What infant feeding looks like in the first 48 hours
Every family's first 48 hours of feeding look a little different, but there's a common shape to them: small, frequent feeds, odd hours, and a few numbers the hospital tracks while you're still figuring out how the bed remote works.
What does infant feeding look like in the hospital?
The first feed often happens in the first hour or so after birth, if both the birthing person and baby are doing well. After the first feed, many babies get sleepy, then feed small amounts frequently. If you're breastfeeding or chestfeeding, the first milk your body makes is called colostrum: a thick, often yellowish milk that comes in small amounts, sometimes just drops, before breastmilk becomes thinner and sometimes lighter in color. Regardless of how you're feeding baby, early feeding volumes are small and build up over time.
What is the hospital tracking, and why?
The hospital wants to make sure your baby is adjusting well to life outside the womb, and feeding and digestion are two of the clearest signs of that. A few specific things tend to get measured:
Blood sugar. At the hospitals where I’ve supported births, babies have their blood sugar checked pretty soon after birth. It’s checked using heel stick - a poke on the heel to collect a small blood sample. Babies with certain risk factors (like being born to a parent with gestational diabetes) might have this test repeated, since some babies tend to have a harder time keeping their blood sugar steady.
Weight. It’s normal for babies to lose weight after they’re born. Once a baby crosses a certain percentage of weight loss (in my experience, 10% of their birth weight), hospitals can get more assertive about increasing feeding frequency and volume. It’s rare for a newborn to lose 10% of their birth weight in the first 48 hours, but the hospital will share baby’s weight data with your pediatrician and you’ll continue to track baby’s weight at follow-up appointments.
Number of dirty diapers. Diaper counts are one of the simplest ways to track whether baby is getting enough to eat. You should see more wet diapers as feeding gets established, and stool shifts from tarry, dark meconium to a lighter stool within a few days.
Bilirubin. Bilirubin is a substance your body makes as the liver breaks down red blood cells, and baby’s level is checked with a heel stick too. Some bilirubin in baby’s blood is normal, but if there is too much it can cause jaundice - the yellowing of the eyes and skin. Because feeding more often and in larger volumes helps babies pass stool - one of the main ways to clear bilirubin - increasing feeding is usually one of the first strategies tried if bilirubin levels start going up.
Other situations, such as a preterm birth or a NICU stay, can bring their own set of priorities. None of this means your original feeding plan is off the table, just that it's running alongside a different kind of monitoring.
I worked with a family whose baby needed a blood sugar check after every feed for the first day. They'd planned on feeding on demand, and hadn't expected to feel like there was a countdown clock running in the background. Once they understood the checks were tied to specific numbers coming down, not a permanent change, it got easier to treat it as something to get through, rather than something that had derailed their plan.
A tip from a doula
When you build your feeding plan, think about why it matters to you. If closeness is one of the reasons breastfeeding matters, and your feeding plans change, skin-to-skin or paced face-to-face feeding can get you a similar closeness.
Why do different staff and providers have different advice on infant feeding?
A lot of what you're told stays consistent. But nurses work in shifts, and providers also rotate, so it's not unusual to hear guidance from more than one person over the course of a day. Everyone caring for you is working from your chart, but feeding support especially has more room for a personal approach than something like a medication dose.
With one family, a hospital night nurse suggested supplementing with formula after a rough latch, and in the morning a lactation consultant encouraged the family to hold off on formula and keep trying at the breast. The family was confused at the conflicting advice. We talked through what each recommendation was actually responding to - one focused on getting calories in given a weight-loss number, the other on protecting the latch they'd been working to establish - and they were able to discuss with their team which priority mattered more in that moment, instead of guessing.
How can a doula help with infant feeding in the hospital?
I provide infant feeding support regardless of how you're feeding your baby, whether that's breastfeeding, chestfeeding, formula, or a combination. A big part of that is carrying details forward across shifts, like the hold that finally worked or the nipple shield you already tried, so you're not re-explaining while exhausted. I can also help you understand which number is driving a recommendation and what to ask your team, so you can make decisions that fit your plan.
And while birth doula support is mostly about labor, I've come back to the hospital to support families postpartum plenty of times - sometimes for a few hours as another pair of hands, sometimes to help someone process their birth.
The clinical mechanics of a latch are outside my scope. That's where a lactation consultant comes in, and I can help you make the most of their visit by remembering what you want to ask.
Bottom line: The first 48 hours of feeding are mostly small, frequent, and a little unpredictable. Knowing what's typical and what the hospital is watching makes it easier to ask good questions.
The moments described here are drawn from real experiences, but details have been changed and combined to protect the privacy of the families I've worked with.