Hi,
I am needing to get some support and tips from fellow lactnetters.  I wrote about a day ago with questions pertaining to pumping and hand expression and whether to do both or just hand expression on day one for a non latching baby.  I want to thank everyone for the responses and resources that were provided to me.  Now I'd like to share a little about the case and with the interchange that I had with the pediatrician.  I am going to make a long story as short as possible.  The baby was jaw clenching, very little rooting with a bite reflex when any attempt at latching.  I did an oral assessment while finger feeding droplets of colostrum at hour of life 20.  There was little tongue movement.  Until that time, she had not fed and I was called into see baby and mother.  Baby was full term with no significant history other being suctioned after vaginal birth.  Mother was a primipara. Skin to skin maintained almost continuously. I worked with mother and baby for next 12 hours with no success.  Spoonfuls (or "puddles") of colostrum were fed from a plastic spoon. Total estimated intake about 12 ml.  By 10 p.m. (no lactation coverage at night) baby was over 30 hours old and vacillating between crying and agitated when trying to latch or deep sleep. Parents, nursing staff and myself worked a plan where mother would hand express or pump if unable to latch .  We also discussed using formula if unable to express any colostrum.  When I saw the mother the next morning she had given 2 feedings four hours apart of 10 ml of formula.  The pediatrician had been to see the baby and examined the baby for discharge.  He told the mother that the baby had been fed too much and that was why she was sleepy.  He told her not to feed the baby and that when she was hungry enough, the baby would latch on.  I then phoned the pediatrician, who I did not know, because I was concerned.  I relayed the above history to him, telling him my concerns about the baby not latching .  He then said "I don't believe you".  In retrospect I am not sure what he meant by that.  Did he think that I am such a great IBCLC that I can get all babies latched?  I don't think so.  However, I was taken aback by his remarks and I asked him to come in and latch the baby himself and he said he would!  Unfortunately, he did not keep his word.  I ended up telling the parents my advice which was against his.  But it was one that I felt safe with.  Basically, I think it is the advice that most of my peers would agree with.  Feed the baby (which includes judicious use of formula if needed)  and establish milk supply and follow up with lactation consultant and pediatrician.  
In over ten years of being an IBCLC working primarily with newborns in the hospital, this was a new experience.  I am usually trying to talk everyone out of supplemental feedings.  I have never had to tell parents that I felt uncomfortable with the pediatrician's advice to not feed the baby.  Something that really worried me was the father asking me how many days did I think a newborn could survive without eating.  
I'd like any advice from others as to how they have handled situations like this one and thanks for listening!

Mary Westra, RN, IBCLC

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