Tamara's point about infant's feeding on the tip is correct.  That's where 
the LC's expertise steps in to evaluate and instruct.  I have found that 
the correct way to get and maintain a deep latch is to put expressed milk, 
if available, or 10 to 15 cc of formula in a feeding tube/syringe under 
the NS to get the baby to start and maintain a nutritive suck sequence. 
Until you get a healthy MER spray the BM just pools in the NS and the 
infant will suck it like a straw.  I suggest the Mom alternates breasts 
per feed, it's too daunting to try to both breasts and then she pumps both 
breasts post feed. Usually these kids are at about 7% weight loss and the 
formula is being pushed and my goal is to send home a BF dyad with a 
scheduled 24 to 48 hour follow-up. Hopefully I am able to observe one or 
two more feeds with the parents doing it,  before d/c. The post-partum 
nurses have all been instructed in this technique and observed by an LC 
during, competancies week,  so I feel pretty confident that if I can't be 
there the parents will get the same message from the staff. The staff 
rarely starts Moms on a NS, they don't have the time to do the initial 
teaching. 

Ann G. Cagigas, RN, MA
GSA Health Unit,  Room 1010
1800 F St., NW
Washington, DC 20405
202-219-1228
202-501-0028 (Fax)

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