At the hospital where I worked before retiring it was all too common, when a baby went to the NICU and couldn't get that wonderful skin-to-skin time for the nurses to take one of two approaches:  If baby was expected to be a NICU patient for some time, then the mom was "tto stressed to cope with pumping" for many hours-8-24 being common.  On the other hand, if it was expected to be a shorter term stay (which usually meant that SOMETIME before mom would be discharged baby would probably by out of NICU) the attitude was wait because baby would be able to nurse "soon".
I rather like the approach that if baby is showing no interest after an hour or two and it has not been a totaly natural birth, then hand expression might be recommended.  It is all in how it is presented.  If we say something like, "Well, your baby hasn't nursed yet, so we better pump.", this may give the message that baby will never nurse without intervention or that if we don't intervene NOW, she won't make enough milk.  Wouldn't it be better to say something like, "Let's express a little colostrum to see if the taste and smell will encourage the baby to nurse."  If baby doesn't "sit up and take notice" we can say, "Oh look at that wonderful colostrum.  Let's save it and if we need to later we can give a little by spoon or dropper to encourage baby."  I used to say to the moms of "slow to catch on" babies that up until now, nutrition was a "free ride" and it seems like some babies don't realize right away that that free ride is over and they now have to work for their food.  Maybe not a totally accurate description, but one that moms can understand and even chuckle about.

Winnie

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