This area brings up many philosophical questions that we have raised at the
hospital where I work.  Part of the question, for me, is this:  what do we (as
health care professionals and breastfeeding supporters, "fanatics", even)
want to REALLY have happen in the first 24 hours or so and then, what is
physiologically realistic for the newborn and mother??
I think/feelbelieve, answering the first part of the question, that I want the
mom
and baby to feel good about being together, to have some uninterrupted time
together, to get the warmth and closeness that comes from having a baby
happily at the breast.  If the baby actually breastfeeds, so much the better!
If, however, the baby does not, or cannot, or is not ready, or mom is
stressed,
etc., etc., then what, exactly are we worried about??  Unless there is an
identified problem (not always obvious within the first 24 hours) , then we
can
confidently expect that the baby WILL latch on sometime within the first 48
hrs
or so.  Now, we all know of situations in which we wonder whether outside
circumstances will make this difficult or impossible, but that is a matter for
referral to appropriate follow-up resources, as available.  OUR job is to
support the normal, appreciate that sometimes the best we can do is keep
everyone positive and NOT create the feeling in mom or both parents that there
is a problem, that something is wrong with the baby who doesn't latch on
within 24 hours.
Unless baby has a low blood sugar problem (with risk factors for checking
this), below 35, we don't do anything except promote togetherness and
continued gentle attempts at latching.  We are fortunate in having pretty good
follow-up agencies in our community (including one home visit program that
the hospital provides, by contract), but it has taken about six years to get
to this point.
I personally don't think it a "baby friendly" practice to use tube/syringe or
cup
feeding for a normal, healthy newborn who hasn't met some arbitrary guideline
for latching on well (especially in view of the other intervening factors,
such
as epidural anesthesia, that could be contributing to this).  I'd wonder where
the "five hour" or "24 hour" rule came from anyway??  Since most newborns
have a deep sleep phase for the first 24 hours or so,  maybe we're getting
worked up over nothing...

Jeanne Brotherton, RNC, IBCLC
To paraphrase Chesterton, "It's not that they can't find a solution, it's that
they
can't see the problem..."