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Duration between feeds within the first 48 hours

Last post 11-24-2009 10:38 PM by HavaNargila. 9 replies.
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  • 11-20-2009 9:24 AM

    • Eva
    • Top 200 Contributor
    • Joined on 11-20-2009
    • Posts 4

    Duration between feeds within the first 48 hours

    Hi, wondering if anyone has some thoughts on this matter. Have just started a placement on a postnatal ward and the policy there is a baby can go up to 8 hours without a feed but after that he/she has to have something, EBM ideally but formula if not. What I have been experiencing is lots of babies who have had a first feed shortly after birth and are then just not interested in feeding for ages! This leads to a lot of pressure on the mum to get her baby to feed within this 8 hour window when the baby just seems to want to sleep. As a result due to hospital policy i had to cupfeed many of the babies formula because they had passed the 8 hours mark and still didn't want to feed. What i wondered was how long people felt it was safe for a baby to go without feeding within the first 48 hours? Obviously tried all the usual stuff to stimulate the babies interest e.g stripping off clothes, skin to skin etc.  These are all healthy term babies btw. Any thoughts very welcome!

     

  • 11-20-2009 9:54 AM In reply to

    Re: Duration between feeds within the first 48 hours

    Apparently healthy and term, but what kinds of births are in the majority?  meds? surgical? epidurals?

    Susan
    Moderator

    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
  • 11-20-2009 10:37 AM In reply to

    • Eva
    • Top 200 Contributor
    • Joined on 11-20-2009
    • Posts 4

    Re: Duration between feeds within the first 48 hours

    Half were c/s and babies were very mucusy which I thought would have an impact, the rest were normal deliveries some with some without pethidine.

  • 11-20-2009 2:51 PM In reply to

    Re: Duration between feeds within the first 48 hours

    Dr. Hale (Medications and Mothers' Milk) says that pethidine (demerol in the US) can be a problem for neonates.  He reports a study (Wittels, B. Scott DT, Siatra,RS. Exogenous opioids in human breast milk and acute neonatal neurobehavior: a preliminary study. Anesthesiology 1990; 73(5):864-869): "Wittels studies clearly indicate that infants from mothers treated with meperidine (PCA post-cesarian) were neurobehaviorally depressed after three days. Infants from similar groups treated with morphine were not affected."  He also reports "poor suckling reflex" in babies who are getting meperidine via breastmilk which is very interesting in your case.  He suggests morphine, fentanyl, or hydrocone as an alternative.

    The protocol in our local hospital is the same one you describe.

    Have you seen/read the book Impact of Birthing Practices on Breastfeeding by Mary Kroeger? Interestingly, I just grabbed this book off my shelf and it literally fell open to this statement: "Bumgarder's recent study confirms the type of problems listed at the beginning of this chapter: healthy, full term newborns that attempt to breastfeed but cannot feed normally.  Although the authors did not report the number of babies exposed to forceps, vacuum extraction, or induction, they conclude 'labor epidural anesthesia had a negatvie impact on breastfeeding in the first 24 hours of life, even though it did not inhibit the percentage of breastfeeding attemps in the first hour.' Whether the inability to latch is because of the medications, mechanical forces, or a combination of factors, is still unknown, the problem is very real."  There's a lot of info in this particular chapter about "assuring adequate hydration and caloric support" as being critical to not only establishing but continuing to support breastfeeding during these early hours.

    What happens directly after vaginal births at your hospital? Are babies and mothers left together, undisturbed? Are babies dried off or bathed immediately? Are routine procedures such as weighing, measuring, footprinting, full newborn exam, vit K, and bood tests held off until the 2nd hour? Are mothers and babies separated after cesareans or are they left together in recovery? do moms breastfeed in recovery?

    Susan
    Moderator

    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
  • 11-21-2009 3:12 AM In reply to

    • Eva
    • Top 200 Contributor
    • Joined on 11-20-2009
    • Posts 4

    Re: Duration between feeds within the first 48 hours

    Thank you for that info that makes a lot more sense to me - I went home wondering what on earth was going on with nature! But on reflection there were probably a lot of different factors at work impacting ability/desire to feed. At my unit after birth generally mum and baby are encouaged to have skin to skin, or if not desired, a cuddle for an hour or so before anything else is done. Assistance to feed is also offered in labour ward shortly after birth. Not sure about c/s ladies as haven't worked in labour ward yet (am a student).

    What is your opinion of feeding the babies formula after 8 hours then? Do you feel its necessary? In one case a baby had a small formula feed and then went on to the breast brilliantly 4 hours later which was encouraging.

