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Family Forum / Pregnancy / Breastfeeding / August 2007How much water should Mom be drinking?
Hi everyone, I'm new to misc.kids.breastfeeding and am looking for some advice. I have a 9 day old little girl whom I'm breastfeeding. At 3 days old, she had lost nearly a pound from her birth weight. But at her one- week check up, she had gained back 5 oz. I was pretty pleased with how things were going until the pediatrician said baby *must* be back to her birthweight at her two-week check up and to that end, I was to drink a gallon of water a day. Is a gallon of water really necessary? I'm really trying to drink as much as I can, but as much as I'd like to sit around doing nothing but drinking water all day, it's just not happening. I wanted to see what you experienced folks had to say about water needs when nursing. Thank you! -Steph > I'm new to misc.kids.breastfeeding and am looking for some advice. I > have a 9 day old little girl whom I'm breastfeeding. Congratulations on your baby! > [...] the pediatrician said baby *must* be back > to her birthweight at her two-week check up and to that end, I was to > drink a gallon of water a day. > > Is a gallon of water really necessary? What you need to do is drink to thirst, so don't forget to drink because you are busy, but you certainly don't have to drink a gallon just because. The other thing you need to do is nurse baby on demand. Don't watch the clock and decide that 20 minutes per side is sufficient for baby. Nurse her until she unlatches herself or falls asleep. Having said that, many newborns fall asleep easily, so make sure you keep her awake (tickle her feet, unwrap her blanket, talk to her) so that she nurses sufficiently. Do not use the 3-4 hour between feedings as a guideline. That is for formula. For breastfeeding babies, the time between feedings (counted from start to start) can be as close as 1 hour to 2.5 hours. (Yes the 1 hour means that if nursing lasts 30 minutes, then you have 30 minutes before the next nursing!) -- Anita -- >> I'm new to misc.kids.breastfeeding and am looking for some advice. I >> have a 9 day old little girl whom I'm breastfeeding. [quoted text clipped - 4 lines] >> to her birthweight at her two-week check up and to that end, I was to >> drink a gallon of water a day. The paediatrician is talking rubbish. As long as her weight gain is steady at an average of at least an ounce a day and she's otherwise well & having wet and dirty nappies, it doesn't matter whether or not she's back to her birthweight. She lost quite a lot, so it is likely to take her a little longer to catch up, but that's OK - it's not a race and, as long as her *rate* of gain is all right by then, the exact figure she's reached by two weeks isn't that important. >> Is a gallon of water really necessary? > > What you need to do is drink to thirst, so don't > forget to drink because you are busy, but you > certainly don't have to drink a gallon just > because. I agree with this. The thing to do is to have a bottle or glass of water to hand all the time and keep reminding yourself to take a mouthful or two - that way you won't get so preoccupied by taking care of the baby that you end up ignoring your thirst signals. However, as long as you're reminding yourself to drink and drinking as much as you want when you do drink, I wouldn't worry about drinking X amount. > The other thing you need to do is nurse baby on > demand. Don't watch the clock and decide that > 20 minutes per side is sufficient for baby. Agree with this as well, but just wanted to disagree with the next bit... > Nurse > her until she unlatches herself or falls asleep. The problem with this is that babies do suck for comfort. Nurse her for as long as she's actively taking in milk, and then a few minutes longer in case she's just waiting for the next letdown. And then, if she's still awake, try her on the other breast in case she wants a bit from that side. But if she's gone on for more than a few minutes just comfort sucking, then that nursing session's probably over for then. No reason at all why you shouldn't stay there and let her comfort suck if she's happy, but it can get a bit much if you have a baby who wants to suck non-stop, and if you want a break and she's reached the comfort sucking stage, you can try giving her a pacifier instead and seeing whether she'll take that. (If she doesn't, try her with different ones in case she's fussy about the type of teat.) So how do you tell the difference between comfort sucking and active nursing? Look at her chin. If it's moving up and down as she sucks, then she's taking in mouthfuls of milk. If it's just quivering on the spot, then she isn't taking in milk. She may, as I said, be just waiting for the next letdown, so don't whip her off the second her chin starts moving - but if she's been sucking in this way for a few minutes with no sign of moving back to an active nursing pattern, then it looks like she's gone to comfort sucking. When that happens, try her on the other breast to see if she wants anything from that side - if not, you can choose whether to let her keep comfort sucking on you or try a paci instead. > Having said that, many newborns fall asleep easily, > so make sure you keep her awake (tickle her feet, [quoted text clipped - 8 lines] > minutes, then you have 30 minutes before the next > nursing!) One other useful piece of info which you may or may not have been told is that you don't have to wait for her to start crying before you nurse her. Newborns will signal their hunger for about half an hour before they get to the crying stage, by turning their heads to the side and making rooting motions with their