Nursing on demand can be a wonderful thing. Let us remember that nursing on demand means allowing your baby to feed at the breast as many times as he wants and for as long as he wants.
I want to emphasize that this does *not* mean allowing your baby to go long periods of time without nursing.
On average, a newborn baby in the first 24 hours of life will nurse about 4 times. Most of the time these babies turn out fine, and mom can go on to have a good nursing relationship. BUT, following these guidelines to the best of your ability (what works for YOU!) is extra insurance that your nursing relationship will start off excellent. Ideally, you want to encourage your baby to eat at least 10 times in 24 hours.
The more your baby nurses;
- the faster your milk volume will increase.
- the faster your baby will expel meconium which harbors bilirubin, that can increase the chance of pathologic levels of bilirubin (leading to jaundice) if not expelled.
- the less likely you will suffer from rock hard engorged breasts when your milk increases in volume between days 3-5.
- the less likely your baby will be readmitted to the hospital for jaundice, hypoglycemia, dehydration, hypernatremia, or excessive weight loss.
What if my baby won’t wake up to eat?
In the first hour or two after birth is when baby will be more alert and willing to nurse. After this, it is common for them to be really sleepy for several hours. In fact, a newborn will typically sleep for about 20 hours in the first day of life. It is still important to watch for early hunger signs such as stirring in their sleep, licking their lips, and bringing their hand to their mouth. Crying is a late hunger sign. Bring your baby to breast if your baby is exhibiting these signs. Ideally, you want your baby skin to skin for as long as possible, this helps facilitate the breastfeeding experience.
What if my baby still won’t eat after watching for hunger signs?
There are quite a few options you can do to ensure your baby is being fed. According to the literature, it is not necessary to supplement a baby in the first 24 hours. These guidelines I am explaining are an ideal situation and should be a goal for establishing breastfeeding. If your baby won’t nurse you can still express your breast milk. It is most effective to do hand expression while your breasts are mainly producing colostrum. Try to do hand expression every 2-3 hours, the same you would do if your baby was nursing. You can hand express into a spoon or in a little plastic medicine cup. You can then use a dropper to feed your baby your expressed colostrum, or save it for a later time. You can also use a manual breast pump, a personal breast pump, or a hospital grade double electric breast pump. Have your IBCLC verify that the flanges fit your breasts correctly, and teach you how to assemble the pump. It is imperative that you don’t use high suction on the breast pump before your milk increases in volume. Using high suction can damage your nipples, breast tissue, cause the nipple to swell, and ultimately cause pain. A very gentle, soft suction stimulation is all that is needed. You most likely won’t get much with the breast pump. This is okay, and it’s normal. To maximize production with a breast pump, use hands-on pumping. This is when you massage and compress your breast as you’re pumping. Express your milk every 2-3 hours, until your baby is able to nurse. Colostrum is thick and syrupy, and can be difficult to express. It takes practice!
Keeping track of nursing in the beginning is helpful for everyone, but why should you worry about it? It helps let us know how nursing is going when no one is there to help you. If we see that baby is nursing frequently for a decent amount of time, and you aren’t having pain, and baby isn’t losing weight excessively, then we have more puzzle pieces to say, “Yes, nursing is going ok for you!”
However, if we see that baby isn’t nursing frequently, is having very short nursing sessions (less than 10 minutes), you’re reporting pain, baby is losing more weight than normal, or is starting to jaundice, then we have those puzzle pieces to get you the extra help that you need. Hopefully from an IBCLC!
Minimizing bumps in the road early on will help establish breastfeeding and prevent negative breastfeeding experiences for you. Nursing isn’t always easy! As an IBCLC, I made a vow to myself not to let these moms and babies fall through the cracks. We must be vigilant, listen to you, and look at the entire picture in order to be most helpful to you.
I hope you’ve found this infograph to be helpful! Let me know if you have any questions.
Edited to include: Explanation of delayed onset of milk production.
There are several risk factors for why milk takes longer to increase in volume. Risk factors include; cesarean birth, excessive IV fluids, first child, traumatic birth, long birth, hormonal issues, and anatomy issues. This list is not 100% complete as there are a lot of risk factors involved. Frequent nursing isn’t a guarantee that your milk volume will increase faster, or even in the normal time frame (3-5 days after birth). If you aren’t noticing significant breast changes by day 3 or 4, make sure you consult with an IBCLC to evaluate your specific situation. In some cases, supplementation may become necessary if milk doesn’t increase in volume between days 3-5. It is not normal for it to take longer. It may be common, but it is *not* normal, and there are specific interventions to help in these situations.