I would be very concerned about a baby who has not breastfed in 36 hours. Questions I would ask: Has this baby shown any readiness to feed (light sleep, quiet alert, rooting, mouthing)? Is the baby's neorological exam normal? Is the baby maintaining normal temperatures and blood sugars? Is this baby late premature? Has the mother started to hand express and/or pump? Is mother doing skin-to-skin frequently?

At our hospital, babies are placed skin-to-skin as soon after birth as possible. Skin-to-skin care continues on the postpartum unit. If a baby has not fed in the first 6 hours, we teach the mother how to hand express. This colostrum is slowly fed to the baby with a spoon or syringe. If the mother does not want to hand express, then pumping is started. (Colostrum is so much easier to collect with hand expression.) Often sleepy babies will respond to drops of colostrum and start breastfeeding shortly afterwards. We would continue to encourage the mother to hand express or pump every 3 hours or so until the baby is waking on its own for feedings. I see excessive sleepiness in C-section babies, vacuum extraction births, late prematurity. 

I can't think of any of our pediatricians or lactation specialists who would allow a baby to be discharged from the hospital without feeding at all.

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