I do use fingerfeeding from time to time.  In all honesty, when I
use it is based a lot on "gut feelings".  Some of the things I look
at are:
1-What is mom's (and to some extent dad's) emotional state?  Are
they up to dealing with one more "gimmick"?  Are they open to what
may seem like a wierd approach or are they giving signals that at
this point, all they are willing to cope with is breast or bottle?
2-Do I feel they are capable at this time of learning the
technique?  I'm not just talking about general learning ability, but
are they so fatigued/stressed by their current status that they just
can't take in anything new.
3-Does baby really have to eat right now?  Remember, not that many
years ago babies weren't fed the first 24 hours even if they were
showing strong signs of wanting to!  I'm certainly not suggesting we
go back to that, but I don't believe there was a huge rash of
dehydrated babies at that time, so if baby isn't interested and
there's no immediate medical problem, they can usually wait.
4-Is there a short-term problem that baby is having that you can
expect will improve in the next 12-24 hours and baby can wait to
eat?  I'm thinking of the little boys that "tune the world out" for
a while after a circ or the babies that have bruised heads.  Some
bruised heads make suckling uncomfortable in in most cases, by the
next day it has resolved enough for baby to be willing to nurse.
5-Do I feel I need to assess the interior of baby's mouth and
whether or not he can organize suckling?  I like finger feeding over
bottle as, while it is not a breast, it certainly feels closer that
an artificial nipple.  I asssess the oral cavity and suck before
introducing any milk.
6-Is this a baby I consider at more than usual risk for "nipple
confusion"?  For example, if mom's nipples are short or flat, by
introducing the finger into the mouth over a few sucks I can lessen
the difference between filling the mouth immediately and the few
sucks it may take him to draw mom's nipple/areoal deep into his
mouth.
(I'm sure there are more I would come up with if I was working on
this as a formal presentation.)

Who teaches it?  Usually I do it.  We haven't had formal training
for all the nurses on the technique.  (We can't even get hours to do
much basic inservicing-have to catch them with a minute or two here
and there-certainly a challenge, but that's another story!)  When
possible, I like to bring the nurse in when I am teaching parents
how to do this.  Some have picked up on it quite well and have
helped parents do it.

I see it more as a temporary tool, although I did have one familiy
that used it exclusively for supplementing for weveral weeks until
baby was finally able to nurse well.

When possible, I use EBM.  If mom has pumped even a few drops, I can
draw that tiny amount up into the syringe (we use 10cc syringe and
5Fr. feeding tube).  If I feel it will only be used once or twice, I
have been known to take a couple cc's of sterile water to rinse out
those few drops of liquid gold so we can get it to baby even though
it is diluted.  Of course, this would not be a good idea for long
term feeding.  If she has not pumped previously I will get
herstarted unless one time with fingerfeeding  is all it takes to
get baby nursing at the breast.  If no EBM is available and baby
really needs to take in some nutrition at this point, I will resort
to formula.  I feel this is one of those situations it is
appropriate for since we don't have donor milk readily available.

As an aside, I dealt with one just yesterday that was a vacuum
delivery and had quite a bulge on the head.  It wasn't bruised, but
I suspected it might be contributing to baby not showing any desire
to eat.  As I was trying to get baby to do something at the breast,
I accidentally brushed my hand against that part of  his head and
the baby literally jerked away and yelped.  I felt so bad, but it
did confirm that his head was hurting!  I did do some finger feeding
to try to "wake up his appetite" and it worked.  As soon as some
milk was in his mouth, his eyes popped open and he started sucking
with great jaw movement, swallowing, etc. After a few cc's, I gave
him back to mom and he did nurse eagerly for a few minutes-far more
that the half-hearted suck or two which is all he had done
previously.  It, unfortunately, was with a shield which we were
trying for other reasons, but it was the closest to success this mom
had experienced and it gave her just the boost she needed to keep
working at it.  Dad was "taking it all in" so I made sure he
understood how to do it in case baby needed additional
supplementing.  After describing, demonstrating this or any other
"gimmick" I always ask the parents if they feel this is something
they would feel comfortable using as a temporary "crutch".  In this
case, now that baby would at least do something at the breast, the
plan was to use the syringe/tube at breast, under the shield if
needed overnight.  Today one of the other LCs will follow-up and
develop a post d/c plan if baby still is having problems.

Winnie

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