In order to establish an adequate milk supply, newborns need to nurse a minimum of eight times, and optimally ten to twelve times or more during a twenty-four hour period. This usually means that your baby will nurse every two to three hours during the day, with possibly one four hour stretch at night. Newborns often nurse almost constantly for hours each day (cluster feedings) and then may sleep deeply for several hours. These longer sleep periods are fine as long as the baby is getting in his minimal number of feedings in twenty-four hours, and his urine and stool output and weight gain is adequate (see article How To Tell If Your Baby is Getting Enough Milk).
Mothers are often told to wake their newborn for feedings every two hours, and there is a very good reason for this. Newborns are notorious for sleeping through feedings, and it is easy to assume that a sleepy baby is a full, satisfied baby. This is not always the case with newborns (I define newborns as babies two weeks old or younger). Demand feeding begins after the baby is a couple of weeks old, has regained his birth-weight, and your milk supply is well established. A healthy baby who is older than two weeks is not going to sleep through feedings -he will most definitely let you know when he is hungry! However, you can’t assume that a newborn will let you know when he needs to eat, and that’s why it is important to wake him for feedings. Some so called “good babies” who sleep long stretches at a time have ended up becoming dehydrated.
The two hour rule only applies during the early weeks, however. Once he is gaining weight steadily, and your milk supply is well established, you can let him set the pace for feedings. It really doesn’t matter whether he nurses every two hours or every four, or whether he takes one breast or two, or whether he nurses for thirty minutes or five minutes, as long as he is having good urine and stool output and gaining weight. I have seen many mothers with roly-poly, thriving babies who are a month or two old who are still setting their alarms and trying to force their babies to nurse and take both breasts at a feeding, when what they really need to do is relax and follow a baby-led sleep and feeding schedule.
So, you have a newborn and you want to make sure he nurses often enough to ensure an adequate milk supply. First, you want to offer him the breast at least every two hours during the day, with possibly one three to four hour stretch at night. Time the feedings from the beginning of the feeding, and not the end. For example, if you start nursing him at 2:00, and finish it at 2:45. you still need to try to feed him again at 4:00. And yes, it is going to feel like all you are doing is nursing, burping, changing diapers, etc., but that’s just how it is for the first week or two. Don’t plan on getting much done during this time. You’re lucky if you can fit in time to use the bathroom or take a shower. That’s why you need as much help as possible with cooking, laundry, shopping, cleaning, etc during this time. Your job is to establish your milk supply, make sure your baby gets enough to eat, and get as much rest as possible during this postpartum period. Remember that women used to stay in bed for weeks after they had a baby, and were waited on hand and foot. Ah, the good old days!
It is important to note that the time spent at the breast is not necessarily an indication of a good feeding. If he goes on the breast and sucks vigorously for a minute or two, then ‘zones out’ and sucks in his sleep for another thirty minutes, he may not have received enough of the high fat hind milk to ensure an adequate milk intake, even though the feeding took forty-five minutes. The quantity and quality of the strong, nutritive sucking is just as important as the length of time spent at the breast. Babies need to suck actively at the breast for 10-15 minutes on the first breast, and then the second should be offered, although he may or may not take it.
Nursing has a tranquilizing effect on babies, which is one of the most wonderful things about it for older babies (there is no better way to put a baby to sleep) but this can be a disadvantage for newborns, who love to use the breast as a pacifier, and many not sustain a strong nutritive suck for as long as they need to. Newborns who are in a deep sleep state often seem to be almost comatose, and this can be one of the most frustrating things that new parents have to deal with.
Some causes of sleepiness in newborns include:
- Drugs given during labor and delivery, including epidurals (especially more than one) and painkillers given during Cesarean sections.
- Medical reasons – jaundice, infection, or circumcision. Jaundice is common in newborns and makes babies very sleepy. It’s kind of a Catch-22 – because he is sleepy, he doesn’t nurse well, and because he doesn’t nurse well, he doesn’t stool and his bilirubin levels go up. Circumcision is a medical procedure that takes a lot out of babies – expect your little boy to be tired, sleepy and not too interested in nursing the day of the procedure if you choose to have it done.
