There is so much I can say about being a hospital LC. It is quite a challenge. The first thing I will say is this: Everything is a judgement call. There is not going to be a clear cut path to take each time. I agree with one poster who said in the first 24 hrs, for a healthy term infant, just put them together skin to skin and give some basics, particularly if baby has had a couple of feeds. Encourage patience etc. Sometimes I ask mom to go ahead and hand express some puddles into a small spoon. She feeds that to baby every couple hours. This serves to initiate the demand for milk, and serves to get some nourishment into baby. 
Things also depend on whether baby is preterm infant, or LGA or SGA infant. It will also depend on the doctor and nurses comfort level. Some babies just want to sleep and some seem very hungry and will really cry alot and eat their hands if they cannot latch or transfer milk. This is a tough call - obviously the baby wants something to eat! I do beleive in baby-led latching but I have seen so many who just can't latch. I have seem some who I can help them latch and really kinda hold them there, but mom just can't do it yet. For example, nipples that invert.
It is always a tough call whether or not to start pumping or just wait a little longer. I call the pump the "middle man" and I always try to avoid using the middle man. But sometimes it starts to become apparent that is the way to go. I look at the baby's hydration, jaundice, wt loss, hunger cues, etc. Some moms just don't give us any colostrum right away, some have lots. It is always a tough call whether or not to start formula. I have had some peer counselors at WIC (when I called to try to get a pump for a mom) tell me that they don't want to use a pump because the mother is likely to stop bf and just keep pumping. Yes, many mothers do this nowadays, but this is a mother who has been TRYING to bf and for some reason it is not working well yet, and I have determined that I need to recommend expressing. Again, I made a judgement, I gave it as much time as I thought I could without beginning to jeopardize the baby, the supply, or both.  
If you have good in-person follow-up in place ( I don't trust phone follow-up for risky dyads)
then you can let things slide a little longer, knowing the baby is coming back to see you or someone else knowledgeable in a day or two. Take note, though, some moms don't keep their appointments and you can't get back in touch with them. So I always give mom a "plan B" giving her exact pumping instructions and alternate feeding amounts. Very thorough info on output and signs of ineffective feeding and make sure to document this on the record. 
I agree with another poster who said getting them bf soon after birth is a big plus. 
I had a mother today with a large baby, born by C section, she had very very long nipples and the baby was totally nipple sucking. After helping and getting the best latch we could get I wasn't seeing any milk transfer/ the baby was about 36 hrs old. the baby was crying alot and eating his hands and looked jaundice altho his weight was ok and his output was too. We could only get a touch of moisture on her nipple, nothing to really express (hand expressing). The baby was latching and suckling so we did #5 French tube at breast with formula supps. the Dad learned how and took over. Later the parents decided to give a bottle. I do not have her pumping with an electric pump as baby is latching and suckling and I am waiting to introduce the "middle man" who can get between mother and baby. If I could get more colostrum I might have the mom pumping, altho she could hand express as well and I really prefer that if it is expected to be a short term thing, but many mothers balk at this and want a pump. 
Good luck with your new endeavor. Remember every situation is multifactorial and all parts need to be considered. With your experience and committment to success, you should do well and effect some good care and positive change there. 
Laurie Wheeler, IBCLC, MN, RN
Mississippi, s.e. USA

_________________________________________________________________
Check the weather nationwide with MSN Search: Try it now!
http://search.msn.com/results.aspx?q=weather&FORM=WLMTAG
             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET email list is powered by LISTSERV (R).
There is only one LISTSERV. To learn more, visit:
http://www.lsoft.com/LISTSERV-powered.html