Hi Heidi,
First off I might suggest that you check the archives as this has been
discussed quite often as of late (assuming that you haven't already!).
In my hospital the unwritten rule is the baby gets 24 hrs (if healthy) to
*practice* with little expected.
After 24 hrs if they remain w/o latch and /or any milk transfer a consult to
the LCs is made. Sometimes by the time we get there, the baby has been fed
something; D5W mixed with colostrum, D5W alone, formula...   and sometimes they
wait for us. This depends largely on the nurse involved, somewhat on patient
and /or circumstances. If upon my arrival I am unsuccessful with latch assist
etc., I will most often leave babe and Mom STS with instructions to remain so
and return in several hours for another attempt. Sometimes I do intitiate
supplements at this point if medically indicated or if parents insist. I usually do
NOT start the Mom pumping at this point (although most of the other staff LCs
will).
We (myself and the 5 other LCs on staff) have explored the option of
developing an algorithm (or whatever) to address this subject a little more
predictably(other than the *as medically indicated* criteria) but have had little
success due to the need for fluidity in this process. I personally agree with
previous posters who have suggested that the baby can go a lot longer than we think
he can without *nutrition* in the first day or two, although this doesn't mean
we shouldn't try and that after 24hrs that this trying shouldn't become a bit
more emphatic.
Lynn Shea Rn,Bsn,Ibclc
Franklin,Massachusetts

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