It seems like many health care providers rely on rules and protocols to keep their patients healthy. Yet in some circumstances applying rules to something with a natural flow like breastfeeding can do more harm than good. In my practice, I hear all sorts of rules around feeding times and intervals, what foods to eat, swaddling, sleep schedules, and more. And for each rule I hear, from another family I may hear the exact opposite in the same day.
It’s enough to make any new family confused and unsure of what to actually do!
I wish I heard more conversation about the real answer to this uncertainty: what do the parents’ instincts say? What is the baby trying to suggest? It appears that many have lost the ability to sit and listen to instinct.
From the beginning of pregnancy, parents hear tons of rules and protocols. Pregnant women get instructions on what to eat, how much weight to gain, and where they should birth. While in labour they are instructed on how fast to dilate, how to manage pain, how to breathe, and when to push. As a doula, I have rarely witnessed a care provider stop and ask “what do you think you need right now?” to encourage a family to tap into what they already do know.
So out comes baby and more rules and protocols follow. Feed every 3 hours. Feed for 20 minutes each side. Hold the baby skin to skin, but just for an hour. Sleep the baby in the bassinet.
And as they grow, there are more rules around how long they should sleep, when they should sleep, when they should get solid foods, when a baby is too old to be breastfeeding, and whether or not they should still eat at night.
Why not trust the babies and breastfeeding parents? Parents know when something isn’t quite right. Even when their midwife, family, and the internet try to say that all is well, a parent’s instinct will hint when it isn’t. Parents are wired to understand their babies—so long as they are given the best start together.
Skin to skin contact should be at least the first 1,000 minutes of life, not just the first hour! The first 17 hours are a massively important time in a baby’s life.
After that time, close contact through sleep, feeding, and waking hours is incredibly important for the first 1,000 hours of life! Keeping babies carried close for these 41+ days not only helps the newborn eat well, encourages abundant milk supply, regulates stress responses and maintain physical attachment, it provides intimate time for the parents to learn their babies. To learn their movements and their hunger cues. Understand when they are full or notice when they’re still a bit hungry. Know where they feel safe and what calms them. Spending this time together and promptly meeting their needs is far more powerful to help families get off to the best start with breastfeeding and their relationship! These first 41+ days are absolutely crucial.
When we cloud this early nuanced care with 3-hour feeding schedules and timed feeding at each breast, parents begin to doubt their true knowledge. Mothers will make babies who are clearly cuing to eat wait for food because it hasn’t been 3 hours yet. Or they swaddle their baby and tuck them into swings for “fussiness” or “gassiness.” When in fact that 20-minutes at each breast wasn’t spent drinking.
As health care providers, we would do our patients the best service if we could spend more time with families and their babies. We need to learn their distinct body language and help parents begin to understand how to read the cues. If a baby is still hungry they will cue to eat. Bobbing around the chest, rooting towards objects touching their face, and trying to suck on fingers and pacifiers are all cues.
Instead of letting parents spend hours calming a hungry baby, let’s encourage families to scrap the rules (which aren’t evidence based anyway). It’s better to listen to our babies rather than guess. Let’s encourage them to feed on demand rather than count or time feeds. Instead let’s focus on whether their baby is drinking at the breast, and that it’s okay to keep feeding them if they are giving us cues. These natural behaviours will lead to far less milk supply complaints and an increase in both breastfeeding duration and satisfaction!
Let’s help families to truly understand demand by removing the barriers to their ability to communicate their needs in the first place. Unswaddle the baby, remove the pacifier, and stop the swing. When we listen to babies we can give them exactly what they need.
Giving babes their voices back, and teaching families how to listen and watch for effective feeding behaviours, is truly the anecdote to the rules and protocols that still endure in breastfeeding medicine.
For further discussion about these rules, and for help getting around them, check out our Parenting 101 course!
Ashley Pickett, IBCLC