  • 11-21-2009 8:05 PM In reply to

    Re: Duration between feeds within the first 48 hours

    I honestly have mixed feelings. My gut says leave nature alone and that baby knows best but then I hear about dehydration and babies who fail to thrive and understand why the protocols are in place.  However, I have seen that mothers and babies who do beautifully at home and who don't take a really good feed for up to 48 hrs postpartum.  They make me nervous, but the midwife doesn't seem to be bothered by it.  I just wonder if the poking and prodding, the lights, the sounds, the smells, in conjunction with all of the other stuff that goes along with hospitals is the cause for problems.

    I'd love to hear from the other midwives here.  Yoo hoo!!!

    Susan
    Moderator

    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
  • 11-21-2009 9:06 PM In reply to

    Re: Duration between feeds within the first 48 hours

    I am a CPM and an IBCLC Registered Lactation Consultant. I have emailed you my phone number privately if you would like my "full" opinion on the matter.... Summarising:

    It takes about 3-4 days for a mother's milk supply to really "come in" full force. During that time, any formula giving by any method is undermining breastfeeding and posing serious health risks for the baby.

    It is absolutely normal for babies to feed after birth, then go into a deep sleep, sometimes even up to 8 hours or more because they are basically exhausted from the birth experience.

    They are not at an increased risk for "dehydration." The babies may not be getting a lot of milk for the first 3-4 days but their systems are uniquely designed to tolerate that.

    The story is different for premature babies. They will need their mother's expressed breast milk -if she is having trouble making enough right away, banked human breast milk can be used. 

    An IBCLC Registered Lactation Consultant present during the birth/immediately postpartum can greatly assist initial breast-feeding initiation, so that the baby is able to take full colostrum, which is all he/she needs for the first 3-4 days if he is a normal healthy infant. 

    Any more questions, please give me a call : )

     

  • 11-22-2009 6:09 AM In reply to

    • Eva
    • Top 200 Contributor
    • Joined on 11-20-2009
    • Posts 4

    Re: Duration between feeds within the first 48 hours

    Thank you thats really helpful - To be honest thats really what I thought but its hard when you have the weight of hospital policy on your back. Can you provide any references to books/research that support the idea that a baby can be left for longer than 8 hours if necessary? e.g I mean if baby is not interested in feeding before then not that we should just leave them for 8 hours if they're hungry! Also when we expressed and cupfed the baby 5ml of EBM the midwife in charge said that this was not enough and would need a top up - I thought 5ml was adequate at least for an hour or 2 - any thoughts?

  • 11-22-2009 8:10 AM In reply to

    Re: Duration between feeds within the first 48 hours

    Are you able to get a hold of Ruth Lawrence MD's Breastfeeding--A Guide for the Medical Profession?  That would be an extremely helpful text to have.

    Susan
    Moderator

    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
  • 11-24-2009 10:38 PM In reply to

    Re: Duration between feeds within the first 48 hours

    Iit is important too that it is understood the difference between a normal healthy infant and a
    hypotonic infant, truly uninterested in breast-feeding.

    On the first day, normal babies do tend to sleep quite a bit, but when
    they do wake up/pee/poop they should be "awake" and hungry. It is that
    one long stretch of sleep though that is not a problem in healthy
    babies. If sleepiness persists, or if the baby meets the definitions
    of a hypotonic baby something should be done.

    Feeding formula is not the something that should be done, the baby
    should be observed breast-feeding by a Lactation Consultant and the
    breast-feeding technique should be evaluated. VERY often, small
    changes in the technique can make a huge difference to milk transfer.

    None of this is really a problem in the first 4 days though. The baby's stomach has a limited capacity which enlarges until day 4. Colostrum is all the baby should have. By day 4, the mother's milk should 'come in.' The baby has brown fat reserves to sustain his energy needs for those first days. In the first week it is normal for the baby to loose up to 10% of the birthweight. 

    Here are a few websites:

    http://www.typeamom.net/infant-stomach-size-and-growth.html

    http://www.llli.org/FAQ/colostrum.html

    http://www.mother-2-mother.com/colostrum.htm

    There is a lot of info out there in textbooks. If you are dealing with your ward you should request that they prove to you why their policy is to supplement. It violates the Baby friendly hospital initiative. If your hospital is a registered "baby friendly hospital," they could lose their status by continuing this practice that is non-research based.

    Naturally babies require no supplementation, only colostrum. They have always done fine with only colostrum. In fact giving formula to a baby who is less than 4 days old will expand his stomach more than it should be expanded, he/she will likely spit up what is given and what has been done? allergens, toxins, unecessary and a lack of necesary chemicals have just been exposed to the infant. Not wise.

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