- Too much stimulation – some babies ‘tune out’ by sleeping when the environment is too noisy or the lights too bright.
- Too much milk - some babies react to the increased flow of milk on the third or fourth day by falling asleep within a minute or two of nursing.
- Inadequate milk intake - another Catch-22 – the newborn baby who isn’t getting enough milk may respond by becoming weaker and sleeping, rather than screaming his head off and demanding to be fed.
Here are some tips on how to encourage a sleepy baby to nurse:
- Loosen or remove his coverings. Undress him down to his diaper, and get some skin-to-skin contact. Try taking a warm bath together.
- Look for signs that he is entering a ‘light sleep cycle’. Babies cycle in and out of light and deep sleep more frequently than adults, and your efforts to wake him will be more successful if you catch him during the light sleep stage. Signs of light sleep include: rapid eye movements (REM) even though his eyes are closed; changes in facial expression; involuntary movements of arms, legs, or mouth (sucking motions). You may be unsuccessful at waking him during a deep sleep cycle, but have good results just a few minutes later if you catch him during a light sleep cycle. (See article Night Waking for more information about your baby’s sleep patterns).
- Dim the lights in the room. Newborn’s eyes are sensitive to light, and bright lights may make him want to keep his eyes closed.
- Talk to him and try to make eye contact.
- Hold him upright. Try the ‘doll’s eye’ technique. Remember the dolls we had as little girls who closed their eyes when you laid them down, and opened them when you sat them up? Gently bend him into sit-ups in your lap by raising his shoulders, legs, and torso, then lowering him back down. Don’t raise his legs up when he’s sitting, though – this could cause internal damage. Be gentle.
- Increase stimulation. Rub his back in a circular motion from the shoulder blades down and back up; stroke his scalp in gentle but firm circles, squeeze gently in the cavity between his neck and collarbone (remember in grade school when someone wanted to get your attention, and they sneaked up from behind and grabbed your shoulder-blade? Remember how you jumped out of your chair? This is effective, but do it gently); rub his hands or feet by applying pressure with your thumb (your partner can do this while you are nursing to help keep him stimulated); walk your fingers up his spine; move his arms and legs in a bicycling motion, play pat-a-cake; or circle his lips with your fingertip. Keep talking to him and trying to establish eye contact.
- Change his diaper and burp him before offering the other breast. Most newborns hate this, and it may make him mad enough to wake up and nurse. Try switching breasts as soon as his sucking slows down, even if it has only been a few minutes. Then go back to the other breast and let him fall asleep on that side if he wants to.
- Wipe his face with a cool, damp cloth.
- Try nursing in the football hold rather than the cradle hold. Babies cuddled in the cradle hold tend to fall asleep more readily.
- Support your breast while nursing so the weight of it isn’t on the baby’s chin.
- Express milk onto his lips or dribble milk into his mouth with a dropper or syringe to keep him swallowing while feeding.
If you have a sleepy baby, remember that the most important thing is making sure that he gets enough to eat. Monitor his urine and stool output and his weight gain closely, especially during the first couple of weeks. If he is not gaining weight adequately, consult a lactation professional for advice on how to increase his weight gain. (see articles How to tell if Your Breastfed Baby is Getting Enough to Eat and Increasing Your Milk Supply for more details).
Supplement if necessary – preferably with your own expressed breast milk. Once he begins gaining weight steadily, you can relax and go to a demand feeding schedule. Soon you will be looking back on these as the ‘good old days’ – “Remember when he used to sleep all the time, and we couldn’t wake him up?”
Once you make it past the newborn stage (which seems to last forever, but trust me, it flies by) you will be able to relax and stop watching the clock, while your baby sets his own individual feeding patterns.
(Edited October , 2013)
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Anne Smith, IBCLC