Although getting baby to breast early, often and unrestrictedly goes a
long way toward solving breastfeeding problems,  things are sometimes more
complicated.  I have in the past week, in the hospital staff nurse part of my
life, dealt with the many frustrations that can sometimes arise after a long
labor, sometimes fetal distress, forceps, long second stage, etc., ending in
C-section, large baby, exhausted, uncomfortable mother, fussy, constantly
hungry baby and very little colostrum.   In one case, the baby seemed
ravenous from birth, furiously fussy when not at breast, latched on and
sucked well, very little colostrum, went from 9-15 to 8-8 by day 5, and no
milk until day 6.  Mom had infection, many antibiotics, large drop in
hemoglobin, which could partially explain the delayed lactogenesis.  At 8
days, baby attaching and sucking well, still inadequate swallowing despite
almost constant nursing.  At two weeks, still being supplemented at some
feedings (per report of pediatrician).
What are the odds of this mom getting a full milk supply?

     I guess there are two separate issues.  One is the mystery of why some
moms seem to have hardly any colostrum - not only in traumatic situations as
above.  The other is the reality of what we often have to deal with:  a
fussy, inconsolable baby, an exhausted mom in pain from major surgery, unable
to get into a comfortable position for nursing, unable to get any sleep,
reaching the end of her rope.  The issue always comes up, at what point do
you start supplementing, knowing the hazards of formula?   Of course there is
no one right answer.  You watch the status of the baby and the mom and decide
on a case-by-case basis.  But I find it difficult and frustrating.  Any other
hospital nurses  with any ideas?   Miriam