mouths. If you look for those signs and nurse her when you see them, this has several advantages - she is not only likely to nurse better at that stage, but also she's starting to learn that she doesn't have to cry to get what she wants, which is a useful lesson for any child to learn. ;-) All the best, Sarah  Signaturehttp://www.goodenoughmummy.typepad.com "That which can be destroyed by the truth, should be" - P. C. Hodgell > So how do you tell the difference between comfort sucking and active > nursing? Look at her chin. If it's moving up and down as she sucks, [quoted text clipped - 7 lines] > can choose whether to let her keep comfort sucking on you or try a paci > instead. I agree, Sarah, about the no need to carry on nursing once it's definitely comfort sucking, at this stage supply is strongly hormone driven, so unless there are any suggestions that supply is an issue (highly unlikely - nothing the OP says suggests it), then there isn't much benefit to it, what I disagree on is the use of a pacifier at this moment in time - we simply don't know enough about this baby, she may have a perfect latch and good strong suck and even if she did, at this stage if at all possible you want to avoid adding anything that might change that. In terms of the weight, she's gained 5oz in 6days, if she carries on at that rate, it will take her another 12ish days to regain birth weight, i.e. at 21 days old. She does not need to regain all the lost weight by 2 weeks old. I wonder if you were on a drip at all in labour, this can artificially inflate the birthweight and thus as the extra fluid has passed out of the body make it seem as if a significant amount of weight has been lost - when in reality the baby has lost an entirely normal percentage of body fat. Everything I've seen points to humans needing a lot more water in general than most actually drink I'm not sure that breastfeeding women actually need more though many do feel thirsty at each feeding and end up increasing intake, plus I think the effects of not drinking enough are more likely to be felt, but it shouldn't decrease milk supply as the first symptom. Feeling thirsty can inhibit let down, but this seems to be far more of an issue a few weeks down the line if trying to pump milk. I don't know where you are, but if you're in a hot place, it's entirely possible that a gallon is a reasonable amount to aim for, wherever you are, you're looking at 2 quarts minimum. In the early days nursing my 2nd I was being careful to drink plenty of water, but not for nursing reasons, but for the reason that the more you drink, the more dilute your urine and the less it's likely to sting down there! First time around, I neglected this and often had to run a shallow bath to pee in and I was slightly constipated, 2nd time around, despite the exact same tear and some new damage to the rectum, I had no problems. I had several sports top bottles that were around a quart and I kept them in the fridge and tried to keep on top of refilling them, so there was always one in easy reach. I think I got through 6-8 in 24 hours and at least 2 would be during the night, when I'd never usually drink. Cheers Anne > suck non-stop, and if you want a break and she's reached the comfort > sucking stage, you can try giving her a pacifier instead and seeing > whether she'll take that. (If she doesn't, try her with different ones > in case she's fussy about the type of teat.) I agree with most of the advice here, but I would hesitate to use a pacifier until it is clear that a baby is maintaining good growth. If a baby is growing well, fills up on milk and wants to continue sucking, but is frustrated by additional letdowns, a pacifier may be the solution. If a baby is not growing well, it can be a good idea to avoid a pacifier and work on improving latch/milk supply. Between these extremes, there are advantages and disadvantages to pacifier use. Some advantages are, lower SIDS rates, baby may be OK with waiting a bit to nurse in a situation where it is necessary etc. Some disadvantages are, pacifier use statistically correlates to earlier weaning, baby may "need" pacifier to be happy. Providing a clean one and putting it back in each time it is dropped can be a bother etc. --Betsy > Some disadvantages are, pacifier use statistically correlates to > earlier weaning, baby may "need" pacifier to be happy. There's very little research that attempts to tease out whether correlation is causation here, but what little there is indicates that pacifier use is a *marker* for breastfeeding difficulties or lack of commitment to breastfeeding, rather than a *cause* of it. A randomized controlled trial in a hospital that had half the moms strongly warned to avoid pacifier use and the other half given the regular postpartum information about pacifiers found no impact on breastfeeding rates or success. There's been at least one other study that addressed the issue that indicated increased pacifier use was a marker of trouble, not cause of it. Both studies were small and not the greatest in the world, but I've found no research that indicates pacifier use plays a causal role in breastfeeding problems. It seems that if babies are smart enough to figure out comfort sucking vs. feeding sucking, they're smart enough to figure out how to treat a dry piece of plastic differently from the boob. To the OP, your pedi is either nuts or meant that less emphatically it sounded. Back to birthweight at 2 weeks is a general rule of thumb, but usually gets bent a bit for babies that lose a lot at first as long as they're gaining appropriately from their low point. Three oz every 2-3 days (20-30g/day) is appropriate weight gain and it sounds like she's nicely