Dear Esther, Kathy, and Jean,
There are some very good and interesting thoughts going on and I will try  to
keep this short.
First, I must say that I do not believe that newborns are hungry when they
are born and therefore are not seeking large amounts of volume when they go to
breast.  I liken this to a woman in labor or a person who is ill and their
bodies are putting all their functions on recovering and not on filling the
stomach.  Does a person in the above categories loss some weight, probably,  but
this is short term and they do not whether away.
The newborn is going through a major transition from intrauterine life to
extrauterine life.  Mother Nature prepares for this by giving them some  extra
interstitial fluid while they recover.  Of course there is still the  long term
debate if some babies have more fluid on board then others (that's  another
topic).  The newborn's organs are going through a transition which  in the
literature takes around 6 hours or more to achieve.  Meanwhile all  can observe
that their stomach is rolling and heaving at times through this  transition
which can last 24 or more hours.  (How many of us could think  about eating while
we have waves of nausea?)  Colostrum is thick and high  in protein, making it
the only ideal food for the newborn.  It easily  sticks to the GI track, meets
the protein needs of the newborn so their insulin  is not continued to be
triggered and does not over extend or encourages  vomiting.
Babies allowed to be skin to skin with their mothers helps them both to
learn, recover, and establish Lactogenisis II.  Even a baby who only licks  and
mouths the nipple stimulates mom's milk production and the start of  antibodies
to protect the newborn.  Using spoons and cups to collect and  give the
expressed colostrum is OK but the first step I would recommend is the  colostrum
dripped onto the baby's lips and mouth so the baby is allowed to make  contact
with mom's skin.  Only a few drops of colostrum can stabilize a  baby's blood
sugar.  When using formula, a larger volume is needed because  it just can't
replicate colostrum.  When this is done a whole list of  potential problems can
occur from the baby vomiting more, expecting large  volumes with fast flows,
and refusing to latch to the softer nature  nipple/areola.
Kathy, when you described your supplemental feeder at the breast you said
"Rather than letting baby "pacify" at the breast and then get a bottle.  By  day
2-3, most babies were nursing well after using this method."  This is  under
the assumption that a newborn needs to eat a fair amount in the first  couple
of days.  I know this is the thought processes of health care  workers but I
feel we as lactation experts need to reeducate them about what is  normal and
that is not formula/bottle feeding.  Because a baby will down a  bottle is not
proof that they needed it or were "starving."
I totally agree with Esther that mothers should be taught hand expressing  in
the hospital.  I am becoming more of "hands off" in my approach because  over
time I feel that this leads to more empowerment for the mothers.  If a  mom
does not understand my instructions or does not get any results from hand
expressing, I will place my fingers over hers and guide them then let her do it
on her own.
Lastly, I believe that the newborn wants to spend long periods at the  breast
to recover.  If you want to use the term "hungry" then I see it as  hungry
for warmth, quieting sounds, security, and substances.  I strongly  believe
mothers need to identify swallowing before they leave the hospital,  therefore so
does all the staff.  What I learned from Tina Smiley this year  is that a baby
needs to do nutritive sucking, nonnutritive sucking and pausing  while at the
breast.  They are all important.
Sorry for the length.
Ann Perry, RN IBCLC
Boston, MA

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