an eternity of abandonment for a baby. Mothers should be told to listen to their instincts, not ill placed advice. A baby's needs should come first, within reason. If the advice she is following feels wrong for her baby, she should stop. Severely restrictive schedules and unrealistic behavior expectations can lead to failure to thrive and often results in child abuse.

 

Should my baby be in his own room?

Multiple studies have shown that a baby sleeping close to mom has a lower risk of Sudden Infant Death Syndrome [SIDS]. I firmly believe that as long as the baby is still nursing at night he should be close by. Many mothers have told me that if they don't have to get out of bed to feed the baby, they can fall back to sleep much easier. Having the baby close, where mother can just pull him into bed with her to nurse is wonderfully easy.

On the other hand, some mothers find that they cannot sleep well if the baby is too close because they wake up every time the baby makes a sound. Mother nature has made new mothers sleep lighter for a good reason: newborns choke frequently. The mother sleeps lighter to be able to wake easily if any danger is perceived.

The AAP recommends that "the infant’s crib or bassinet be placed in the parents’ bedroom, which, when placed close to their bed, will allow for more convenient breastfeeding and contact." There are special cribs made side-car style that connect to mom's bed so baby can be slid over to feed then safely put back in their own bed.

Soft surfaces, bumper pads, waterbeds, blankets, sheets, pillows, heated mattress pads etc... are all dangerous for baby; sleeping on the stomach and entrapment are significant causes of infant death. The most dangerous is falling asleep with a baby if you are in a stuffed chair or couch. An infant should never share a bed with older children.

 

Is it OK to have my baby in my bed?

The American Academy of Pediatrics4 states that bed sharing "can be hazardous under certain conditions." The AAP's task force on SIDS recommends "that infants not bed share during sleep. Infants may be brought into bed for nursing or comforting but should be returned to their own crib or bassinet when the parent is ready to return to sleep. This of course, applies only to normal sleep. The mother (or father) who is taking pain medication, sleeping pills or drinks ANY amount of alcohol will sleep very deeply; the baby should not be brought to the bed.

Breastfeeding mothers often find it more convenient if the baby sleeps in the bed with them for night feedings. Although the possibility of rolling over on the baby exists, most mothers cradle the baby in their arm while they are asleep. On occasion, I have asked mothers if they sleep with a small pet in the bed and ask if have they ever rolled over on it, to prove the point. Because mothers become amazingly light sleepers, they are aware of the baby's every movement. If a mother were to roll over on her baby, the baby would struggle and mother should wake up.

Should mom decide to co-sleep with her baby, some warnings are in order. Extra pillows can be a hazard if the baby is in mom's bed. Parents should be warned to never put the baby face down on a traditional waterbed. The waterbed mattress can fold up around the infant's face or trap the infant so that he cannot move his head to breathe. Also the parent's bed should be in the center of the room, away from any walls on the sides and/or bottom. Headboards should not leave any space where the baby might fall in and become trapped. Parents often place a rolled towel at the head of the bed to help prevent trapping. Babies have died when they have become trapped between the mattress and the wall. A baby should never be left in an adult-sized bed alone. Babies are more mobile then parents realize. It is easy for the baby who is left alone to squirm or crawl into cracks and crevices or under pillows and blankets and suffocate.  

 

 


© Marie Davis, RN, IBCLC     email

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The First 4 Weeks: Baby
Questions After The First 4 Weeks
Family Issues
Breastmilk Expression
Storage of EMM (Expressed Mother's Milk)
Working And Breastfeeding

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Last Reviewed: Saturday, February 11, 2012 11:14 AM