Following the first "get acquainted feedings" when baby may merely
nuzzle the breast, then mom should watch for feeding cues:
Eye movement under closed lids,
Movements of arms and legs,
Tossing, turning or wiggling,
Changes in facial expression,
Squeaking noises or light fussing,
Crying is a late sign of hunger.
Tight swaddling is no longer recommended because it restricts baby's arm and leg movements and hand to mouth movements. When babies are swaddled feeding cues can be missed. Infants should be wrapped lightly in a blanket.
Extended crying can affect the baby's ability to latch on
It is almost impossible to get a crying/screaming baby latched on to the breast.
If early feeding cues go unheeded, and baby begins to cry loudly or is left to cry, he may be disorganized and have a difficult time latching on. Then, sometimes when he does latch on, he may suckle briefly then fall asleep in a few seconds which is a sign that his nervous system has been overloaded. It's like he has to take a time out to get his act back together. This is normal because babies have immature nervous systems. If he falls asleep after a few suckles, he may not get a full feeding. Avoid changing diapers or clothing before a feeding if it seems to upset baby and affects his ability to latch on. If baby is crying loudly, rather then trying to latch him on, give him a clean finger to suck on (or a pacifier if you prefer: see overcoming artificial nipple preference) and gently rock him from side to side (from ear to ear rather than front to back). This will help organize his nervous system. Once he is calm, mom can try latching him on again.
Don't let baby "cry it out"
Crying is a baby's only way to "talk" to his caregivers. Some people will tell mom that baby has to be on a schedule and he will have to cry it out until it's feeding time again. Our mothers and grandmothers were given this advice based on formula feeding and mistaken beliefs that babies need to be scheduled. Today experts believe that we should view the breast as an external placenta providing nourishment whenever it is needed. Newborns aren't on the same time clock that adults are. In fact, most newborns seem to have their days and nights mixed up (see The first 4 weeks: baby ). A newborn responds to his natural internal clock.
Letting a baby "cry it out" is bad, if not dangerous, advice.
Prolonged crying is physiologically detrimental to the infant. The effects of crying are like the Valsalva Maneuver in the adult. [The Valsalva Maneuver is where you try to push air out of your lungs without opening your throat, it can also occur when an adult strains to have a bowel movement or during the pushing stage of labor.] The Valsalva Maneuver affects the way the body functions: large changes in blood flow occur, oxygen levels in the blood decrease, blood pressure rises, the heart rate slows, intracranial pressure (inside the head) rises, pressure on the ear drums increases, and blood flow from the inferior vena cava (a large vein in the abdomen and chest) to the heart decreases, which keeps the heart from pumping as much blood as it should. (Marasco and Barger)
For the first week, the baby will need to nurse approximately 10-12 times in 24 hours. Feedings do not have to long to be effective. Mother must attempt to wake the baby after three hours, (measured from the start of a feeding to start of the next feeding). During the first week baby may not demand to nurse as often as he should because of the effects of labor and medications used during labor (see Labor medications). Once mom can trust that baby will let her know when he is hungry, she can feed on demand. After the first week or two baby needs to nurse a minimum of 8 times per day during the first few months of life.
If the baby remains sleepy and difficult to nurse, try not to be alarmed. Don't worry too much if the baby is sleepy during the first 24 hours after birth. The baby should become more alert and eager to nurse after the first 24 hours. It is common for an infant to nurse infrequently in the first 24 to 48 hours. If sleepiness continues beyond 48 hours or if baby looks yellow (see Jaundice and Is baby getting enough? ) call you baby's medical provider.
Following the initial quiet alert stage in the first 2 or 3 hours after birth, baby goes into a deep sleep,. This helps him recover from the rigors of labor. The period of deep sleep is followed by increased wakefulness and increased nursing demands. This is called "cluster feeding." Mothers often interpret cluster feeding as an indication "that baby is not getting any milk or is getting an insufficient amount" of milk (Riordan and Auerbach 283). This is the prime time when women resort to using supplemental bottles of formula in the early postpartum period. Please be assured that cluster feeding is normal. Cluster feedings are actually series of mini feedings that are often followed by another period of deep sleep. Mom should catch up on her own sleep between cluster feedings (Riordan and Auerbach 283). Even if mom is unable to sleep, she should still rest either in bed or in a comfortable chair with her feet elevated.
Cluster feeding may also serve a physiological purpose. The increased frequency and breast emptying may have a major role in signaling the breasts to begin producing more milk. Mothers often report that the baby seems to have a heightened need to nurse right before their "milk comes in." Some mothers refer to this period as "marathon nursing."
Riordan and Auerbach state that "If baby is denied access to the mother when cluster feedings are most likely to occur this behavior [cluster feeding] may not occur until after the mother is home (284)." So if the baby has been separated from the mother in the hospital for reasons such as medical complications in the mother or baby, these sessions may not occur until mom and baby go home from the hospital.
Learning about these episodes can prevent mom from falsely assuming her milk is inadequate and giving the supplemental bottles of formula when they aren't needed.
Copyright Marie Davis, RN, IBCLC 1999