It can feel very reassuring to have specific instructions about when to feed your baby, especially when everything about caring for a baby is new and uncertain to you. It is better, though, to learn how to read your individual baby's hunger cues and feed her when she is hungry or thirsty (just as you would eat and drink yourself). This may sound difficult but, despite claims by various people that a feeding schedule will positively influence your baby's sleep patterns, in most cases there are risks to be considered: some strict regimes have been associated with breast milk supply failure, poor infant weight gain and failing to thrive infants.
There is also evidence that allowing babies to feed according to their own appetite, rather than imposing feeding schedules, is more compatible with the biology of mothers and babies. Although breastfeeding according to a schedule may seem to work at first, many women who use strict feeding schedules in the early weeks find that their milk supply dwindles and their baby may be weaned by about three months. By restricting feeds or repeatedly spacing them out with dummies, you may limit the development of the hormonal process that enhances ongoing milk production. This translates to: early and frequent breastfeeding will promote a continuing milk supply, which means that your baby will get lots of milk so he is less likely to wake up often to be fed.
The amount of breast milk you produce and how much your baby drinks is influenced by other factors including your baby's stomach size, and the milk storage capacity of your own breasts. At first, your baby's tummy is only the size of his tiny fist and breast milk is very quickly digested so your baby will need frequent feeds, at least in the early weeks. It is common for a breastfed baby to need feeding from several times in one hour to about every two hours at first ” and that means two hours from the beginning of one feed to the beginning of the next, not two hours between feeds. It is also common for babies to need a ‘cluster' of feeds closer together in the evening.
Ultrasound studies by biochemist Dr Peter Hartmann and colleagues at the University of Western Australia have shown that breast milk storage capacity can vary up to three times as much between individual women (this is not necessarily related to breast size and doesn't influence milk production ability). This means that while some women who have a large milk storage capacity will be able to feed their babies enough milk to go three or four hours between feeds (providing their baby has a big enough stomach), other women will need to feed their babies more often. For women with a smaller milk storage capacity, a rigid three- or four-hourly feeding schedule could result in a hungry, unsettled baby and a mother who questions her ability to produce enough milk when really, it is the schedule that is inappropriate, not the mother's feeding ability.
Instead of becoming stressed about how much milk your breasts are making or storing, think in terms of drinking out of a cup ” you can still drink a litre of water whether you drink it from a large cup or several small cupfuls. If you allow your baby to nurse whenever he lets you know he is hungry, you will never have to worry about your milk storage capacity.
Milk production and infant intake are also influenced by the fat content of your milk and the degree of breast emptying at any given feeding. According to Dr Hartmann's research, an empty breast will make milk more quickly while a full breast will make milk more slowly. This means that milk production will speed up or slow down according to how hungry your baby is and how well he empties your breasts ” if he sucks vigorously and 'empties' the breast (because you make milk continuously your breasts will never be completely empty), production speeds up and if he doesn't take much milk from the breast at a feeding, your breasts will get the message to make less milk. If your baby seems to go on a feeding binge at any time, this isn't an indicator that you are ‘losing your milk' but that you will need to take it easy and feed your baby more frequently for a few days so your breasts get the message to produce more milk. By responding to your baby's signals, in a few days' time, he will space out his feeds again.
Babies also regulate the type of milk they need by the way they suck. The first type (foremilk) will quench their thirst, which is why they often have short, frequent feeds on hot days, just as we sip from our water bottles. Hunger will be satisfied by longer sucking periods when baby gets the fatty hind milk which is squeezed down into your ducts by the reflex known as ‘letdown': this is usually felt as a ‘tingly' sensation in your breasts and accompanied by leaking from the breast that your baby is not sucking from. Letting your baby decide how long he needs to feed and letting him finish the first breast before switching sides, rather than limiting him to an arbitrary number of minutes each side, will ensure he gets the rich fatty hind milk.
There will be times when your baby has a growth spurt and will need to feed more often to match his increasing appetite. Babies who are unwell also often increase their feeding frequency. Researchers now believe that this not only provides comfort, but also increases the baby's intake of antibodies and immune factors through the mother's breast milk.
So, it is better to watch your baby, not the clock, because if your baby is hungry but is not allowed to breastfeed, your breasts will remain full and your milk production will slow down. Also, if you offer a bottle as a ‘top-up', your baby won't be sucking the whole amount of milk from your breasts so they won't get the message to produce the amount of milk he needs. As you offer another bottle, and so on, the decreased sucking will cause your milk supply to dwindle until soon your baby will be refusing your low milk supply in favour of a fast-flowing bottle and, before you realise, he will be weaned.