on track for that. I'd find it painful to drink that much water. Drink generously to thirst and it should be fine. Kate, ignorant foot soldier of the medical cartel and the Bug, 4 years old And I want to halfway disagree with Sarah. > Agree with this as well, but just wanted to disagree with the next bit... > [quoted text clipped - 13 lines] > whether she'll take that. (If she doesn't, try her with different ones > in case she's fussy about the type of teat.) First on the pacifier part. I agree with Anne and Betsy that pacifier should not be introduced at this time. Now on to comfort nursing. I think I know where Sarah is coming from, in that some babies are very "needy" in terms of comfort nursing, and she is concerned that is the mom doesn't get a break for constant demands, she may fail to keep breastfeeding, or may become sore and have difficulties. I agree you should watch for this and try to avoid it, but not all comfort nursing is bad, and not all mothers are bothered by a reasonable amount of comfort nursing. It is also true that in the first 4 months after birth, comfort nursing will help to increase a mother's supply. So take Sarah's advice with a grain of salt. If necessary, follow it, but if things are going well, comfort nursing is OK. Larry > And I want to halfway disagree with Sarah. > [quoted text clipped - 25 lines] > but not all comfort nursing is bad, and not all mothers are bothered by > a reasonable amount of comfort nursing. Er, yes, Larry. That would be why I said "No reason at all why you shouldn't stay there and let her comfort suck if she's happy" and said that the pacifier was to try "if you want a break" and finished off by saying "you can choose whether to let her keep comfort sucking on you or try a paci instead". > It is also true that in the > first 4 months after birth, comfort nursing will help to increase a > mother's supply. That's useful to know, yes. What evidence is there? I'd be interested to see it. > > So take Sarah's advice with a grain of salt. If >> necessary, follow it, but if things are going well, comfort nursing is >> OK. My advice was for her to decide for herself whether she wanted to comfort nurse or not. I've no objection to you giving her more information about the pros and cons to help her make that decision. I do object to the idea that advice to a mother to make her own decision on a particular matter should be taken with a grain of salt, and to the implication that I tried to suggest that comfort nursing wasn't OK when I suggested no such thing. All the best, Sarah Signaturehttp://www.goodenoughmummy.typepad.com "That which can be destroyed by the truth, should be" - P. C. Hodgell Trying to answer coherently, with not much time to do it... > > First on the pacifier part. I agree with Anne and Betsy that pacifier > > should not be introduced at this time. [quoted text clipped - 12 lines] > saying "you can choose whether to let her keep comfort sucking on you or > try a paci instead". My concern that in the context of the overall message even with those "disclaimer" a person could read it as advice to stop nursing when milk stopped flowing and that comfort nursing was never useful. Not that you intended it this way, just that it could be read this way. > > It is also true that in the > > first 4 months after birth, comfort nursing will help to increase a > > mother's supply. > > That's useful to know, yes. What evidence is there? I'd be interested > to see it. I don't have the cites (yes, several) not the time to look it up right now, but I believe it was either the MIT Lady (Carol Novak?) or Beth K. that first posted the information. I will summarize the results of the studies. One (or more) studies showed that past 4 months of age, milk supply was dependent only on the volume of milk removed. That is, the more milk that was taken per unit time, the more milk was produced, the less milk taken per unit time, the less produced. Also shown (perhaps in the same, perhaps in different studies) was that prior to 4 months, and particularly for newborns, total length of nursing sessions was also a factor in increasing milk supply. That is: before 4 months, longer nursing sessions also increased production, even if milk volume did not increase. I think this would fit the category of "comfort nursing." I will be a wimp, and ask that anyone who can remember the studies to post the references. I think they are 5 or 6 years old. > > > So take Sarah's advice with a grain of salt. If > >> necessary, follow it, but if things are going well, comfort nursing is [quoted text clipped - 7 lines] > implication that I tried to suggest that comfort nursing wasn't OK when > I suggested no such thing. My concern was not that you intended to say that comfort nursing wasn't OK, but that it could easily be read to say that it never useful, and therefore of little value to anyone. I was not objecting to what you intended to say, but to any erroneous conclusions the reader could draw from it. Must be the different accent across the pond. :-) > All the best, > > Sarah Best regards, Larry Lets not think in gallons per day yet. The usual recommendation is a 12 oz glass every two hours. Now assuming that include a glass when you want to nurse in the middle of the night, that works out to 120 oz. I think that is just 8 oz shy of a gallon. Now, that said, I think you ped is being an alarmist. If your baby is gaining so well already, I see no reason why your ped should make such a statement to scare you! I suggest you try to make the 12 oz glass every 2 hours, and see how it goes. Larry > Hi everyone, > [quoted text clipped - 13 lines] > Thank you! > -Steph |
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