Breastfeeding around the clock

Breastfeeding around the clock – and my baby is still losing weight.

There are times when moms are breastfeeding around the clock – literally every 2 hours. Babies do breastfeeding frequently. They even have cluster feeding sessions where they nurse non-stop for 3-4 hours in a row. However, when babies are nursing every 2 hours and are still losing weight – This is not normal. If the weight loss is more than 10% and continues past the 4th day of life, I agree that supplementing is good advise.

My argument is that often times moms are not given appropriate advise on how to supplement a baby while still working on breastfeeding. My argument is that often times moms are not given appropriate advise on a pumping plan. They are just told to supplement. Or they are told to just keep breastfeeding and come back in a few days. All the while, the baby continues to lose weight. Both of these common scenarios greatly affects the mothers ability to continue breastfeeding for the long term. Learn why I think that more should be done for this dyad, other than just telling mom to supplement. I will then offer an opinion as to how the breastfeeding should be managed.

If you are told that it is normal for breastfed babies to nurse around the clock and still lose weight,

Do NOT listen to anyone who tells you this is normal. This is NOT normal.

This week I had 3 consults in a row, all with the same complaint.
Mom says: “My baby is breastfeeding around the clock and is losing weight. I am getting conflicting advise – what do I do?” This is a complaint, but make no mistake. Just because it happens on a regular basis, does not mean that it is normal.

I want you to know with 100% certainty, that babies who are breastfeeding around the clock and losing too much weight, is not normal.

Do NOT listen to anyone who tells you this is normal. This is NOT normal.

This week I had 3 consults in a row, all with the same complaint.

Mom says: “My baby is breastfeeding around the clock and is losing weight. I am getting conflicting advise – what do I do?” This is a complaint, but make no mistake. Just because it happens on a regular basis, does not mean that it is normal.

I want you to know with 100% certainty, that babies who are breastfeeding around the clock and losing too much weight, is not normal.

Here are 3 common reasons parents are told why it is normal for their babies to be breastfeeding around the clock. To compensate for the weight loss, they are told they need to supplement.
1. They are spending a lot of energy at the breast and losing calories while doing so.
2. Or, it takes much longer for breastfed babies to gain back their birth weight.
3. Or, this happens to a lot of moms. When your milk comes in, your baby will start gaining.

Unfortunately, this is all poor advice. It is wrong, wrong, wrong. My response to this crazy advise is to tell parents the following:

Babies who are breastfeeding well, with moms who are producing enough colostrum do lose a little bit of weight, about 4-7 oz in the first 4 days, but by the 5th day they should definitely be gradually gaining each day. A gain of about 1/2 ounce each day is the usual. At 2 weeks old, babies should be back to their birth weight.

You can supplement and your baby will pack on the weight. However, this alone, will not help you with breastfeeding. You need professional help so you understand why this is happening and work together to fix this problem.

Without good breastfeeding preparation and expert help:

You may be told by your baby’s pediatrician to stop breastfeeding and go straight to bottle feeding – until your baby gains back their birth weight. Once this happens, you will be given the go ahead to return to exclusive breastfeeding. This advice totally sucks… and yes, that pun is intended. It sucks because you are removing your baby from its natural habitat, your body, your breasts and giving them a bottle 24/7. Your baby gains the weight, your pediatrician is happy and announces hooray! You can go back to breastfeeding.

But now what? You were given no other guidance. You may not have been given information about the need to pump what kind of pump to use, how frequently you should pump, how long you should pump for? Using a breast pump is not something you have ever done before. It certainly is not instinctive to use a plastic pump.

Does someone go home with you to help you transition your baby back to the breast. It is now 5 days later with a baby back to birth weight. You are excited to breastfeed again. The problem – your overall supply is low and your baby is use to the bottle and freaks out every time he or she is brought to the breast.

Another version of poor advice:

Mom is given strict instructions to breastfeed every 3 hours. Offer both sides for 10 minutes each and then supplement 1 oz. Parents are now ignoring their babies cues. They are busy watching the clock, timing feedings, and counting ounces.
Perhaps mom is pumping. Perhaps she is not. She may not be following a specific care plan except to pump purely because she needs the relief.

Between limiting her babies time at breast and not pumping regularly, she begins to struggle to keep her milk supply up. After 3 days of little pumping, she finds on the 5th day, that her breasts are comfortable and she does not need to pump anymore. Pretty soon, she is not making enough milk for her baby. After her next pediatric visit, she is told to stop supplementing, only breastfeed, but now her supply is so low her baby is frustrated all the time at the breast.

And as if all of this is not bad enough, some parents are turned into zombies. The pediatrician gave parents very strict instructions to – wake your baby up every 2 hours. Feed your baby at breast first and when done, give them 1 oz of milk in a bottle until they are full.

Now just think about this –

Wake baby at 1:00. Between breast and bottle feeding and diaper change and settling back down to sleep, average feedings take an hour. Up again at 3:00, feed takes 1 hour, sleep at 4, wake up at 5, then 7, then 9, then 11, and then 1:00. Welcome to Zombie-land.

A quick review of what normal is:

Babies should lose no more than 4-7 oz in their first 5 days of life. If your baby is not gaining weight, there is something not right and you need to get professional help.
Babies should begin gaining by their 5th day of life – about 1/2 oz per day would be normal. If they are not close to meeting these goals, something is not right and you need to get professional help.
Recognize bad advice –

Don’t listen to anyone who tells you that it takes a baby a specific time 10,15,20 minutes to remove the milk from the breast. Sure we have averages, which are appropriate, but only when we are sure your baby is breastfeeding well. If your baby is just hanging out at the breast, sleeping at the breast, inefficient at removing the milk at the breast – then time spent at breast is a moot point.

Don’t listen to anyone who tells you to supplement, but does not spend a good amount of time explaining to you all the details of pumping, what kind of pump to use, how long to pump, frequency to pump, etc.

Don’t listen to anyone who tells you to keep supplementing your baby, come back in 3-5 days and if your baby gains back the weight we wanted, then I will give you the go ahead to stop supplementing and go back to breastfeeding.
If your babies are getting bottles of formula and you are not pumping, you are at a great risk factor for losing your supply. The general rule of thumb is to pump every time your baby gets a bottle.
Good breastfeeding management –

There is no cookie cutter answer to this problem. What should happen? How about a referral to an IBCLC. A complete evaluation will allow the IBCLC to help mom understand why her baby is nursing around the clock and why her baby is losing weight. The consultation will include a full assessment and a care plan that will specifically address the babies need for more food. The World Health Organizations goal is to increase breastfeeding duration rates. Appropriate breastfeeding management will play a key role in accomplishing these goals

Prepare for breastfeeding.

Join the All About Breastfeeding Class where you have lifetime access to a comprehensive online breastfeeding class. You will be invited to join our private breastfeeding mothers group which is for students only. Typically, once you walk out the doors, class is over and access to an IBCLC and ongoing breastfeeding education is gone. Our online class gives you daily support with other students and your IBCLC, for as many days, weeks and months as you need it. The ability to meet up with an IBCLC for LIVE virtual chats means amazing lactation and new mother support for as long as you need it.

Say YES, I want and need ongoing support for the whole time I am breastfeeding.

Lori J. Isenstadt, IBCLC