Where does this myth come from?
It's technically true that a full-term newborn has glycogen (energy) stores to last about 12 hours, even if they don't eat at all. This gives a bit of a cushion when it comes to that learning curve that some babies have when first learning to suckle. But instead of waiting until those energy stores run out, we should use that time to help the baby learn to use their instincts. There is clear evidence that the sooner and more often baby nurses the first days the better breastfeeding outcomes.
What if baby won't latch on?
Sometimes, because of a variety of factors from prematurity to sedating medications to a difficult birth process, a baby will not be able to latch on and breastfeed right after birth. Remember, mom can't "make" a baby nurse; she can only set up an environment to make it likely. So keeping the baby on mom's chest skin-to-skin where they have access without pressure to nurse helps. But there are other ways to get milk and other ways to feed babies during this first day or two. I recommend hand expression and syringe or spoon feeding at first instead of not feeding the baby at all.
How much does a baby need the first day?
Many parents feel as if their baby is not getting enough milk the first few days while it is colostrum instead of mature milk in the breasts. Be assured, however, that even tiny amounts are helpful, and their stomachs are tiny on the first day (think the size of a marble). The average amount babies get the first day is only 1.3 oz total (Saint, Smith, & Hartmann, 1984), so if that is split between the recommended 8+ feedings, the amounts at each feeding are tiny! Even though you may feel like nothing is there, these tiny amounts are definitely beneficial, and no more is needed.
What could happen if a baby doesn't eat much the first day?
Hypoglycemia is when the baby's blood sugar levels get too low. This is actually normal to some extent, and we don't actually have an agreement on how low is too low, but we do know that breastfeeding often and early helps to prevent dangerously low blood sugar levels. Sometimes artificial baby milks are suggested because they are thought to prevent too low blood sugar, but research shows the opposite is true. Breastfed babies actually can mobilize their energy stores better than those given formulas. As long as the baby is able to get it, breastmilk is best for preventing abnormal hypoglycemia.
Another huge benefit from breastfeeding several times on the first day is the reduction of jaundice. While jaundice is not in itself harmful, a high level of bilirubin (jaundice) caused by insufficient feeding could make health providers nervous and land the baby back in the hospital for phototherapy or even a blood transfusion. It's something that should be avoided if possible. One study of 140 healthy babies found an association between the number of times the babies breastfed in the first 24 hours bilirubin levels on Day 6 (Yamauchi & Yamanouchi, 1990). The fewer times the babies breastfed on the first day of life, the less meconium was passed, and the more babies on Day 6 had bilirubin levels higher than 14 mg/dL:
- 28.1% who fed two or fewer times
- 24.5% who fed three to four times
- 15.2% who fed five to six times
- 11.8% who fed seven to eight times
- 0% of those who fed nine more times
What if I'm still having breastfeeding problems after the first day?
The good news is that almost all problems can be overcome, especially with help. Many problems are more easily fixed in the beginning before they become intolerable. An IBCLC is the expert in breastfeeding, and many hospitals have them on staff. Here in San Angelo, we have three. Another source of help is a breastfeeding support group, such as the one I organize locally. There are also many excellent resources online if you can't see someone in person. Kellymom.com and Breastfeeding USA have many articles that will at least give you a basis of education.