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Regina Woodley- Lactation Consultant, Educator, Doula, and Herbalist in Huntsville, AL and surrounding areas
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Myth: Babies don't need to eat in the first 24 hours

6/19/2016

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I have heard a new mother struggling with getting her baby to latch on and start nursing be told, "It's OK, babies don't need to eat for the first 24 hours because they have energy stores."  While this may reassure and relax the mother in the short-term, it often can end up exacerbating breastfeeding problems and causing even more anxiety. 

​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.   

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Supplements

6/6/2016

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 Women obviously want to do what's best for their babies, and the idea of taking a prenatal vitamin and other extra supplements to guarantee a good outcome is very appealing.  It's so easy to take a pill every day!  I want to rock the boat a little and point out some things you may not know about whether supplements are always needed or even beneficial. 

​Studies have shown no clear and overwhelming benefit to supplementing all women in pregnancy with vitamin C, vitamin E, magnesium, calcium, and iron.  Certainly, in some cases of malnutrition or an absorption disorder a woman would greatly benefit from something she is lacking, but this should be done with her health care provider on a case-by-case basis.

It seems the message most American women get is that taking a prenatal vitamin will ensure they have everything they need for a healthy baby.  They are often instructed to "watch their weight", but not given much education about what is truly unhealthy to eat.  Often, diet is given little attention until a problem has already surfaced and there is little time to correct the issue.  Ideally, women who are planning on getting pregnant will be eating a very healthy, varied diet BEFORE they conceive.  If a prenatal vitamin was a cure-all, our pregnant women and babies would be a whole lot healthier.

​​Then there's the point that too much of any one thing is usually not a good idea unless there's a clear reason.  Our bodies try to keep all chemicals within ranges.  For example, too much iron can be very constipating, too much calcium can lead to heart disease, and too much potassium can result in stomach upset. 

​There's also quite a difference in the quality of prenatal vitamin.  The cheapest ones probably aren't doing much of anything for you.  In order to make them cheaply, the nutrients are in a synthetic form that is not in a form readily absorbable by your body.  The highest-quality ones are food-based, so your body actually has the correct enzymes and knows what to do with it.  Think about how much dehydrated vegetables there are in a few prenatal vitamins.  Couldn't you eat more than that every day? 

​The point of this is not to tell you not to take prenatal vitamins (I take them), but rather to remind women that diet is the first and best line of defense in a healthy pregnancy and life.  I'm afraid some women are taking their vitamins and then eating junk food all day.  Prenatal vitamins are there mostly as a back-up for those who are not getting proper nutrition either because of a poor diet or genetic metabolism problems, but does not lead to as equally good outcomes as great nutrition does.  Ask yourself: how's my diet?

To read more about individual supplements from previous posts:
Vitamin C
​Calcium
​Folic Acid

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    I'm a natural childbirth educator, lactation consultant (IBCLC), and doula in Athens, AL.  Here is where I put healthy recipes, current research, and helpful articles for pregnancy, postpartum, and life in general.  Check back often!

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